God Damnit

May. 17th, 2011 10:07 am
piasharn: (Lateral C-Spine in Flexation)
OK... so I told myself a while back that I a) want to post more on this thing, and b) do less bitching about things (my job in particular). However, I think that this warrants an exception to the latter part of said promise.

A bit of information that is relevant: with CT scans, a contrast medium is often used. It can either be drunk orally (PO), or injected intravenously (IV). Depending on what the doctor wants to see on the scan, one, both, or neither might be used. (If appendicitis is suspected, for example, one would ideally use both. When looking for a kidney stone, however, you wouldn't use either.) When an exam calls for IV contrast, part of my job is to make sure that there is nothing contraindicating the use of it. I have to check to see if the patient has any allergies to iodine. If they are 50 or older, I also have to check their creatinine results so that I know that the patient's kidneys are functioning properly. This is because the IV contrast puts a strain on the kidneys. If I were to use IV contrast on a person whose creatinine was too high, it could cause them to go into renal failure (or worse). There are some exceptions to this (i.e. dialysis patients), but it would take me a while to explain them all.

Still with me?

So, early Monday morning, I get an order for a CT with IV contrast on an inpatient. Before I even call the nurse to discuss bringing the patient down for the scan, I always check allergies, creatinine, etcetera. (Having OCD has turned out to be a blessing in this field of work.) The creatinine on this patient was high. Very high. There-is-no-way-in-hell-I'm-using-IV-contrast-on-this-person high.

I called the nurse who was in charge of the patient's care, because sometimes they (or the ordering physician) don't remember to check. Usually in this situation, all I have to do is alert them to the creatinine level and the exam is changed to a non-contrast study. Which is how it should be.

The nurse told me that the doctor was aware of the patient's high creatinine and wanted the study done with IV contrast anyway.

I explained that that was not possible. Even if the doctor wanted it, it is completely against hospital protocol. Which means that, like it or not, I can't do it. I suppose that if the doctor documented in the patient's chart that s/he was aware of the high creatinine, was authorizing me to do the scan with IV contrast anyway, and was willing to take full responsibility for anything that went wrong, I could have done it.

Could have, not would have, mind you.

Given that the patient is in his/her 90s, not in good health, and is DNR (Do Not Resuscitate) and could very easily die if I used IV contrast on him/her... Yeah, I'm not having that on my conscious. Even the nurse couldn't understand why the doctor was doing this. The ordering physician also seemed to be under the impression that we simply needed a radiologist to approve the exam and it could be done. I had to point out that there is no radiologist present during the graveyard shift (and even then, I can't imagine why they would allow said exam to be done).

The nurse was very uncomfortable with the whole situation. There's no way I would consent to inject contrast into that patient. (In general, I am a very easy-going person who does not like confrontation in any form, but I can be a stubborn bitch in some cases, and I don't care if you're a goddamn M.D. and I'm only a technologist. You will not fuck with me in these situations. Write me up. Suspend me without pay. Fire me. Do it. I don't give a shit. I am not doing something that I know could kill a person.)

In the end, the doctor agreed to delay the scan until later in the morning. I made sure to tell the tech who relieved me about the situation and to emphasize that we needed one of the radiologists to talk to the ordering physician about this exam. S/He wasn't listening to me or the nurse, but perhaps another doctor could talk some sense into them.

If you're curious, the exam was eventually done without IV contrast. Still, the fact that this doctor was trying to use IV contrast on this patient at all really, really bothers me. I just... I... I don't even have the words to express how angry this situation made me. If you're a doctor, you're job is to heal and help to the best of your abilities. You don't do this shit. You just don't.

Or you shouldn't, at any rate.

I've come across some pretty lousy doctors over the years, but this one takes the cake. Needless to say, there is a new name on my list of doctors-I-am-not-letting-laying-a-finger-on-me list.

Now, if you'll pardon me, I just had the weekend from hell (the aforementioned incident was not the only bad thing to happen. On Saturday, I worked for 12 hours straight with only five minutes to sit down the entire time, just to give you a hint.) so I'm going to get something to drink and go watch cute, sparkly anime until I feel better again.

God Damnit

May. 17th, 2011 10:07 am
piasharn: (Lateral C-Spine in Flexation)
OK... so I told myself a while back that I a) want to post more on this thing, and b) do less bitching about things (my job in particular). However, I think that this warrants an exception to the latter part of said promise.

A bit of information that is relevant: with CT scans, a contrast medium is often used. It can either be drunk orally (PO), or injected intravenously (IV). Depending on what the doctor wants to see on the scan, one, both, or neither might be used. (If appendicitis is suspected, for example, one would ideally use both. When looking for a kidney stone, however, you wouldn't use either.) When an exam calls for IV contrast, part of my job is to make sure that there is nothing contraindicating the use of it. I have to check to see if the patient has any allergies to iodine. If they are 50 or older, I also have to check their creatinine results so that I know that the patient's kidneys are functioning properly. This is because the IV contrast puts a strain on the kidneys. If I were to use IV contrast on a person whose creatinine was too high, it could cause them to go into renal failure (or worse). There are some exceptions to this (i.e. dialysis patients), but it would take me a while to explain them all.

Still with me?

So, early Monday morning, I get an order for a CT with IV contrast on an inpatient. Before I even call the nurse to discuss bringing the patient down for the scan, I always check allergies, creatinine, etcetera. (Having OCD has turned out to be a blessing in this field of work.) The creatinine on this patient was high. Very high. There-is-no-way-in-hell-I'm-using-IV-contrast-on-this-person high.

I called the nurse who was in charge of the patient's care, because sometimes they (or the ordering physician) don't remember to check. Usually in this situation, all I have to do is alert them to the creatinine level and the exam is changed to a non-contrast study. Which is how it should be.

The nurse told me that the doctor was aware of the patient's high creatinine and wanted the study done with IV contrast anyway.

I explained that that was not possible. Even if the doctor wanted it, it is completely against hospital protocol. Which means that, like it or not, I can't do it. I suppose that if the doctor documented in the patient's chart that s/he was aware of the high creatinine, was authorizing me to do the scan with IV contrast anyway, and was willing to take full responsibility for anything that went wrong, I could have done it.

Could have, not would have, mind you.

Given that the patient is in his/her 90s, not in good health, and is DNR (Do Not Resuscitate) and could very easily die if I used IV contrast on him/her... Yeah, I'm not having that on my conscious. Even the nurse couldn't understand why the doctor was doing this. The ordering physician also seemed to be under the impression that we simply needed a radiologist to approve the exam and it could be done. I had to point out that there is no radiologist present during the graveyard shift (and even then, I can't imagine why they would allow said exam to be done).

The nurse was very uncomfortable with the whole situation. There's no way I would consent to inject contrast into that patient. (In general, I am a very easy-going person who does not like confrontation in any form, but I can be a stubborn bitch in some cases, and I don't care if you're a goddamn M.D. and I'm only a technologist. You will not fuck with me in these situations. Write me up. Suspend me without pay. Fire me. Do it. I don't give a shit. I am not doing something that I know could kill a person.)

In the end, the doctor agreed to delay the scan until later in the morning. I made sure to tell the tech who relieved me about the situation and to emphasize that we needed one of the radiologists to talk to the ordering physician about this exam. S/He wasn't listening to me or the nurse, but perhaps another doctor could talk some sense into them.

If you're curious, the exam was eventually done without IV contrast. Still, the fact that this doctor was trying to use IV contrast on this patient at all really, really bothers me. I just... I... I don't even have the words to express how angry this situation made me. If you're a doctor, you're job is to heal and help to the best of your abilities. You don't do this shit. You just don't.

Or you shouldn't, at any rate.

I've come across some pretty lousy doctors over the years, but this one takes the cake. Needless to say, there is a new name on my list of doctors-I-am-not-letting-laying-a-finger-on-me list.

Now, if you'll pardon me, I just had the weekend from hell (the aforementioned incident was not the only bad thing to happen. On Saturday, I worked for 12 hours straight with only five minutes to sit down the entire time, just to give you a hint.) so I'm going to get something to drink and go watch cute, sparkly anime until I feel better again.

July 2012

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