Love-hate

Finally, last day of my shift!!

Before I started working I said to myself that I'd try and hold on as long as possible before my spirit is broken and I become just like the doctors people complain about: cold, not smiling and not engaging in conversation with other staff.

It didn't last very long. My spirit, I mean. When you've been hassled so many times (in public) and people don't bother treating you nicely, I think why should I freaking bother. I don't feel like smiling to someone who orders me about like I am their orang suruhan. It's not the ordering about that bothers me; it's how they do it. A subtle insult inserted, a snub.. as if I hadn't been doing a good job already before this.

So now I only keep my smiles and friendly conversation to people who are nice to me. People who engage me like a member of the profession rather than just another appendage to the ward with a legal signature.

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I have a love-hate relationship with my nurses. Because I started off being very accommodating to them; now they would happily do whatever I ask them. And quickly too. I'm glad I made that move. Now even when I say No, they don't get pissed off with me because at tea time we'd have a chat in the tea room or at the nurses' station. We get along.

But sometimes some of them can be very exasperating. Degil. Don't trust my clinical judgement.

Yesterday there was a 25 year old obese patient with lower lobe pneumonia who suddenly had low oxygen saturation (88% on room air). The nurses were all panicking like it was code blue or something. After taking the history and examining her, I concluded that it was the pain (from her pneumonia) causing her to be very anxious and not breath properly. The painkillers had worn off. Gave her some oxygen and that improved it but until the pain can be managed, you can't expect her to achieve high saturation! Just give her painkillers and make her breath more deeply la! I had no reason to suspect that it was a pulmonary embolus and she was already on prophylactic enoxaparin anyway. The patient looked fine! Just anxious of course but well perfused and no cyanosis.

Nurses degil; still didn't want to hear my opinion and just discussed among themselves about what to do. Ignored me completely! Fine la, do whatever you want. I'll just write my recommendations in the patient file. Geram gak kenkadang. Apa gunanya ada doctor there on the ward if you don't want to listen? Baik tak yah ada doctor. Manage la patient sendiri! Derang ingat doctor ni kerja dia tulis medication kat drug chart and sign aje ke?

And they always want a solution that involves giving the patient medication or getting an Xray done. Some things don't need drugs or imaging. For example a nurse called me to check on a patient's eye because it looked sticky (banyak taik mata). I took a history and examined his eye and decided it was not infectious conjunctivitis; merely a blocked tear duct. All that needed was massaging the duct and washing with salt water. Told the nurse that and she wasn't happy. She thought that I should give the patient antibiotic eyedrops or something.

I also had to do a report when a patient fell down in the toilet. Had to ascertain the cause of the fall and any injuries sustained. The patient merely slipped on some water in the toilet. (Itu pun nak suruh doctor tanya kaaa). She twisted her ankle but I had no reason to suspect any ankle fracture. So I didn't order an ankle Xray for this patient. The Head Nurse questioned this. I had to defend my reasons; the patient wasn't even in a great deal of pain anyway and when I touched the ankle, she didn't even complain. It wasn't even freaking swollen!! We don't need an Xray to tell us that it's NOT a fracture!

I may be a very junior doctor but I'm still a doctor and I was trained to make diagnoses. Nurses aren't trained to make diagnoses. So let me do my job, sometimes I might get it right, sometimes wrong. If I don't know what to do I'll ask my senior doctor; not nurses okay. But conditions evolve; just because a patient has breathing difficulties doesn't mean he has a lung clot then and there. It might just be simple thing as painful to breathe. He might get a clot later but it doesnt mean the doctor who saw him earlier got it wrong. Just that there weren't any symptoms or signs to suggest a clot at the time.

Yes, my relationship with them can be frustrating on one end but comfortable on another end. Nurses are invaluable to us all and if they do their job properly; contribute massively to the care of the patient. But everyone should know their place and respect each other and let each other do the job that we're meant to do.