Wednesday, February 17, 2010

The stupid: It BURNS.

This has been One Of Those Weeks. The level of Stupid has gotten to the point that, if somebody doesn't do something soon, the Stupid will all roll together into one big ball of Damn That Was Dumb and there'll be a cataclysm.

For instance, Doctor Fuquad, you should probably not put a luer-lock access on to an arterial line. (For you non-medical types, an arterial line is just what it sounds like: a big IV-type thing that goes into an artery in your wrist so we can monitor your blood pressure directly during surgery.) For one thing, if you're monitoring pressures with an A-line, the luer-lock access will screw things up and make it look like the patient is running a blood pressure of 264/264. For another, and here is where I start to get all-cappy, YOU ARE NOT SUPPOSED TO PUT ANYTHING INTO AN ARTERIAL LINE EVER EVER EVER AND PUTTING AN ACCESS ON ONE MIGHT CONFUSE PEOPLE.

Let's make it simple, Doc: arterial lines are to be flushed only with pressure bags through pressure lines and are supposed to be directly connected to whatever they're going to. Luer-lock IV accesses are only for intraVENOUS access and are meant to allow you to shoot drugs through them. YOU ARE A MORON.

Gracious. Was that a rant? I think that was a rant.

*ahem*

Okay, boys, second thing: If you've done belly surgery on a patient, and that patient has developed a rigid abdomen and a sharply falling hematocrit about two hours after surgery, please don't keep that patient in the CCU for eight more hours to see if the bleeding will stop on its own.

(Yes, I just said that. And I just put my head in my hands In Remembrance Of Things Stupid.)

Ten hours after surgery, things were going.....badly for that poor bastard. Dr. Fuquad's brother, Dr. Diqhed, looked with some surprise at the lab values that were incompatible with life. A hemoglobin of five-and-a-half and a pH of seven-point-one? (For you non-medical types, these lab values are both fatal and entirely preventable. If you're not STUPID.) Well, then! Let's pour eight fucking units of blood into this guy using pressure bags, and if we don't have enough pressure bags, let's have Jo just stand there and squeeze!

And let's watch the blood we pour into the patient pour straight out into his already board-like belly!

Dr. Diqhed stopped by the unit after his patient's second surgery and expressed surprise at how well the patient looked. I couldn't stop myself--I hate this guy; he's an attending who should be weaving baskets--and said, "Yeah, it's amazing how great people do ONCE YOU STOP THE BLEEDING." (YOU MORON)

Uh, oh. Ranty again. So very sorry.

*koff*

And, finally, Manglement At That Other Hospital? It doesn't matter how sick your immunocompromised patient is with his widely-disseminated herpes simplex: you probably shouldn't put him into a unit meant for people who are seriously immunocompromised. Because if you do, all those poor bastards will be showing up at Sunnydale's CCU, medevaced in with screaming disseminated herpes simplex infections. It really doesn't matter how much negative pressure you have and how much your nurses scrub; that shit will travel.

Herpes encephalitis is bad enough. Herpes encephalitis combined with a cutaneous herpes outbreak bad enough to obscure major anatomical landmarks is worse. Like, if I can't see the person's navel for the blisters, that person is fucking SICK. And, if not for the level of MORON at your fine establishment, this could've been prevented.

*rubs eyes*

Every morning between three-thirty and five I get a little shirty and short-tempered. This week's been worse. I only cry when I'm angry or frustrated, and today I found myself sitting in the locker room on a bench, facing the wall, trying to decide whether breaking my hand by punching that wall was worth it, or whether I should just sacrifice my mascara to the Stupid.

I ended up having some Gatorade and a chicken sandwich and going back to work. Sometimes there isn't enough time to get upset about The Stupid; you just have to try to fix it.

14 comments:

Maha said...

Dr. Fuquad's cousin, Dr. Fuqups works in my hospital. I believe he maybe too mentally handicapped to even weave baskets. So sorry you had to put up with asshattery of such magnitude.

Kyndig Azhei said...

Jo-

I'm non-medical personnel at a small hospital, and I just want to say, we all feel your pain. The idiocy I see on a daily basis, both through my job and a couple family members who are medical personnel at this hospital, is painful.

Fortunately for me it's limited to teaching people how to use the computer systems (I've had people walk into my labs, pick up a mouse, and talk to it. Seriously.) For my father, who's an ED doc, it's much, much worse.

Btw, first time posting here, I just wanted to say I've been reading your blog for a few years - my family has been in the medical profession for generations, it's great to see a serious but fun take on things from someone who understands the tech generation. I love this blog. Keep up the good work!

Tonjia said...

OMG those doctors have a relative who works as a hospitalist at our hospital.... we just call him "BoBo the clown". Actually that name glorifies his intelligence.

what would these educated morons do without nurses to come behind them and fix things for them??? sigh....

keep your heads up girls, we have to always keep watching!

Sunflower RN said...

Hi Jo,

I have news for you. After these dough heads give up on the surgery side of things ie finally get tossed out of an acute care hospital, they become psychiatrists and then I have to deal with them.

Honest to Pete, can you not tell the difference between an M.I. and an anxiety attack? Doc ordered some nitro. When that didn't work, I suggested ativan but they decided to send him out to the acute care facility instead. 8 hours later, he was returned by cab with a Dx of panic attack and a couple of doses of ativan. I didn't gloat, but I wanted to.

Too much time in school rots the brains.

Hang in there. I don't know that it will get any better any time soon. Our new batch of shrinks all look like they have spent too much time in the dirty laundry. All rumpled and smelly. I kid you not. There was one I had to ask to wash before she came back to the unit as she smelled so bad that it was triggering my allergies and the only known thing that I am allergic to is mold. That's right, she was molding.

Just gross. People skills and clean laundry are required if you plan to see anyone. And maybe running a brush through your hair every second day while you are at it.

Oh look, a rant!! Must be contagious just like that herpes crap.

May we all survive their care.

Rat said...

Want to compare MORONS? I bet you I can beat you! I have MANAGEMENT MORONS. People who half ass their job and when an educated question is asked jump down your throat because they are just MORONIFIC (I just made that word up...Like it?) to think there is an underlying smart-assed comment, rather then just a question. Oh, an EDUCATED QUESTION. Then when it winds up in the MANAGERS office the story changes JUST enough to make it YOUR fault for nosing into other people's business...Which is rather funny when the other person's business is part of your job discription. Hmmmmm......

In my 18 years of doing my job, I have done my best to do it with pride and integrity. Not by kissing ass. Today I learned that the only way to work in my job is ass kissing. Today I learned that when someone asks me a question my first words will be "Call MORONESS". It's not my problem.

Yesterday I was given notice of Reduction of Forces. I have 28 days left. I will learn to not give a crap when something goes very wrong and MORONESS cannot be reached for consultation. I will hope that this is not a trend in every place I work. Some people actually appriciate help and educated questions.

So remember: In most situations, there are no stupid questions except the ones that are not asked. In my current situation, every question is stupid, so don't ask it. You will get written up for it later! Then you will know what your job discription really entails!

*WHEW*

NOW THAT WAS A RANT!!!!

woolywoman said...

So grateful that today my day was not your day. Also, crying on nightshift is something I used to do. It was so predictable that I just put my break at that time so I could cry in piece. Also, mascara? You're wearing mascara on nightshift? Wow, you are a girly-girl!

coulrophobic agnostic said...

I'm a non-medical person and even I know that those lab results are ultra-bad. Which apparently puts me ahead of actual doctors. Which is freaking scary.

me said...

Ye gods and little fishes!! I so strongly rememeber that urge to kill!!!
Big hugs coming your way ~

miamichaela said...

Don't worry, STUPID is in all areas of life, not just in medicine.

I am a Graphic Design student and I see it everyday, and now I don't mean just my (NONEXISTENT AARGGHH) clients - my teacher was persuading me recently to get to the BA (Hons) year saying I can start with Medical Illustration there.
FUCKING MORON, 1 year "Med Illu" (quotation marks are necessary here) with NO scientific classes?! I'd rather be an OK Graphic Designer than a shitty Med Illu but that moron doesn't get that and just wants his tuition fees. -_-

Cindy said...

I once saw a bumper sticker that said:
"Stupid should hurt"

Yet I wonder would it really help?

Jenn said...

I agree with *almost* everything you have ranted about. I say *almost* because that luer lock on the aline is actually useful. First off, you mention ABGs later in your post......that leur lock allows you to draw ABGs from your aline without breaking the closed sterile system. Secondly, while you usually have said *brilliant* (cough, cough) doctors at your disposal for an immediate central line, sometimes, in an absolute crisis, you DO have to use that aline as an access point. It won't kill them; you just have to be extremely careful.

That said, I have personally worked with those said doctors, and their seniors, and their attendings (at times). They make for a ton of frustration and very little reasonable justification. I am sorry you had the pleasure.

Jo said...

Jenn: We have special accesses (acci?) downline of the a-line for that that don't interfere with the BP readings. The locks we use for IVs do.

Gert said...

I just loved this post so much....made me laugh! Thanks!

Anonymous said...

I know this is an old post, but I hope this blog-website-thingy still shows you new comments.

That said, this is a little trick I picked up from a Sports Medicine Paramedic (Yes, such people exist. They have special sports training, and pretty much only work sporting events). I was shadowing an Athletic Trainer, and we had a guy get dehydrated and start cramping bad. Since they had another game in 2 days, the EMT-P set up a saline bag for him. First off, the EMT got him with 16 gauge in the vein in his lateral forearm. Impressive. He wanted a pressure bag to pump the saline in faster. But...ambulances don't carry those. Solution? A poor man's pressure bag--IV set up and running. Bag hung on pole. Wrap BP cuff around upper half of bag. Inflate BP cuff. Re-inflate cuff as needed as bag empties.

Voila! 250 cc's and less than 5 minutes later, guy felt a lot better, had a nice hole in his arm (but could still bend his elbow fine thanks to his veins being so freakin huge), and the Athletic Trainer and I learned a really cool trick :).