Free The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins Page B

pressure was low.
    Molly started an IV and hung fluids to try to increase his blood pressure. Before long, the man looked better, was talking normally, and reported feeling fine. Molly ran a few blood tests to make sure.
    When Dr. Baron came into the room, she declared, rapid-fire, “He’s hypotensive because of blood loss. We need to transfuse immediately.”
    Molly shook her head. “I don’t think he could have possibly lost enough blood out of a foot wound to be hypotensive. I think he’s septic,” she said.
    “I’m ordering blood,” the doctor insisted.
    “I just ran an I-STAT and his H/H [a lab that shows blood volume] are normal.”
    Dr. Baron raised her voice. “Since he started bleeding so recently, his H/H might not reflect the blood loss yet.”
    “
Or
he’s septic,” Molly said. “His lactate is elevated.”
    Dr. Baron couldn’t possibly let a nurse upstage her. She called the blood bank and ordered the transfusion, stat.
    Molly reluctantly transfused the blood, per the doctor’s orders. The ICU doctor who came downstairs to examine the patient before transferring him looked confused. “Why are you giving blood for septic shock?” he asked Molly.
    “You’ll have to discuss that with Dr. Baron,” Molly said. “I asked the same question.”
    When Molly complained to the charge nurse, the nurse answered, “We get a lot of complaints about how she treats nurses. She’s been reported to the director of the medical staff several times. It’s frustrating that no one does anything about it.” Most hospitals Molly had worked at had individual doctors here and there who mistreated nurses, but at teaching hospitals like Academy, the overall egotism led to particularly horrendous communication.
    One autumn afternoon, Molly was waiting for a call from gastroenterology to find out whether doctors were going to take an ER patient bleeding from the stomach to the OR or to the endoscopy suite, or if he was going to be admitted to a floor. She was at the nurses station talking to the charge nurse about the case when she saw the attending GI doctor, whom she had not worked with before, and a resident pushing a stretcher carrying her patient down the hall.
    “Hey, that’s my patient!” Molly said.
    She hustled down the crowded corridor after the doctors. “Excuse me! Where are you taking this patient?” she asked.
    “I’m the
attending
,” the doctor announced.
    “I understand that,” Molly responded, “but I need to know if the patient will be coming back to the ER or if he has been admitted. If so, he can’t leave until he has orders. I need to know who is writing the orders.”
    Molly wasn’t trying to engage in a battle of egos; she had to look out for her patient. A patient leaving the ER for another floor needed to have an admitting doctor accept him so that someone was officially taking responsibility and writing orders. Because the patient had not yet been assigned an admitting doctor, once the GI doctor took him to another floor, the patient could potentially fall through the cracks of the hospital system. The charge nurse needed to know whether the patient would be coming back to the ER to be discharged after surgery or whether he would need a room elsewhere in the hospital. Otherwise, after surgery he could be left in the PACU (Post-Anesthesia Care Unit) with nobody managing his care.
    The surgeon looked at Molly as if “I had a penis growing out of my forehead,” in Molly’s words. “How could I possibly question what he was doing?”
    He scolded, “All
you
need to know is I’m taking the patient,” and continued down the hall.
    The nurses and ER doctors within earshot were so accustomed to this behavior that they didn’t say a word.
    Various doctors displayed this kind of egotism again and again. During another shift, police brought in a 27-year-old who was arrested for drunk and disorderly conduct. The officers had wrestled him to the ground to take him into custody, and he