Stories From the Core

Since my work establishment is a large teaching institution, we always have observers, med students, nursing students, prospective employees, staff from other units, visiting doctors. They can be annoying for a variety of reasons even if they do nothing to make themselves annoying. They take up space in an environment when space is at a premium. Some types, though, are annoying beyond just taking up space. There’s the overly caring nursing student, the Yes Man, the know-it-all med student, the sensitive type who tell on surgeons when they have no idea what really goes on there, and on and on and on.

For the last couple of months, we’ve had a foreign doctor who I call the Spy. He takes pictures of everything. EVERYTHING, from suture packs to table set ups to drill bits to the surgery itself. He makes notes on some James Bond type notepad. He tries to finagle a desk for himself so he can type on his laptop. He contaminates people and tables and instruments. He never listens to anything you tell him. He’s a sidler. He never announces himself, he just comes in and out as if it were a playground and not an OR. He leaves piles of standing stools all over the place so people trip all over them and never puts them back. He hangs over people’s shoulders. In short, he drives me up one wall and down another.

He’s been here for months and I have no idea how long he’ll stay. As far as I’m concerned, he’s overstayed himself and I’m sick of looking at him. The docs humor him but I get the feeling they’re a little tired of having him around as well. One of the bosses has recruited him to take pictures of the surgeries for him but even that doesn’t work out all the time because he isn’t always there when he can make himself useful.

The worst part, he’s so hung up on the tiniest details that it’s almost like he’s going to go home and copy everything they do like a monkey and will not just be there to learn techniques and discuss new ideas. I hate copycats and that’s what this man is. He’s the Spy. Perhaps it’s unkind of me, but kindness has never gotten me anywhere. I can hardly wait until he and his camera get out of my life.

There’s so much that I wish I’d been writing, but logging in online is so arduous and I have yet to register MarsEdit, chiefly because I think it’s overpriced by about $10. But I had to share this nugget. Granted, I didn’t hear this first-hand, someone told me about it.

One of May’s new general residents has seen it all and knows it all… he thinks so, anyway. The surgeons teach via Socratic method and hence enjoy asking all kinds of questions. It’s always okay to say you don’t know. It’s not a good idea to bring up what you saw during your adult surgery rotation. It’s not a good idea to try and teach an old dog new tricks, especially when you’re only in your second year of surgery. This resident breaks these rules of what not to do all the time. As they were closing, he disagreed with the way the surgeon, known as Breakneck Billy because of his speed, wanted him to close and continued to try and talk the surgeon into doing things his way rather than shutting his mouth and allowing himself to learn from a man who’s been doing this longer than the little upstart’s been alive. Instead of getting angry or screaming or yelling or ridiculing, Billy finally said, “Son, are you a Republican? Because you keep trying to make me believe things that just aren’t true.” If you knew this man and the way he has of speaking, you’d be on the floor laughing.

Today (this I heard), he asked the resident, “What do you do if you cut the vas?” Of course, this resident knows everything right, or at least he tries to sound like he does and lives in the hope that maybe the surgeons won’t be able to tell. He started on a long explanation on how you could try and sew it back together though you might not be able to in someone so small. Billy said, monotone as ever, “The right answer then would be ‘I don’t know.’ ” The Republican continued. You have to admire his tenacity though it’s completely misplaced. He began saying something like he’d been it done by urologists in the adult world. Billy broke in, “So I wasted my time with the extra training to be a pediatric surgeon?” I laughed. I couldn’t help it.

Today, the Republican told me he felt this particular surgeon was “condescending sometimes.” I told him to get over it. Where do people get off on thinking they know everything when by definition, they’re students and they’re there to learn? It makes for some hilarity, though.

I didn’t mean to hurt your feelings if that’s what occured. Surely, you must understand that when you asked if your co-resident was present during the last case and I said, “I don’t know” I truly meant it. Would it have made you happier if I had lied. You were looking for him, weren’t you? Did it matter if he had been there for the last case since he was so longer present when you walked in? He carries a beeper, does he not? Did it occur to you to use it before grilling me about his whereabouts. Eight cases in, all performed by the attending himself, your dear co-resident had been in snd out. I lost track of which cases he present for and which ones not. I documented times and IV locations for each child. There isn’t a blank purely for the residents, especially if they just look on and don’t take part. I’m not your co-resident’s keeper.

You looked so shocked that I said I didn’t know. Would you rather I had lied and said what you wanted to hear? I would have been mean to you if I’d said what I had wanted to say and offered to pull him out of my pocket for you. But I was honest and you looked so startled. I wonder how you’ve gotten this far in your medical career at all. I didn’t yell at you or ignore you or been smart with you. I wanted to. I didn’t. Someone else would have. Stay away from general surgery.

I’m not necessarily quoting Jerry Maguire but everyone’s had occasion to think of a come-back and then say something entirely different. In my employment and for nurses everywhere, it’s a uncommonly frequent fact of life at work. When it comes to mean patients, insane families, and spoiled doctors sometimes it seems like every other exchange leaves the nurse with a feeling of, “That’s what I should have said.” Sometimes your learned response leaves you and your filter fails you. It happened to me just the other day.

I was in the add-on room working through a merciless row of neurosurg cases. I hate neurosurg. Our anesthesiologist was one of the ones notorious for not helping the staff with getting ready, not organizing his time so he’s the right place at the right time, and pleading out of any heavy child lifting by a convenient flre-up of mysterious back pain. The anesthesia tech was still setting up the anesthesia machine, the CRNA was drawing up drugs, I was drawing up the antibiotics and the other nurse was wheeling in the equipment when he came in and said, “So are we ready?” We? We? The use of “we” requires the speaker to be involved in the group not be talking at a group. In this case, it required the speaker to have lifted a finger to get his room ready for the case rather than going out to the break room to devour anything edible. It requires the speaker to have a record to being someone to work with not someone notorious for standing in the hallway talking as small nurses struggle by pushing heavy beds and not lifting a finger to help. It requires some involvement.

There was a moment of silence and then I heard my brain say, “What do you think?” Clearly, if useless in every other way, he could use his eyes and see the four people working to get the room ready and not sitting around having tea and scones. He doesn’t do a thing and then bothers us with some useless question as if asking him to look around and use the brain he’s clearly so proud of to arrive at the appropriate conclusion.

A burst of laughter told me I’d actually said that out loud. I heard him say, “Well, that wasn’t very nice,” and a moment later left the room. I finished drawing up the stuff, cued the computer record, helped the tech finish up, made sure my scrub person was ready, and checked with the CRNA. Then, finally ready since rooms don’t make themselves, amazingly, I went out to the holding area. There he was, reading the chart. Wasn’t that his job to have done that before checking the room. I wasn’t mad, though, these things happen so often, it’s not worth being bothered, but these guys do need to be snapped every once in a while before they become completely spoiled. And no one deserves to be treated like the help, even if they are the help.

He helped me push the bed back. I’ve never seen him do that before.