Thursday, September 25, 2008

Not My Best Moment II: The O.R. as a Cultural Anthropology Lab

I have friends who are nurses.

I have friends who are surgeons.

I have friends on the housekeeping team.

I have friends who are physicians in other departments.

When we are acting in our professional capacity, we sometimes have to assume certain roles according to our expertise, with some roles more directive than others. In the lunch room, though, we're all Red Sox fans together.

Or I should say, almost all.

I've heard some disillusioning things about some of the nurses' attitudes to members of the housekeeping staff. Some of the nurses have told the night crew to stay away from the leftover coffee in the coffee pot. Others have warned the night cleaning staff not to trespass into the area behind the main O.R. desk, which begs the question, how then are they supposed to do their work and empty the waste paper baskets or sweep the floor in that area?

It sounds very much like the housekeepers have been spoken to as if they were children or chattel. I am sick at heart to hear about these things. One of the reasons I prefer life in America to life in the Philippines is that here, people aren't supposed to expect "lording it over others" to be acceptable, as it often is in countries like mine. Here the people we serve are not supposed to be our "betters;" they pay us, we work - it's a contractual rather than a feudal relationship that demands mutual respect of people's rights.

In theory, that is. But the sad truth is that there is classism here. There are people who look down on those who have less education, less income, or more menial work than they have. There are those who would refuse to recognize the intrinsic dignity of another simply because she's holding a mop rather than a scalpel.

One of those is the woman I once rebuked for behaving unacceptably during a crucial moment in the O.R.

This same woman, Nurse X, yelled at my friend on the housekeeping staff, let's call her Z, to get her cleaning supplies cart out of the way while a patient was being wheeled out of the O.R. I saw the incident. The cart was not in the way to begin with. Nurse X took Z by the shoulders and shoved her to the wall, crashing her into the cart in the process, causing the cleaning water to spill into the corridor and Z to nick her shin. Nurse X roughly manhandled Z, who is small, in a way she would never dream of doing to a man "of rank" in the hospital.

It happened so fast. I was so shocked I didn't know what to say, then it was over and people went back to the hustle and bustle of O.R. life, and I got pulled away to take care of some medical thing. Later I kicked myself for not saying something - for being a weak leader, and succumbing to Bystander Effect - then rationalized my shocked silence by telling myself that Nurse X would have made an ugly, unprofessional scene right there in full view of other staff and patients, and it would have been fruitless to allow a scene to be made. But I should have done more. What's that famous line - "All that is necessary for evil to triumph is for good men [and women] to do nothing."

I talked to Z afterward to see if she was ok, and she was not. Later that evening Z's supervisor approached me to ask about the incident and I spewed my guts out, not just about the horrifying incident but also about the stupid coffee pot thing and the behind-the-desk rule. But I don't think that "testimony" will do enough, and I went to bed that night knowing that in a very real way I had failed a friend.


Anonymous said...

I make it a point to be nice to our cleaning people because without them our tiny RT offices would be even more dank.

I am sorry to hear of nurse X and housekeeper Z. I don't wish to speak ill of my colleagues, but for some reason most of the negative encounters I've had with nurses have been with OR and PACU nurses. My experiences with them as a group lead me to cautiously hypothesize that they consider themselves better than others, for whatever reason.

Anonymous said...

I imagine most of us have been in the same situation of perceiving an injustice, but not reacting fast enough to properly intervene. In the heat of the moment it is also not always clear what is the best course of action. Nurse X certainly appears to need some re-education by those in a position to demand it.

Ron Newman said...

Have you considered writing a short letter to Nurse X, explaining why you think her actions were inappropriate? That might be a better alternative to directly confronting her.

Anonymous said...

Disgusting. At least you made it clear to the supervisor what had happened. As a lawyer in a "prestigious" law firm, I have seen the way other lawyers treat paralegals and secretaries, although its been verbal, not physical, abuse.

I always want to remind the lawyers that Secretary X is a concert violinist in her spare time (i.e, she can do other things besides law, which generally the lawyer cannot) or that Paralegal Y went to a better university than did the attorney (and is just doing this until she gets into law school). I need to find a way to bring these things out into the open to bring the lawyers down a few.

Anonymous said...

How sad. Why is it that just because we are at work are we perceived to be in these fixed hierarchies? I would imagine that such a thing would not occur if these individuals were 2 people walking on the street. And if we are in a social order, professionalism and maturity should cause a person in a position of authority to be held to a higher standard, not allow them to treat others as below them. In the care of patients, we are all part of a team with equally important jobs.

One of my best teachers in surgical residency was an attending who would stay after each case to help clean the room.

Anonymous said...

Co-worker violence is never OK, and that is exactly what this incident was. Nurse X should be disciplined. End of story.

I thought you said you were the housekeeper's friend?

Is your conscience's horrid victimization by "Bystander Effect" how you rationalize your cowardice and make this about you?

It should be about your supposed friend's human dignity. It should be about keeping your workplace safe and helping a coworker address an anger management problem, as well.

Spare us your angst and make the decision to grow up, please.

Anonymous said...

There are two issues here: one, you failed to report (and by report, I mean pick up the phone and call security for immediate intervention) assault and battery. Second issue: in failing to even say anything, or call security, you failed to immediately remove this violent person from your patient's care. If Nurse X feels like throwing a housekeeper against the wall, how rational and level-headed are they going to be in regards to the patient? Not only were they violent, but they were violent near a post-op patient!

Anonymous said...

Brava to you for recognizing the issue and for sharing it with all of us! Don't let harsh comments here dissuade you in the future. People on blogs can be very free with criticism and lack of empathy.

Anonymous said...

I call 'em as I see 'em, both in person and in the cyber-world.

Didn't BI Deac just post for a Director of Compliance? LOL

Anonymous said...

"begs the question" does not mean "raises the question"

Anonymous said...

Seems to me T. already acknowledged that she failed her friend. A mature observer would recognize that they are certainly not in a position to judge whether there would have been time to intervene on the spot, not having been there in the heat of the moment, and that T's processing of what happened is exactly what one would hope can lead to a better reaction time in the future.

I agree that assault and battery could be charged and that this nurse clearly has issues that could compromise patient safety. She should be written up big time.

Anonymous said...

Classism in America is a very real thing. It can't be denied.

You've seen it in the medical field, attorney's see it where they work, and you see no small amount of it in the law enforcement world, too.

I wish that it weren't so.

Anonymous said...

Amen. Classism is the new racism.

Ironically, T's example reveals her own classist overlay when you think about it. Good for her for sharing some honest thoughts!

We have two worlds now in America and we see the two sides lining up to square off quite clearly in the news. Remember the old song: "Which side are you on?"

I am in the "professional class" but I find I do not mix well with privileged people who have to remind themselves to be nice to the little people who hold the door or man the security desk.

In the interest of full disclosure, when I was younger it was a club I aspired to. But now I do not think it is just sour grapes talking when I say that I do not like what I see or hear on the other side of the exclusive country club fence.

The housekeeper is someone's mother or sister or daughter and there was a time in this country when it was very possible she was the mother of a person who made it to the esteemed "professional class." I am afraid that the days of social mobility are ending as ugly classism is becoming entrenched among the elites.

But, ladies and gentlemen, that faint chook-chook sound you hear is the chickens. Coming home to roost.

T. said...

Hi, all -

Long day in the O.R. today, so this is the first chance I've had to come here.

First, thank you, everyone, for taking the time to share your thoughts here.

Secondly, I think I should clarify the situation somewhat by expressing regret that I wrote "I saw the incident" without really getting into how incomplete my perception of the incident was. I saw Nurse X raise her voice, then looked away because I was in the middle of something; then I looked back up and saw the back of Nurse X with the cart in front of her being pushed rapidly aside, with Z somewhere in the mix, and then Z and the cart disappearing behind a wall that then obstructed my view of them. Then I saw water pouring across the corridor floor from that general direction. I couldn't quite understand what had just happened and thought Nurse X had just roughly pushed the CART against that wall, judging by the angle of her arms from behind. Later when I talked to Z she confirmed that Nurse X had her hands on HER, not the cart (both of them had been partially hidden by Nurse X's body), so the whole event only became clear in its aftermath.

That said, I agree with everyone who has reiterated to me what I expressed in the post about my own actions: I didn't act quickly enough and feel I did not do enough, and I know it, and I regret it. But I was also involved in something that I couldn't just set aside at that moment, so conditions weren't ideal all around.

I have to disagree with the melodramatic characterization of this post as filled with a sense of "horrid victimization" or "angst." It's a little funny, actually, to see such overdramatic language applied so bitterly simply because I wanted to write out and reexamine an incident from my work day. I write my blog to tell myself stories that help me learn - learn about my flaws and strengths, and learn about the world I inhabit. Perhaps it's tempting to read into my motivations, but really I'm just interested in stories: telling them, sharing them, reading them, learning from them.

Keepbreathing - I, too, have noticed a certain tendency among some nurses to treat others in a way that fits in with your cautious hypothesis. But I suppose the same can easily be said of physicians, too...Thanks for reading!

Lawyerdude - it's true about the reaction time. In this particular case I wasted too much time with my brain almost in slow-mo asking itself, "What's going on here?" Then you don't react fast enough, then the moment's gone, you're already tied up with something else you can't just drop, and later there's no good way to make up for any of it...

Ron - I've a lot to think about in terms of follow-up and appreciate the good suggestion. I'm trying to proceed in a way that would minimize the fall-out on Z's head.

Anon 6:39 am - I LOVE your point about the secretary who might be a concert violinist. It's a great lesson about making assumptions...

Paul - I appreciate your stopping by. It's been my experience that people whose comments proceed from a feeling of superiority and arrogance are very often the very people who have no reason to feel superior at all, as evidenced by their inability to communicate without being demeaning or hostile, or read something - as most readers here do - in the spirit in which it was intended, or make criticisms in a constructive way. I won't be dissuaded.

Beerdoc, Gunfighter1, other Anonymous folks - thank you, sincerely, for your time. Rest assured I'm going to keep up my efforts to grow ever-better with each passing story.

Anonymous said...

I hate to say it, but to many people in the healthcare field, the absolute lowest "class" of person is the patient.

As a patient, I have experienced abusive behavior toward me much of my life. This has ranged from being sat on by my pediatrician as a small child so that his nurse could draw blood, to being told as an adult that it was a waste of time to answer my questions about a procedure because I was incapable of understanding the answers without a medical degree.

As a friend having surgery recently told me, "I am always extra polite to people in the hospital, because they can hurt me."

Maybe someday we will no longer have to be afraid of violence from coworkers, and patients won't go to medical visits thinking, "I hope I don't get hurt today."

gelci72 said...

Megan, my experience of people in the health care field has been that most who dedicate their lives to helping patients have tremendous concern for their wellbeing.

Unfortunately, some of the truly unpleasant or painful tasks involved in health care feel absolutely terrible to patients despite the fact that our goal is to provide only comfort and RELIEF of suffering, yet we have to dish them out anyway.

I am sorry your experience sounds like it's been largely negative. Speaking as an ex-pediatric doc, I'm not sure if it would have been possible for the phlebotomist to have drawn your blood without someone holding you down at that age, but from my past experience I can say that abuse of children is not intended.

I don't agree with the physician who told you it was a waste of time to answer questions. I truly hope your future interactions with health care workers manifest more of the caring intentions I have seen in my work environment and fewer of the disappointments you have encountered in the past.

Anonymous said...

Thanks, T. for your response.

I agree with you that most people go into healthcare wanting to help patients, and really care about people.

Unfortunately, there are few that, for whatever reason, see the patients that they deal with as an "annoying part of the job". People that feel that way really should be in another line of work.

Maybe it is an HR issue where the need to fill positions with correctly trained people has taken precedence over the candidates' interpersonal skills. And job seekers have seen healthcare as "growing industry" with lots of jobs, rather than a career choice that they would pursue irregardless of the market.

As for my pediatrician, I was 11 years old at the time, (so yes, my description of small was relative to him at 6'7") so a 5 minute conversation could have probably gotten me through my fears better than being held down. But that was 30 years ago and was "how they did things" back then.