Dr X: "Why hasn't the Argle-Bargle T380A test been run on my patient yet?"
Nurse Jo: "Because it's a timed test that has to be done by the lab. It can't be drawn through a central line."
Dr. X: "Why haven't you drawn it yet?"
NJ: "Because...it's...timed. As in, it shouldn't be drawn until a...specific time."
Dr. X, growing upset: "But you could draw it right now! Out of the central line!"
NJ: "No. I can't. It can't be drawn through a central line. The heparin lock we use will screw up the test results, and besides, it's a timed test. It's not due to be drawn until 1630."
Dr. X: (incoherent ranting about incompetence of nursing staff.)
NJ: (finds herself on the opposite end of the hall, unsure of how that bruise got on her forehead. Oh, wait. It was Head-Meet-Wall again.)
Dr. Y: "Why did you change my patient from calcium gluconate to a calcium citrate and magnesium supplement?"
Nurse Jo: "Because that's our protocol for people who have had gastric bypass surgery."
Dr. Y: "But this patient didn't have a gastric bypass! She had a parathyroidectomy!"
Nurse Jo: "Yes, I know. However, the patient's history shows that she had a bypass six years ago, and her blood calcium levels have been low enough to warrant IV repletion. Therefore, according to protocol, we changed her over to citrate and mag, and her calcium levels have come up."
Dr. Y: "Are you a doctor? I didn't write that order!"
NJ: "It's the standard hospital nutritional protocol for patients who have had bypass surgery. Here it is on the computer (clicks twice)."
Dr. Y: "I didn't write that order! You had no right to change that patient's medication!"
NJ: "Her calcium has been stable at 9.2 for three days, after being between 2 and 3.5 for the proceeding week. Is there a problem?"
Dr. Z: "Why didn't you replete this patient's magnesium and transfuse blood?"
Nurse Jo, looking worried: "Because I didn't see an order for it."
Dr. Z: "Her hemoglobin is ten! TEN!! Why didn't you transfuse her??"
NJ: "Um... ... ...because her hemoglobin is ten. And has been ten for the last four days. And her magnesium is 2.0 and has been for the last four days."
Dr. Z: "But I always transfuse patients with a hemoglobin less than twelve!"
NJ, taking chart in hand: "See this preprinted sheet? You filled out this preprinted sheet. It says right here that if hemoglobin is less than nine or crit is less than 25, we transfuse. It says we replete magnesium for mag levels of less than 1.7. Her crit and hemoglobin and mag have all been above those levels for four. days."
Dr. Z: "But that's not how I do it!"
NJ: Considers banging head on desk, then decides that the bruise that's already there is enough, and wonders why on EARTH the new docs in rotation aren't briefed on our protocols.