Wednesday, April 26, 2006

Warning: Ranting Ahead!

There are days when nothing seems to go right, and today is one of them.
I am normally a very calm, relaxed, respected member of the health care team. For years I worked in an environment where the more stressful the situation, the slower and more focused I became so as not to make a fatal error in a life or death situation. I have become very adept to look at the big picture, prioritize quickly, problem solve effectively, anticipate what the next step would be, and let the doctor know when there was something 'not right with the patient.' And even if I started with "I'm not 100% sure what is going on here, but my patient is not looking right, and something is going to happen if we don't stop to really figure out what we're missing." I was always respected, and I always knew that I was a good advocate for my patients.

I am so upset right now, I am fighting tears.
I had a patient today who was 75 yrs old, weight 37 kilos (~100lbs) and was Iranian so she didn't speak english. No problem, we have non-english speaking patients every day. The anaesthetist gave me report, and basically just joked about how tiny she was and left the Recovery Room. She woke up screaming and moaning like nothing I'd ever seen before! She was grimacing and trying to hold her back where the incision was and writhing around in the bed in absolute agony. I gave her quite a bit of morphine trying to get her pain under control, but was a little nervous because she really WAS small, and a knew I was giving her a shitload of drugs. I thought I'd better take another look at her Anaesthetic record, maybe I had missed something.
Well. What I missed, was that she didn't get enough analgesia in the OR! Basically, this woman, who had back surgery, had as much pain medication as you would give a cat during surgery.
The drug he chose to give (Fentanyl), is very quick acting, but with a shorter duration than morphine (which is a GREAT drug!) This other drug, is also good precisely BECAUSE it is short acting. It's a great drug for short procedures, like when you are putting in central lines, or breathing tubes. Not when a tiny dose is the only pain relief given during a general anaesthetic! This woman woke up, and it was like she'd had surgery with the local witch doctor.
So, I spoke to the doctor, and basically said that I felt that she did not have adequate narcotics during the OR, and now she was in excrutiating pain. I'd already tried to top her up with morphine, but it wasn't working because she was in SO much pain. I needed something else. His answer: let's sedate her. I repeated to him, that I did not think it was a sedation issue, she needed something else for pain.
He came into the room, basically told me that HE was the doctor and I was a nurse, what did I know, did I want to tell him how to do his job? I again said, Fentanyl is a short-acting drug, it's out of her system now and she's in pain. He then (The Fucker) said "Oh did she TELL you she was in pain? Last I heard, she didn't speak english! I responded by saying that as far as I was concerned, moaning, and crying, and holding your back and grimacing where the INTERNATIONAL SIGNS for pain! His response? She doesn't speak english and clearly she has Cerebral Deficits !
Can you fricken believe that?! The only person with Cerebral Deficits was That Jackass! Then he tells me that fentanyl is the same drug as morphine and that I was wrong in saying that it had a short half-life. I said that "I, and my collegues must all be wrong then." He said we were.
I know that he feels that I was disrespectful towards him today, but this is not the first time I've had to wonder about what he's doing in the OR. Truth is: I don't respect him. He's lazy and sloppy. And even more truthful: he's the kind of person who's gotten by in life based on their good looks and charm. And he's a shitty Anaesthetist who's lives people put into his hands every day.
What I wanted from him, was for him to acknowledge that he did not use the most effective drug, or that he could have used other drugs in conjungtion, that he was not considering the patients post-op pain intra-operatively, and did not deal well with it post-operatively. He was arrogant, and belittling. And I know he is incapable of learning from this.
Anyway, this story is droning on and on. I could go into more detail, but then you'd probably think that I was the one with the Cerebral Deficits.

Right after that Fun-World Interaction, I went to lunch and broke the crown on my tooth. That, my friends, was the highlight of my day.

Good thing, I love my dentist.

Oh. And I had a good hair day.

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