Thursday, December 14, 2006

I don't want to fight anymore

I used to be one of those zealots. The"I can change the world right now dammit" kind of zealot. I used to believe through sheer force of will I could make people do the right thing. Then I missed too much sleep. Being this tired triggered an epiphany. I don't care anymore.
Not the I don't care anymore so I will do a shitty job, spend all my time on the phone or even better doing my BScN homework at the desk while my patients monitor alarms and alarms.
Not that kind. The I don't care anymore I speak of is I don't give a shit what other people are doing or saying. I no longer have an opinion on anything. I give the fastest report in the well not west but east? Okay central.. anyway, my report? Fast.
I then tune out everything else and repeat in a monotone: "put it in the orders".I don't take verbals anymore. I ignore them completely. If it ain't written down I ain't doing it.
That has lead to some interesting times. Docs love verbals. They slide by mumbling under their breath and fully expect you to not only hear but understand and then dictate. Fuck'em I say.
The law of the hospital is if it ain't written down it didn't happen. Ordering drugs ain't my order? Not my problem.
The second part is I will no longer tell the fellow the patients diagnosis or surgery. I know that sounds insane but let me clarify. We have the laziest student docs in the damn world.
I don't know when it happened but our "learning" docs no longer bother to read the chart, they don't carry stethoscopes and they lift word for word the nurses entire assessment straight into their notes. This has lead to some very funny moments.
Sometimes nurses are tired, they get a little confused and can mix up one patient for happens. Usually a nurse will catch it pretty quickly and correct their mistake. But the docs are oblivious. So when rounds start here is the doc announcing to all involved the wrong diagnosis.
What is funny is they will fight to death over it..waving the nursing notes as proof. When asked if they assessed the patient they will lie their ass off.
Maybe that is when I stopped caring about rounds.
It could have been when the staff doc agreed with the fellow about the wrong diagnosis and created an amazing care plan...Except the patient would have died from it.
Or it could have been when the staff doc and the fellow yelled at the nurse for her mistake and accused her of nearly killing the patient.
I mean why should two docs who are too damn lazy to actually assess the patient or read their chart be responsible for the medical treatment of that patient? It's got to be the nurses fault. So I never tell them anything, gotta reduce the threat.

I maybe stopped caring when I read the notes of three different docs having a brutal fight on paper. For those who don't know the progress note in your medical chart is where the docs write about your condition , your past and present treatment and their plan to fix you so you can leave the ICU, one way or another. Docs are passive aggressive by nature towards other docs. They will never confront another doc head on, that's reserved for nursing. Instead they write vicious little progress notes. Each blaming the other for the patients decline.
Surgery will NEVER accept any blame. Just because a surgeon agreed to do a massive open heart surgery on a diabetic, hypertensive, renal failure, dialysis dependent, alzheimers patient with a fifty year history of smoking with COPD on home oxygen doesn't mean it's their fault the patient is refusing to recover.
The surgeon will cheerfully announce "there is nothing wrong with the heart" and stomp around demanding to know why the patient is so sick. The other services all blame the intensivist and infection control blames that nurse who once wore her wedding ring to work and quite possibly, just may have, brought in some kind of bacteria, maybe..But it's her fault.

So now I just step back. I let all the blame bounce off. I know who is responsible. The patient is. Any sensible person who was that sick without surgery should have known surgery was a really bad idea. But they took a shot and it failed.
I wish everyone would stop trying to be the very best. You are patronizing and irritating. Your quest to be the best makes you stupid. All you care about is you and how you feel and how other people will feel about you.
You are very boring.

I am not going to fight anymore because it isn't about you, or me or that other guy..It's about that person laying in the bed. They don't care who is to blame, I have a sneaking suspicion they already know it's probably them so give it a break okay?

I go to work and look after the gambler in the bed. I follow the orders that are written for me. I call the doctor when my patient is not staying within the parameters you, the doctor have written down.I implement any new orders. I speak with the family when you sneak out.I keep the patient clean and comfortable. I keep all my lines and machines in good order. I stay organized and do whatever needs to be done when it needs to be done. I write pages and pages of paperwork. That is my job, that is the job I care about.
All the rest? I couldn't give a damn.
And why you still care baffles me everyday.
Highschool is over kiddies..How about growing the fuck up already?


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