Thursday, October 8, 2009

What Do You Mean???

Told you I would survive. My cold is nearly gone. I have a cough, but it's not bad. I had no problem working 3 nights in a row. To think back to a week ago...wow, what a difference! I'm not 100%, but getting there. I even went ahead & got the regular flu shot this year. I am refusing the swine flu shot though. There just isn't enough testing for me to feel confident that 1) it will even work and 2) that it won't cause more problems because no one has a clue because it hasn't been tested enough. As far as my illness last week...I don't think it was the swine flu. I never had a fever & it felt more like the usual congestion of a cold. Oh well, I'll never know.

Work has been pretty simple this week. The patients weren't bad. I mean they are very sick and half the ones we discharge don't seem to be any better than when they came in. I think it's the general population of where this hospital is. So many are nursing home patients that they give a few IV antibiotics & send them back until the nursing home wants a break & sends them back to us. And others....they are there for weeks. I have no real idea what we are doing for them other than wasting money on keeping them in the hospital day after day. For those that think one will be turned away simply because they have no insurance...that is so not true. At least not in Florida.

It's overkill with the testing here. I had one older gentleman that came in with a fever of 100.0. They did nothing to treat the temperature & it went away within a couple of hours & stayed away. However, they admitted him with the diagnosis of "Fever rule out Meningitis." What? Because of a one time fever of 100.0??? They attempted to do a lumbar puncture THREE times & could not get it. So then they decide to order an MRI of his spine. This patient is unable to answer the questions on the MRI form because he has dementia & we have no next of kin to call. Sooooo they do a series of x-rays to try to determine whether he has any metal in his body that would prevent him from having an MRI. All this for a guy that showed up with no other symptom than a fever 100.0 one time. Needless to say, he had no meningitis...but it took thousands of dollars just to be sure. Ridiculous!

I get this call last night from a doctor I have never spoken to (nor would like to speak to again). He runs through a list of orders...blah, blah, blah...now repeat it back to me. I like that...he's efficient even though you can tell he's being cocky at the same time. Like he's waiting for me to mess up. He orders an MRI of the thoracic spine & lumbar spine for a patient of mine that has to be done asap. I call the patient's daughter to make her aware since she is the power of attorney as her mother has alzheimer's. She tells me her mother will need something to sedate her in order to get the MRI done.

So I call the doctor's service....only to find out he's not on call. Ummm, I just talked to him 5 minutes ago. "Sorry, he's not on call." Ok, then who is on call & have him call me back. They give me a one word answer as to who's on call & they page him. This P.A. (physician's assistant) calls me back. I don't generally like talking to them, because it doesn't seem that they know what they are doing. Anyways...I explain to him what is going on...that Dr. so & so ordered for an MRI & the patient needs sedation. He replies with something like "My partner ordered that?" Ummmm...since when are MD's partners with PA's? Anyways, I say yes & the patient's daughter requests she get some type of medication for sedation in order to have this MRI done.

I think I'm speaking clear english that makes sense. It's not uncommon for a patient to be claustrophobic or uncomfortable having to lie still during an MRI that takes over an hour. His reply..."Is she medical?" What????? Medical?????? What are you talking about? He says "Is she medical services?" Huh??? What do you mean medical services & what does this have to do with sedation? I mean he did just call my floor at the hospital...is he really asking if she's a patient that's been admitted? I don't understand! He finally gives up or I finally give him the answer he's looking for...I'm not sure which, but he moves on to ask "What kind of sedation do you want?" WTF? MRI sedation! What do you mean what do I want? I want my patient sedated so that she can get this MRI done. Am I not speaking clearly? He replies "Conscious sedation or regular sedation?" Say what????

My co-worker/friend is sitting next to me & is amused at my conversation as she is only hearing one side of it & I'm giving her a look like I'm talking to a nutcase & that I need her to step in & interpret even though both the P.A. & I speak very clear english. So he asks again if I want conscious sedation. In my mind, the only times I think of conscious sedation are during certain ICU procedures and to be cardioverted during SVT. It requires anesthesia administered by a professional........I have never heard of that type of sedation done for an MRI. I was looking for an Ativan, maybe Xanax, Valium.....something to make the patient sleepy/relaxed but not unconscious.

Now the P.A. is getting really annoyed with me as we simply don't understand one another & he is trying to talk me into calling the primary doctor for this. I couldn't understand why he wanted me to call the primary who didn't order this test nor had any clue it was even happening. I just wanted to speak to the doctor that ordered this MRI & get some sedation. Is that too much to ask?

Long story short...he orders Valium which I also imagine he was hurrying off the phone so he could take some himself since he seemed so rattled at my questions. The patient went down for the MRI, but complained one time she felt a little short of breath...so the MRI tech stopped the exam, called me....I went down to assess her, but couldn't find the MRI tech anywhere. So my charge nurse calls the nursing supervisor who basically handles it like a rapid response & brings the patient back = incomplete test.

I go to assess my patient upon her arrival back to the floor & ask her "How was the test?" Her reply...."What test?" I asked her if she was short of breath. She had no clue what I was talking about. Sigh. My charge nurse wanted me to call the doctor to let him know the test wasn't completed. Ummmm....at 2 am I'm supposed to call?????? I knew I'd end up getting that P.A. again. No way. What are they going to do? Attempt to medicate her more when she complained she was short of breath? I don't think so. I called him at 6:30 this morning & guess what....got no call back. The answering service kept paging him...my only guess was that he was waiting until shift change was complete as I'm sure he had no desire to speak to me again. :)

I'm sleepy. Heading to bed. I have 5 days off...yay!!!

1 comment:

newnurseinthehood said...

Wowzer. Concious sedation? Really? C'mon, why didn't you pump the old lady full of Etomidate and stick her in the MRI machine? Cause you can totally use the required monitoring equipment in- wait, what?