When I was still working as a registered nurse, I don’t know how many times I heard, or how many times I said, “I wish I could retire NOW”. I graduated in 1985 from an ADN program, and very soon after getting my license (we had to wait for snail mail back then) moved away from home to begin my career in a state/city 1200 miles from home. I was so excited!
At first, I was the typical newbie. I was idealistic and knew just enough to not kill someone on purpose. That’s all nursing school teaches. It takes experience to make someone ‘good’, and that takes time and enough brain cells rubbing together to ignite a spark now and then. Those first few years, I loved all of my patients, and everything they did was something to learn from. The poop and puke, not so much, but I had a good gag reflex, and could smile through anything. I didn’t even mind being elbow deep in someone’s butt sore if that’s what needed doing. And I was a supervisor’s dream- not married, no kids, and phone always turned on with no answering machine. Yep. A huge target from the get-go; I’d pick up extra shifts, even at the last minute if I was home and answered the phone.
Then I grew up. Many things became decidedly less amusing. The call-light jockey topped the list. When I found out that the spiel in nursing school about the call light meaning I didn’t ‘meet my patient’s needs well enough’ was a bunch of hooey, I learned to hate that thing. Some people are just so scared, or so regressed into the self-centric view of the world when they’re sick, that they need some sort of contact, a LOT. I never minded the legitimate things patients needed, or even wanted. But there was always some nitwit who had the audacity to complain about the brand of orange juice the hospital served. Really? And I can do WHAT exactly, at 2:00 a.m., about that particular life-threatening issue? Maybe run out and grab a few nice juice oranges, and get to fresh squeezing them for ya? Eh?
Most patient families were very nice, and appreciative. They knew the real reason they were there- to support someone in getting well. And then there were the invaders. These are the families that send out messages to all known living relatives within a single day’s flight away that there’s free coffee in Junior’s room, and the nurses have nothing else to do but bring refills. Though they do complain about the lack of service when there’s a Code Blue in the next bed. Go figure. Lack of pulse? Lack of coffee? Tough call. I’ll get back on that one. But spell my name right if you’re going to take it to the supervisor, got it? Thanks a bunch!
Doctors were another part of the equation. Most were great to work with, and knew if I was calling at 2:47 a.m. that it wasn’t to keep me awake; something wasn’t good, and it couldn’t wait for 3 hours when he/she might start drifting in to do rounds. I couldn’t just leave a note on the chart. One or two didn’t return my calls at all. That would make me so mad. Easy enough to fix that one- call the doctor he/she had ordered a consult from, and let them know that I knew they weren’t the primary doc, but since he/she wasn’t returning my calls, did they want to do something about the guy having seizures who had never seized before? No? Well OK, just thought I’d ask. That usually got the doc I really wanted to discuss the matter with to call back (after a brief call from their ‘real’ colleague) apologizing for the phone upstairs not working right. Uh huh. Blame the phone. It worked when the other doctor called…
There was the one neurosurgeon who had a vast reputation as both a superior physician and world class asswipe. One of his patients had the hiccups as a side effect of one of the IV meds we had to give them. And every last doc but him would order a bit of a sedative to get rid of them; they’d go on for hours if nothing was done, and it was cruel and unnecessary. But I had to call and report the hiccups anyway (even knowing the patient wouldn’t get anything to help) since it was the patient who was miserable. The asswipe doc told me there was nothing to do for hiccups but put a paper bag on someone’s head. SO, I wrote the telephone order, IN THE CHART, “Paper bag to head as needed for hiccups”, and signed/dated it. He had to cosign that order. He’d given it. He was still a jerk after that, but at least he’d address his patients’ needs a bit better. This is when we all still used pen and paper charts.
This was about the time I learned to clean up diarrhea from one end of the bed to another, and then go on dinner break and eat chili. No problem. In a pinch, I’d use a little kidney-shaped puke pan to warm up my Lean Cuisine Chicken Chow Mein…kinda looked like it belonged in there, to be honest. Made the docs nuts to see me in the back room with a fork in a puke pan. But then they got to know me, and they were glad that’s all I’d dreamed up. 🙂
One of my horror docs was a real genius who thought if he didn’t know about something that meant nobody would call and bug him about it. *rolling eyes* Picture this: a very sweet, but cash strapped guy who was diabetic, and could either get his diabetic meds OR the test strips to check his blood sugar. He wasn’t non-compliant for fun. He chose to get the medicine. He ends up in the ER with some nutso blood sugar in the 600’s, and the ER gives enough insulin to get it to the mid-400’s (should be about 70-100 for the normal person- and I’d taken care of many diabetics who ended up permanently vegetative for ultra high or low blood sugars; nothing to joke around about. This guy wasn’t in that range, but I wanted to keep him there). The guy is awake, and with the program, so stable enough for the floor. OK, fine. The dude gets to the floor and I’m checking orders. Nothing for blood sugar checks after getting IV insulin, and still not in a normal (or tolerable) range. Lab isn’t due for several hours to check the regular blood work. And I’m supposed to sit on this guy not knowing if he’s tanking, or has bounced high again after the insulin’s duration maxed out? I don’t think so! SO I call Dr. Genius, and ask about blood sugars since I’d checked one on admission to the floor, and it was still rocking in the 400’s (he was a bit irked that I’d checked it). There was no sliding scale insulin (the dose depends on the blood sugar, taken right before giving it), no orders to check the blood sugar (which would be standard), and the guy was still too high. The MD I would never subject a corpse to responds “If I don’t know about it, I don’t have to fix it”. *crickets* I got nothing for that one (aside from an immediate call to my supervisor to let her know).
People really need to know what nurses have to deal with on the phone with some doctors. It’s nuts. Then they’re supposed to be diplomatic to not make the doc ‘look bad’. I learned that his image is not my problem. If a doc wouldn’t give an order to deal with something, I’d let the patient know. No problem. Fortunately, the vast majority of doctors I worked with knew that it was a team effort, and I was the part of the team that meant THEY didn’t have to wipe butts, serve coffee, have their arm halfway to Mars inside someone’s butt sore, get spit on, duck flying objects, referee family fights about Grandma being resuscitated until she turned inside out, not be able to pee for 8 hours easy, and sometimes 10-12, and on and on. Most doctors knew that the nurses had their backs. I was up all night, it didn’t make any difference to me if I had to call someone, but the good ones left me orders for a lot of the ‘what if’ situations, so they knew that if I was on the phone, something wasn’t OK. I didn’t send him/her to med school, and it wasn’t my fault he/she was on call!
But I miss those nights (and days). They were my life. Once a nurse, always a nurse.