No, Thank You

"I don't believe it."

That's what the doctor said over the phone when Lori called him about Mrs. K. As if one of us would wake him up in the middle of the night just to fuck with his head a little.

"The other doctor is right here and I could have him read it to you," Lori told him. No, the doctor replied, adding that she shouldn't have bothered him about this, the patient had been having this pain all along, he had been adjusting her medications for it, and he already knew all about it so why was she calling him again. That sort of thing.

Mrs. K. had been in for an illness unrelated to chest pain and she didn't have a cardiac history. Her lungs were crap and we all know that can cause pain, but this was different.

"She says her pain is like a heaviness, she's guarding her chest, and I've never seen her do this before," Lori told the doc. Lori had ordered an electrocardiogram and had pulled labs off of Mrs. K.'s PICC-line. X-ray was coming up to do a quick portable chest.

"Who ordered all that?" the doctor asked Lori.

"It's a Telemetry floor, Doctor Phlegm. It's what we do."

Since he had declined to have the other doctor, a younger guy on his first hospitalist job, read the EKG to him over the phone, Lori suggested that they just fax a copy of it to Dr. Phlegm. He acquiesced to that, but still insisted it was no big deal.

Two minutes later he called back and ran off a breathless list of orders including labs, an EKG, oxygen, morphine, nitroglycerin, the chest X-ray, (all of which Lori had already initiated) as well as a drip and transfer to intensive care.

I got the story at seven in the morning when I got in for my shift and Lori was reporting off. She speaks with the tiniest bit of the most elegant accent. I don't think Dr. Phlegm likes accents.

They still had a copy of the EKG and it showed definite T-wave elevations in leads II and V6. Mrs. K.'s Troponin levels were twenty times higher than normal range, too. That's pretty much how you define and diagnose myocardial infarction these days.

Lori had nailed it. She did what all of us nurses live for, what we dream of doing; that is to say, she did her job. And all she got for it from the doctor was shit.