Tuesday, July 29, 2008

Laxative, Please

Oh my hell. Kill me now. Seriously. Dr. Constipation was in our ER the other day and I officially decided that taking a really long ice pick and stabbing it into my eyeballs over and over would be a really good thing.


Dr. Constipation makes my life hell. He holds onto his patients and just will not let them go until you shove a big ole' enema up his ass and make him squirt them out the door. What should be a less than one hour ER visit ends up taking 6 or 7 hours. Why you ask? WHY? Well, let me tell you.

Apparently Dr. C feels that ordering ONE FREAKING TEST AT A TIME is a GREAT way to practice medicine. Yes. Uh huh. You heard me right.


52 year old presents with sudden onset right upper quadrant abdominal pain. She is very obese and had fried chicken, bisquits and gravy, and chocolate cake for dinner. She meets the 4 F's for probable gallbladder attack:

Female? Check
Fat? Check
Forty? Check
Food - greasy? Check

Most docs would order a CBC, Chem Panel, Amylase, Abdominal Series, and a possible ultrasound right off the get go. Dr. Constipation? OH NO! Never could he imagine ordering more than one thing at a time.

"Julie, start with a CBC."

"That's it? Don't you want a Chem panel and an Amylase at least?"

"No I don't Miss Thang. We'll start with a CBC and maybe we won't need to do anything else and we can save this patient multiple tests," he says in that wonderful I-am-a-doctor-and-you-are-a-stupid-little-underling condescending way.

"I'd like to know how a little old CBC is going to tell you everything about your patient. So what if the WBC's come back elevated? You'll still do another test to find out why. I know your kind you SOB."

OK so I didn't really say that. But I thought it damn it! I thought it.

"Sigh........OK Dr. C."

Guess what? The WBC's were elevated.

"OK nurse Julie. Let's get a chem panel now," he says.

I wanted to scream.

"Can I draw an amylase with it? And maybe get radiology involved?"

"No Nurse Julie. She probably won't need those things."


"Dr. C. Look. I know you want to avoid unnecessary tests for this patient. I know you are trying to look out for their best interests. But we know she is most likely having an issue with her gallbladder. If we keeping adding test on top of test she will have to be poked mulitple times and we've actually added to her suffering rather than preventing it. We know we're going to need radiology and we know we're going to need a surgical consult. Can we PLEASE just do that all now rather than delaying and doing one thing at a time?" I actually did say that. Yes, pat me on the back now.

"Nope, just get the chem panel please."


So 4 hours and multiple doses of morphine later the decision is made for a surgical consult. Guess what? Yep. Exactly. To OR for a cholecystectomy.

So not only did we delay treatment, we caused suffering by prolonging her pain when it could have been dealt with earlier through surgical intervention. We also potentially could have caused more pain with multiple needle sticks for all the lab tests. Luckily, I am a sneaky little nurse who drew all my tubes the first time and had lab hold them for the additional tests I knew would be forthcoming.

I battled with Dr Constipation for the rest of my shift. The next day there was an enema bucket hanging from the nurses station ceiling with a big note on it saying "Rx for Dr Constipation."

Hmmmm....... wonder how that got there?


Braden said...

That is why 98% of the time if I am drawing blood I just get a whole rainbow. Yes, I may be occasionally wasting a tube or two of blood, but it has happened over and over again that I have seen nurses just get one tube and later need another. and another. and another.

Tex said...

Scary thing is, his type of Emergency Medicine is gonna kill someone eventually, and you get hauled in court. I hope you're documenting something regarding you're interactions with the doc.

Anonymous said...

agreed, he really isn't thinking of the patient first here. i'd take it over his head soon. he needs to shit or get off the pot.


ERnurse4hire said...

We call him Dr. D, and Mr. McGoo. They can lock uo an ER in a matter of an hour when on duty.....

But I can guarentee you when you see Dr. D. and you are d/c'd from the ER there is not a darn thing wrong with you... as he feels the need to do everything... one thing at a time... and then does a lumbar puncture to boot...

Mayb that is his way of preventing the frequent flyers... fear of that needle going in their back... hey he might be onto something

Ida said...

oh I have one of those. But he will snow his patients with pain med's so they don't complain. Then he will order test piece by piece. I HATE it!

Anonymous said...

Dr. C = Meconium for brains.