The Nursing Scuffle Shuffle

Last night, a Chinese woman who spoke no English came with several relatives to the ER. It was obvious that something was wrong with her left ankle. It was deformed, swollen, blue and purple. My immediate guess was that she had some type of accident and fractured her ankle.

I got her on a stretcher and used the translator phone to determine that my assumption was correct -- she was a bit elderly, was walking to dinner, tripped in a pothole, and down she went. She said it didn't hurt that badly. I told her I was going to give her some pain medicine, and she declined -- she said, via the translator, that she just didn't want any medicine right now. Fine, I said, let me know when you do.

Five minutes later, the nurse Sandy came up to me and asked why I was letting this old lady sit around and cry in pain.

First of all, let me tell you about Sandy -- she's one of the old guards of this old hospital, and has been around for a long, long time. Today was her last day, and she was retiring. Bottom line: she's nasty, has a terrible attitude, is awful to patients and to doctors, and often fails to carry out orders in a timely fashion. In addition, she's loud, obnoxious, and universally unpopular except to her contingent of other old-guard bad-attitude nurses that are her friends. For some reason, many people are afraid of her. They don't want to get into an argument, they don't want confrontation with her, they simply just want to avoid her altogether.

One time, she had (finally) done an EKG on a patient who was triaged for chest pain. An hour after that EKG was done, the patient's clinical picture had changed, and he was having active chest pain. I asked Sandy to do a repeat EKG on the patient, and she cocked her neck to one side, put her hand on her hip, raised one eyebrow and said, "what for?"

"Because his clinical picture is changing. He is now having worsening...."

And she rolled her eyes and walked off (but did the EKG). No matter how you slice and dice it, that was just RUDE. And very few things make me more upset than being rude and wrong at the same time with an air of superiority about it.

"Just let it go," said my attending who saw that exchange. "She's getting the EKG."

That's the problem. Everyone lets it go. Sometimes I guess I do too, but I was not in the mood for it that night. So I ran right up to Sandy after she did the EKG (and I made sure it was benign) and said, "Look, you can ask any question you want to, I'm fine with that. But what I'm not fine with is when you walk away during the answer. If you don't want to know the answer, don't ask. You KNOW that was rude and there's no excuse for that."

She said nothing, but I know she knew I was right.

So back to this particular story (and I'm still getting riled just recollecting the events).

"Why are you letting this poor lady sit there and cry in pain?? Give her something!"

"Sandy, I JUST got off the translator phone with her and she refused ANY pain medication. Now that the situation has obviously changed since she's crying, I'm happy to reassess her and give her anything she wants to control the pain."

Not good enough for Sandy. She said, "I mean, for goodness sake," and her voice is rising and patients and their families are noticing, "you give any fucking alcoholic in here as much morphine as they want, but you won't give a lady with a broken ankle any fucking morphine? That's bullshit! But what do I know?? YOU'RE the doctor, right?"

"First of all, did you hear anything I just said? Second, if you don't think I'm treating a patient's pain appropriately, you say, 'hey doc, I think your patient is having worsening pain, can you re-assess her or give her more medicine?' Third, I think we can all agree that there is NO need for that kind of language in any setting, much less in an ER in front of patients, families, nurses and doctors. That is completely inappropriate and out of line and you know it. I'll deal with you later but right now I'm going back to the patient."

So I doped up the patient with plenty of vicodin and went back to Sandy.

"Come here, Sandy, I want you to hear this." I had her stand in front of me while I picked up the phone and called the Director of Nursing. While the phone was ringing, I said, "Sandy, I want you to hear exactly word for word what I'm telling Lorrie, that way you can tell her if anything I'm saying to her is inaccurate in any way."

So I told Lorrie exactly what happened. She came downstairs in less than one minute.

"Sandy, is this true?" she asked.

No answer.

"Sandy. Is what he's saying true? Did that happen? Did you say those things?"

"Yes I did."

"Go home."

Call me an asshole, but I got her sent home the day of her retirement before her retirement party. I don't regret any of it, and different doctors and nurses alike who witnessed this whole event kept saying that more people should have spoken up to her and combatted her bullying much, much sooner. And that's exactly how she's been acting to many people over the years -- like a bully. I wish her the best in her next endeavor whatever it may be, but I sure hope it's in an administrative role inside a cubicle.