Everyone has that one doctor.
That one jackass that you want to sneak up to the call room and strangle in his sleep. The one with the weird personality that makes you wonder how they survived into adulthood, the one who wants shit done exactly how he wants it even if it doesn't make sense, the one who writes stupid fucking orders and then gets mad when you call him to clarify.
The one who loudly proclaims at the nurse's station that the nursing care of his patients is "abysmal." (Yes, this actually happened, he really said that.)
Well, this one is a surgeon. Ever hear that old joke "What's the difference between God and a Surgeon? God doesn't think he's a Surgeon." It's true. This douchenozzle thinks he walks on fucking water. He thinks that he farts rainbows and shits solid gold. He thinks that he is a gift to mankind, that his presence on Earth is something we should all be grateful for. That we should fall on our knees and thank God that he was fucking born, or something.
He's not even that good, is the problem. He's messy. He's rude and intolerant. He treats his patients like shit. And he hasn't the slightest fucking clue how to manage them, but yet insists on being in charge of them instead of having the hospitalist or intensivist medically manage his patients. As a result, we have to call him all the fucking time. We have to call for insulin orders for the diabetics, or diet orders, or daily labs. We have to call him because he doesn't write orders the right way-- we have very specific order sets that need to be filled out for shit like Sepsis protocol or vasopressors or electrolyte replacement. God forbid one of his patients gets intubated, he wants to run the vent settings himself. He doesn't listen to the respiratory therapist. He tried to put PEEP on a patient with a hemothorax, for Christ's sake. This guy is something else entirely.
So when any of us get one of his patients-- which is often because he insists on all of his patients coming over to ICU post-op because the nursing care there is so abysmal-- we all groan inwardly, say a little prayer (even I do, and I'm an atheist) and hope it goes smoothly.
The other day I got one of his patients. This old dude was status post ex-lap and resection. He's an old dude who hadn't pooped in forever and it turns out he has bowel cancer. Guy got dealt a shitty hand of cards. So, Doctor McFuckface puts him on a PCA, which is really awesome and nice. I was surprised.
Our PCA order set is very specific. I LOVE our order sets because, really, a child could understand them. A foreign child who doesn't speak English could look at our order set and go "Ach so! Ich verstehe!" It takes a lot of the guesswork out of shit, eliminates the need for us to call for a million incidental things, and it reminds docs about shit they might forget about (like ordering triglyceride levels for patients on propofol.) Hooray for order sets!! I don't care if I'm unpopular for that opinion. I love them. So there.
The one for the PCA is super simple. It allows you to choose the medication, Morphine or Dilaudid. Then the next box asks you to choose PCA bolus only, or bolus and continuous. The next box sets the time between boluses. The next box sets the lockout. Easy as pie. So he picked Morphine PCA bolus only, 1mg every 10 minutes, no lockout.
The next box is the source of all my woe and frustration. The next box caused this doctor to have a fucking nuclear meltdown in my boss's office. The next box caused this doctor so much heartache and pain that he felt the need to go to my boss and complain about me and now I have to go meet with her.
The next box says:
If the patient's pain is not controlled, the RN may give a 2mg bolus dose one time. If one hour after the bolus dose is delivered the patient's pain is still not controlled, the RN may increase the dose by 0.5mg a total of 2 times BEFORE CALLING THE MD FOR ADDITIONAL PAIN CONTROL MEASURES. These boxes have to be checked in order for us to be able to do this, and they were. They were checked.
So, this guy when I came on shift was saying that the PCA wasn't working. I gave him a 2mg bolus. About an hour and a half later he was saying that it still wasn't great but it was better. So I took him up from 1mg every 10 minutes to 1.5mg every 10 minutes. And then he said everything was fine. His pain was at a tolerable level. He went to sleep. I checked on him through the night and he'd wake up periodically and tell me everything was ok, and that the button was working, and that his pain was fine.
When the next nurse came on, the guy woke up and said "Oh, the pain. It's an 8/10." Ok, well, he had been sleeping for like 2 hours and not pushing his button so naturally he was in pain. "Push your button my friend," I told him. And he did, and he felt better. The nurse looked and saw he had 60 demands in 12 hours. She didn't like that.
You guys. 60 demands in 12 hours, guys, is not a huge deal. In 12 hours there are 720 minutes. A patient with a 10 minute PCA can push that button 72 times. And while I was managing that patient's pain he was pushing that button like every freaking minute or so until I got it under control. So 60 times. Big fucking deal.
Anyway. So I go home, right, thinking that I'm done and everything is okay. Until I get a text from my boss: Call me immediately.
So I call her only to learn that Dr. McFuckface had been in her office throwing a goddamn temper tantrum that this patient's pain hadn't been managed and that I didn't call him. Well, OF COURSE I didn't call you, asshole. I followed the PCA orders you wrote. So I explained to my boss (who hadn't looked at the PCA order set before she called me which would have solved everything) that I had followed his orders to the letter, exactly as he had written them. I told her that the patient had not reported to me that his pain was unmanageable. I told her that he had been on the 1mg settings ALL DAY without issue. And I told her if Dr. McFuckface has a problem I'll be happy to talk to him. Because fuck that noise.
Well, now I have to go meet with her and I'm scared and worried that I'm in trouble. I've been burned before so I'm paranoid that she's going to be all "Hand over your badge, security will escort you out." She won't, I don't think, but still. I hate meeting with the boss. It's hard out there for nurses like me.
This doctor and I do not get along at all, mostly because I simply do not put up with his bullshit. This one time he was at the nurse's station and I was taking care of his patient who was day two post op and needed sliding scale insulin orders. So I politely approached him and sweetly asked, "Dr. McFuckface? The patient in 9 needs sliding scale orders, especially if you're going to start her on a diet today. Would you mind putting her back on a low dose sliding scale? That's what she was on up on the floor."
So I'm thinking, since this is my first real interaction with him, that he'd go and get the order set and fill it out, right? Nope. He scribbles "Low dose sliding scale" on an order sheet and hands it to me. I can't give this to pharmacy. WTF am I going to do with this? Cherish it? No. So I go and get the order set and hand it to him and say "I'm sorry, doc, but pharmacy needs it to be filled out on this. Plus there's other things that should be addressed, like if you'd like her to have correctional and nutritional and whether you'd like her to have Lantus as well."
He lost his goddamn mind. Seriously. And I guess he was so used to losing his mind and all the other nurses just taking it that he was hideously unprepared for what happened next.
Yall ever see The Color Purple? Where Sofia and her boyfriend are in the juke joint with Harpo and his new girl Squeak and Squeak gets up in Sofia's face and calls her a big ol heffa and then slaps her? And then all the musicians pack up their shit, like "Whoop, time to go" cause they know that Sofia is about to cloud up and storm all over Squeak? Well, people know me, and they know that I don't take kindly to that kind of shit. And so I say to him, "ExCUSE me?" And everyone stops and looks. And it gets deadly quiet.
"Who do you think yo're talking to like that?" I say. "Do you think that's an appropriate way to speak to someone? Are you seriously yelling at me right now because I asked you to fill out the proper form?"
"Well, I'm a busy man! I have patients to see! I can't be bothered with damn paperwork! I wrote the order, what more do you want?" he yells.
"Yeah, patients including the patient in bed 9, whom you've already seen but neglected to order insulin for. We use very specific order sets here, a fact of which I'm sure you're aware since you've been working here much longer than I have. I asked you politely to manage your patient. I do not deserve nor will I tolerate your behavior. I suggest, sir, that you refrain from speaking to me in such an unprofessional and condescending manner in the future if we're to work together." And I hold out the insulin order set to him, looking over my glasses with my eyebrow raised and my jaw set and a don't-you-even-fuck-with-me look in my eyes.
So he starts sputtering and gets red in the face and then slams the chart down and grabs the paper from my outstretched hand.
And that's when the charge nurse came and led me away because she knew it was about to get even uglier. I got spoken to about that incident, told by my boss that while she admired my courage to stand up for myself, Dr. McFuckface is BFF's with hospital administration and can make my life miserable and it's probably not a good idea to challenge him.
Which is total bullshit.
Do your fucking job. Do your job the right way the first time. We're a fucking TEAM, for crying out loud.
Anyway. Wish me luck.
Hopefully Still Gainfully Employed MoJo