The Good Doctor

It was near the end of the shift and I was saying to my coworker in frustration that I wished a good doctor would step in. She answered that four doctors had already seen the patient, but I again emphasized that we needed a good doctor.

When we had begun our shift, the patient was already circling the drain. He was a healthy guy who had joint replacement surgery earlier that day. Now he was blue, drifting in and out of consciousness, thrashing about, disoriented and no matter how much oxygen we gave him, it wasn't enough.

Day shift had called the anesthesiologist and his solution was to use a type of oxygen mask that would supply more oxygen. Later he gave narcan to reverse the morphine without effect. There was a good reason that his interventions didn't work, the patient was not overdosed. Yes, I know that we frequently overdose our patients, but this time the symptoms didn't quite fit.

When my coworker took over the care of the patient, I insisted that his surgeon be called. I figured that he would want to know that his patient was in serious trouble. The surgeon just asked us to call the on-call doctor to see him.

She came up and ordered tests to determine if he had a PE (pulmonary embolus). That's what we figured had happened to him, but she didn't see any reason to transfer him to a higher level of care, such as ICU. I don't like unstable patients on my floor because it's not a safe place for them to be, so I told the supervisor. She cringed when I told her about the patient's condition and that the doctor didn't want to order a transfer, but she didn't intervene.

The doctors then had a change of shift and the next on-call doctor took over. He was so sure that it was a PE that he ordered us to start a heparin drip. By this time, the patient had developed a wet cough and was wheezing, when he wasn't unconscious.

It was a surprise when the CT showed no blood clot in the lungs. The doctor cancelled the heparin and started treating the patient for pneumonia. There was nothing wrong with treating the symptoms, but after that, the doctor left. He was no longer trying to find out why the patient's lungs had suddenly filled with fluid. Pneumonia doesn't come on that quickly.

The patient was steadily deteriorating and I really wanted him off my floor. It was then that I was complaining that I wanted a good doctor. Then the phone rang. The surgeon wanted to know how his patient was. His nurse described what had happened and the surgeon said that it sounded like the patient had a fat embolism in the lungs. A CT scan wouldn't show that. He then hung up. I was astonished. Why doesn't anyone do something?

The phone then rang again. It was the on-call doctor ordering us to transfer the patient to ICU. The surgeon had called him and intervened. It turned out that we had a good doctor after all.

I don't know how the patient is. The last patient we had with that problem died, but at least now he is in the best place for him and receiving appropriate treatment.