Wednesday, March 9, 2011

Lessons

There are lots of different personalities that work in the ER. Loud, relaxed, abrasive, and low-key. Usually we all get along pretty well, but occasionally there are spats. The student I had shadowing me the other day discovered that first hand.

I had a pretty sick patient, who we decided needed intubation. I prepped all the RSI stuff, the doc explained everything to the patient and family, and respiratory got the vent set up. We intubated, and I started the sedation drip. The patient was down for maybe five minutes, and then when the initial drugs wore off but the drip hadn't kicked in yet, the patient started fidgeting. I was talking to the patient, reassuring, and she was nodding yes or no. I assured her that the sedation would kick in shortly, as I titrated the meds up a little.

Respiratory, however, apparently didn't like this. "The patient is going to pull the vent out! She isn't sedated! What is Doc thinking?! This patient isn't ventilating, she's going to crash!"

I'm all like chill, it will only be a few minutes, the patient will be fine. Nope, Doc walks in the room and Respiratory lights into him. Like all out verbal spat with him - you didn't adequately sedate this patient! This patient is going to die! Doomsday! Accusations!

Seriously, talk about overreaction. I look at the student, who is making herself as tiny as possible in the corner, student looks at the patient, and Doc looks at me like for realz, is this actually happening? Since I'm well aware he doesn't like this RT at all and this RT hates pretty much everyone who works at the hospital and all the patients that come in, it was rather apparent that this spat was on the verge of becoming an epic hissy fit. I stepped into the middle of the room and sort of put my hands out - "Okay, people, let's not forget that this patient can hear us and is probably wondering what the hell we're bitching about. And there are a bazillion people outside this curtain who can also hear this. So let's grow up and not fight inside this room, kapish?"

Both the doc and RT gave me about two seconds of silence, and then lit back into each other for a good five minutes - albeit in a relatively quiet volume - regarding care of the patient, vent management, proper sedation, and generalized insults. I snuggled back into the corner, handed the student a bowl of popcorn, and told her to enjoy the show.

Until the doc rounds on me, and blurts out "and you, you stay outta this!" And then blows out of the room all huffy.

Respiratory, now that the patient is properly sedated - as she would have been, with or without this argument - blows out in a huff too. And the poor student is left with her jaw on the floor. "You guys fought! He yelled at you and you didn't even do anything wrong! Is it always like this here? It's so rude of Respiratory to say those things, and Doc was so rude to talk to you like that. How can you stand it?" The poor student was astounded.

A useful lesson, though. Not all staff get along. Not everyone can have an adult conversation over a disagreement. Sometimes nursing staff is in the middle of it all, and we just have to remember to focus on the patient. The best part though? When Doc blows back into the room three minutes later and apologizes for getting snappy with me when his beef was with Respiratory, and for getting sucked into a pointless argument.

I think the student had a good experience. I always hope the students get to see some crazy sick patients, wild stories, and generally interesting cases; it's even better when they get to learn how staff can fight, resolve the issue, and move on.

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Eh, I need an editor. Sorry this post is so fecking long! Obviously the literary world is not my calling...good thing I have a day job.

1 comment:

Zazzy Episodes said...

I loved this post however long it was.