Wednesday, October 06, 2004

Chuckleheads on Parade

I was not going to blog about what happened yesterday at work. As I told friend Arlene, it made me sick to my stomach to even think about. Then, as I was sitting outside with my coffee this morning, I started getting angry.

I have the feeling that what I did yesterday is about to blow up in my face.

Here's the situation: a young HIV positive patient came in for an emergency joint replacement. He has a condition that makes the bone in his large joints die off--it's a side effect of the medication he's been on. He had the surgery Thursday and should've gone for rehabilitation Saturday or Sunday, but he was still at the hospital yesterday. The Chucklehead Brigade from the orthopedic service had decided at the last minute that blood transfusions and more cultures were necessary. He almost left AMA (against medical advice, without formal discharge), but the lead doc on the team talked him out of it.

This kid didn't understand that the fluid a doctor had drawn out of his hip was going to be used for cultures. He didn't understand what the word "culture" meant. He didn't know why they'd transfused two units of blood into him and didn't understand that he'd given consent for the transfusion when he consented to surgery. The lead doc's explanation consisted of "I'm really busy and have a lot of patients in clinic right now, so I don't have time to talk to you."

In short, he didn't understand what was going on, and nobody had bothered to explain it to him.

I had this guy in my care for *four hours* yesterday. Of that four hours--and keep in mind I had three other patients as well, including a new admit--I spent probably two hours with him. That's a huge amount of time for any hospital nurse. This kid needed it, though.

He's poor. He's non-white. He's HIV-poz. His family has limited transportation. He needs to get home, but for some reason he can't conceive, the doctors aren't letting him go. At five yesterday afternoon, as I was filling out his discharge paperwork--because we'd both been told that everything was ready for him to leave--the ortho resident swanned in and said he'd have to stay for an internal medicine consult.

This is when Nurse Jo takes off her cute nurse mask and becomes Ratched.

Long story short, I made a lot of people very unhappy yesterday, including the attending doc who'd done the surgery and then blown off his patient. The patient, however, is going to go home today with pretty much everything he needs, including a long-term venous access for antibiotics. I told him I'd call today at ten to make sure he was on his way home and that if he wasn't, I'd raise hell.

This is what really pisses me off:

For several years, I worked as a paraprofessional with mostly-poor women, some of whom didn't speak English. I managed to make clear the consents that they signed even if they were Chinese-speaking immigrants, even if they were deaf, even if they were illiterate. Literally. I took the time in a busy clinic to do such cutting-edge things as answer questions in plain English. The place I worked didn't have a lot of money, didn't have readily-accessible doctors (the care was provided by nurse practitioners), didn't have a lot of clout politically in the community. And yet I managed to do my job, not only to *minimum standards*, but to what I think were pretty damn good standards.

Why can't a fully-staffed, cutting-edge hospital do the same thing? Why did I have a patient who was ignorant of almost everything that had happened to him in the last three days? Why had nobody informed the doctors that his pain control was bad? Why had nobody talked to him and his family about what was actually going on in his hip joint? Why was *I* the one who had to get angry and motivated in the last four hours of the day and make things happen for this guy?

I swear to God: If one person wants to give me trouble about what I said, did, promised, or acted on yesterday, all everloving hell is going to break loose. The political implications of some of my reactions and actions yesterday might lose me my job--seriously, as it's never a good idea to be insulting to an attending physician--but at this point, they can fucking have it. Any place that spends more effort on getting fruit baskets for some VIP than on making sure a run-of-the-mill patient understands why we're cutting on him is not a place that deserves me.

Some days I really, really wish I lived in the country and worked at some tiny hospital where I'd have the chance to do *happy* things, like helping babies be born or taking care of people who aren't getting jacked around.


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