There is a doctor at work who NOBODY likes because it seems he goes out of his way to treat the nurses like crap. I had a run-in with him when I first started that scarred me for a long time when it came to prepping the abdomen before a cesarean section. I've since gotten over it, but that is neither here nor there because this story is not about me. This story is about something that happened at work tonight involving this doctor that absolutely appalled me...
Now, I realize that in telling this story there may be some terminology that some of you may not know, but it is necessary in getting the point across, so I will do my best to explain anything that may not be clear...
A nurse at work, let's call her C, comes in EARLY because day shift is swamped and they need help. She gets this patient who is a Russian having her 3rd baby. Now, normally race is unimportant in any story, but when it comes to having babies, it is important to point out that Russians, as so eloquently put by Larry the Cable Guy, "get 'er done." They don't fool around - they come in and pop those kids out, and the more they've had, the faster it goes. No joke. So the asshole doctor, let's call him K, gives C orders to start Pitocin, a drug that makes contractions come faster and stronger. ASSHOLE POINT #1: This patient was in good labor on her own. K wanted to go home so he ordered the Pitocin so the baby would come faster and he could go home sooner.
So C starts the Pitocin and increases it by 2 every 20 minutes, just like K ordered. (Nursing background: When docs order Pitocin, they order it to be increased by 2 every 20 to 30 minutes. We ALWAYS increase it every 30 minutes just because it is nicer on the charting.) At one point in the night, C goes to tell K something, what it was is irrelevant, and K cuts her off to ask what the Pitocin is at. She tells him and he pauses to figure out if the level she told him was right with increasing it by 2 every 20 minutes, given the time it was started. ASSHOLE POINT #2: You are checking up on the nurse?! If you don't trust her to carry out your orders and provide good care to your patient, do it your damn self!
So things are progressing with the patient and she is getting increasingly uncomfortable. The IV medicine has not helped and the patient is requesting an epidural. C checks the patient and she is 7cm (Nursing background: Babies come at 10cm. Also, remember how I said Russians "get 'er done"? Well, after 7cm, by the time you have to do everything you have to do to get the epidural, it's not worth it because they'll probably be 10cm and just push the baby out anyway.) But C, being the patient advocate that nurses are, starts doing everything that has to be done before you can have an epidural, which, by the way, was written in the orders that the patient could have. When everything is ready, C checks the patient again and she is 8 to 9 cm. C calls the anesthesiologist to tell him everything is ready, and after him giving her some grief (She'll have the baby soon, why bother? This REALLY pisses me off because you know that if it were him laying there having the baby, the fool would want pain relief regardless of dilation. By him saying that, he's essentially saying that it's not worth his time and to let the patient suffer, which deserves an asshole point as well, but we're focusing on K's, not his.) So he comes to the room and is doing the epidural when K walks in. K says - and I was in the room so all of this is first hand - "What's going on here?" "She's getting an epidural." "What's she dilated to?" "8 to 9." "Stop. Stop the epidural. She's going to deliver soon. She doesn't need it." The anesthesiologist looks at K and says, "You want me to stop?" "Yes." At this point the patient is in tears and is begging, literally begging, for the epidural. The look of horror on her face was the most gut-wrenching thing I have ever seen, to be so close to pain relief, only to have it taken away. I felt for her right then, I really did, which brings me to ASSHOLE POINT #3: That's WRONG. It would have taken 2 more minutes for the epidural to be placed. The patient would have been comfortable, even if it was for only 30 minutes before the baby came. That's still 30 minutes she's not in pain. But because he's an asshole, he didn't let her have the epidural because it might have prolonged the baby coming (she wouldn't have had the urge to push) and he wanted to get home as soon as possible.
After the epidural is stopped, K asks what the Pitocin is at. C says 12. K gets all angry, saying, "Why is it only at 12? An hour and a half ago it was at 10. It should be higher than 12." (Nursing background: Pitocin is pretty powerful stuff. You turn it up until contractions are adequate - they feel firm to the touch and are every 2 minutes. If you keep turning it up, it makes the contractions come too close together, not giving the uterus time to rest between, and there is a risk of rupturing the uterus. That is a MAJOR emergency. So you stop turning it up when you reach adequate labor, you DO NOT keep going.) ASSHOLE POINT #4: You are a freaking doctor, you know everything I just said. The number on the Pitocin does not equal adequate labor. The patient is 8 to 9 cm, obviously it is doing a good job at the level it's at. You DO NOT risk rupturing a uterus because you want to go home.
So K leaves the patient's room and goes to the nursing area and is ranting and raving and carrying on about how C should have known better and this and that and the nurse in charge (Darn, her name starts with a K too, so let's call her CN for charge nurse, who, mind you, was in the room also during the whole epidural thing), tells him to leave it alone, to which he tells her that she is supposed to have control of the until and is not doing a good job, to which she says that she cannot be in every patient room and that C is a good nurse and did nothing wrong. ASSHOLE POINT #5: You don't yell at the charge nurse because you are mean and impatient and want to go home. CN is a great charge nurse and she absolutely had control of the unit and indeed C did nothing wrong - the epidural was ordered and nowhere on the orders did it say the patient could not have an epidural past x centimeters. You don't yell at people because things are not going your way.
So the patient doesn't get the epidural, and she is crying and screaming with every contraction. Her husband is pissed, and rightfully so. Her sister is walking the halls crying because her sister is in tremendous pain. K says to the patient, after he makes them stop the epidural, "the baby will be here in 30 minutes at the most." Well, an hour later, still no baby, even after pushing for 45 minutes. The patient is in so much pain, she is out of control and cannot push. The patient is screaming, "Christ, please help me." You know what happens? They do a cesarean section. ASSHOLE POINT #6: If you had let the patient have the epidural, granted, it may have prolonged the labor a little, but she would have had adequate pain relief and been in control enough to push the baby out, but no, you had to get home as soon as possible and you made a decision that cost the patient major surgery and a much longer, more painful and difficult recovery. Good job.
A long story, I know, and if you have made it this far, I thank you. And if you or anybody you know in the Sacramento area is pregnant, drop me a line. I'll tell you K's name so you don't have to be subject to his abuse.
