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Wednesday, March 5, 2008

Grumpy doctor's like to share their misery

It's busy here tonight, and I don't have a lot of time to write, but I'm here anyway. Both the day shift RTs were not in the cave when I arrived, and that was a bad sign right off the bat.

Then the phone rang. Dee was in ER with a patient who had coded on the way to her doctor's office, and Jane was busy with a phych patient who's having hallucinations, on BiPAP due to low sats, and keeps trying to rip the mask off.

Before I took off for the CCU I figured I'd at least put my work shoes on, but there was a new key pad on the storage room door, so I ended up setting up a vent, before I even got report, with my boots on.

No big deal. The patient will be fine.

However, when I did her 10:00 vent check I noticed her BP had dropped significantly, and Sandy just happened to come into the room at that time and she told me she was going to call doctor Mark about it.

I watched as she hung up the phone. "What's wrong. You get chewed out too."

"Yes, " she said, "Dr. Mark said, grumpily, 'Why are you calling me for this? Is the patient sleeping. It's normal for blood pressures to drop when a patient's sleeping.' And I wanted to say to heim 'The patient's pressure was in the 70s. I don't care if she's sleeping or not. It's my job to call you.' but I held my tongue like I always do."

Later the patient who was on BiPAP was pulling off her mask, and when she did so her sats dropped into the 50s. Michelle gave some Haldol to the patient, but that didn't seem to calm her much. So Michelle called Dr. Mark.

While she was on the phone I went into the patient's room and pretended to do something to the Vision.

"What are you doing?" the patient asked.

"I'm fixing this machine so it works better for you." I lied. "There, how's that?"

"Oh, it feels much better now," she said.

"Great. You're doing a great job. This thing is working so well for you." That was the truth. However, I knew if I could keep this patient on calm terms, and she kept the mask on, she'd be fine. The alternative was to be intubated.

I stepped out of the patient's room and saw that Michelle seemed to be defending herself on the phone. Then hung up.

"Dr. Mark is such a crab ass," she said to me.

"She yelled at you, hey," I said.

"Yeah. She said if we can't keep the mask on her that we need to call the anesthesiologist to intubate her, and if we're going to do that we better do it before eleven, or at least before the anesthesiologist goes to sleep because we don't want to inconvenience him more than we have to."

"Well, the patient's calm now. She should be okay for a while anyway."

"Good. I'd hate to inconvenience Dr. Mark again."

It ticks me off when a doctor gets mad at an RN or RT for doing his or her job. If something's not right with the patient, like a significant drop in pressure, we can't just sit on it. Not only did these nurses have to call the doctor out of good conscience for the patient, but to protect their licences.

But Dr. Mark wasn't going to be satisfied until he shared his grumpiness with those two nurses and made a valiant attempt at ruining their nights too. But that wasn't to be. We all know Dr. Mark has his nights.

I left the unit and knocked off five treatments, all on out to lunch patients who would have survived just fine if I never gave them their treatments.

My next stop was in the emergency room. After I did an EKG I went to hand it to Dr. Call, perhaps the nicest doctor on earth, but he was on the phone with DR. MARK.

"Hmmm," I whispered to Sue, "Do grumpy doctors chew out other doctors, or is it just RNs and RTs they treat like scum? Because Dr. Mark just got done chewing out both nurses in the unit, and they called him for a legitimate reason."

Sue smiled and said, "He has his nights."

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