Nurses... we're our own worst enemy

"Hey doc, could you prescribe me some fluids please" I asked, the bag of intravenous fluids already in my hands. "What's up with this one?" asked Dr Munro. "Twenty year old male, intoxicated, conscious, obnoxious" I replied. Dr Munro began to write up a bag of IV fluids for my patient.

"What do you think you're doing?" protested Sue. Unfortunately I hadn't noticed her presence and she had taken another opportunity to go on the offensive. Sue was the nurse in charge of the 'Major' injury department of the emergency room. It didn't matter to her that I was in the 'Minor' injuries department. I thought that I wouldn't have to see her this shift, but she seemed to be stalking me. I shrugged my shoulders, "Just being organised" I replied calmly.

Dr Munro was startled as Sue grabbed the chart from under his nose. "The doctor hasn't even seen your patient yet, give him a chance to do some work. Your patient will have to wait to be seen" Sue said. "Ah, I realise Dr Munro is busy, that's why I'm making things a bit easier for him. It'll be at least another hour, probably two, until he sees my patient, and if I get him sobered up and cleaned up now, then he'll be ready to go home instead of having to wait another hour or two" I explained. I wasn't trying to justify my acitons to Sue, I was trying to make an effort to be polite. I might as well have held my tongue.

"That is not how we do things here" Sue began. I cut her off, "Well maybe you want to tell Dr Munro that, he was happy to do it. In fact this is the way we've been working all night. Perhaps you should ask him if I'm making his job harder" I glanced at Dr Munro who was trying to shrink into his seat. Sue's mouth opened, about to spout out another protest, but I cut her off again "Sue, you saw how busy we were at the start of the shift, no beds free and an overflowing waiting room, and Dr Munro and I have cleared the place out. Just what is your problem Sue?" I realised a little too late that my voice had risen by an octave or two. Sue's face turned red and she stormed out of my department back to her own.

I started the fluids on my patient and had him discharged in two hours. There was no 'Thank you" from Sue, but Dr Munro promised to buy me a round or two for saving his ass that night.

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Going against the parents

At six pm my cell phone rang. I put down my dinner plate and answered my cell phone. "Can you come quickly, he's breathing funny" said the woman on the other end of the phone. "Hello, who is this?" I asked. "Is this the nurse on call?" asked the stranger on the end of the line. "Yes. Now calm down" I spoke calmly in the hope of getting the women on the other end of the line to follow my example. "Now, who are you, and who is having breathing problmes, and where are you?" I asked.

The caller was Mrs Anderson, a teacher on duty in the junior boys' dorm. She was with a boy called Mohammed who was breathing rapidly. The boy had no history of asthma, no medical problems, and according to Mrs Anderson, no sign of any injury. I told her I'd be there in five minutes.

My diagnosis was instant, although I still gave him a full check up. Mohammed was sitting outside on the steps because he said the 'Air was more fresh.' He was breating at a rate of 40-45 breaths per minute. At 85 beats per minute his pulse was fine, and his blood pressure was a healthy 125/75. His hands were beginning to cramp, looking like a bird's claws.

I sat down next to Mohammed. I moved slowly and calmly, every movement, every phrase aimed at creating a calm environment, my body language trying to say 'Don't worry, you'll be ok.'

Mohammed was having what is known as a 'Panic Attack'. With end of year exams about to begin he'd been getting more and more worried the closer exams came. As far as 'Panic Attacks' go this was definitely a good exmple of how nasty they can be.

I spent the next hour talking to him, trying to get him to slow his breathing, trying to have him blow into a paper bag, but it was all to no avail. I called the emergency doctor but he was busy with an emergency and couldn't come to see Mohammed, but he gave permission for me to give Mohammed a medicine to calm him down.

The medicine worked wonders and withing twenty minutes of taking the small tablet he was fast asleep in bed.

"I want the doctor to see him now" insisted Mohammed's dad. I had to hold the phone away from my head as he was nearly shouting down the line. "I'm sorry, but the doctor can't see him, and besides, Mohammed is fine now, he's fast asleep" I said. I had spent the last twenty minutes explaining very simply what had happened, but it wasn't getting through. "You're just a nurse, I want a doctor to physically see him and assess him. Take him to hospital, call an ambulance. I don't care, but do your job. He's my son and you will do as I say."

Nurses are generally understanding people and put up with a lot of abuse, but not when it comes to compromising their patients. "I'm sorry sir, but that would be the worst thing to do to Mohammed right now. It's taken a lone time to calm him down, and finally he is asleep, his breathing is fine. It really would be wrong to wake him, especially to drag him out of bed and take an half hour drive down the mountain. It could trigger another panic attack." I was determined not to wake Mohammed up at this stage, it would be the wrong thing to do, and may even make him worse. I had to stick to what I knew was right, regardless of what the parent said.

"You're telling me what I can and cannot do with my own son. I want a doctor, no, a I want a specialist to see him tonight or you won't have a job by the time I'm finished with you" screamed Mohammed's father. "I'm sorry you feel that way, but I'm doing what I know is right for your son. You left him in our care, you trusted us to make the right decision. That's the issue sir, you're not here to assess your son. I am. If it makes you feel any better I'll be checking on him during the night and will take him to the doctor in the morning. I'll call you then. Goodbye" I turned off the phone.

Mohammed woke the next morning back to his normal self. He was at breakfast with his friends, laughing, running, doing all the things a healthy teenager should. I had made the right decision, alhtough I did wonder if it could have been handled better.

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A Parent's right to know

"Ah, I'm sorry Mr Smith, but I can't tell you" I said. There was a brief silence on the line, then it exploded in my ear. "Who the hell do you think you are? You're just a bloody nurse. I pay your bloody wages. Tell me what I want to know or you won't have a job by the time I'm finished with you." I held the phone away from my ear so the other nurses assembled in my office for this historic confrontation could hear.

Mr Smith was unhappy because his eighteen year old daughter, who was a student at our school, had needed some medical assistance, and he wanted all the details. He felt that because he paid for her to be here then that gave him free licence to look at all her health records.

"I'm her father and I demand to know what she was in the health center for" Mr Smith was beginning to sound like a broken record. "Perhaps you could speak to your daughter. But I can't divulge her health records to you. Even though she's at school, she's legally an adult now. Legally I can't give you her records" I explained. "So parents don't have any rights over their children? Is that what you're telling me?"

It wasn't about parents rights, but the right of the patient to recieve confidential care. Even though the patient is a student at a private boarding school. In fact, confidential care is even more important to a student living away from home, who often feels they have no one to turn to. Sometimes the health center is the only refuge some of these kids feel they have. If they think we are going to tell parents every thing the confide in us, it could in fact work against us, maybe even put students more at risk. I could tell there was no reasoning with Mr Smith, so stuck with the legal argument.

"Mr Smith, legally I can't tell you anything. I understand your worried, but I can say your daughter is fine" I said. "It's damn well not fine. It was a pregnancy test wasn't it, that's what she had" The guessing game had begun. It was time to end this conversation. "This conversation is over Mr Smith" I said. "Well, can you at least pass on a message from me?" he asked. That seemed reasonable enough and I agreed to do so. "Sure, go ahead" I replied. "You can tell her that if we find out it was a pregnancy test, she won't be getting a car for graduation, and she'll be paying her own way to university. Tell her she can give me the records herself, and if her record is clean, everything is ok."

"I'll be documenting this conversation Mr Smith. Goodbye." I hung up the phone, fuming with rage.

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