Saturday, February 20, 2010

Rules for Residents Redux

Actually, let's call this Rules For Everybody. Auntie Jo has some bones to pick.

Number One: I do not intimidate well. Please don't try.

The night supervisor threw a pissfit at two o'clock this morning because I was sitting in His Chair, using His Computer. Silly me; I had thought that it was just another computer at the station, and just another chair.

Rather than asking me to please get my ever-widening ass out of said chair, though, he went on and on about how he hates it when people sit in His Chair and use His Computer.

"All you had to do was ask me to move, Mark" I said.

"I hate having to tell people to move!" he said.

"You just did. About six times."

Shit like that wears me out. I am not cute when I'm tired. Save us both the trouble and don't get all puffy-chested on me, okay?

In other words: the queen of passive-aggressive taught me well. I can recognize that shit a mile away, and Mama don't play.

Number Two: If you don't ask the question, I can't give you the answer.

I don't care how stupid a question it seems to you, or how stupid it actually is. If you don't ask me, I can't help you. Whether you're embarassed about your ignorance or you don't believe that a creature as humble as a nurse could actually know something you don't, you're tossing a shoe into the works if you hare off on your own. Just ask me. I won't laugh at you, I won't get annoyed, I won't sigh deeply and roll my eyes before answering. We are all here for one goal: to get these gomers out of the beds and up the stairs; anything that helps you helps me reach that goal.

Number Three: Say what you mean. Mean what you say.

Who'd'a thunk working at a hospital could be so much like working in government or dating? Not me, but it is. I guess it's just people that make living on this planet so difficult. It doesn't have to be hard, though: if you want something, ask for it (see above). Likewise, if you want something specific, ask for it directly, rather than bumbling around and wasting time. A simple order should be just that: a simple order.

Likewise, if you mean something specific, say what you mean. This is not hard. If I fuck up, tell me about it clearly and specifically and simply. I ask this boon not because I'm any dumber than your average bear, but because it saves time and makes life easier. Avoiding bush-beating also ensures that I won't make the same mistake twice.

Number Four: Just because we worked out that little problem doesn't mean I'm not watching.

Nurse Jo is like Big Brother: always watching. If you're the resident that lied about my calling and charting to both my boss and your attending, then you know that we've already resolved the issues of your idiocy and inelegant behavior. Don't think, though, that you get a free pass from here on out. I am not a vengeful Jo; I am, in fact, slow to anger and quick to turn again. I don't hold grudges, in other words. But I am also not an idiot; I know that if you tried undermining me once, you'll likely try the same thing either with me or with a coworker.

So don't.

Number Five, and perhaps most important: Never, ever, ever lie to me.

You would think, wouldn't you, that helping sick people get well would kind of, you know, push the whole issue of ego and self-aggrandizement out the window.

Well, it doesn't.

There are still people--mostly doctors, I'm sorry to say, although there are some nurses in there, too--who think that being busy or getting stressed or being unable to accomplish something is a direct reflection on their worth. It is not. Let me say that again: everybody gets busy, stressed, and overwhelmed. If you didn't manage something, or some test didn't get drawn, or you fucked up inserting that drain, it's okay. Tell me you screwed up, tell me you didn't get X done by Y time, and I will bust ass to help you out and make you look good. I look better when you look good, so it's really all self-interest.

That said, do not lie to me. Do not lie to me about why you didn't do something, or why something else didn't work out as it was supposed to.

Example: I had a patient who was on pressors to maintain blood pressure. I wandered into work, yawning, to find that the patient's blood pressure was not only sky-high--totally out of parameters--but also that her pulse was off the charts. The reason was that the nurse and resident together had hung a bag of a particular pressor, but used the IV pump settings for another, less-intense sort of pressor. These things require two signatures for a reason: if your eyes aren't good enough, another set helps to catch any mistakes you might've made.

The nurse's reaction was "Holy shit, did I ever fuck up." The resident's reaction was hemming and hawing, denying that she'd ever double-signed the checkoff, and blaming the nurse.

The mistake was fixed without harm to the patient, but the stuff surrounding it sticks in my craw: a mistake is no big deal. Everybody makes them. Lying to me about it, though, and attempting to blame the nurse/the phase of the moon/your mother? This is another one I'll be watching.

It's funny how, when I started the whole CCU thing, I figured that it would be a closer, more professional, less fraught environment. On many levels, it is. I'd already earned the trust of a number of the doctors and nurses down here; most of 'em have expressed surprise that it took me so long to move to the CCU.

On another level, though, it's much like living with somebody you don't particularly like, or with a brother or sister you don't get along with in such close quarters. Ego and emotion come into everyday interactions to a degree that I frankly find uncomfortable sometimes; there are turf battles and irritating complications that could be resolved with a little plain talk. Some mornings I come home feeling like I've just spent a long night dealing with an old boyfriend.

I had hoped to work in a place where brains mattered more than hearts. I'm finding that, even though it's still neuroscience, hearts (and egos) play into the whole damn thing more than I'd like.


Rat said...

I hope this doesn't happen to me when I move up to a more "professional floor." I will not be directly under Moronica's foot, however, I may still have to deal with her on an occasional basis.

When Dr. Friendly heard about my misfortune, he offered me not the BEST job in the world, but when dealing with OPM, there are no absolutes. But it should get me from one job to the next while giving me more experience without the eggshells I have been dealing with for the past 8 months...added bonus, I don't have to move to South Dakota. Or deal with Moronica on a day to day basis. *whew*

So while humming the theme song to The Jefferson's...I am praying that the money crunch between Dr. Friendly and Dr. Happy goes well and I can make enough to live until perminant position comes along.

Until then, I will try not to "sit in anyone's chair"

slipbananapeel said...

I HATE lying. It's ridiculous. I'm working as CNA in the Cardia ICU right now. One of the patients was on pressors and had sky high blood pressure. (Sound familiar?) So the charge goes in and finds wrong IV settings. The patient's nurse told the charge< "Natalie(me) was in there. She must have been messing with the pump."


Just My 2¢ said...

You said:
"I had hoped to work in a place where brains mattered more than hearts. I'm finding that, even though it's still neuroscience, hearts (and egos) play into the whole damn thing more than I'd like."

Nope. Sorry. Brains don't matter. I'm an engineer with 30 years experience. In my current hitch, ego wins over the mission e every time. Been that way forever.

Jenn said...

Wow, just wow. I second, bravo, cheer, etc, everything you wrote here! It is SO NICE to hear my perspective written "aloud" per se. I get to say, "see, see? I'm not the only one!" LOL. Seriously though, kudos. We should print this list for every icu out there. Thanks!