Crust

“Hey,” I say. pointing to the ambulance stretcher being triaged. “EMS is bringing us a severe epigastric pain into 3,  10/10, radiating to the back.”

We’re in the Resus Room, Terrie and I. Green-scrubbed nurses, hospital green room, wires, tubes, machinery: all designed to coax life from people too sick to live. She’s looking at her nails, long tapering hands ending in ten tiny polished jewels. It’s been a slow start, a couple of nothing chest pains soon discharged, a morning to restock and take stock. We check the code carts and the trauma carts, make sure the wall suction is attached and the IVs lines are primed and now we’re leafing idly though old magazines. Waiting, as emerg nurses sometimes do. Just waiting.

I don’t know Terrie well, though I’ve worked for her for a few years. She has children, I know, and grandchildren and a husband, I gather, she doesn’t like much and there are hints that there are more serious, unfixable problems. She doesn’t disclose. But it’s clear she isn’t a happy woman. She’s crusty and abrasive with patients, and she terrorizes new grads mercilessly. You can read sorrow and regret into her words, sharp icicles falling from rosebud lips.

Having acquired multiple accretions of crust myself over the years, I am not intimidated by the nurse-as-battleaxe, old school persona. But still, I tread around Terrie as carefully as a cat picking its way through broken glass. Don’t exactly like her, which means I don’t exactly trust her, either.

I pull the ECG machine up to 3, and flip on the monitor and start fiddling with leads.

“What do you think ” I say, half to myself, running through the possibilities, the differentials. “Triple A, STEMI, nonSTEMI, gastritis, bilary colic?”

“Would you stop that?” Terrie’s voice is suddenly sharp, angry.

“Stop what?”

“You need to leave the diagnosis to the docs. That isn’t your job. And,” she adds. “Some of us are getting sick of you doing this.”

I look at her, surprised. Running through the contingencies is what I thought all emerg nurses do: anticipating care should be as natural as breathing.

“You’re arrogant,” she continues. “You’re lazy. You substitute what you think is smart for work. You —” Her tirade is cut off abruptly by the arrival of the paramedics with the patient. Ricky and Craig are pushing the gurney, and their jaws are open. Even the patient is surprised.

“What’s the story, guys?” I ask. They all look for an explanation, and I offer none.

We get the history,and I assess the patient, my stomach wrenching, while Terrie hooks him up to the monitor and starts the IV. We don’t speak to each other except as necessary. I am embarrassed, and suddenly shy. I try to focus on my patient, his words, his anxiety. But then I wonder: is she embarrassed by her words, regretful, sorry? I can’t tell. Her face is placid and unmoved. Her nails sparkle adjusting the monitor cables.

Another nothing chest pain, I decide when the assessment is done, and so it is.

I won’t pretend I wasn’t hurt by her words; they cut deep and hard. I don’t have that much crust after all; the rhinoceros hide I supposed I had turns out to be tender and thin. And so help me, the day my crust is so thick I have no feelings at all is the day I leave nursing.

I understand the whys and wherefores of horizontal violence, of power gained by tearing down, of hurting to palliate hurt. How is she hurting? What has been done to her?

I’m not sure I have any profundity to offer on this. I feel like a victim of a hit-and-run. Being formerly Catholic, I do the guilt game. I must be at fault. Was I condescending, patronizing, or arrogant, as she says? My conscience runs down the list, considering how I’ve spoken, what was said. I don’t see how. So the question remains. Why am I suddenly the target of her rage? This I don’t understand.

Or maybe there is no explanation at all.

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  1. #1 by Frugal Guy on Saturday 19 December 2009 - 2053

    Jealousy at competence, happiness or other attributes might explain things.

    Keep up the readiness for various conditions — even if you aren’t sharing it verbally — if that’s what works for you.

  2. #2 by Cece on Sunday 20 December 2009 - 1421

    This is a wonderful blog. I found it by clicking around. You are an excellent writer and your subject is heart-rending, so very timely. Tip of the hat.

  3. #3 by JC on Saturday 02 January 2010 - 1608

    Sounds like her behavior is really her problem, not yours. Keep being competent, keep running the differentials (even if just in your head), and keep being professional. You’re fine.

  4. #4 by Penelope on Saturday 23 January 2010 - 1358

    What an awful experience. I expect that the last thing you want to do is open yourself to further contact with her, but if you are up for it, could you invite this colleague for coffee to talk about the incident?

    Perhaps you could ask her if she has specific examples to share with you. If she does, it is an opportunity for personal reflection (and no, no one should ever get ‘feedback’ in the way she exploded to you) My guess is that she won’t have any – and will probably be embarrassed by her own behaviour.

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