One Giant Leap

I quit my job today. Actually, it was yesterday. It's a quarter to three in the morning and I can't sleep. I'm not worried, not troubled. I'm just awake. Maybe I just don't want this incredibly perfect day to end.

I won't boar you with the details of quitting. Suffice it to say that if you have spent three years and one month in Hell, you can pretty much imagine my last day. Luckily I had no delusions of how my resignation would be accepted. It was as if I had scripted the entire day and everyone played their roles perfectly as expected.

The handful of people that I respect and have enjoyed working with seemed genuinely disappointed at my leaving. And I would be genuinely happy if our paths crossed again. The rest....? Well, that was just good, clean fun.

Your last day in Hell is when your Force Field and Evil Deflectors are at their optimum strength and luminosity. It is astounding. It is the closest the average Joe will ever come to experiencing the joy of making the winning touchdown in the Superbowl, winning the lottery AND receiving an Academy Award for Best Actor all in one day.

I would like to say that my decision to quit this job and take care of Rich was soley for Rich's benefit, but truthfully, I REALLY WANTED OUT OF HELL. The fact that Rich needs me just provided the courage and resolve.

Wow. I've never quit a job without another job to go to. Interesting....

One of the things that made my day especially delicious was that I gave 8 hours notice, resulting in the shock and awe effect. That was not my intention, just a side benefit. It also eliminates that last two weeks of awkward and antsy.

It was a strange day, with a herd of butterflies in my stomach occasionally distracted by interactions with pockets of kindness in a sea of stupidity. One Attending and a few Residents had something to say to me. A few of the Office Staff as well. The other nurses responded as if I had told them I would be calling off tomorrow because I didn't feel well. Again, I had no delusions, and therefore, no disappointments. If anything, all my suspicions were confirmed.

Every week a drug rep caters lunch. There is always an amazing amount of food, but unless you're a doctor or medical student, you must wait a full half hour after they have grazed before you are allowed to remove some morsels from the table. So when I hear the director talk about how we at the Consortium for Funtime Medicine are a “family”.....? What?. Am I stupid?

It has been 37 months of walking on the eggshells of doctors' egos. Take your basic office situation, only instead of one boss, there are 22. Some First year residents hit the floor running with a sense of entitlement and hubris. What they can't take out on their higher-ups, they dump on the nurses. By their third year residents are so battered, bruised and burnt out that they're almost more work than the newbies. But at least you can understand where they're coming from. The real problem is the Attendings, or about half of them.

The rules don't apply to Attendings. If I documented patient care the way these doctors do, I never would have graduated nursing school, and I would have been written up repeatedly at every job. Here's a tip...if your doctor's office calls you because your doctor wants to know what meds he/she has prescribed for you. ...get a new doctor.

Ask me how many times I have had to call a patient because their urine test was positive for a bladder infection and the doctor wants to know if they want to be treated. Every time I have to resist the urge to message back to the doctor......”No thanks, Patients prefers to pee with pain.”.... brain cells die.

Our office began electronic medical records in Jan 2010. Doctors who don't like the system simply do not use it, which means they do just enough to transfer the work to someone else. They are “too busy and important” to learn. (Yes, that WAS a direct quote) For Attendings, if it's something they don't want to deal with it is simply an S.E.P. = Someone Else's Problem. Many residents quickly learn this technique and happily employ it. The SEP trickles down until it reaches a nurse. We are not licensed to diagnose, order tests, or prescribe meds. But we take the heat for all of it and clean up the messes and then apologize to the patient for them. All while the doctor talks to us like we're stupid and resents every time we catch their errors.

Generally there is one nurse rooming patients for two doctors, while juggling phone calls, looking up results and handling her own nurse visits. There are five rooms for each nurse. Doctors will become downright abusive if she is not rooming patients quickly enough. I have been told “you don't need to talk to the patient, just get 'em ready.” Right. Then you'll get called on the carpet when the patient complains that you were rude or curt. How many times have I bit my tongue with the desire to look at the doctor and ask “is that stethascope around your neck a fashion statement or do you know how to get a set of vitals?”

If we talked to the patients the way the doctors talk to us, we'd be fired. If we talked to the doctors the way they talk to us we'd be drawn and quartered. They are the center of the Universe, and being that close to the Center of the Universe, the gravitational pull has permanently damaged my inner ears.

Imagine, if you can, being audited, and when the results are not to your liking you simply reject them. Seriously. A nurse is assigned to periodically and systematically audit doctors' charts. It is objective and very clear cut, black and white, period. It is the closest thing medicine has to accounting. But if the doctor doesn't get the perfect rating she feels she deserves she simply rejects the audit. How cool is THAT?!

Please do not delude yourself into believing that Obama (or any politician) can reform healthcare. They are not big or bad enough to strike fear into the hearts of these gods of medicine. Unless and until nurses have any measure of power, and consumers take responsibility, sickcare will continue as always.

So these were the thoughts playing through my head as I sat at my desk and worked on getting insurance approval for Viagra prescriptions because if you're a 36 year old morbidly obese patient who can't work because your back hurts, I'm all about getting the state's welfare system to pay for your erections. As I sat on hold I questioned if I was doing the right thing by terminating my employment with the Consortium of Funtime Medicine.... My next task made everything clear....

The pharmacy had called earlier in the day because the patient was ordered simvastatin AND Crestor and they wanted clarification because the patient should not be on both. I had sent the message to the doctor with a Please clarify and a “thankyou”. The doctor messaged back....”Call patient and ask her what she's taking.” Seriously? Apparently you misunderstood the question.... I messaged back....”Patient was seen Nov 11, and med list confirmed by doctor, including both meds in question, pharmacy requesting clarification.”
The Attending (who saw this 73 yr old patient on Nov 11 and checked off her med list) messaged back the following...

“I SAID call the patient and ask her what meds she takes. Tell her to read the labels on the med bottles to you. If you can't do that, schedule an appointment for patient to see me to discuss her meds.”

I read that three times. Each time my heart got a bit happier, a bit lighter. I heard laughter and realized it was me. I reassigned the message to the main work list at 16:58 and thought “fuck you, bitch”.

If you saw Braveheart, you'll recall the climactic scene where William Wallace lies drawn, about to be quartered and rather than “confess” and receive a merciful death he screams “FREEDOM!!”
That's how I felt walking to my car.