A nurse’s intuition

Every once in a while, someone tells me, “Thanks for saving my life, doc.” And I feel slightly guilty.

I learned an awful lot of stuff in medical school. But as a newly minted doctor wearing my crisp white lab coat and walking into the ICU for the first time, I didn’t know a damned thing. My cousin Fanny, a nurse, sent me a med school graduation card and wrote, “If you treat nurses with respect, they will be your ally and make you a better doctor.”

I remember that the first ICU nurse I worked with right out of medical school, Lynn, was kind and soft-spoken. Our patient was crashing. Septic shock, on the ventilator, pneumonia and in atrial fibrillation. Lynn asked me what I wanted to do about the low blood pressure. I was sure I would be committing murder if I made any decisions. The base of my neck felt cold and sweaty.

“Um, I honestly don’t know … Got any suggestions?”

She read me. She suggested giving some IV fluids to start with, and possibly asking my supervising resident about starting a pressor medication. I did both, the patient got better, and she had my back for the rest of the month, preventing me from inflicting death and destruction on countless unsuspecting patients. (The rule that you should never go to a teaching hospital in July is a pretty good rule to follow.)

A few months later, I was at a different ICU in the VA. Another crashing patient. The nurse, older, a bit of a smoker’s husky voice, was a battle-hardened warrior nurse who took no BS from snotty young doctors.

“Well,” she said, edgy, “our little patient has white out of the left lung, afib, tachycardia, is still on heparin that the intern before you didn’t want to stop, is now bleeding out of his rectum, NG tube and endotracheal tube and has a systolic blood pressure in the toilet. So tell me, what do you want to do, DOCK-TOR!”

This time, I read HER. With a bit more confidence, I asked almost deferentially: “Well, you know the patient a lot better than I, so what do YOU think is best?” Which not only led to better care for the patient, since she had spent the last 11 hours with him, but she also became an ally and teacher and friend.

The names of my teaching attending physicians during residency were the leading voices in pulmonology, nephrology and cardiology not

just in the USA but in the world. And yet I learned more about being a doctor from spending the early morning hours awake in a nurses station or an ICU trying to figure out what to do and talking it through with the patient’s nurse. It always seemed strange that the next morning when we rounded and reviewed all that had been done, the nurse had already changed shift and wasn’t there to take any of the credit.

Some nurses have this weird “spidey sense.” If there is one true certainty in the world, when he or she says they have a “bad feeling” about a patient, regardless of all the normal lab work, and X-rays, something very very bad is gonna happen. A heart attack, an intracranial bleed, pneumonia, a pulmonary embolus are a small fraction of the myriad “saves” made in just the last few months thanks to a nurse with a spidey sense.

The next time someone says to me, “Thanks for saving my life, doc,” it’s likely that a nurse was behind that save.