Hurricane Jill

Treating the nurses

I’m getting close to halfway through this rotation. Last night on call was probably the most painful, although educational, night so far. All my patients had issues of one sort or another, and I can’t help wondering if the nurses were testing me to see if I know what I’m doing.

Back in my allied health days, the point was impressed upon me by all my teachers (both in school and on the job) that you should never call a doctor with a problem, without also providing a suggestion for solving it. The tricky part is suggesting your solution without making the doctor feel like you think you know more than s/he does. Because there are usually several ways of solving any care-related issue, and the superior attitude on your part will only encourage the doctor to think of some other way to solve it than what you’re suggesting. –Usually just as legitimate, but creating more work for you than your preferred solution.

Well, some of the ICU nurses at our University Hospital are lacking such people skills. They frequently call with problems and no solution, and when they have a solution they present it more as a demand than a request. And if s/he doesn’t agree, they will manipulate the system to get what they want, even if the doctor’s solution was totally legitimate. My entire team, all the way up to the attending, is aware that this happens. And yet still it goes unchecked, and not just unchecked, but actively rewarded.

This happens because ICU nurses are extremely good at presenting information in a way that sounds emergent, even when it totally is not. I spent a year and some change as the pharmacist for the ortho, gen surg and CT surg ICUs, so I know that the numbers we follow to assess patients in the ICU can look terrible and mean nothing. Likewise they can look fine in a patient about to crump. Certainly we can figure out the difference ourselves, but since no doctor can be in more than one place at a time, we rely on the nurses to give us a sense of whether the numbers correlate or not, and to call us when they do.

So I wish the nurses would not cry wolf so much. It makes it harder to sort out a real emergency from the agenda-driven fake ones.

In any event, nobody died. And in fact, no one even tried to. No one was in worse shape this morning than they were yesterday morning. They just have a lot more unnecessary lines and tubes and drips and films. But the nurses feel better.

Oxymoronic

Livin’ large in the PACU
Early this past week, the roof got blown off the residents’ sleeping quarters at our main hospital. I don’t recall it being all that windy, but nevermind. The name of the place says it all: we call it the Crow’s Nest. When the residents talked about it in orientation, I remember thinking how cool it sounded. But in real life, it’s drafty and cold all the time, with lights that work only when they want to and communal bathrooms. And the stairwell leading up to it smells like urine.

It was probably a pretty neat place to hang out. Fifty years ago.

In any event, the roof got blown off and all the walls got soaked through and through by the rain. As a result the residents have been assigned alternate sleeping quarters until it can be repaired. So last night I got to experience these “alternate quarters,” and let me tell you: I don’t care if the Crow’s Nest EVER gets rebuilt. We got to sleep in the private short stay rooms in the new surgical wing of the hospital. And oh my God, that was the best night’s sleep I’ve ever gotten in a call room! No lumpy, midget-sized mattress, no bunk bed, nobody else’s pager within earshot. My own bathroom. A remote control light switch. It was awesome.

Dude, with that as my call room, I can take call all week.

Closet Full of Skeletons
The chief resident on my current service is a guy who by reputation is kind of an ass. So naturally I was a bit nervous about having to work with him. However, it hasn’t been at all what I expected. I mean, I believe the stories I’ve heard, and he will freely admit that there are certain people he likes to torment. But what I’ve also seen is someone who’s truly excellent at talking to patients, and explaining neurological diseases and plans and outcomes in language they can understand, in an unhurried manner and without giving too much false hope, or conversely painting too dim a picture.

On a personal level, I’ve actually found him very easy to work with. He used to date one of the surgery clinical pharmacists at Harborview, so he remembers most of the pharmacy crew from back when I worked there. He said he’d been wondering why I looked familiar. And the neurosurgery pharmacists at the time were friends of mine. So we spent a few minutes today chatting about pharmacy gossip from way back when. Small world.

I can’t believe I’m using these two words in the same phrase, but it was actually a fun call day.

Mah mad assistin’ skillz

Ahhhh! Back on neurosurgery!

It’s been two days, and already I’ve scrubbed in on two operations. All spine, but then nearly every spine surgeon I’ve met has been loads of fun in the OR. There have been one or two exceptions, but by and large it’s been the rule.

Today the surgeon complimented me on how well I assisted with the surgery. But it’s easy to be a good assistant when you’re interested in what’s going on and you’ve seen and done enough to know how to help. Although up to this point, I’ve generally avoided spine cases if at all possible, so that doesn’t really explain it.

I think it’s just that I got some really excellent teaching on my neurosurgery sub-I’s. I was fortunate to encounter a number of chiefs and seniors who were excellent surgeons themselves, and who took time to teach me how to hold and work with the various tools. I still don’t know the names of all the tools–there’s a bewildering array of them, and for one thing I can never keep all the Penfields straight. But I definitely feel more at home operating on the brain or spine than the abdomen.

But this whole deal with neurosurgeons being malignant personalities…I just don’t get it.