Several years ago, a doctor threatened to have me fired because I refused to give a chemotherapy without adequate pre-medication to a large, newly diagnosed leukemia patient. It was a doctor I respected but because of my extensive training as an oncology nurse with special experience in high risk leukemia patents, I refused to administer this order because I knew it could possibly harm the patient. The physician came in on his weekend off, gave it himself and admonished me in front of our patient for delaying his chemotherapy and told me I would be meeting with him and my Supervisor come Monday and by Tuesday, I would be lucky to have job.
This story took an unexpected turn for this patient, me and the doctor. It has relevance to the current direction of health care reform. For our Congressional Representatives, many progressives know in their experience that a weak, bad bill offers far more harm to patients than delaying this plan without constructive changes.
After the humiliation at the patient's bedside by the physician with his smiling intern at his side who got his first lesson on appropriate nurse-doctor relationships, the patient received the chemo by the doctor. I not only refused to administer the drug but ruined his weekend by making him come to the patient's bedside to do what I refused to do. I was the only chemo-certified nurse on duty. In addition, I had called the oncology nurse specialist at home, who was coming in to help. Calling in the RN calvery was my back-up. Debbie was the best in the business and could order drugs I couldn't as an RN.
After the dress-down in front of the patient, I went back to work and soon received a call from my nursing Supervisor to report to her office Monday morning. I was to face disciplinary charges that would lead to a suspension at minimum and possibly termination if I did not formerly apologize to the doctor and patient, both verbally and in a written letter. To be honest I wasn't worried about my job. I had representation with CNA, the California Nurses Association, the strongest voice for me as a nurse I could possibly have. I was worried about the patient. I felt I hadn't done enough to stop the whole process putting the patient at risk by an overly tired MD who wasn't thinking as clearly as he should.
I continued my rounds, trying to keep my mind off what happened. After an hour, the call light for this patient went on. Sensing dread, I ran toward the room. I noticed that the wall to the right of the patient had chunks of yellowish bile dripping to the floor. The sounds of the patient gasping for air is one I will never forget. Fish out of water sound less distressed. Ashen, that's gray to non-nurses, eyes popping out of his head, the patient continued to projectile vomit all over himself, me and floor as I hit the code button and put the patient
backward, to improve blood flow to the head.
Funny how training kicks in. I could hear the patient asking what was happening to him. I kept reassuring him that things would be all right. I ordered 50 mg of Demerol stat, as the oncology nurse spealist walked through the door. Great minds think alike as she ran back to the nurses station to get the demerol with another 50mg on hand. Oxygen, by mask, was placed immediately on the patient, as another nurse ran into the room with our blue crash cart. My goal was to keep the patient from crashing.
With no doctors in sight for the first 15 minutes, as our nurse team, worked to stabilize the patient. The patient in essence, had an allergic reaction to his chemo which would have been prevented with the medications I had earlier advocated for. Without heavy duty pre-medications,the doctor gave straight chemotherapy, which started a whole chain of potentially life threatening events, including a temperature spike to 102 and high blood pressure. A cooling blanket, IV reglan, prednisone were ordered and being run in by our nurse run code team, with our nurse specialist at the helm. Within 30 minutes and a nervous Intern standing paralyzed at the door, the patient was much better. Temp dropped to 100, vomiting stopped and the BP instead of 190/110 dropped amazingly to 130/92. Instead of a heart rate of 140, it was now 90 and regular.
The patient was alert for most of the code we were running looking frightened and puzzeled at why this had happened. I kept comforting the patient, letting him known that he wouldn't be going to the ICU and he was in good hands. Most of the other nurses had taken my other patients so I could remain with the patient through this experience.
When left that day, I felt that I accomplished my goal. But Monday would soon be upon me.
When I showed up monday morning, I was informed that the meeting had been canceled and the Doctor wanted to meet with me, privately. When I faced him, I could tell he understood fully why it was necessary to listen to an experienced nurse and not rush ahead with a bad treatment program. He apologized for making my day go badly and thanked me for what I did after he left. I told him that he didn't make my day go badly, it was the patients day that did. My feelings were of no consequence but the patient's were. Trust in our judgements had been compromised by not listening to a nurses' experience and training. Patients want to feel we have their back and we know what we are doing by preventing side efffects of the drugs we give. Their lives are in our hands daily.
It is the same with health care reform. If the treatment plan makes a bad situation worse for the patient, then don't vote for it. Begin again until you get it right. Patients lives will be at stake and a bad bill that makes their and their providers lives worse will not be easily forgotten let alone undone. Advocacy is never easy but that is what patients expect from us 24/7.
This bill must put the patient first before anything else. If it doesn't do that and we know that there is a better plan, then take the time to make it right.