Ripped Dumbass Medic a new one, that is. Had a clash of wills with Glacier Doc as well.
As promised, the dressing down of Dumbass Medic was loud, verbally eviscerating, humiliating and embarrassingly public.
It was also very wrong and unprofessional of me.
Folks, I let my temper and my unreasonable standards lead me to commit a Cardinal Sin of health care the other night.
You never question another provider’s treatment of a patient* in public, and you never, EVER do so in front of the patient.
I did both.
Never mind that Dumbass Medic’s testicularly-deficient decision to bring the patient to Podunk General ER rather than a stroke center thirty miles further away virtually assured the patient of a bad, permanently debilitating outcome, it was the epitome of arrogance to state so in a hallway in full view of a dozen witnesses and the poor patient.
Understandably, Dumbass Medic did not react well to the public humiliation. An argument ensued, and the Ex-Missus had to step between us. Twice.
Occasionally, my arrogance can lead me to be an utter ass.
After cooling off and taking care of the patient (like I should have been doing in the first place) I approached DM and apologized. I had already tried once, which led to the second time we had to be separated.
“Stay the fuck away from me, AD,” he warned. “We’re gonna have this out between us, but right now I’m too mad to talk to you.”
I didn’t say anything right then. I walked down to the vending machines, bought us a couple of Cokes and came back. I remembered the times I’ve sweated my ass off working to stabilize a patient by myself and then had some pompous asshole in the ER look down his/her nose at my efforts.
“Look,” I told him. “I’m an arrogant prick, and what I did was wrong. I have my differences with the decisions you made, but it was wrong and extremely unprofessional of me to do that to you in public. I’ve been in your position when some prick dressed me down over my patient’s stretcher, and I came damned close to knocking the stupid out of him. I’m sorry for how I behaved, and it’ll never happen again.”
He just looked at me for a moment.
“The apology stands whether you choose to report me to my supervisor or not,” I continued. “My supervisor already saw the whole thing. I’m not saying this because I’m scared of the repercussions. I’m apologizing because I was wrong and I want you to know that.”
At that, he just sighed and shook my hand.
“I don’t make these policies, you know. I just have to follow them. I know just as well as you where I should have brought that patient, but unfortunately that isn’t where I could bring the patient. I don’t like it any better than you do.”
Fair enough, I suppose. I still don’t think much of Dumbass Medic’s EMS chops, but on that night, he was more professional than I was.
Back in the nurse’s station, I plopped down next to Ex-Missus to catch up on some charting.
“That was completely unacceptable, and it had better never happen again,” she remarked calmly, without taking her eyes off the chart she was updating. “Do we understand each other?”
“Completely,” I told her. “So do I get a verbal warning, written warning, suspension, or what? I’ll take whatever I have coming. I’ve already apologized to DM.”
“This is all I’m going to say on the matter,” she answered, “and I knew where you were going and why when you walked down the hall. I do know you better than most, you know.”
“I was wrong in the way I handled it,” I tried to point out, “but I wasn’t wrong about what he did.”
“You know what your problem is?” she sighed. “You insist on holding everybody to your standard, and that’s not one many people can meet.”
I chewed on that one for a while. It’s not the first time she has pointed that out to me.
I was spoiled in that I helped build a system in which the EMTs and medics were expected to use a great deal of clinical judgment and were afforded much more trust and responsibility than at just about any ambulance service in Louisiana. It was a great place to learn and grow as a medic.
Not every place is like that. A great many systems do not trust their medics to use their brains, and to be fair, often for good reason. I worked in such a system in my years at Huge Soulless Corporate Conglomerate EMS.
“This is not about you being a good medic, this is about you being a good employee,” was a refrain I heard rather often from the Operations Manager, who was an excellent employee, but a piss-poor medic. At that agency, the two terms were mutually exclusive.
Still, I quite often ignored our more inane policies and cookbook protocols and did what I thought was best for my patients. My trump card was that I was almost always backed up by the doctors, virtually all of whom I knew. They held me to a higher standard than the other medics.
Such trust is flattering, to be sure, but other medics I know, worthy medics, have gotten into trouble for doing some of the exact things I routinely get away with, simply because the doctor does not place the same degree of trust in them.
And then of course, they got beaten over the head with the same unyielding policy and procedure manual that I routinely flouted.
Not exactly fair, I know, and expecting other medics to operate the same way I do just rubs salt in the wound.
The nickname “Doctor AD” got stuck on me early on. About 75% of the time, it’s a term of respect.
The other 25% of the time, it means, “AD thinks he’s better than the rest of us because he’s so chummy with the doctors, they’ll let him get away with anything.”
They have a valid point there, and as I proved the other night, sometimes I’m just not worthy of the respect I get.
Glacier Doc knew he wasn’t liked by most of the staff. After taking every little miscommunication as a personal affront to his intelligence, religion or manhood, he had vowed never to work here again. We were fine with that. The feeling was mutual.
Like many ERs, we use a physician staffing agency. Unlike many ERs, we have a good deal of influence over who gets assigned to work here. Glacier Doc got a second day at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut because of a glitch in the schedule. The agency was unable to fill his remaining shifts there.
Fine. I can work with any asshole for one shift, and despite the fact that he’s all about politeness and civility as long as you’re not a woman or disagreeing with him, I had not yet gotten on his bad side.
That changed the other night. After a night of his patented forty-minute patient histories, ridiculously extensive workups and utterly unnecessary consultations, all our nerves were on edge.
We had already had four LWBS (left without being seen) patients due to his leisurely pace, and at Podunk ER, LWBS patients are a Bad Thing. Administration gets cranky.
He had already flung the pink leg* on me by demanding that I chart that one of the LWBS patients had been sitting in the waiting room for three hours because there were no available ER beds.
I told him I would, when I got around to c
harting. At the time, I had an acute stroke patient in one bed and an active MI in the other – both of whom I was solely responsible for, other than the occasional look-see by the equally harried nurse with equally sick patients.
But nooooo, this Asshat demanded that I do it right then, because he was leaving in two hours, never to return, and he didn’t want me to leave him hanging out to dry on it.
One does not accuse Ambulance Driver of lying, or creatively charting to paint a poor picture of someone else. It ranks right up there with questioning my intelligence in the Things That Get Your Ass Whipped pantheon.
But I counted to ten, took a few deep breaths, sang Kumbaya with my Inner Child, and did as he requested. With a smile, no less.
Not ten minutes later, the clerk informed us of the fourth LWBS patient.
Glacier Doc slammed his palm down on the table and said, “This is an Emergency Department! We take care of very sick people here! You people must move faster! I am tired of being the only one doing any work here!”
I put the ER nurse at Big Chest Pain Center on hold, duck-walked my chair over to his until we were sitting knee-to-knee, and leaned very close. If I had violated his personal space any more, we’d have been French kissing.
“You slap that fucking table one more time and snap at anybody here, and I’m going to snap back. You will find out very quickly just how fast I can move. I suggest that for the next two hours, if you want anything from me, you will write it on the order form and put the chart in the appropriate slot in the chart rack, and I will carry out the orders. Do. not. open. your. mouth. again.”
And he didn’t.
*when the standard red-ass becomes so bad that it creeps down into your thighs.