Episode Transcript
[00:00:03] Hi, everyone. This is Dawn Klem, and you are on my podcast, Milkweed and Monarchs.
[00:00:11] When I look back on my nursing career, over 45 years in health care, beginning as a corpsman in the military, in the Navy, to the day that I retired, I think that one of the things that stands out the most to me is that I was a fierce patient advocate, and you can imagine why. I just think about some of my cancer patients.
[00:00:46] They're already frightened of their diagnosis, and they really don't know what kind of questions to. To ask the physicians.
[00:00:56] The physicians are busy, and even though they think they're doing a pretty good job of explaining, and it has gotten better, I have to say, over time, there's still a disconnect between what the patient understands and what the physician is telling them. And so it is part of the nurse's role to. To be an advocate for that patient.
[00:01:27] I would find myself lots of times going in and speaking to the patient before the physicians made rounds and getting a list of their concerns that they might want to ask the physician or needed help asking the physician. And that made it easier for me, too, so that I had a better understanding of what, how the patient was feeling and what I was going to be able to do to help alleviate some of that worry.
[00:02:02] So I think I was a fierce advocator.
[00:02:08] That's probably putting it mildly.
[00:02:11] But I definitely made it my mission that, that that was going to be one of the things that I excelled in. I'm a strong communicator, and so this is something that I really felt like I could help with the patient and the physician and create a better bond between the two of them.
[00:02:34] And I did that on a regular basis.
[00:02:40] I'm going to tell you a story of fierce advocation today, and you'll get an idea of how I was as a nurse when I was working on the inpatient oncology unit at Main Medical center in Portland, Maine.
[00:03:02] So in previous episodes, I have told you that it was a 44 bed inpatient unit.
[00:03:09] We had it divided up into three nurses stations, and the third nurses station was for our bone marrow transplant patients.
[00:03:20] So it was patients who had lymphoma.
[00:03:25] We also took care of a lot of people with leukemia and Hodgkin's lymphoma. So there were. Most of those are. Well, they all are blood disorders or blood cancers of the patients.
[00:03:44] So that was down in Station 3. Those were the type of patients that we cared for down there, and they were acutely, acutely ill.
[00:03:53] In the second Nurses station were patients, predominantly female patients, who had ovarian, uterine or some kind of female cancer, not necessarily breast cancer. A lot of times breast cancer patients didn't need to come into the hospital, but it was more uterus and ovarian cancer patients that had gone through surgery and were getting chemotherapy inpatient.
[00:04:27] So that was in that unit. But as you can imagine, there is overflow. So if we had empty beds down there, some of our medical patients with cancer would go down there.
[00:04:40] And then station number one was the medical oncology patients, your lung cancer patient, your kidney cancer patient, your liver cancer, colon cancer.
[00:04:55] So all of the other generic esophageal cancer, those patients were predominantly in Station 1.
[00:05:03] And Station 1, when you came on the unit, was the first station that you entered into the unit. It was in a large oval circle shape, the unit. And in station number three, where the bone marrow patients were, because we did bone marrow transplants then, we had five isolation rooms at the back, like a little spur off from the circle.
[00:05:34] So it was a large unit. It was a lot of territory to cover. I think they, when they designed it, they designed it so that it would have three nurses stations, so the nurses could stay in their own little pod that way.
[00:05:50] But it was still a lot of geography to cover, and it was hard on everyone, really. It was. It was hard to maneuver that unit.
[00:06:02] So on the weekends, the attending oncologist would come in and he would have to round on all the patients that were medically oriented. He didn't round on the gyn or gynecological patients, he just rounded on the medical patients. And that did include the bone marrow transplant patients as well.
[00:06:31] So he was there, he or she, because we had female oncologists as well, they were on that unit. They might get there at 10 o' clock on a Saturday and they were lucky to get out of there by 4 o' clock in the afternoon. I mean, it was a lot, a lot of patience to see and it was a lot of geography to cover.
[00:06:56] But on this one particular day, I was working in Station 2, I did have a medical patient down there that was an overflow patient because Station 1 was full and one of our male oncologists was in to do rounds. He started in Station 3. His motto was, get the most acutely ill out of the way first and then make your way around.
[00:07:28] And they spent a good portion down there because they were acutely ill.
[00:07:34] He had made it to Station 2 to see the overflow patients in there, and he had rounded there and he made his way down to station one. It was a busy day, there's no doubt about it.
[00:07:50] And so I had two of his patients.
[00:07:56] The one patient, I had gone in to see her, she was a lady in her 70s, and her daughter was present in the room. They had put the call light on for me to come and see her. And I went into the room, and the patient was starting to struggle with her breathing.
[00:08:16] I listened to her lungs. I didn't really hear anything concerning, but she was definitely having a hard time.
[00:08:26] The physician had already rounded on her.
[00:08:29] I looked back at his notes, and she must have been stable when he was in the room.
[00:08:35] And so he had said, stable, continue treatment as ordered.
[00:08:41] And he was still on the unit down in station one. So I thought, I'll just go down and give him a heads up about what's going on with this patient.
[00:08:52] So I went down to see him and I waited. He just finished a conversation with somebody, and I said, hey, I wanted to just give you a heads up. The patient in room.
[00:09:03] Whatever room number it was is starting to have a little dyspnea. She's struggling with her breathing, and she's been fine up to now. I read your note. I didn't see anything.
[00:09:17] He says, why don't you go ahead and get her out of bed, put her up in a chair and see if she does any better.
[00:09:22] So I go, okay, that's a good idea.
[00:09:25] So I go down there and with the daughter's help, we get her up in a recliner.
[00:09:30] But now she's not. She's starting to look kind of yucky, you know, still struggling with her breathing.
[00:09:38] I took her vital signs, and her temperature had spiked way up, so she was over 101 now. And I'm like, something is going on here. Something is done, definitely going on.
[00:09:53] So I go, I got to go down and see him again.
[00:09:56] I just kept thinking, I want to get this taken care of while he's still here, because once he leaves, then we have to have him paged. And it takes a long time sometimes for them to call right back. So while he's here, I want. I'm going to get this problem rectified.
[00:10:16] So I go back down to station one to see him again.
[00:10:20] And by now he sees me coming, and I can tell immediately that he is annoyed that I am coming back to talk to him again about this patient.
[00:10:31] I said, I got her up in the chair like you suggested, but something isn't right. There's something that is clearly wrong with her. She's struggling to breathe. I took her temp, she spiked a little bit of a temp. She's just not right. I really think that you probably need to come back down there and just take another look at her.
[00:10:54] Give her some Tylenol. He belted out at me and literally, I mean, he yelled at me to give her some Tylenol. And I'm sure if there would have been a bubble over his head and it would have said, please, God, make her go away.
[00:11:15] I'm not saying he didn't have a long day, but this is his job.
[00:11:23] And my job is to point out problems with the patient.
[00:11:29] Okay? That's it. Let's just be clear about it.
[00:11:34] So I go back down to the other nurses station. I get the Tylenol out, I give her the Tylenol.
[00:11:41] She had been on oxygen previously, so I put oxygen back on her.
[00:11:46] Got, we got her legs up in the air now in the recliner, but she's struggling and she really does not look good at all.
[00:11:56] And now I'm kind of annoyed.
[00:12:00] I feel like I'm a pretty reasonable nurse. Of course, that's in my own mind, right?
[00:12:07] And I try really hard to be independent with the patients if I can be.
[00:12:13] So I don't want to bother the physicians any more than they want to be bothered. But when I have a problem, I'm speaking out because there's a reason.
[00:12:25] So by now I am irritated that he yelled at me at the nurse's station. I am completely fuming over that and worrying about my patient at the same time.
[00:12:41] And I said to myself, I'm going back down there one more time. I don't care. I am definitely going back down there and that is the way it's going to be.
[00:12:52] So I, fuming, smoke was probably coming out of my ears, stomped my way back down to station number one, where he still was.
[00:13:05] And I went up to him and I said, I got her out of bed like you suggested, and I gave her Tylenol like you suggested.
[00:13:17] And she is still doing poorly, like I've been trying to tell you, I hope you're happy. And I turned around and stomped off. I don't know what possessed me to, to act like that, because I knew something wasn't right, okay? And I was trying to get his attention.
[00:13:44] So the next thing you know, it's the end of the shift. It was right at the end of the shift when all of this was going on. So I was going to be done at 3:30 and the new shift was Arriving.
[00:14:00] So it was up to me to give report to the next oncoming shift nurse.
[00:14:08] And we had a back room behind the nurses station where we could give our report in person, privately to the next nurse.
[00:14:19] And it was good because if we needed to get up, we could go and take a look together at the patient.
[00:14:27] It was just an excellent setup, the way they had done that unit, even though it was a long walk many times.
[00:14:36] So I am in the back room getting ready to give report, and believe me, I am a very unhappy nurse. At that time, the patient's daughter was beside herself.
[00:14:52] The patient was struggling to breathe. I was hoping the Tylenol would kick in and maybe her fever would break, but that wasn't going to explain the respiratory distress.
[00:15:06] So I sat down, and I was starting to talk to the nurse, the other. The oncoming nurse, but I was so angry, I put my middle fingers up in the air, and I said something very derogatory about that doctor and how unhappy I was that he couldn't take the time to get down there and see this patient when clearly there was something wrong.
[00:15:40] So right when I. And I had my back to the door, right when I had finished my little tirade, I just happened to turn around and guess who is standing in the doorway. Yes.
[00:15:58] The physician was standing in the doorway.
[00:16:01] And he said, dawn.
[00:16:03] I came down, I looked at the patient. You're right, she is not doing well.
[00:16:10] I've ordered a set of blood cultures to be drawn on her, and we're probably going to have to get her started on IV antibiotics right away. I don't know if she's septic, which means blood infection, or if. If something else is going on, but let's do a workup on her and. And get her straightened out. And then he kind of pats me.
[00:16:35] He pats me on the back, and he turns around and walks away.
[00:16:40] I look at the other nurse and I go, great.
[00:16:45] I said, of course he would see me doing that. She was in hysterics, laughing about my very bad behavior.
[00:16:57] But at the same time, we knew that this patient was going to get treated now.
[00:17:04] And that part was good.
[00:17:06] I mean, I don't know. I think it was me going back to the station the third time and saying, I did what you told me to do, and I hope you're happy, because she has not improved at all.
[00:17:20] When you have made me that mad, then you know something is clearly wrong. And I think he did, too.
[00:17:30] Well, time went on.
[00:17:33] We got that patient worked up, and then I left for the Day I helped get her settled, get the lab up there, get the blood cultures drawn, and also got the orders in the computer for the IV antibiotics and got them up there so that they could get her going before I left.
[00:17:55] And then I was off from the unit for like four or five days because I was in the middle of graduate school school at that time, so I worked a lot of weekends and during the week I wasn't as often on the unit, but I went home. I was seething mad, even though I had one. Just the fact that I had to get to that point where I was having a major meltdown kind of annoyed me. Like, why don't you believe me? I'm. I'm not talking just to hear myself talk, you know what I mean?
[00:18:29] I take my job seriously and I'm trying to advocate for a patient that has a problem.
[00:18:37] So I went home and I was kind of fuming mad the whole drive home. And thankfully I had a 20 minute drive. So by the time I got home, I had gotten it out of my system. And actually, I should be happy because once I threw my little meltdown, temper tantrum, the patient ended up getting what she needed.
[00:18:56] But nobody likes to go to that length, you know what I mean? I get that he's tired, I get that it's a long day for him, but this is what you went to medical school for. That's what I kept saying to myself. I'm sure he wouldn't want to hear that.
[00:19:13] He was a good physician.
[00:19:15] He was a good physician, but I don't care. He should have listened to me.
[00:19:22] So anyway, the four days go by and I'm not thinking too much of it, I managed to get over myself.
[00:19:30] And I'm at the parking garage elevator getting ready to come back to work, and lo and behold, the elevator door opens and guess who's standing there?
[00:19:46] That doctor. Okay, there's nobody else waiting for the elevator but me. There's nobody else on the elevator but him.
[00:19:57] Now if you don't think that that was a God moment, then you're crazy, because God definitely set that up for me to be able to face him directly in a room without a lot of people around.
[00:20:13] And he saw me when the doors open and he gave me the biggest grin on his face and he said, I have missed you.
[00:20:25] Where have you been? I go, I've only been off for four days, you know, I'm in the middle of graduate school, which he did know. And I said, I'm coming back up there today. He says, well, I really miss you when you're not up there, because, believe it or not, you definitely make a difference when you're on the unit.
[00:20:48] And I was like, oh, my God, I gotta go home and mark this on my calendar.
[00:20:57] That I actually got past my little hissy fit with him, and he told me he appreciated me, and that really was all I needed to hear.
[00:21:15] I was over it immediately after that.
[00:21:20] I knew that I had done the right thing, and he knew that I had done the right thing. And even though I had to storm around a little bit to get to that point, it all paid off for the patient. And that's the whole point.
[00:21:38] But, you know, being in that role where you're an advocate and someone's not paying attention to what you're trying to say is not always an easy job.
[00:21:50] And I just hope that people who listen to this podcast or my friends that are nurses, they know. They know all too well what it's like to try to advocate with a physician who does not want to hear what you have to say.
[00:22:09] So this is for a shout out for all nurses out there who have been in my same position and have risen above what the physician. The roadblocks the physician is putting in your way, and you win for the patient.
[00:22:30] And that's really why we're nurses.
[00:22:33] That's really is why we're nurses.
[00:22:37] I went home that day with a skip and a song in my heart, and I couldn't wait to tell my husband. Can you believe it? I actually made a difference, and he pretty much told me so.
[00:22:58] I hope you enjoyed my story today.
[00:23:03] I have so many stories like that, but this is the one that stick stuck out the most in my head, and I think it's because I was flipping him the bird, which I'm. I'm ashamed of myself, but that just tells you the level of frustration I had. I'm flipping him the bird, and he walks in the room just in time to hear my whole report out to the other nurse. That's how frustrated I was.
[00:23:30] But in the end, there was a good outcome, and that's all that counts.
[00:23:36] And the best part of the story is he ended up becoming one of my mentors for me when I was in graduate school, and we were great friends after that.
[00:23:51] I guess sometimes you just have to go through a little turmoil to get to the other side of respect until the next time.
