"those who can, do. those who can't...apparently run this place"
i have a love hate relationship with our trauma team. mostly hate. as a whole, the team is made up of underachievers. the residents are less concerned about quality patient care and interventions that make sense, and more concerned about guessing which orders their seniors would like them to write. they don't order tests, because they don't want to know what's going on. they hate labs, because then they will be obligated to come up with interventions. they loathe medicine doctors above all else, and frown on nurses who call on them for help in emergencies. i have decided this is because they feel threatened by these doctors because they know about medicine. they have taken nearly everything that i learned in nursing school and thrown it out the window. there are many days that i feel personally victimized by our trauma team, one of those being today.
i have a patient that i'm watching like a hawk. he's here because he stabbed himself. when i got him out of surgery, his heart rate was in the 140s-150s. not ok. the team ran a few tests, and determined that he wasn't having a cardiac issue and that his blood counts were decent. apparently this was good enough for them, so we let the patient sit at this heart rate for 24 hours.
the next day, he became short of breath. they sent him for a chest CT and found out that he had a pulmonary embolism. NOT OK. i have watched people die horrible deaths of PEs in front of my face, and as a result i live in fear of them. it's the kind of condition where a person is talking to you one minute and the next they aren't breathing...completely terrifying and emotionally scarring. so one can imaging how i felt when i found out that the patient had not one but two PEs in the left lung...kind of like i had just been handed a ticking time bomb. i started the patient on a heparin drip to thin his blood, and we kept a close eye on his vital signs.
so imagine my surprise when i come to work today and my patient is off his heparin drip. when i asked the day nurse why, she quoted the trauma team. "his PEs are little...he probably had them before he came in. and he doesn't have insurance". allow me to break down the things that are wrong with this into an itemized list.
1. the PEs are little. ok, so certain types of PEs aren't as serious. but personally, even the thought of little ones make me want to wet my pants.
2. he probably had them before he came in. maybe. although this would fall under another of the trauma team's biggest faults, the failure to acknowledge/treat/give a crap about pre-existing conditions. basically, the doctors will say "this is their baseline" and use that as an excuse not to deal with the problem. once again, not ok. and for the record, the patient's first EKG didn't show changes that would happen due to PE, and the second and third EKGs did. therefore, we might want to rethink this theory, people.
3. he doesn't have insurance. i think i can sum that one up with a OH NO YOU DIDN'T.
fine, so we aren't going to treat his PEs. but he also has chest pain. and blood counts that are half of normal. and suddenly, i understood!!! his body doesn't have enough blood cells to deliver oxygen to the heart. low oxygen equals chest pain. this can also explain his sickly grey death skin and the fact that he just sleeps all day long. it was like heaven opened up and the angels sang. we could give him blood and he would be better!!
so i did what a good nurse is supposed to. i went to the resident and presented my evidence. i had labs to back me up. i had a good argument based on pathophysiological principles. i followed the right steps. and then i got the order, gave him blood, and everything was perfect, the end.
oh wait. actually i was told that "it will be discussed", and then my (right) idea was completely shot down and the team decided to give him some lasix to get rid of extra fluid. apparently the idea de jour is that his blood counts are low because his blood is diluted. DID WE ALL GET OUR MEDICAL LICENSES OUT OF A CRACKERJACK BOX?!?!?!
i am tired of being rejected by the trauma team. i'm tired of working hard to think critically to have no one take me seriously. i'm tired of the groupthink. and i'm tired of caring about these patients and feeling like nobody else does.
but do you know what i'm not tired of? being right. mark my words i WILL give this man blood if it's the last thing i do. because he needs it. it will make him feel better. and it is medically appropriate. and i don't need the trauma team to validate my feelings.
but i will enjoy saying i told you so.
rant over.
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