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 done…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 weren’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 woman’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 patient’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 woman’s subclavian triple lumen. The nurse found it later and was given the explanation that the physicians changed their minds and didn’t want to pull it for 24 more hours. When the patient asked the intern questions such as, “when will my foley be pulled?” the intern became rude, said she was not the one to be asked and then POINTED at the nurse saying, “You do it.”

My patient needed care, empathy, patience and straight answers. What she did not need was some bitchy intern, who didn’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 doesn’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 won’t also spend the next 4 years making up for this intern’s mistakes.

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  1. It is remotely possible that this particular intern is salvageable. I certainly hope so — and your reaction was the first step in rehabilitation if that is the case. Giving a pass on bad behavior doesn’t correct it. I’m glad you didn’t give her or the resident a pass.

    We had a pediatric resident once who was competent, but quite rude. One day, he walked into the NICU and ordered the secretary to do something for him. 7 nurses turned to him and said in unison “Say Please!” He stormed out of the NICU, but was a changed man on his return. I suspect he had a chat with an attending who was finally able to make some headway with him. I hope something similar results in this case.

  2. Now I’m glad I didn’t go into medicine. I’m afraid my first impulse would have been to look for a sturdy chair to break over someone’s head.

  3. I will forever bless the med students with the ‘tudes who so annoyed the nursing staff in the medicine rotation just before mine. That caused the chief resident to sit us all down & explain the team concept to us. I was not raised by wolves & try to treat folks with respect. But, thanks to that lecture, I made even more of an effort. And it has paid off in spades, with better care for my patients and a better residency for me.

    But, when teaching housestaff now, I see how hard it is to teach common sense.

  4. Hay Em you know the differance between a doctor and god? God dosnot think he’s a doctor. Good Job. We have a simaler doc up here in CL. I tell her to shove it all the time.

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