Saturday, September 20, 2008

Orientation

“This is an experimental hospital, so you are bound to see a lot of things that you feel are unethical. If you want to practice here, you will have to keep those feelings to yourself.”

It is my first day of orientation on a MICU in another university hospital where I will be working. My preceptor, Jim, has worked here for 15 years. It is hard to imagine that he could be so direct with all of his orientees. Perhaps he has sized me up quickly. He adds that once I have been around for a while and established my name, I will be able to intervene from time to time and say enough is enough. He does this himself and clearly feels proud of it and that it is his role. That is a good sign at least, but out the window goes any hope that this hospital is going to be different from the others I have worked in. But I knew that already, right?

“They are proud of being an experimental hospital. They just like to use the word ‘innovative.’ That means they try a lot of things on patients who have no chance of making it. If something works, they broadcast it. If something does not, they bury it.” Trial and error being what it is, I expect the latter happens much more than the former. Human experimentation anyone? These people are on the verge of death anyways, so how much harm can you really do to them. It can get to be an “anything goes” scenario if you play it right. It is always open season on the dying. They are defenseless. Even their families do not protest. Does everyone feel comfortable with this? This is where the miracles of modern medicine come from right?

Jim says that he sometimes flatly refuses to assist with experimental procedures and blocks them when he thinks things have gone too far. MICUs tend to get a lot of hopeless cases. Jim talks about how it is a good place to practice code skills. Knowing the end result will not be changed takes the stress out of it all. “We have fun with the codes. Well not fun really, but we take a few minutes at the end so that the new nurses can practice their chest compressions and stuff.” I decline the practice opportunity in advance. I do not really need it. I know what he means about codes being fun. They are exciting and they provide an opportunity to work closely with coworkers in a pleasing way. “It is a teaching hospital. This is what it means. Everyone needs to learn how to do these things. We try to stop it before it goes too far.”

I remember a story one of my nursing instructors told one day in lecture. She had gone to check on a student who had been placed in the ER for the day. She had peeked around a curtain to find her student alone, straddling a recently deceased patient, happily practicing chest compressions. Seeing her teacher, the student looked up, smiled and waved, “Oh, hi Professor Calloway.” Then she had gone back to her practicing. My instructor had stumbled away, thinking about how strange her life had become. I appreciate more and more how she shared her experiences like this with us.

2 comments:

bret said...

Disturbing.

I have only been working as a nurse for nine months now. I find that I'm experiencing situations where I have to think very carefully about what I say and/or do.

I sometimes have an internal conflict wondering: how do I fit in to the culture that stands in this hospital and in the attitudes of many of my coworkers?

Leo Levy said...

A coworker once told me that being a nurse means putting yourself in constant moral peril. It is not easy, and you will not always get it right. Keep thinking. That is the best thing you can do.