My name is Dr. Val, and I yelled at the nurse.
Yes, I yelled at the nurse. After two terrible back-to-back experiences at the outpatient center, I yelled at the nurse, and no, I am not sorry.
So, the back story?
Well, the first incident was when my patient returned to my office a week after surgery with cut EKG wires on her back. Rather than have the patient lean forward and peel off the electrodes to which the leads were connected, the nurse simply cut the two wires that had been placed on her back earlier for pre-, intra-, and post-operative monitoring. I’ve played the scenario a hundred times in my head hoping to understand the logic. I’ve asked thousands of questions about the process to reaching that decision. I questioned the questions that popped into her head as she walked away from the patient in search of scissors, which I’m sure were not readily available, because in no way is this a standard protocol that would lead to having scissors readily available at the bedside. I imagine the colorful sticky note (which I always put on the top of the chart) with my cell phone number starring back at the nurse as she questions whether she should pull the dressing to remove the electrodes, ask a colleague for their help or opinion or … take the road less travelled and just “cut the wires” … after all, who is going to know, right!?
So that is why I’m really upset.
Because this nurse had to know that someone would have to deal with these cut electrodes. Someone would see the change in procedure that led to cut electrodes making it to a patient’s house and eventually my office instead of the PACU (post anesthesia care unit) garbage can. She had to know that this would eventually have to be addressed. She had to know that someone would have to “fix” this deviation from standard care. Someone would “see” this moment in time with her, the patient, and the EKG electrodes. A moment where her authority as the person in charge (i.e. the decisionmaker), the patient’s vulnerability, and doing the right thing meet. A crossroads where she gets to make a decision that will reflect on who she is as a person, not just as a nurse. When no one is watching, when the patient is too drowsy to understand and question, when the need to discharge is more important than the need to nurse (read that again and insert the word care in place of nurse). At this moment in time, at this crossroads. What is she going to do…
(Well, I already told you. But let’s get back to the story….)
As she walked to and from wherever the scissors were kept, she never once thought to stop. She proceeded with doing the wrong thing because it was more convenient to cut the wires than to ask for help, try harder, or think through a more acceptable course of action. So this adult woman, tasked with taking care of people at one of their most vulnerable times, saw the electrodes, wires and patient as a burden that she simply needed to discharge herself of. And for her, that day, she was discharging home, by any means possible.
I know you may be thinking it’s not a big deal. But keep reading. (click here for Doctors Anonymous, Part 2)