May 16, 2006, 6:12 pm

Incongruence

07.jpg

How?

By getting interviewed?

Put a reporter in my face and I’d produce so much adrenaline I wouldn’t be tired for a week!

Maybe he’s a detective, but that would only be worse.

Maybe he’s getting her opinion on how well her support hose is working, but then she’d probably slap him.

(Back then women could get away with that. They did it in the movies all the time.)

She looks so happy that someone is talking to her and writing down every word.

She’d gladly break every HIPPA law on the books for her fifteen minutes of fame.

You can just feel it….

*********************************************************************

There are a million stories out there in the Naked Hospital.

And there are three sides to every one of them.

******************

Perception is everything.

Having had recent experience as the nurse, the patient and the family member, I am in the unique position of seeing all three sides.

Let us examine how the perception of time, place and situation differ depending on which “chair” you occupy.

Episode One: The Perception of Time

  • Nurse: Okay, patient is back from x-ray and needs to be re-revitaled, but he’s stable and I have a new admission and need to start an IV on my other patient and start his pre-op antibiotic.
  • Patient: I’m sedated.
  • Family Member, RN: Geeze, he’s been back for an hour and I haven’t even seen his nurse yet. Hmmm….he’s had Dilaudid, I wonder what his vitals are? (Thinks about putting pt on monitor….nah, they might think you’re pushy.) Well, his airway is intact, his respirations are regular, his color is good and he’s sedated. No problem, I’ve got this wonderful three-year-old Time Magazine to help pass the time, obviously written before Tom Cruise had his meltdown. Oh look at this, Britney wasn’t even married yet. How time flies (no pun intended).

Episode Two: The Introduction

  • Nurse: Gotta get these vitals done, thank god he’s still asleep, there’s a woman in the room, couldn’t care less who it is. No time for pleasantries. No, we don’t have any results back yet. No we don’t know what the ultrasound showed. No need to tell you who I am.
  • Patient: I’m sedated.
  • Family Member, RN: Ah yes, five hours after arrival and three hours after blood has been drawn, how could I possibly expect any results. Silly me. That’s why I don’t work in this ER; I had forgotten. Now, the ultrasound is another story, they are probably swamped and those results can be delayed. Dang, this chair is giving me a backache….geeze that nurse is a bitch. No one smiles around here. Must..blog..on..paper…towel…to…ease…frustration….

Episode Three: Pain is the fifth vital sign

  • Nurse: How could you say your pain is that high, you were asleep when I came in! How can you be in pain and asleep?
  • Patient: Huh? What? Oh, it’s the blood pressure cuff…huh? About 4-5. Oh, gee, I must have given the wrong answer, let me drop the number by two and see if I pass the test. I’m sure tired.
  • Family Member, RN: I cannot believe she just questioned his pain scale. (Outloud): “Honey, you need to say what the pain is for you. There is no right or wrong answer” (/outloud) Geeze that nurse is a jerk. But at least she started smiling after she found out I was an RN. For awhile there I thought she had botoxed her way to mediocrity.

Episode Four: And the hits just keep on comin’

(Heard via ringdown: possible triple dissecting AAA enroute Code 3

Heard two seconds later, overhead: Trauma Code, Alpha, ETA 5)

  • Nurse: Oh (insert four-letter word of choice here)…….!!!!!!!!
  • Patient: I’m sedated.
  • Family Member, RN: Oh (insert four-letter word of choice here)….I feel sorry for the staff….bad shift….this means it will be another two hours before we see anyone or get any results. Good thing I’ve got this Family Circle from 1963 to keep me occupied. Hmmm….look at this article that states some women actually work outside the home….and a great recipe for lard-encrusted deep-fried cake! Dang, my back aches in this chair.

Episode Five: The Change of Shift@1900

  • ER Doctor: You have gallstones (Ed note: diagnosis=seven hours in the making). Your blood sugar is up. Do you have a doctor? Do you have insurance? (Ed note: oh yes, he did say that! And this is the only time I saw him.) You’ll be followed up by the hospitalist and surgeon. Looks like you’ll have to stay in the hospital tonight.
  • Nurse: Hey dude! I’m your totally cool and energetic new nurse. Let me introduce myself to your wife! Why she looks familiar. Why, we know the same people! Dude, how’s the pain – can you deal? You call me if you need more of the good juice, man, okay?
  • Patient: I’m awake and okay. Good to meet you. Do you think we can put this off until after my son’s graduation?
  • Family Member, RN: Thank you, God. He’s in good hands now. Probably laparoscopic chole and we’re good to go! This is the second time someone has mentioned blood sugar. And now they’re giving insulin……is this true diabetes or a fluke response to cholecystitis. Pancreas numbers normal. Hmmmmm…..

Episode Six: The Pain Returns With A Vengeance

(Heard overhead: Trauma Code Alpha, ETA 5)
(Yes, this is another one!)
  • Nurse: Oh (insert new four-letter word)….Man, this is frustrating, I have asked the doctor to write another order three times but he hasn’t gotten to it yet. My patient is hurting worse and can’t find a comfortable position. This isn’t fair. We are so freakin’ busy!
  • Patient: The pain is worse and I can’t find a comfortable position. I need more of the medication, I’m almost at the same level as when I came in, and I am now wide awake and cranky (when the nurse is out of the room). I think you should go home and check kids.
  • Family Member, RN: Oh (insert two four-letter words here)…now we are that much more behind in getting anywhere. (Reminds patient that kids are adults.)Where the hell is the pain medication? Forty-five minutes have elapsed so far from the time of the request. Gee, watching a clock is a pain. Here, I’ll put the call bell on your siderail instead of five feet away from you and if the pain gets worse I want you to call. I’ll go get Son and we’ll switch cars and get yours home. Yes, I have your wallet. No, we don’t know about surgery until you see a surgeon. I’ll stay until you get your shot. Okay, I’ll go now but only if your promise to call the nurse prn. That means as needed. Sorry. Nursespeak.
Episode Seven: The Hospitalist

  • MD: Hi! I’m Dr. Young-Enough-To-Be-Your-Son. Looks like you have gallstones and your sugar is up. Let me take a comprehensive history! Yes, you can have a sip of water! Nice to meet you!
  • Patient: Okay! (I would be sedated but someone is talking to me. It took an hour to get medicated and now I am and no one will leave me alone! So this is what “high” feels like.)
  • Family Member, RN: Wow. He’s young enough to be my son. He’s cute, too. In a theraputic way, of course. I’ll pull the curtain so there is some privacy for the exam. We still have to wait for the surgeon. You’re just the introductory doc. Good thing I brought this book called “Cutting Remarks” about the life of a surgical resident in the ’70s, to read while I wait. Only a nurse would bring this. Haha. I crack myself up.
Episode Eight: THE SURGEON
(Time elapsed since patient arrival: Ten Hours)
  • THE SURGEON: Hello, I am THE SURGEON. You may bow in my presense and call me GOD! I am about to take an extremely thorough history and I will take no nonsense from that woman in the corner, nor will I engage in any nonsense. I may be small and female, but so help me, ME, I have more authority in my little finger than you’ve had your entire life. Answer the following questions. They will come fast, they will come succinct and they will help me save your life. Let me finish discussing the surgery and risks before you barage me with question about if you will be able to travel to your son’s graduation. (Raises eyebrow at Family Member, RN, who shuts up immediately). I will use this detailed model I have just drawn at the bedside to explain exactly what I am going to do. We don’t have to do surgery right away if your pain is better and your liver enzymes are down tomorrow. If they are not, we will have to do surgery. You are a diabetic and fooling yourself if you think you are healthy. I will now depart with my flowing scrub jacket flapping behind me.
  • The Patient: Oh man. I’m tired and want to go to sleep. You go home, you need some sleep.
  • Family Member RN: I love that SURGEON! She’s’ tough, she’s cool, she rocks! She has the bedside manner of a screwdriver but in the OR, it’s her skills that you need and she used to do trauma! Hella cool! No, I’ll stay until you get up to your room. I’m a night nurse, remember? I’m used to this. (I’m exhausted. My back hurts. I’ve read the same paragraph four times, but you don’t need to know that.) I’m fine (smile, girl, smile – get your Academy Award later).
Episode Nine: The Admission
  • Nurse: We have a room assignment, we’ll have you up by 2330. Change of shift, you know.
  • Patient: Thank god. I’ve been here 12 hours. Honey, you go home.
  • Family Member, RN: (It’s change of shift, you won’t be outta here until 0100). I’ll go so you can sleep. Love you, too! (Keep smiling…..lose it in the elevator….don’t lose it in front of him). See ya tomorrow! (I’m gonna go home and blog)
And there you have it.
The view from all three sides of the health-care triangle, from someone who’s been seen it all.
But no matter where you sit, the goal is the same.
The health, care and comfort of the patient.
It’s what we do.

10 Comments


  • Erica

    May 16, 2006 at 8:56 pm

    So true, how different perspectives can be on the same situation. When this really hit home for me is when I traveled emergently to a neighboring state to visit my dad in the ICU – he’d been visiting a patient in said hospital and had chosen the 5th floor lobby to pull a nifty little MI/v-fib arrest 1-2 punch. They’d extubated about an hour before I arrived, and as I pulled back from that first hug, Dad said to me in that raspy, larynx-trauma croak, “Please, please, if you tell your patient you’ll be right back, be right back. It’s been 17 minutes and 30 seconds and she still isn’t back with my ice chips.” He smiled weakly as he told me this, but I thought of how many times I make this same mistake in any given shift. See, I think I’m being positive and optimistic, and trying to convey that my honest intent is to “be right back,” or to get that patient back to a bed “in just a little bit,” or whatever the unlikely promise might be – but from the point of view of the patient, who, as Dad put it, “has nothing else to do but watch the clock,” you might as well have forgotten about them.
    (evil grin) Further proof that clocks, like call buttons, should not be allowed items in patient rooms.



  • Jodi

    May 16, 2006 at 9:44 pm

    You Rock!



  • gilgul1

    May 17, 2006 at 6:11 am

    Wow, that was a rad entry! It looks like you put a lot of effort into it! Love your exclamation points! Like a comic book! Grand Rounds, baby!



  • Annemiek

    May 17, 2006 at 2:15 pm

    I love this entry, and how true!



  • difficult patient

    May 18, 2006 at 8:40 pm

    Keep writing, Kim . . .



  • Monika

    May 19, 2006 at 4:22 am

    Great post, Kim… Thanks!



  • StudentNurseJack

    May 19, 2006 at 6:32 am

    Love. It.

    Thanks for my morning laugh.



  • Natalya

    May 20, 2006 at 2:42 pm

    I hope your husband is recovering quickly, and I wish him the best in coming to terms with diabetes.

    I have been the ‘family’ both while my mum was ill with cancer ten years ago and when my partner had gallbladder issues two years ago. I extremely grateful for all the usually nursing staff who were able to take extra time to explain things slowly and audibly to me as I’m partially deaf and often struggled to understand the busy doctors with the bedside manners of as you say a screwdriver!



  • NPs Save Lives

    May 22, 2006 at 4:47 am

    This is soooo true! I am humbled by the eloquent way that you write..



  • radtec

    May 24, 2006 at 9:59 am

    You ROCK!! 🙂


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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