Hubris: Not Just a Problem for Hercules

The more time I spend in hospitals, the more I am convinced that there is a certain amount of hubris required to be a surgeon. When mother nature stamps out doctors, she most certainly must have a different cookie cutter for “the surgeon”. I realize I run the risk of making one of those overly general, wet-blanket statements here, but I think you’ll be hard pressed to find other nurses who disagree.

In case your desire to be an open-minded, non-judgmental, compassionate human being should try to sway you to side with the surgeon, let me present a brief recounting of a recent interlude between me and him that occurred last week:

I’m standing outside a patient room in the early afternoon writing the most epic of progress notes on a rather medically complex child when I feel a presence behind me. I turn to find a tow-headed man in scrubs, chest hair bared for all to see through the v-neck of his top. He is loudly chewing gum in the most obnoxious manner, a manner neither professional nor appropriate for a hospital setting. Before I can react he’s reaching for the bedside chart to check on my patient’s fluid output from the two chest tubes he had inserted.

I defensively slap my hand on the binder. Hello, HIPAA!? My face clearly says “Who the hell are you?”

“I’m surgery,” comes the reply with a smirk. I’m surgery? Not, I’m from surgery or I’m the surgical resident. Who died and left the profession to you?

I provide a brief update on the progress of our patient. I’m concerned about the chest tube outputs. I have the patient to water seal rather than wall suction.

[Side Bar: For you non-medical folks, water seal is just a technical term we use when we no longer use pressurized suction to remove fluid from a patient’s body. Water seal essentially means the tubes are draining via gravity and the patient is getting ever closer to have the tubes removed. Keep in mind these tubes are about the diameter of a quarter. Yikes!]

Instead of the daily total for each tube being closer to our goal of 200ml, the left side had dumped out a whopping 1060ml of pinkish-yellow fluid. Of course, it could always be worse. The fluid could be frank, bright red blood instead, but as a nurse, you shouldn’t allow yourself to think that thought lest it become a self-fulfilling prophecy.

“Surgery” seems to have left his math skills in the OR and, despite my careful documentation over the past 8 hours, he can’t seem to understand how the hourly totals add up to the cumulative 8 hour total. I have awesome, extremely legible handwriting so I know that this is not my fault.

This is the point in the conversation where he gives me a look that suggest that I am the real moron here.

“Is it putting out chylas?” he asks. Come again? What kind of question is that!? [Side Bar: First of all, it’s “chyle”. Secondly, chyle is lymphatic fluid]

“No,” I say, “it’s sero-sanguinous.”

“But is it chylas?” he asks again.

I am tempted to utter a Meredith Grey “seriously!?” here. How should I know if the chest tube is draining lymphatic fluid versus interstitial fluid? I’m not a micro lab. I observe output, color, consistency, odor…I don’t test to see where the fluid came from. But what do I know? I’m just the nurse.

With an air of exasperation, “surgery” whisks by me and into the patient’s room without a protective gown, completely ignoring the CONTACT PRECAUTIONS sign on the door.

I think about following him in, but then I think “oh well, let the jerk get MRSA”.



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