Tuesday, February 17, 2009

My mother doesn't curse

I don't remember what prompted my 13 year old to say that, but he did say it to someone I'd never met before.

Without thinking, I said, "He's never been to work with me."

It's true. I don't curse at home. I very seldom curse at work either. Some of my co-workers are of the same mistaken opinion as my son. Most of the docs are.

I don't swear in front of families. That would be unprofessional.

I don't even swear at the people who elicit the most foul language - almost always the folks in the lab. It doesn't do any good. Occasionally I'll write an incident report or three (in the same night), but I wait until I hang up the phone to say what I really think. It can be quite colorful.

NOTHING makes me angrier than being told one of the BIG LIES about a blood sample I've just extracted painstakingly from the tiniest infants.

Lie #1: The sample was QNS (quantity not sufficient).
Don't tell me there's not enough blood in the microtainer when I obtained the sample myself. I filled it to the top line when you should only need me to fill it to the bottom line, and I know the patient's hematocrit is on the wrong side of 30. Tell me you spilled it or that the machine malfunctioned. Either will make me far less angry.

Lie #2: The viscosity of the blood kept the machine from working properly.
Do you think I don't know what that word means? Maybe you think I don't know the patient's hematocrit. Maybe you just need someone to teach you how to use the (expletive deleted) machine.

Lie #3: The sample was clotted.
Oh I know that samples sometimes clot, but if I have a heelstick sample clot twice in the same year I'm having a bad year. If it came from the heparinized arterial line. Just tell me you dropped it, OK?



Occasionally a family member will push me over the edge, but I maintain control until they are out of sight (and hearing):

The day shift nurse told me that the mother wasn't quite getting the message about how sick her 530 gm 23 week baby was. Intubated, high ventilator settings, barely maintaining temperature. Electrolytes totally out of whack. She just couldn't hear the painful message that her baby was critically ill and in danger of dying due to extreme immaturity of all systems.

The baby was born years ago, before we allowed any visitors other than parents and grandparents. There were vast numbers of extended family members and the mom wanted them ALL to see the baby. From the window.

Unfortunately, the plastic wrap we were using to help maintain the baby's temperature in the radiant warmer was blocking their view. I explained repeatedly what she'd already been told, that the baby needed the protection of the plastic wrap and that I couldn't take it off for each of her visitors.

No, I couldn't lift the baby (and his ET tube and his chest tube and his umbilical lines up to the window so they could see better. He was too fragile.

She asked if I could take the baby to the door so they could have a closer look.
"He'll die if I do that" was my response.

She FINALLY got the message: The baby is tiny and fragile. It will be a long time until he goes home -- if he does at all. She finally heard that. I hated to be so blunt, but she was quite literally endangering his life every time I moved away for any reason.

Her behavior changed instantly. Instead of asking for him to be handled, uncovered, carried to the door, she started questioning the necessity of each intervention. She wanted the day shift attending to come back. The night shift attending might not know the baby well enough. On and on it went for the better part of an hour after my blunt explanation. Finally she became too exhausted to continue and retired to her room.

I decided I needed to take a very short break while she was gone and headed for the conference room. The night attending had decided it would be a good place to complete her charting, so she was sitting at the desk in the corner. I'm pretty sure I enhanced her knowledge of English slang and profanity as I expressed my opinion of how the last couple of hours had gone. I never raised my voice, but I turned the air quite blue while expressing my thoughts. After about 5 minutes or so, the charge nurse opened the door, listened to my ongoing rant, and said: "You know we can hear every word you're saying in the nurse's station.

That was BIG LIE #4. Fortunately she couldn't keep a straight face once she'd said it.

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