When Docs Attack

ERnursey, one of my favorite bloggers, has a post up called “When a Doctor Assaults a Nurse.” Now, fortunately, nothing like that has ever happened to me. But it did remind me of one situation I had recently. (Sorry for such a looooong post; I'm kind of venting here.)

Early one morning we got a trauma--an elderly person who had been hit by a motor vehicle. This person had some head trauma and several other fractures, had been intubated and placed on a ventilator, and the neurosurgeon was paged and subsequently accepted the patient to his service. No beds were available in the ICU at the time, and the nursing supervisor was contacted and started scrambling to arrange a bed.

This patient required very close monitoring, so when I came in for my shift, I was assigned to provide one-to-one care. (For the first few hours of my day, I’m a float nurse. My job is to give people their lunch breaks and then take over an area.) This meant that the rest of the nurses got shortened or no lunch breaks. The whole ED was aware of the seriousness of this patient’s condition and was pitching in (with almost no complaints) to ensure that this patient got the best care we could provide.

The patient’s family was at the bedside, and I answered any questions I could about what was going on, explaining the different readings on the monitors, explaining why we were keeping the patient sedated, why the patient had loose restraints on, what the different medications I was giving were for, and trying to maintain a quiet and soothing environment as best I could in the ER. The family was distraught but calm, and thanked me for being helpful and informative.

I worked with the residents and PAs as they bustled around with orders (some that I found questionable) that were phoned in by the neurosurgeon: extubate the patient (despite a possibly expanding head bleed and the previous orders for sedation and narcotics for pain medication that could compromise the patient’s respiratory drive), a stat second and then third CT scan (as I ran alongside the stretcher with an ambu bag, concerned about the aforementioned respiratory drive), starting drips and then abruptly stopping them on orders from the absent neurosurgeon. A lot of action with not a lot of results.

Finally someone in the ICU was downgraded, a bed opened up, and I had to give report. Just as I finished getting my last set of vital signs and was leaving the bedside to go to the phone, the neurosurgeon showed up, the family anxiously gathering around him as if he was the second coming of the messiah.

The neurosurgeon was in the room as long as it took to give report to the receiving nurse in the ICU. I turned around from the desk and encountered the patient’s relative, staring at me and ranting about how if his parent didn’t go “upstairs in the next FIVE MINUTES” he was going to have the patient transferred to another hospital. He loomed over me and declared that we had DONE NOTHING for the patient all day long, how DARE we keep this patient down here in the filthy dirty ER ALL THIS TIME AND DON’T YOU KNOW THE PATIENT IS BLEEDING IN THE HEAD?!?! Wasn’t I aware that the patient was SEVERELY INJURED and in VERY CRITICAL CONDITION? WHY HAS NOTHING BEEN DONE! He said, sotto voce, “We could SUE YOU, you know.”

What the heck? Apparently the neurosurgeon (who accepted the patient to service at 6:30 AM and FINALLY DEIGNED to SHOW UP AND EXAMINE THE PATIENT at SEVEN PM) had told the family that it was a travesty that the patient had not been assigned a room and had even gone so far as to say that if we could not accommodate the patient WE (the ER staff and administration) SHOULD HAVE TRANSFERRED THE PATIENT to another hospital.

Never mind the fact that the patient was under the NEUROSURGEON’s CARE since about seven AM, and if anyone was responsible for transferring the patient, it was the NEUROSURGEON. Never mind the fact that the neurosurgeon had not even MADE AN APPEARANCE in the ER to even SEE the patient until TWELVE HOURS LATER--had just phoned in orders to the residents and PAs.

And then the doc had the nerve to come in, look at the patient, and undermine and denigrate all of the work the whole ER (the docs, who helped the neuro residents out when they needed help with a central line, the nurses who gave up their breaks, and who had helped me with the patient when I needed it) had done. I was at the patient’s bedside, doing everything that would have been done in a bed in the ICU, doing everything that a nurse is supposed to do: caring for the patient, advocating for the patient, maintaining the patient’s safety, and educating and speaking therapeutically with the patient’s family.

I was completely speechless. I could not even utter a word. I managed to stammer out that I had just finished giving report on the patient and would be taking the patient up within twenty minutes. For the first time in my ED career, I was close to tears. I was shaking with anger, and actually had to go into the bathroom to splash cold water on my face. I felt as if I had been slapped.

Postscript: The patient made it upstairs without incident, and was discharged from the hospital for a rehab facility about ten days later, conscious and speaking.