Slightly Used Posts: Crust

The last of the series of reposts of one of my (IMHO) better entries in the past year, to mark the first year of this weblog. First posted December 2009: it hurt when I wrote it, and it still smarts.

“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 girlvet on Thursday 09 September 2010 - 2314

    Your co worker is an asshole. You intimidate her. She knows that you are smarter than her so she tries to make you feel bad. Don’t feel bad. You ARE doing what every ER nurse does, anticipating needs. You are probably very good at it.
    If someone told me something like that I would address it with them and tell them it will never happen again. Or I would go to the manager. Thats unnecessary shit.

    • #2 by torontoemerg on Friday 10 September 2010 - 1147

      Fortunately, she no longer works with me. I have to say also, she was extremely old school, in the sense that nursing for her was just a job, not a profession demanding critical thinking skills. But still… I have never had such a reaction to normal ED practice!

  2. #3 by NNR on Friday 10 September 2010 - 1404

    I know the feeling well. You just feel like you’ve been slimed by a drive-by psychological shooting. Why? Yeah, there may be no reason. This kind of thing is such a shame.

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