Day 8 of the New Interns
For the first time in my career, I wanted to smack the SHIT out of a doctor today.
Okay, there are times when slow torture, stoning, sabotage and just plain evilness have danced in my fantasies in relation to physicians, but this was just an out and out violent impulse. If she would have been within eyesight I probably would have been fired (or jailed).
Today is hospital day 6 for Ms. M. She is a 50 something woman who has had to endure 3 orthopaedic trips to the OR plus and exploratory lap after a very bad car accident.
As a nurse practitioner, my job roles are kind of a mix between medicine and nursing. [I know I probably risk sudden death from lightening strike from such a simplistic explanation, but I am no mood to do the touchy, feely political correct thing.] With Ms. M. my initial approach was all business, get it done, get it doneâ€¦until I saw the look in her eyes.
How easily I shift-changed into my nurse demeanor. After a few carefully worded questions, the dam broke allowing Ms. M. to relay her very well founded fears, concerns and emotions.
She had seen her face in the mirror for the first time this morning.
She was able to see the bruises, the broken teeth.
She was worried about being able to return to the job she loved.
She expressed guilt about the accident.
If it werenâ€™t for her quick reaction to the car that pulled in front of her, both her and her passenger as well as the mother and her children in the other car would all have been killed. And this womanâ€™s reaction was guilt.
I almost cried with her. I did what nurses do. I listened, I helped her blow her nose, I told her that we would do everything possible to get her through this. I also told her that it was ok to cry, that it was ok to have bad days.
Then I got the phone call from the nurse.
Her abdominal incision had dehisced. I gave the nurse a quick supply list that we would need on the phone as I was walking to the room.
The trauma intern had removed the patientâ€™s staples without replacing them with steri-strips. The trauma resident did not assess the incision line prior to telling the intern to pull them. Neither considered the fact that this lady had cellulitis (now resolved) all over her abdomen post op and maybe, JUST MAYBE they should be left in her for a few extra days.
Her wound gushed sanguineous fluid all over the bedding and her. She slipped further into her depression right in front of my eyes. Nothing I could say or do was going to help.
Earlier in the day, this same intern had undressed, de-sutured and left flapping in the breeze this womanâ€™s subclavian triple lumen. The nurse found it later and was given the explanation that the physicians changed their minds and didnâ€™t want to pull it for 24 more hours. When the patient asked the intern questions such as, â€œwhen will my foley be pulled?â€ the intern became rude, said she was not the one to be asked and then POINTED at the nurse saying, â€œYou do it.â€
My patient needed care, empathy, patience and straight answers. What she did not need was some bitchy intern, who didnâ€™t learn a damn thing in medical school, to come in and DO MORE HARM.
Ironically, in a matter of minutes I transformed from being the new NP who was trying to do best by everyone by lying low and going slow to the NP who doesnâ€™t give a shit about being new and still green as hell.
For the first time ever, I chewed someone out (the resident) for screwing up.
He better keep the intern away from my patients.
Moral to the story? It costs nothing to be kind, it will cost you everything if you are not.
It cost this intern the next 4 years during which she will have to make up for 12 hours of stupidity and unkindness. I just hope my patient wonâ€™t also spend the next 4 years making up for this internâ€™s mistakes.