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Just let it go - but boy that's hard
Mountains
Veteran
I'll try to be brief, but the following story happened to me earlier this week and it may take a few paragraphs. I'm an ICU nurse, and was taking care of a very sick patient. The surgeon, who also happens to be the patient's attending physician (and is therefore "in charge" of everything to do with him) ordered me to insert a PICC line (a type of IV line). I gave him a blank look I guess, because the patient had at least five or six really strong contraindications for putting one in. To physically insert a PICC line in him could very well (and likely would have) caused him harm, and quite possibly killed him. I tried to gently explain to the MD why I couldn't do a PICC, and what I got in return was "You're just not getting what I'm saying..." (making it sound like I was a moron). I re-explained to him the reasons why I couldn't and wouldn't put a PICC in this man, so he got in a huff and demanded the house nursing supervisor come and do it. I told him she wouldn't do it either, which she confirmed when she arrived a couple of minutes later. The MD then got in a real huff and said he'd do it himself. Someone (I honestly don't remember who) went and got the materials he would need to put the line in.
Since one major reason for not doing it was that the patient had just had a cardiac pacemaker put in three days before (an absolute contraindication for a PICC), I asked the MD if he would at least speak to the cardiologist before proceeding. He said (typical of his normal attitude) that he didn't need to talk to anybody about it. I went out and called the on-call cardiologist on his cell to get him to verify that this was a bad idea, which he confirmed immediately. I asked if he would speak with the surgeon who was about to put the PICC in, to which he agreed. I took the phone in the room and handed it to the surgeon, who proceeded to tell the cardiologist he didn't have anything to say to him, and then literally threw the phone back at me.
I was so angry that I had to clear out of the patient's room before I said something I'd regret. In the end he didn't put the line in, and later that day took him to the OR and inserted a different type of line in the patient's groin that accomplished exactly what needed to be accomplished, but in a safer way. He could have done this to start with, and that would have been the end of it. This MD doesn't appear to comprehend the concept of "no" when he demands something be done. Had he elected to proceed with the PICC line, I would have physically put myself between him and the patient to prevent him from doing it until another MD arrived on the scene. I could very well have been fired, but my first, foremost, and only obligation at that point is to the patient and his well-being, and I would have happily been fired rather than see this MD kill the man or cause him serious harm. I've seen other patients die needlessly because of the exact same cavalier attitude and refusal to ask for or accept help from another physician. Three times, in fact.
I know this isn't something I should dwell on, but I'm so angry at the arrogance and cowboy attitude, simply because I had (quite calmly and rationally) explained why I couldn't do something he asked. Had there been no other choice it might be different, but there was, and a much safer one at that. I've pretty much avoided the MD the rest of the week. I will continue to work with him when I have his patients, and I will be professional and courteous, but I have exactly zero respect for this man's clinical judgement. Unfortunately he's a big money earner for the hospital, and despite having written up the incident and made it known to the medical director (as has been done in the past), nothing will happen because he brings in the bucks. Oh, and we can't fire a physician because that would ruin his reputation. So regardless of how bad a physician is, we have to grin and bear it because we wouldn't want to do anything to ruin his reputation. Exasperated? You bet! Welcome to medicine in America. Nurses we can fire, but not physicians. Don't believe what you see on TV.
Trying to let it go, but boy this one is tough..
Mtns
Since one major reason for not doing it was that the patient had just had a cardiac pacemaker put in three days before (an absolute contraindication for a PICC), I asked the MD if he would at least speak to the cardiologist before proceeding. He said (typical of his normal attitude) that he didn't need to talk to anybody about it. I went out and called the on-call cardiologist on his cell to get him to verify that this was a bad idea, which he confirmed immediately. I asked if he would speak with the surgeon who was about to put the PICC in, to which he agreed. I took the phone in the room and handed it to the surgeon, who proceeded to tell the cardiologist he didn't have anything to say to him, and then literally threw the phone back at me.
I was so angry that I had to clear out of the patient's room before I said something I'd regret. In the end he didn't put the line in, and later that day took him to the OR and inserted a different type of line in the patient's groin that accomplished exactly what needed to be accomplished, but in a safer way. He could have done this to start with, and that would have been the end of it. This MD doesn't appear to comprehend the concept of "no" when he demands something be done. Had he elected to proceed with the PICC line, I would have physically put myself between him and the patient to prevent him from doing it until another MD arrived on the scene. I could very well have been fired, but my first, foremost, and only obligation at that point is to the patient and his well-being, and I would have happily been fired rather than see this MD kill the man or cause him serious harm. I've seen other patients die needlessly because of the exact same cavalier attitude and refusal to ask for or accept help from another physician. Three times, in fact.
I know this isn't something I should dwell on, but I'm so angry at the arrogance and cowboy attitude, simply because I had (quite calmly and rationally) explained why I couldn't do something he asked. Had there been no other choice it might be different, but there was, and a much safer one at that. I've pretty much avoided the MD the rest of the week. I will continue to work with him when I have his patients, and I will be professional and courteous, but I have exactly zero respect for this man's clinical judgement. Unfortunately he's a big money earner for the hospital, and despite having written up the incident and made it known to the medical director (as has been done in the past), nothing will happen because he brings in the bucks. Oh, and we can't fire a physician because that would ruin his reputation. So regardless of how bad a physician is, we have to grin and bear it because we wouldn't want to do anything to ruin his reputation. Exasperated? You bet! Welcome to medicine in America. Nurses we can fire, but not physicians. Don't believe what you see on TV.
Trying to let it go, but boy this one is tough..
Mtns
0
Comments
Think how much good you did the patient. Sure it's hard to unwind from that, but you will eventually.
you think something should be done but you haven't decided weather you would do something about it or not.
once you decided of what will be the best thing to do when a situation like this arise, then you will do your best to do just that without any feeling of remorse or anger etc...
(best thing to do might be something, or might be nothing.)
It's hard to let go of that experience because you know that the patient was endangered, because you know it could easily happen again (or a similar miscall on this doctor's part) ... and because you care.
In this instance, I do not see you angered because of your own ego, but out of concern for the patient. Yet it is still anger that has to be dealt with ... how about looking at that doctor and feeling sorry for his great insecurity that drives him to be an MDeity and does not allow him to admit his mistakes. It's got to be pretty hard to be him, and trying to develop compassion for him will help reduce your anger.
First, of course congrats on doing good work for the well being of the patient. Your compassion shines directly through your words.
As far as the lasting anger, I wonder how many components of the puzzle are making you angry. Just how many arrows were shot at you, and how many more did you make from those that stuck?
People get caught in their certainty, doctors especially, but I've seen even well seasoned Buddhists become thick skulled and seemingly deaf. That the doctor's ego got in the way of wisdom is sad. That he then condescended you seems to have really gotten riled also. There he is, being an ass, ignoring your precise wisdom, and getting angry with you! Ego's get angry when they feel spited, it sounds like both sides of the exchange had that happen. Luckily, you were on the side of wisdom... at least in the sense of the PICC line.
I wonder if you can use your experience of anger toward the doc as a source of compassion for him. If you can see that your anger harms yourself, and not the doctor, then perhaps you can see how the doctor's ego harms himself as well? I wonder if the doctor's ability to hear constructive criticism is absent... in the same way your metta is absent for the doctor? When the situation is in front of him, perhaps it is simply absent as a path. It might be a long shot, but these events happen for us so we can learn compassion and equanimity. Then again, a good square kick to the groin might do the trick for him.
However you work it out, I hope you find happiness to match your courage.
With warmth,
Matt
STRONG WORK!! I have been an ER nurse for 11 years now I can ceratinly identify with how you feel.
Be happy! You pretty much knocked these out of the ballpark!
Forget this person's unskillful words and actions. Go meditate and let it be.
Mtns
These types of situations, I would suggest, would be very difficult for even the best Buddhist out there. Were talking about risking someone's life because of this particular man's impatience and his utter sense of self. I have seen this, to varying degrees and on many levels, in my time as an RN. What Mountains did was very difficult and trying. She stood up to a surgeon, and a surgeon who is a cash cow for that facility. If it comes time to side with someone, who do you think the hospital will side with? She showed lots of courage on behalf of another human being. I am sure Mountains will duly reflect on the day and work on areas she feels that need to be addressed, if need be. These situations can be fired at you point blank range with no warning, it takes a lot just to keep your perspective. I come home many nights and think this was skillfull, this wasn't so skillfull. I keep in mind that unskillfull side of me, do what work I need to do (usually Metta practice) and hopefully my next day at work is just a little more skillfull. Your dealing with lives, lots of egos, anxiety, big time issues, families, life and death- all the while your trying to be a skillfull,mindful compassionate Buddhist. It can be done, but your gonna run into Mara:rarr: an awful lot!
Yours in the Dharma,
Todd
As for that doctor, we should have compassion for him because he is the way he is because of something negative in his life. And it must have been pretty bad if he's the state he's in now. There's a lot of suffering other people go thru that we dont see. That's how I would rationalize it and let go. But yes it is understandably hard to let go of that situation.
Wish you the best. Peace.
As for that doctor, we should have compassion for him because he is the way he is because of something negative in his life. And it must have been pretty bad if he's the state he's in now. There's a lot of suffering other people go thru that we dont see. That's how I would rationalize it and let go. But yes it is understandably hard to let go of that situation.
Wish you the best. Peace.
"She" is a "he"
Mtns
Todd,
Certainly all those things you say are important to consider. I hold mountains in high regard, and only offered what I offered to give possible help if needed, not to criticize the situation (emotional, mental w/e) he is in. I only wish for him to find peace, equanimity and compassion in difficult times.
A friend of mine once said "She has a personality that would piss off a Buddha." I know its inaccurate, but I think smiles upon the points you're bringing up. Difficult is still heal-able.
With warmth,
Matt
Everything that I have seen posted by you seems to reflect a genuine concern and compassion on your part, as well as being well informed and well thought out. My apologies if I was being overly emphathetic; I have been party to many of just these kind of situations Mountains described. I didn't feel you were critical. And you are correct, it will best serve Mountains and his path to turn his anger into forgiveness and compassion for this person. You said "It might be a long shot, but these events happen for us so we can learn compassion and equanimity" I don't think this has to be a long shot. I believe this statement to be very true. All things, good and bad, are what make up our lives. Accepting this point is a good beginning. In accepting our lives for the reality they are, we often can find some of our greatest teachers. There is a doctor I work with (done alot of Metta work regarding her) and I know she will teach me something everytime I work with her. It may be patience, equanimity, forbearance, humility, compassion and will often easily remind me of the Four Noble Truths and the Eightfold Path. As hard as it can be, she is often my best teacher.
Yours in the Dharma and with Metta,
Todd
My bad! I stereotyped my own profession and assumed you were female. :doh:
Keep up the right effort and at least know (as trying as nursing can be) it's a pretty good calling for a Buddhist, right livelihood and all. All the best to you.
Yours in the Dharma,
Todd