today is one of those days that nurses dread across all teaching hospitals... the changing of residents. for non-medical folk, this is the day that our old (2 months), well trained (not all of them) and molded (verbally beaten into submission by ICU nurses... jokes... sort of) docs leave and are replaced by new, green, some fresh out of med school, never stepped foot in a critical care setting residents.
what does this mean exactly? well... of course... i'm going to tell you. it breaks down (not all of them are like this) to incompetent, useless, inexperienced new docs trying to tell you how to do your job OR attempting to do invasive procedures that they've only read about in books. granted... they're learning... its a teaching hospital but for fuck's sake it seems like they're getting dumber with each new group.
for example:
- my patient today had three chest tubes. two to suction, one to gravity. so during my excruciatingly boring rounds with all 7 new residents occupying our bedspace (pet peeve #1... get the fuck out of my way. DO NOT block my view/pathway to my patient, my monitor or my ventilator... you will get knocked over)... the staffman (intensivist) ask me to turn off the suction to the remaining chest tubes... so while he was slowly explaining something inane i walked over to my bed space (SERIOUSLY GET THE FUCK OUT OF MY WAY... second time) and proceeded to turn off the suction. piece of cake. flick of a switch. check my 2 pleur-evacs for air leaks and quietly return to my chair. before they start to leave i say, "there is still an air leak with the suction turned off". so as an experiment the team decides to turn up my PEEP without the RT i might add. so they play with my vent, crank the PEEP up to 10 from 0 and see what kind of effect it has on my aforementioned air leak in chest tube #3. when blondie pipes up... "when the floaty thing is up that means the suction is applied. well.. i don't see any floaty thing... is the suction on????"
trying not to pull my hair out, i calmly and sweetly say... "there is no suction. i turned it off because you asked me to." meanwhile in my head im screaming "YOU FUCKING TWIT". pull your skirt down sweetie... it's cutting off the circulation to your brain.
trying not to pull my hair out, i calmly and sweetly say... "there is no suction. i turned it off because you asked me to." meanwhile in my head im screaming "YOU FUCKING TWIT". pull your skirt down sweetie... it's cutting off the circulation to your brain.
i was thisclose to gouging out my eye with a pen.
another example...one of my buddies today needed a new arterial line in her patient... a skill that is so crucial to critical care. no nurse wants to sit around "assisting" some asshole resident who's stabbing her patient's wrist 42 times because he can't insert a fucking catheter into an artery. FUCKING RT'S CAN DO IT... and they have like 8 years LESS schooling than you do, you twat. ANYWAY... so her resident is at the bedside needle in hand, sterile gloves and gown on wiping the cleaning solution off the patient with a dirty towel. keep in mind this procedure is supposed to be done under sterile technique.
so my buddy says "um... you've just contaminated your sterile field."
and he replies "oh.. this is supposed to be sterile?".
YOU ARE INSERTING SOMETHING THAT BREAKS THE PATIENT'S NATURAL SKIN BARRIER TO INFECTION.... YOU DUMBASS... OF COURSE IT'S SUPPOSED TO BE STERILE.
eyes were rolling... let me tell you.
but... that wasn't even the best part...
so he finally gets the catheter into the artery and says,
"what do i do now?"
EXCUSE ME???? YOU"RE DOING A LINE INSERTION AND YOU DON"T KNOW WHAT YOU"RE DOING????
(the proper answer is: make sure there is flashback, feed the guidewire past the black line so it's fully in the artery, then pass the catheter through skin in a twisting motion OVER the guidewire into the artery, remove guidewire, look for blood return, connect to pressurized monitoring tubing, zero system, check/confirm waveform, suture it nicely, clean up the site with saline and top it off with a nice tegaderm dressing)
instead... we got this:
he says to our fellow (intensivist in training)..."well.. i got it in the artery... i just didn't know what to do next."
so gord says... "um... maybe ask for help?"
ARE YOU FUCKING FOR REAL THEY LET YOU A) GRADUATE MED SCHOOL and B) NEAR PATIENTS??????
neither my buddy nor i could believe it.
unacceptable in an ICU setting.
amazing. absolutely amazing.
ilovemyjob. ilovemyjob. ilovemyjob.
oh.. and my patient blew a pneumo 20 minutes before shift change....
sweet.
1 comment:
You're like a real life Scrubs! If you haven't seen that show, you should.. because it's essentially what you're writing about.
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