Somedays I Feel Like A Mole or Why I Went to Medical School

I always wondered what doctors really thought of nurses, or how nurses were portrayed to medical students.  I could never really get an answer I truly believed because none of my doctor friends would ever make disparaging comments about nurses around me (or if they did they'd preface it with some disclaimer so that I wouldn't be offended).

I saw how some doctors listened to nurses, I noticed how some would always do the opposite of anything a nurse suggested or would ignore any information a nurse brought to the table.

The dynamics were always very different too, depending on the department and location.

The first ED I worked in the docs and nurses got on fairly well as a general rule. There was banter between the two, you could clarify an order without attitude, you could ask 'why?' if you didn't understand the rationale for something being given to a patient. It was expected with urgent patients that the blood work, x-rays, and I.V's would be initiated by the nurse before the doc saw the patient and you had better run for cover if they weren't. It was a pleasant place to work, although I must admit I was nauseated and insomniac with fear the first 6 months (I was a new grad).

In my second/third ED the nurses and doctors barely even spoke to each other, except out of necessity. The doctors wrote orders, put them in a slot, the nurses picked them up and carried them out. R.N's wouldn't initiate any sort of treatment (other than I.V's) without an order. And with certain M.D's you wouldn't even do that because then they'd make some passive aggressive remark to the patient like, "I wasn't going to order an I.V and make you get a needle for no reason but the nurse decided you needed one".

The two camps never socialized together. 

On the wall in the hallway to the department were a bunch of historical photos and documents from the hospital when it was established over 100 years ago. One of the documents was a framed timetable of nursing duties which started off with "0630h--clean and mop doctors lounge and locker room".

I am sure that some of those docs wondered why the nurses weren't still doing that before report.

Then I started working up North where the nearest doctor was hundreds of kilometers away (by plane ride only) and my sole interaction with them was by phone or teleconference. I generally had a great working relationship with all these colleagues who I strangely never met but spoke on the phone with many times. When I needed a medevac they'd arrange it and find me a bed in the south--no questions asked. There was a great deal of trust and respect (for the most part) because many of the physicians who worked in the receiving hospitals had been to these remote communities and knew what we were up against; we could do chest and limb x-rays, HgB, WBC (using a microscope, counter, and half an hour of spare time), HCG, fetal fibronectin, and RBS. With only 1 exception of the 11 stations I worked in there was no defibrillator, no monitors, no I.V pumps, no rapid troponin machine, and no blood.  The new residents were told in no uncertain terms--if an outpost nurse calls you for a medevac--you arrange it.

My only major head-bang-into-concrete-because-it-feels-better-than-this-conversation moment was once when I called to arrange a non emergent transfer of a patient who clearly needed a cardiology consult in the south. I told the ED consultant that the patient had been having unstable angina for over a week and due to his past history of heart attack and hypertension I felt that keeping him in the high arctic (i.e 8 hours by plane to a major hospital and cath lab) was unsafe. He told me not to "use the word 'angina' because that was a diagnosis. And nurses don't make diagnoses."

After that I worked in a very busy ED which happened to be at the bottom of two very large mountains that skiers, snowboarders, monoborders, and telemarkers enjoyed--sometimes to the tune of over 20 000 people on a busy day. This was like a fairy tale ED. 80% of the patients were pretty healthy but had some acute injury which we were really good at dealing with. People came in, we fixed them or stabilized them, and they went away satisfied (for the most part). This is not usually the case in most emergency departments. The morale between the nurses, docs, and paramedics was very good. They had Christmas dinner together, stood up for each other at their weddings, skied together, biked together, raced together. I loved it there and knew it was a place of trust when one day I saw the orders for a fx humerus that read: analgesic.

The paramedics, nurses, and docs were all very good at orthopedic trauma (to the extent of which I didn't appreciate until I had to witness ortho trauma handled in my subsequent ED's). With no doubt in my mind if any of those doctors were asked their opinion of nurses their deep respect and trust would shine through in any answer they gave. And the patients knew it too. Time and time again I had patients tell me--everyone here is just so nice and all of you seem to get along so well!

Fast forward to my last 4 months of nursing before moving to Ireland to become a medical student. I was working as a travel nurse in 2 different emergency departments--one was very rural and one was about 1 hour away from a tertiary center. Something changed, in a very palpable way, when my physician colleagues discovered I was going to medical school. Even though my knowledge base, education and experience hadn't changed--the way I was treated by the docs changed. One day a doc I barely knew and had hardly worked with turned around at the desk and said, "hey! aren't you the nurse that is going to medical school?" Um yes, and apparently word travels fast. He didn't know my name but he knew that fact about me.

Suddenly I was given more opportunities to suture (most of them knew that I sutured up North), I was invited to look at x-rays and shown what they were looking at, I was handed lab work and asked what the differentials were, I was doing small procedures under their direct observation. When I asked questions they really took the time to explain it to me, and then would often grill me about the answer at a later date. I was loving it. But it also left me feeling a little uncomfortable. I hadn't done anything special to deserve this treatment. There were many of my nurse colleagues that would have appreciated (and certainly deserved more than me) the interactions and opportunities I was getting.

If I had consistently had that degree of respect, that chance to discuss cases, and my opinion listened to I might not have gone into medical school. But every time I saw some medical student working through a list of differentials with a doctor or looking at an x-ray I thought "Hang on. I have a brain. I am curious. I want to know the rationale for these choices--not because I am being a bitchy-know-it-all-emerge-nurse-who-questions-your-every-move, but because I want to learn too".  But I was a nurse. And even though as a triage nurse I had to come up with differentials and acuity for every patient I saw I never had the reason or forum to bounce ideas off my physician colleagues. I did learn a great deal from the many fantastic, brilliant, hilarious nurses I've worked with along the way who've taken me under their scrub sleeve and shown me the way when I was walking around in circles (you know who you are...)

But it was that change in responsibility when I was seen as the 'nurse who is going to medical school' -and those extra opportunities started occurring--which solidified my decision. I was making the right choice to become a doctor. I couldn't live in the arctic permanently just so that I could have that autonomy and respect. At some point I'd have to live in the south where I was required to get an order to give a tylenol to a patient. It was too schizophrenic and too bizarre.

So now I am in medical school. And I feel a little schizophrenic again. Because I am still a nurse yet I am also a medical student.  Someday I will be a nurse and a doctor and I don't know what that is going to feel like or what that it going to look like in my practice. 

My first interface with the medical world as a medical student was very brief but gave me a glimpse of what is to come. We have this aspect of our education called the Early Patient Contact program which pairs us up with another medical student and we are given a chronically ill patient and a prenatal patient to follow for 2 years.

Our first meeting with the prenatal was at the doctors clinic, but we arrived before the doctor and the patient. The nurse greeted us and got us all set up in her office, let us use her computer to look at the charts, and went back to the main reception. During our entire interaction I wanted to tell her "hey! I am a nurse too!" but there was no need to and it would have seemed strange and artificial for me to just blurt it out. I guess a part of me wanted her to know that I knew where she was coming from, I wasn't some completely clueless 1st year medical student.

I have to chuckle at the irony of always wanting to come across to the medical students as a 'with-it' nurse yet now I wanted to come across to the nursing staff as a 'with-it' medical student.

I am pleased to see in my lectures from visiting consultants or during PBL sessions, nurses are mostly referenced with respect or used in anecdotes as the person who 'really knew what was going on'. Lecturers have made points to our class like "listen to the nurses", "respect the nurses and their knowledge", "nurses will save your ass" and "nurses will make your life hell if you come off as an arrogant medical student/doctor". All of which I, of course, agree with.

I almost never feel like a medical student, but some days I feel like a mole--sent by my nursing sisters and brothers to see what happens on the *inside* of medical school. What doctors really think about nurses, how nurses are portrayed in medical education. And of course I know, it comes down to the individual doctor and the individual nurse.

I am interested at the layers this metamorphosis will have for me. I like that the lines between nurse and doctor for me will forever be blurred because I know that I will always be a bit of both.   

In the meantime I'll be reporting back and keeping my fellow med students in line.