During my first year of residency, I had a situation with an inpatient where I suspected he had a very elevated INR (I'm not going to get into the background story).
We sent a stat INR. An INR of about 1 is normal. If you want to anticoagulate someone (for most things), you want the INR between 2 and 3. We were concerned his INR might be upwards of 10 and my attending and I were planning for this situation.
Anyway, an hour or two after the stat INR was drawn, I checked in the computer and not only was the stat lab not back yet, it wasn't even pending. I called the lab and the tubes of blood had never even made it down there.
The lab asked me how the blood had been sent, so I called the nurse over and asked her. By now I was getting very agitated because I was afraid for my patient and now it seemed like it was going to be another hour or two of waiting. The nurse said she had "tubed" the blood to the pharmacy... apparently, the blood was now lost in the tubes system.
I went over to the nurse to ask her to redraw the blood. As soon as I walked over to her, she said to me, "You know, you were very disrespectful."
I was totally baffled. "What?"
Apparently, she was really upset that I had called out her name to have her come over to the phone to help me. I tried to explain to her that I was talking to the lab and it was very important and that I needed to know what happened to that blood. I apologized for being disrespectful and said I was just worried about the patient, and I really didn't think calling out her name was that horrible... I was on the phone, I didn't want to lose the connection by putting the phone down... and I could see her sitting at the next table over a few yards away, not dealing with a patient or anything. I just wanted to know where the blood was.
"I tubed it to the lab," she said. "I have witnesses."
"I never said you didn't," I said. (It never for a second had occurred to me that she didn't do exactly what she said.)
"I have witnesses," she repeated.
I was totally confused. Did she think that I thought she just tossed the blood in the garbage can? I didn't think I accused her of anything. I was just trying to track down the blood to run the tests on it. She kept telling me that she always treated me with respect, which wasn't untrue but it wasn't like anyone treated me with THAT much respect. I mean, nurses were constantly calling out MY name. While she yelled at me, there was another nurse who was just sitting there, listening to the whole thing, not saying a word.
This is a situation where I was particularly peeved at being yelled at. First, because she was wasting time yelling at me instead of redrawing the blood. Second, because I honestly hadn't done anything wrong (yeah, what else is new?). And last, because I was hugely pregnant and I thought it was a special brand of awful to yell at a woman who's very pregnant.
On that last point, I have to admit, I always did expect to be treated a little nicer when I was visibly pregnant. It just seemed like something that should have been done, considering everyone knows pregnant women sleep badly, feel crummy, and have raging hormones. Plus, yelling at a pregnant lady is slightly like yelling at a newborn. And you know what? I never was treated different. Nobody treated me even a bit nicer due to being pregnant, as far as I could tell. In fact, one time when I was eight months pregnant, I was looking for a seat on the ward so that I could write a note, and nobody even offered me that. I almost cried.
And if I started yelling and acting like a lunatic while pregnant, I very much doubt anyone would have given me a free pass, saying, "Oh, don't mind her. She's pregnant and her hormones are out of control." Which is okay. I never expected anything like that, which is why I had to make an extra special effort to be nice while I was pregnant. I don't think raging hormones are an excuse to be a bitch to the people you work with. (Only having your name called out in an emergency situation is an excuse to be a bitch.)
Anyway, in case you were wondering, that patient's INR was fine.
It kind of shocked me when I was hugely pregnant myself the number of times that nobody would even offer their seat on the bus, and I almost passed out from standing all the way to school. I decided that people must have thought I was obese (because obese people DESERVE to pass out, yeah whatever) because it was winter and my coat was rather large. It wasn't even one demographic in particular that did this. Maybe people just don't notice others?
ReplyDeleteAfter my kid was born, and I'd carry her on the bus in the ergo, people were much more accommodating, which makes me lean even more towards the obesity theory. Even if it wasn't I think a lot of people don't realize how incapacitated being extremely pregnant makes you, and are inclined to view asking for a seat as "attention seeking" or "melodramatic," since, well, that's how many people view women in general.
Not saying you shouldn't have been offered a seat, because I think at 8 months there shouldn't be any ambiguity.
DeleteSometimes you mistake a lady with a gut for being pregnant and the tongue-lashing is never a good experience.
OMDG: A friend of mine was on the bus with crutches AND being 8 months pregnant, and she wasn't offered a seat.
DeleteAzuka: I was clearly pregnant. And these were people I worked with, who knew it.
I was just thinking about how some of the meanest comments I've ever received in my life where in the hospital when I was 8/9 months pregnant. No topic was off limits - my weight, hip size, how good a mother I'd be, how boring babies are and are such uplifting and personal comments.
ReplyDeletedo these sort of things blow over after a while? Or is it a strained relationship between you and the nurses from there on in?
ReplyDeleteI "apologized" later, even though I didn't think I was in the wrong. I'm all about keeping the peace. I told some of the other residents about it and they said that nurse was a big drama queen.
DeleteOn the topic of inconsiderate people on the bus, a few years ago, I was getting off a busy bus on a rainy day and slipped and fell on a newspaper somebody had dropped on the sidewalk. It was embarrassing, but I didn't hurt myself. There were maybe 50 passengers getting off with me, and the only one who offered any kind of help (or even looked down at me) was a woman who must have been in her 80s with a cane!
ReplyDeleteNow, at the time I was a healthy-looking man in my late 20s, so maybe I didn't merit a second look because I could clearly get up and help myself. But it would have been nice to hear "are you okay?" from a little more than 2% of the people around.
When I was visibly pregnant and lots of young people were in the subway a nice woman offered me her seat. I gladly accepted until she got up and I saw she had a bump herself. I told her there was no way I could take her seat and I apologized because I did not see she was pregnant herself while she was sitting. Everybody was listening but do you think anybody else would have given up his/her seat? Absolutely not... even though about 20 people got up at the following stop a minute later!
ReplyDeleteAnother time, I was 9 months along - I just asked a young guy in his 20's if he could give up his seat, and he asked "why?" - so I showed him my HUGE belly which I am sure he already saw. He reluctantly gave me his seat...
People are just mean...
I would be embarrassed! I'm a woman and I'd give up my seat for a pregnant person.
DeleteWow. I think that nurse was a little over-sensitive. In our hospitals, doctors and nurses are always shouting for each other (FOR, not AT), because things are busy and crazy and if you tell the lab to "hold, please", they tend just to hang up.
ReplyDeleteI suspect she thought I was accusing her of having lost the blood, which I wasn't.
DeleteI don't know -- with both of my pregnancies, whenever I was on the bus someone offered me a seat. The only times I ever ended up standing were when I refused (because everyone looked old/pregnant/infirm or because I was not going to be on it for long). They have also always offered whenever I have a baby/toddler with me. Is this just differences in selective memory? Or, are people in my northeastern, stereotypically "mean," city actually very nice? Or, was I particularly pathetic looking?
ReplyDeleteI remember a few years ago, I was on a bus with my two year old daughter. There were no empty seats except in the very back, and nobody offered to get up. And when the bus started moving before we reached the back, she actually FELL and still nobody offered to give up a seat.
DeleteYeah, I'm in Philadelphia, and I've noticed that people often do not give up their seats to pregnant women/ parents with small children. This refusal spans races, genders, and generations.
DeleteThe only people who did give up their seats on the bus were the slightly older women...who had clearly recently been there. Not the perfectly hale & healthy young men & women (really none of the men ever).
DeleteWhen my aunt was well along in her pregnancy she took the T/subway after work--so the it was rather full. When we walked on all eyes were on her, and not in a kind "awee" manner either!
ReplyDeleteAfter standing for awhile and visibly exhausted she said loudly, "There is not one person on here that would give up a seat for a pregnant woman?"
Eventually, one of two teenage girls sitting next to each other got up to give her her seat. I wish I could say this was kind of them--but unfortunately they were very open about how unfair they thought giving up their seat was! GRR!
When I was 7/9 mo pregnant and on 36h call, my program director was swinging by the morning after 24h passed and ordered that I go home, while my co-resident stayed and helped the interns. My co-resident young single male immediately said it was unfair and he did not agree that I go home.Brings some memories back of my former country. On vacation in remote region my family including 2 young kids, mother and grandfarther boraded a bus. Travel time 11 hours, all seats already taken. Immediately several young men on a bus stood up and offered their seats to us kids, my mother, my grandfarther. They stood in the back for the whole 11 hours. It would never happen here..
ReplyDeleteWere you supposed to still be on call or not? Was it typical for one of the residents to go home early in the morning while the other stayed for several more hours? Why does pregnancy mean less responsibility?
DeleteIf he offered, sure, fine. For the program director to do it is blatantly unfair unless it was standard for one to go if not otherwise busy and the criteria for it was not just who happened to be pregnant.
To be honest, I agree with the anon replier. If your co-resident offered to help, that would be nice of him and perfectly fine. But for the PD to order him to do your work so that you could leave early for no other reason than that you're pregnant seems a bit unfair. Considering women who have babies already receive coverage while on maternity leave, I feel like we should at least do the best we can to show that we're not slacking. Asking to frontload calls to the beginning of your pregnancy is fine because then you're doing your fair share. Getting to leave early just because you're preggo is not fair.
DeleteI'm mostly talking about being courteous. Not asking others to do my job.
That's so inconsiderate. I always try to offer my seats to old, handicapped, and pregnant people on the metro (in DC). Usually they politely refuse.
ReplyDeleteI also agree with the Philly remark. I've never seen that common courtesy extended in that city.
I had the opposite experience. I was 7 months pregnant and had admitted a guy after trauma, normal neck x-rays, for observation when he complained of weakness I couldn't confirm on exam. At three in the morning, the nurse went in to check on him, and he couldn't move anything from the neck down. (Ended up being a c spine hematoma, only seen on mri.) He didn't call me until 6 because he "knew I was pregnant and probably needed the rest."
ReplyDeletewow. what a very considerate guy!
DeleteYikes, that's just poor triage skills. Sure, don't call about the colace order but something that sounds like an emergency?
DeleteI am Anon June 27 1:27. I never once had anybody pick up my call with pregnancies- calls were all lined up early on with first pr, the electives. When a fellow I was forced to take 3 weeks off instead of being eligible for 3 months. Then my fellow colleagues made me take my several calls back (one the phone only. usually 3-4 calls overnight, usually not between 11 pm and 6 am). By then I also underwent brain surgery. Any sympathy? No ! One fellow jelously commented how I lost pregnancy weight so quick. Not how I felt about post-surgery paralysis.
ReplyDeleteWhile pregnant I was covering for another more pregnant resident, who almost passed out on her call and the same program director ordered she not take any future calls before her delivery. We all covered for that girl. then we all covered for one month for resident whose close family member comitted suicide, and for resident who had retinal detachment on call, and resident who had nervouse breakdown from work/divorce. And you know what I never once felt resentful. I felt if I am in betetr shape and can do it I would do it. Someone else will help me later down the road. Since there is no social garantees in this country - no extended family/parental/sick leave, people should stick together. I felt that that program director created a great culture of sticking together and covering for whoever was vulnurable at the time. I have fond memories of that program. And not so fond of my fellowship where I with 2 infants at home and after having brain surgery with residual paralysis, was told by healthy and single fellows to do calls they felt I had to pay back. You know like those guys who stood on the bus for eleven hours. They did not have to do it.
This is not about drama argument here. I did not go home as program director offered. I did not have a second to even say anything. It is about integrity. No matter how horrible I felt I went to work till very last day with both pregnancies. Just acknowledging me being more tired then others would go far.
I wasn't saying you did anything wrong. I just said that I don't blame that other resident for being upset if his co-resident was allowed to leave early for no other reason than being pregnant.
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