"I'm not the doctor!

"
As a patient family member (who is also a nurse), I recently encountered an
interesting situation. The nurse corrected the assumption she was the doctor
by saying "Oh I'm not the doctor, I don't want that much responsibility"!
Attitudes such as this one perpetuate the subservient mentality of many
nurses today. We MUST start acting like the educated, experienced, capable
professionals we are!

1. cost too much to transfer license from another state. About 220 bucks just for me to transfer my RN
license since I am moving to another state. Lame. it's not like ive performed any crimes in the past few
months.

2. Phd in nursing- LOL? Who would get a phd in nursing? it is not like it is as an elaborate field as
chemistry, biology, or psychology. WHAT A JOKE. This is pretty much just a bullbeat way to try to
OVERLEGITIMIZE the nursing profession. What are you performing double blind controlled studies on....
HOW TO GIVE A BEDBATH OR BREAK THE SEAL ON THE ASPIRIN TABLET???? Keep it simple folks.

3. Overcomplication- nurses are probably the worst at over complicating things. I remember back in
undergraduate, we were taught those elaborate care plans. Do you know what care plans are?
GARBAGE. You never use them and nobody cares about them. Unless you are one of those old hags with
a Phd IN NURSING..... You know what else is dumb. NURSING DIAGNOSES. you know what those are?
cheap copies of medical diagnoses, aka nurses trying to legitimize themselves with medicine. I
remember having to come up with these stupid things. IMPAIRED NUTRITION SECONDARY TO
DIFFICULTY SWALLOWING. ARE YOU KIDDING ME, NO CRAP, IF YOU CANT SWALLOW YOU CANT EAT.
NO CRAP ROFL. I also remember the nursing skills manual. 10 pages on HOW TO FOLD A FREAKING
WASHCLOTH AND MAKE A BED. Go home overcomplicators, go home.
I also remember having to learn indepth about diagnoses such as cardiac tamponade. WHENS THE LAST
TIME YOU PAGED THE DOCTOR AT 3 AM "Hey I think this patient is in cardiac tamponade, you know
when they stick the tampon in lemonaide???" ARE YOU KIDDING ME... NEVER.
I could go on and on about point 3.

Overcomplication is a simple way to try to self-legitimize. Something the PHD level nurses are
professionals at. Good professionals simplify as much as they can, not do this garbage.


Well, it's happened.
Despite my best efforts to provide excellent care, I've been involved in a serious error.
I say "involved" rather than "made" not to avoid my role but to recognize that it was a chain of events
that led to the error.
I'm sure many people are familiar with the concept of the Swiss cheese model of medical errors... in
order for the error to happen, all the holes have to align to provide a path from the patient to the
error... and in this case... unfortunately... they did... and the very last hole ran right through... me.
So, now I'm one of 'those' nurses... the ones who are so easy to criticize... to shun... to ridicule... though
thankfully, I've thus far been treated with compassion and empathy by those around me.
A whole host of thoughts and emotions accompany the experience... fear, shame, humiliation, self-
doubt, frustration, anger... and a few that I cannot even name (I'm just not a wordsmith)
I've no idea of the repercussions though I'm hopeful that all the talk about creating a non-punitive
environment in which errors can be explored and preventive measures developed is sincere and that I
can play a role in educating our docs and nurses in how to avoid another event like this.
I'm thankful for my colleagues who've listened and encouraged... and who've recognized that I'm not
some lame-butt doofus who's carelessly nor mindlessly working on patients... and who've recognized
that they could very easily be standing in my shoes.
Still... I feel shame and humiliation... and whatever other nameless emotions accompany having to
accept that, despite my best intentions, I have hurt another person who was counting on me to help
them... To Hippocrates or whomever, I have to say, "I have done harm." To that patient I would have to
say, "You did not receive from me the care that you have a right to expect" and, from the patient's
perspective, the reasons don't really matter...
Now, for some perspective... it really could have happened to anyone... it was one of those "seconds-
count" emergencies... with sequential system failures, any one of which would have prevented the
error-train from ever having arrived at my station... though it did... and my chosen role is to be the
person at the end of the line so it's not something I can shirk.
The truth is, though, that despite my strong desire to tuck tail and run... and perhaps the desire among
some to demonize me or toss me under the bus...

I am a BETTER nurse today than I was last week - precisely because this has happened... not only
regarding the specifics of this event but in ways that will impact every moment of nursing career
henceforth.
I am moment-by-moment learning how to live with this new recognition of myself... how to bear the
scarlet letter that I've now affixed to my scrub tops.
What does the face of a serious error look like? For me, I simply have to look in the mirror.
Be very careful out there because you never know what you don't know... until you do...
Another storry
This is in the context of an outpatient appointment with a guy who was a missionary for decades. I do
not happen to be a believer, but I have quite the religious background. It's been enough years that I am
very friendly with my religious culture and use what I know. It is the underpinning for my thoughts on
culture, morality, etc.
I said I do. I think I do. At the same time, it's a complete lie in HIS context. He wanted to know if I was
"saved" in his terms. I knew at the time what he was asking about and deliberately misled him. He
prayed for me towards the end of the appointment, and I participated with him when his obvious cues
became apparent.
I'm not sure I really have a question to ask here. Part of me thinks that it's really none of his business
what my spiritual/religious life is like. Part of me wants to be honest with him. Part of me is irritated that
he feels welcome to make me feel uncomfortable for his own benefit. It's a bit presumptuous, isn't it?
I don't feel offended. I'm more thinking about how my dishonesty will affect our therapeutic
relationship. He's probably run into people like me before and I'm guessing he figured out I was BS'ing
him about this.
I'm just not sure where to go with this, so give me your thoughts.
answer
I don't discuss my beliefs with my patients" and it's possible he will respect your wish. Let stick to what it
is that you need today."
"I have found great peace with my spiritual beliefs, but thank you for caring enough to ask" works well
to end the conversation on a positive note.

What do I carry?

I carry with me the tears of a father that he cried over his baby who never had a chance to take his first
breath. The baby they'd tried for four years to have.
I carry with me the woman who had lived with domestic violence for over two decades, her arms
covered in scars from shielding herself as he attempted to stab her to death. "No matter where I go, he
will find me and kill me," she said.
I carry the gratitude of a twenty-something man who had what was then called 'full-blown AIDS' and still
being written off by too many as a 'gay plague' and other nonsense. He was dying and he knew it,
suffering with horrible neuropathy and on amounts of morphine that would knock everyone I know into
the next world. It barely touched his pain. No one ever came to see him. I'm not sure which hurt him
worse. We bonded over the course of several days and he mentioned in passing that he was really
craving a Butterfinger. Hospital policy dictated that we weren't supposed to bring food to patients, but I
pretended not to know that when I got a couple Butterfingers from the gift shop (yes, he was still on a
regular diet). The look on his face when I snuck them in to him.....I can still see it. He died a couple
weeks later.
There are the twin daughters of a patient who was with us for months before she died. I remember their
names and faces. They were never anything but kind and grateful for the care their mother received,
even when they had their grief over her impending death to smack them in the face every day.
I carry the exhilaration and happy tears shed when men and women become fathers and mothers. The
delight that overtakes a new mom when her baby looks at her like he's known her forever, or a daddy
when a contented baby falls asleep on his chest, is something that can't be bought.

But primarily, I carry the memory of my 13 year old son, body decimated by pneumonia post bone
marrow transplant. I will never forget his solemn, adult-like instructions not to keep his body artificially
alive if he could not truly live. I will never forget asking him, as he struggled to breathe, if he were afraid
and he quietly told me "no". I'll never forget the awful decision to allow the ventilator and never forget
the horror of the decision that had to be made three weeks later. I will never forget my inability to
continuing singing to him as the machines were turned off, my weak inability to keep my hand on his
chest and feel his erratic, fluttering heartbeat fade and then stop. I will never forget how his courage
changed me and propelled me into the reality I now live, keeping his experience close to me,
anonymously and with inner hope fueling my ability to help others in their dark hours of fear and illness
until my life is done. His cancer journey was the most difficult thing I have ever done. When being a
nurse gets hard, I remember him. It is good to have a personal reason to push through the foibles and
nonsense our medical system can be.

I carry with me the alzheimers patient wandering up and down the halls at night in search of her
husband and children. Going back in time when her husband was still alive and her children were just
little ones. I carry the difficulty to re-orient her and seeing the frustration and confusion on her face,
trying to understand that her husband was deceased and her children were married and had children of
their own. I carry the anxiety she felt of not knowing her surroundings and not accepting this
explanation.

I carry with me the family who is not willing to accept that mom is not going to live much longer. They
were in denial that there was nothing else that could be done and she doesn't need hospice care. Their
mother was in pain and denied her the comfort she needed for fear this would cause her to give up
living or die. I carry with me the last moments of their mom's life and knowing that they are still in
denial as they are asked to make preparations for her death.
I carry with me the patient in the nursing home who is dying all alone. They lay there not saying anything
as you give them their morphine and ativan. As their breaths get shallow and apnea sets in, they reach
out for something not seen by your own eyes. You give them the best care you know how and make
sure they are comfortable. You have become their family and hold their hand until the end.

I carry the ICU patient I took care of twice a week for nearly 6 weeks - racked with
myasthenia gravis and unable to breathe without the vent. at about week 2 they trached
him, and by week 6 he was talking to us and starting to eat! His words of thanks for the 6
students in my group (we rotated taking care of him) was magic.

Even on the worst days I know being a Nurse is what I am meant to be. I am blessed
beyond measure to be able to help people and be part of some of the worst and best times
of their lives.
The 40 year old man living in a nursing home because he was severely depressed and
suicidal in life and tried to kill himself with carbon monoxide. It left him so brain damaged
he was like a child. He'd spend his whole life in a nursing home surrounded by people twice
his age- there was no other suitable accommodation for him other then locked psychiatric or
locked dementia- and locked dementia was deemed less stressful and more homelike rather
than a hospital psych ward.

The 40 year old man living in a nursing home because he was severely depressed and
suicidal in life and tried to kill himself with carbon monoxide. It left him so brain damaged
he was like a child. He'd spend his whole life in a nursing home surrounded by people twice
his age- there was no other suitable accommodation for him other then locked psychiatric or
locked dementia- and locked dementia was deemed less stressful and more homelike rather
than a hospital psych ward.

the man at my last nursing home who everyone complained about- refusing medications,
refusing care- then yelling at the nurses and doctors because his condition was worsening
and we were all "terrible nurses/ doctors" despite the fact he was refusing all treatments.
You never knew what hew as going to yell Or cry about next- it was terrible. His lungs were
failing him and he was dying a slow agonising death and it was brutal, heartbreaking, soul
destroying to watch. The day he knew he was dying, he chose to do so in hospital, so I was
sent to sit with him while we waited for the ambulance. I have never felt so guilty that all
the nurses thought he was so annoying and hardworking, so angry and grumpy all the time-
those last few hours he was a different person. He told me his life story and his greatest
regrets- he'd never even made love to a woman even though he always wanted a wife or
someone to love- he was a terribly lonely man with no family or friends, who'd missed out
on love and sex. He was on the edge of hysteria over his fear of death- he was crying loudly
about how scared he was. All I could do was hold his hand and try to tell him how physically
it would be- that his pain would be controlled, he could be sedated so his breathing
problems would not distress him, they'd sedate him so he would feel calm not distressed...
He believed in god so we talked for a long time about his belief on heaven and afterlife- the
idea of heaven comforted him.

ill never find out what his death was like- he went to hospital. But I prayed so hard when I
got home to the god he believed in that he could be allowed to die without pain and in a
calm state of mind- I hoped there was a nurse who could comfort him at the hospital and a
doctor who could ease his pain and anxiety.

I carry the regret of not doing more...Three months after starting working as a CNA in the
hospital, I took care of a man with no family or friends. He has a big open abdominal
surgery and the first few days was doing well. Every morning, we would talk while I helped
him bath and got vitals and weight. One the 3rd day, he was different and things changed
within a few hours. The nurse was in the room and I had just completed our daily routine a
little over an hour before. I was telling him to breathe and he would breathe. The next
night, he was doing "ok." I explained to the new nurse what had occurred over the weekend
and expressed my concern that I did not think he would make it through the night. I did my
rounds to collect vitals. Once I sat down, I got a strange feeling. I asked the nurse if she
had checked on the man. She said yes. I went to the patient's room anyway...the man had
died...alone...
Whether the memories are positive or negative they all have a special spot in my heart. I
will never forget the strength of the patient's fight life or death and eventually finding their
inter peace. even if that peace for them is anger and hate. These are the moments I cherish
and why I love my nursing job.

1. Watermelon....Initially, Ms. C was placed in a NH due to dementia after she was
evacuated from LA during the Hurricane Katrina chaos. When it was discovered that
the dementia was caused from end stage AIDS, she was admitted to my floor at the
state mental institution because the NH couldn't handle her violent behavior.
According to them, she tried to bite someone. However, Ms. C never tried to bite me
or any of my patients for the year that I took care of her. AIDS had infected her
brain so badly that she couldn't tell me her name, the date, where she was from, or
where she was. The only thing she could say was "watermelon" . She must have said
"watermelon" five-hundred times a day while she rocked back and forth in her chair.
Sometimes she yelled "WATERMELON" as loud as she could. Other times, she
whispered "watermelon" so quietly that you had to strain to hear it. One afternoon,
Ms. C was shuffling back from the bathroom when she collapsed in the floor. I rushed
into the hallway and saw that she wasn't breathing. I called a code, but it was too
late. Before the crash cart arrived, she had died in my arms.


2. Opal.....Ms Opal worked at the state mental institution for 30 years. Our facility
housed the most violent, high acuity, psychiatric patients for our regional area.
These were the patients that no other psych facility could take because they were
either too violent, to much of a security risk, or too high acuity. For our patients, it
was the end of the line. Ms. Opal had seen and cared for the worst of the worst on a
daily basis for her entire 30 year career. However, she was the most positive, good-
hearted woman that I have ever met. On one particularly bad day, I was ready to
give up. With my head in my hands, I asked her, " What can I do for all these people
? " I will never forget what she said to me, it guided my practice, saw me through
many hard times, and has stayed with me, always. She said, " Sugar, sometimes all
you can do is feed them, clothe them, and give them a soft place to fall..."

What I carry with me, well one of many is the patient that came into our
rehab unit after having a CVA. She wasn't able to walk, talk feed, dress or
bathe herself when she came in. With a lot of hard work and determination
on the rehab team and the patients part, when she left she was walking,
talking and could perform all ADL's herself. I'll never forget this lady, she
holds a special place in my heart et memories and always will.
These are the people I carry: The one I lost. The one I saved. And the woman who saw me
doing my best to fix it.