#10: Verbal sparring

Sorry I've been absent - surgical oncology really is a difficult rotation compared to my last rotation. I'm writing this entry post-call while I still have two dictations to do and I have to prepare three cases to present at conference tomorrow morning. Also, I didn't get much sleep last night because I was standing at the bedside of a really sick patient all night.

I got in a fight with the transplant surgery nurses on my last call night, which was Saturday August 5th. The night had been going well as Saturdays are pretty chill call days since all the teams sign out to me around noon on Saturday and I have all day to get things under control. At 10 PM, one of the transplant nurses called me and wanted me to order Tylenol for patient who had a liver transplant a year or so ago. I know that we're not supposed to give Tylenol to patients in liver failure but that it's OK to give Tylenol to patients after they've had a liver transplant (they have a new liver after all.) However, this patient was in the hospital because his liver enzymes were elevated and the transplant team was trying to figure out why. So I sort of balked at the idea of giving Tylenol to the patient and had the nurse hold on the phone line while I looked up the patient's liver function tests on the computer. The tests were elevated, so I eventually decided on Motrin at a small dose for the patient's headache and I could tell that the nurse was annoyed at me for taking a long time to decide on this. Besides, Motrin is contraindicated in liver failure as well, but the patient had been getting Tylenol for several days so I thought maybe I'd switch it up. Regardless, the decision was really not that important in the grand scheme of things.

Still, two hours later at midnight the Charge Nurse for the floor paged me on behalf of the nurse taking care of the patient and said that the patient still had a headache and why hadn't I entered the order in the computer so she could give the medication to the patient. Now, I have a pretty easy-going personality but I've found that one thing that gets me mad in the hospital is when patients I am taking care of have pain that isn't addressed promptly by their nurses. Usually when I am on call and there is some medication that is as simple as Tylenol or Motrin the nurse enters the order into the computer herself, but this hadn't happened in this situation. So what this meant was that the original nurse had forgotten about her patient for 2 hours, hadn't given him medicine for his headache, and decided to blame me for her laziness and/or forgetfulness.

Me: Usually on your unit you guys take verbal orders for things like Tylenol or Motrin.
Charge Nurse: We can only take verbal orders in the case of an emergency.

If I entered in orders into the computer for every medicine I gave during a call night for all 45+ patients that I am covering I would not be able to do it. It simply takes too long and in order to do it I would have to spend all night putting in orders into the computer and I wouldn't be able to see patients in person.

Me (slightly sarcastic, slightly joking because usually I have that sort of relationship with the floor): Oh, so that's how it's running tonight...
Charge Nurse (accusatory): What do you mean by that kind of statement?
Me (backpedaling): Oh nothing, sorry. OK, I'll enter in the order into the computer.
Charge Nurse: So what medicine are you going to give?
Me: The same medicine I was going to give 2 hours ago, but I guess what you're saying is that you want to wait until it prints out on the computer to see it, right?
Charge Nurse: That's an incredibly immature statement and I'm going to have to discuss this with the team in the morning. (Hangs up.)

Me (calling right back to apologize and talking to a nurse that I usually work closely with on the floor): I'm really sorry I don't understand what just happened and I must have gotten caught at the wrong moment (blaming myself for the interaction, when in fact it seems like someone just picked a fight with me over nothing.)
Nurse: Yes, I don't understand either. Things have been hectic around here.

I go promptly up in person to the floor with the intention of apologizing. I can tell by the time I get there that they've been talking about me. It seems that the Charge Nurse had decided to pick a fight with me for some reason, perhaps because she thought it was the first night I've covered patients on her floor. I can tell that the nurse that I usually work with has told the Charge Nurse that I am a pretty nice guy, because we have a long conversation where we both apologize to each other. I see the patient in person and apologize for him not getting his Motrin for 2 hours while he has a headache.

A whole lot of hoopla over nothing. Also, I could have been sleeping during that whole hour.

Last call night: Saturday, August 5st.
Patients covered last call night: I don't remember but probably 40+.
Amount of sleep last call night: 3 hours!
Currently reading: Patient histories.
Currently watching: On Sunday post-call I watched the first few laps of the Indianapolis 500 with a patient who is a huge NASCAR fan.
Next call night: Wednesday, August 9th. I'll write another blog this Saturday about the call night, in which I get 10 minutes of sleep while taking care of a really sick patient who had mesenteric ischemia.