…but a witty one can silence a fool.”
Living in New York City means living in close quarters with people who are at times cocky, arrogant, brusque, dismissive, and overbearing. People do not sit on the front porch sipping lemonade here; they do not bring casseroles to new neighbors. No, they run over others who happen to get in their way, they insult those in proximity who happen to annoy them, and they often have no regard for others they may be inconveniencing.
Thankfully, the hospital atmosphere usually smooths out the rough edges. Usually. I remember vividly when I was interviewing for residency at NYU, I stopped at the security desk and asked politely for a visitor name-badge. That simple request at 7:30 in the morning apparently ruined that security officer’s day.
The other day, I was going to bring a patient back to the operating room. One of the nursing assistants had already started an IV on the patient–a bit of a luxury at my institution. I usually will just carry the bag of intravenous fluids as I escort the patient, but this time, without thinking, I started to push the IV pole with the patient as we headed toward the door of the preoperative holding area.
“I knowyou’re not taking that pole!” one of the nursing assistants said in a condescending tone. I stopped, instantly feeling annoyed. I usually don’t think about the medical hierarchy, but there definitely is one. Attendings > Fellows > Residents > Interns > Medical Students. Nurses have a bit of a different ladder, but I would generally place an average nurse somewhere between an intern and a medical student. Interns write orders that nurses follow, but they are still credentialed professionals; medical students are not. Otherwise, the nursing hierarchy is something like Nurse Manager > Charge Nurse > Nurse > Nursing Assistant.
As a senior resident (a chief resident at that) I intuitively feel I’m perhaps a couple rungs higher than this nursing asssistant. And while rudeness (in the sense of condescension) is never professional, it seems particularly egregious when it’s directed up the ladder.
And so, I turned, and I said in the most neutral tone I could muster, “Are you asking me to leave this IV pole here? Because if you ask nicely, I would be happy to.” This was met with absolutely no reply, so I unhooked the bag from the pole, and escorted the patient out of the room.
On a different day, I happened to have a medical student on an anesthesiology rotation assigned to my room. We were doing a complex case–a resection of a lobe of the liver for a living-related liver transplant. The surgeons like the patients dry so the liver doesn’t bleed as much, and I was trying to accommodate, though the risk would be hypotension. Throughout most of the case I was successful in walking the fine line of hemodynamics, though at one point the patient seemed a bit bradycardic (heart rate of 46, baseline of 60, running most of the case in the 50’s) and hypotensive. I gave a dose of ephedrine and a little fluid, and explained to the medical student my rationale as we watched the monitors for the response.
Just then, I heard a voice say, “The patient is bradycardic.” I turned around. It was a woman who had been one of the two or three people floating mysteriously on the periphery of the room; she was now standing immediately behind me.
Rather than answering her, I asked, again with a neutral tone, “Excuse me, who are you?” “I’m with the liver transplant team, but I used to be an ICU nurse,” she replied.
I then asked her, “Are you asking me or telling me that the patient is bradycardic?” She said nothing, so I turned around and went back to my job of taking care of the patient.
I think the thing I found particularly insulting is what this former ICU nurse’s interference with my work implied. If I’d been sitting there working on a crossword puzzle while the patient was on the brink of death, that is one thing. But I was clearly monitoring the patient, so this woman’s comment suggested that I was not qualified to recognize a problem. This I found highly offensive. This is my job. I monitor patients. I keep them alive while the surgeons hack out major organs. Not only did I already knowthe patient was bradycardic (not so worrisome) and hypotensive (more concerning), I had already treated it by the time this woman thrust herself into my area of sanity on my side of the drapes.
I will spare my gentle readers the story from the same day of the animal, er, older man, who resorted to pushing on the subway when people were in his way, rather than walking around or *gasp* saying “excuse me.”
I don’t know…maybe I’m the arrogant, dismissive one. But better to be clever and arrogant and dismissive, than foolishly arrogant.