Say the word and be like me.

It's so fine; it's sunshine. It's the word "no."

A meditation on saying "no."

I had one of Those patients today. You know the sort; they come in with poorly defined abdominal pain that stays poorly defined and resists all efforts to diagnose it. The only thing that calms the pain is a patient-controlled pain pump with X number of milligrams every Y minutes (determined by the patient) with a Z bolus of A milligrams every B minutes.

You know the sort.

This one wanted to go smoke. Then she wanted to go to the gift shop. Then she wanted just to walk around outside. I told her she could do none of those things; that leaving the floor with that much narcotic was not allowed.

So she put an aide on the spot by asking *him* to take her out to smoke.

Which I called her on. Then she called the aide a liar, which I called her on. Then it became a huge joke, which I did not find funny.

The last straw, for That patient, was when I told her that, regardless of what she *wanted* to eat, she'd be getting a particular diet. Period. No argument.

Whereupon she, being an old hand at this hospital business, called the Big Boss and poured out her tale of woe. Oh, the cruel nurse! Oh, the inhumanity!

Immediate Boss dealt with it and came back with this ultimatum: either give up That patient and offer a "half-assed apology" or offer a "half-assed apology" (and I'm quoting, here) and go on for the rest of the shift.

I said "no."

As in, No, I will not apologize to the patient who will not follow the rules. As in, I was not rude or condescending or nasty; I simply stated how things would be. As in, No, That patient won't get an apology, and further, *you* get to handle her for the next four hours.

As in, No, I will not be abused in the name of customer service.

Because, you see, my job is not customer service. My job is to provide the safest and most therapeutic environment possible for my patients. If that means that they don't get to smoke their usual two packs a day while they're being evaluated for a duodenal perforation, so be it. I'm happy to offer nicotine replacement; it's their loss if they refuse.

My job is also to protect the people who have less power than me. If you call my aide a liar while trying to get him to do something he knows he can't, I'll call you on it. And if you continue to screw around, I will not tire of telling you "no."

The surgeon, thank God, is on my side.

The other nurses I work with are shocked. And admiring, that I had the huevos to say "no" to something that we'd all normally go along with in order to keep the peace.

I've had enough of saying "yes." It's time we, as a profession, got rid of this imagine of being pushovers who only want to please. I'm sure the first twenty-dozen nurses who refused to stand when the doctors entered the station got hell, as did the first twenty-dozen who refused to carry the MDs charts for them during rounds.

I'll take hell for saying "no." I've already defined my job; my bosses' job is to make sure I can do *my* job safely and without untoward interference.

I have the feeling I'll hear about this once Biggest Boss Of All gets back from vacation. In the meantime, I'll savor the feeling of "no."