When I started working as a nurse, one of the scariest things for me was realizing that when my patient was having symptoms that were no longer manageable with nursing interventions, there was no easy option on a multiple choice test that you could select without second thought- that magic nursing school formula- “Contact patient’s provider.” Nope, in real life I am the nurse and there are many shades of gray. Not only do I have to decide if something is serious enough to contact a doctor about, but also when I should contact them, how I should contact them, what I should say, and what are they going to ask me that I need to anticipate? These are the things that nursing school cannot teach you. It does, however, give you a reverence and fear for doctors not unlike that for an angry deity, and the knowledge that you don’t waste doctors time or call them unprepared. And I as a young, somewhat socially anxious Mennonite girl had no difficulty further cultivating that fear.
The first time I called a doctor, it was under the supervision of my preceptor. My patient was complaining of a severe headache, had already had oxycodone, and only had Tylenol ordered in addition. “The doctor said yesterday I could have tramadol if oxycodone didn’t help,” she told me. Her blood pressure was also elevated at 176 systolic, but she hadn’t yet had her morning blood pressure pills. Did I mention she had a reputation for worrying, complaining, and asking for pain medication?
“Page the doctor,” said my preceptor, “and tell him what her blood pressure is, that you didn’t give her blood pressure medication yet, and that she’s having a severe headache not relieved by oxycodone and she says she was told she could have tramadol if she needed it.”
I paged the doctor and sat there deep breathing, trying to calm my pounding heart. When he called back, I answered, willing myself to keep my voice steady. I began reciting my piece, and before I got to the part about the patient saying she wanted tramadol, he cut me off, “Give her Tylenol and her blood pressure medication, okay?”
Wow, I thought, should I have done that instead of calling him? Those were both things in my scope of practice. “She said you said she could have tramadol if she needed it,” I stated hesitantly.
“I didn’t say anything, because I haven’t even seen her yet,” he snapped out. “Give her the Tylenol.”
“Ok, thank you,” I said, and he hung up.
Thinking back, I’m a little surprised that this didn’t upset and unnerve me. It actually empowered me. I had called a doctor, and I was still in one piece to tell about it. He had been somewhat short with me, but I found I could live with that and not take it personally. Perhaps I should have given Tylenol and blood pressure pills before reporting either headache or blood pressure to the provider, but after all, I had done it at the instruction of a very experienced nurse. If she had called, he probably would have said the same things to her. I could have assumed that he was not the same doctor that had talked to my patient the day before, but after all I was human and had to sometimes make mistakes, right? Any lasting chagrin was relieved when the doctor came to the floor later and talked to me civilly, even explaining somewhat apologetically that he couldn’t prescribe tramadol because of the patient’s kidney function.
It would be nice to say that from that time forth I no longer had any difficulty with provider contacts, but that wouldn’t be true. I still get anxious sometimes when I call doctors and wonder if I should be doing something else first. I have had the experience of being asked a question and then making the provider wait a moment while I go find the answer. But I have also had the experience of reminding providers of orders they forgot to put in, only to have them apologize effusively and put them in immediately. I have questioned orders and they have changed them. I have asked for orders and they treated me civilly, talked to me about my thoughts, and came to a logical conclusion we both understood.
Most of all, I have realized that doctors are not angry deities. They have a lot of knowledge and have worked hard to be where they are, but they are human. They are tired and overworked and sometimes their interactions may reflect that- not unlike my own. And sometimes, I have been so happy and relieved to hear the doctor’s voice on the phone or to see them walk through the door, when I have a patient screaming in pain or in respiratory distress and there’s nothing that I as a nurse can do. Thank you, doctor, that you are the doctor and know what to do…
I was thinking reflectively the other day of the first doctor I ever knew personally. He was one of my residents when I worked full time on a lock-down dementia unit. I never once thought of being over-awed by him and he was one of my favorite residents. He had been a pediatrician and he loved babies. He had the nicest smile and was one of the sweetest, although sometimes most stubborn, residents I had. He made all of us laugh sometimes. He sometimes would crawl out of bed at night and crawl across the floor to peek out of his room until we saw him. He one time hijacked a wheelchair out from under another resident as she stood working at a puzzle and wheeled away in it. People said he liked me, and was not as stubborn for me, because I was his regular caretaker. We got along.
He was a doctor, but it didn’t matter in the least. I respected what he had done with his life, but he was human just like me. I was a nurse’s aide and he was a doctor and I treated him with dignity just like all my residents. To him, I was only another human, and all that mattered was whether I treated him with kindness… And I was sad when he passed away- not grieving a doctor, but a human that I loved and would miss.
Who are you that you should fear humans who die, or a son of man who is given up like grass? -Isaiah 51:12