Updating our blog has definitely gotten away from me and how does one go about catching everyone up when so much has transpired in the literary absence of the postings? Well, I figure I am simply going to post some of the goings on of my people since I last wrote many months ago, or simply the continued ramblings of this author. Pictures will come at some later point I imagine as they are warranted. They are such a hassle to add on this relic of a machine I am using.

My current thoughts roam to recent incidences I have experienced while at work. I have been employed at my current hospital since last November and for the most part it has been a huge change. I don't arrive at work with contempt for my fellow man, I don't loathe the management, and my stress and anxiety are negligible for the most part. I moved from one of the busiest (if not the busiest) EDs in the nation to a twelve bed unit staffed by experienced nurses, paramedics, doctors, and ancillary staff members. I do miss the teaching aspect that comes with personages new to the medical industry but this has been a good move for myself and the family. However, despite all the positive changes, there are always challenges. I reflect now on one of the more recent such "challenges."

A brief disclaimer, if I may--and I may, I have a brother-in-law whom I have a great respect for and for the profession he represents. Nevertheless, it is not uncommon for nurses to disagree with orders received from primary medical providers, and it is to this end I make my telling--I wish no offense nor project any hostility towards the Medical Doctor profession.

I saw him walk in at the changing of the shift for the doctors and inwardly I groaned. I was working on my third of three shifts on the week and he apparently had been slated for the same coverage of days. I only had ten more hours to go and then I would be through for four days, and most likely working with a different doctor for a while. "Put your head down and get to work." I thought. I recognize of myself a recalcitrant tendency but there isn't room for insubordination or open rebellion in the Emergency Room. Patient safety comes first and so the medical team has to behave as such, a team. This particular doctor's approach to the medical staff came off as arrogant, at least when it came to orders. There is little room for discussion once he placed an order and conversation regarding patient care is often marked by sarcastic undertones and curt replies. His bedside manner at best can be described as smarmy, and it is one of the few times I regularly see him smile, after his condescending responses to the patients are spattered across their faces; a satisfactory punctuation mark for his superior intellect.

Oh how I wanted to limit my interaction with him, but as it was, one of my patients was in need of his skill as a doctor and a consent for a procedure was necessary. The patient had already received a narcotic, read pain-killer with Jedi mind trick capabilities, but to no therapeutic effect. The intramuscular injection was made impotent by dosage per body habitus and nature of injury. A gravitational force rendered the underlying supporting structures of an upper extremity component in disarray. A peripheral IV was inserted via ultrasound guided technique-thanks to our doctor-and an additional dosage of narcotic was ordered through this newly acquired route. With the pending consent still needing a critical and competent signature I delayed the administration of the pain medication until the consent was obtained by the doctor. This was met with a deluge of sarcasm from the physician directed at myself. Feeling the pressure of my "superior" as well as the obvious need to mitigate the patient's pain I went ahead and drew up the medication. I did voice my concerns and told the doctor pointedly not to "screw me over, don't screw up the procedure."

One thing I learned at Parkland is that a narcotic, such as morphine, given prior to a surgical consent will make the surgeons very upset as the patient's cognitive abilities are considered altered. The signature won't stand up in court if something were to go wrong and the patient to bring litigation against the hospital, or nurse. I've got a license and job to protect, I don't make the hospital near as much money as the doctor and consequently am more likely to be fired if something were to go awry even though not directly involved in the incident.

The doctor did obtain the consent prior to my giving the medication, which is a bit stronger than morphine and had a marked affect on the patient. Everything turned out fine, the procedure was completed safely and with the patient's pain assuaged, was discharged home with a follow up recommendation/referral with a specialist. My mood remained bitter over the incident, fueled by the support of a fellow cohort I commiserated with for validation over my concerns. I was upset at the doctor for chiding away my concerns, minimizing my role to a "pill pusher." I was able to finish my shift, rendering as near as I am able to recall, appropriate patient care for those under my assignment. The doctor left at his assigned time, an hour before my shift's end, and his anti-thesis took his place. Even still, I felt the tinges of negativity in my being.

Upon heading home I reflected on how mentally tired I was, having nothing to do with the actual work load but rather due to my negative feelings. It really does consume a lot of energy to be upset, angry, and hostile. These feelings could have no outlet at home as that is unfair to those I love.

I thought about something I had heard in a bio-chemistry class some years ago while attending BYU. On the first day of class the professor was surveying the class regarding sentiments and exposure to chemistry. One student spoke up and remarked, "I hate chemistry." The professor replied, "You don't know enough chemistry to hate it." It seems irrational then, to have such loathing for a thing not well enough understood, for in so doing, the ability to understand is diminished and disfigured-that is to say the understanding is skewed towards the emotions whilst the learning was done.

I also thought of a thing learned in seminary my ninth grade year, perhaps the only thing I remember from that year in seminary. To paraphrase, "that which you find most at fault in others can often be found within yourself." I really find this to be true. I have my own arrogance and it certainly comes into play when confronting authority. For the most part I feel I do a pretty good job of repressing my base nature and am able to perform professionally and courteously.

As I reflect on last weeks challenge and the ensuing chastisement for not being more "Christian" I find the need to be more forgiving and understanding, as well as to seek for forgiveness. That was a feature in church this past Sunday-perhaps only to me as I was sensitive to the point. I have therefore determined to seek to try to understand and get to know this doctor better. I can start by building on common ground, like the fact that we are both LDS.