Wednesday, November 16, 2011

The Catheter Interrogation

First thing this morning, a urologist came to place a supra pubic catheter bedside. The patient had been retaining crazy amounts of urine and neither his nurses nor his orthopedic surgeon could place a foley in him. So urology was consulted.

The doctor had called in a list of supplies that he'd need bedside by 0530. Apparently he was rather rude to the evening secretary about it, saying 'everything better be ready", in a 'you people always mess up' sort of way. But I know the evening secretary is something of a sensitive whiner, so I took her report with a grain of salt.

He arrived examined the patient and then decided to try his hand at placing the foley first, giving me and the patient's nurse a new list of supplies. We have coude catheters in different sizes and foley kits stocked on the floor so much of his list was immediately manageable. But he wanted Urojet (lidocaine) syringes too. We don't have them in our McKessen so it was a short process to get them up to the floor. He needed to write an order, I faxed it to pharmacy and then immediately ran down to pick them up.


Though it took 10 minutes tops to get them (5 of which were taken by him arguing about writing the stupid order), he was incredibly put out. I heard about how ridiculous we were, how he doesn't have time for this stupid delay.. etc, eye rolls and disdain galore.

Fortunately for the patient, he was able to successfully place the foley. Whew.

A few minutes later, I stopped in the room to check on the patient and I noticed that his collection bag had over a 1200 cc in it.

I remembered reading somewhere that draining the bladder too quickly can cause the patient major discomfort so I pointed it out to his nurse. She was busy doing her end of shift med pass and instructed me to ask the urologist if she should clamp the catheter.

So I did.

I thought he would attack me.

He completely lost his temper and flayed into me.

"That's the stupidest thing I've ever heard! Why do you think to clamp the catheter? Why?" and then he waited. It took me a moment to realize that it wasn't a rhetorical questions but that he actually wanted a response.

I tried told him that I had read somewhere that it could hurt the patient if the bladder emptied too quickly but as soon as I started talking he restarted his rampage.

I was mortified. I tried to explain that I was just an aide and the messenger for the nurse but he kept at me. I can't remember everything that he said; I was flustered and just trying to escape. I remember him saying that they don't teach nurses to be doctors and thrusting a new order at me, written in block letters as though I were in grade school, DO NOT CLAMP CATHETER. It was the only completely legible order he'd written thus far.

He ended up staying to yell at me for longer than it took him to place the foley.

So much for his valuable time....

I'm totally re-writing one of my evil book characters in his honor and he's (the character) is going to suffer.



  1. Oh urologists can be fun...One of my favourite run-ins with urology was a similar case of a patient whom multiple nurses had tried unsuccessfully to catheterize. My friend (a first year resident who had never placed a catheter) was asked to give it a try, but she decided to consult urology rather than subjecting the man to unnecessary torture at her inexperienced hand. When the urology resident arrived and successfully placed the catheter, he wrote a tirade on the consult note about how the resident had not even tried to place a catheter and about how easily the catheter had gone in. My friend felt humiliated by the whole experience, but fortunately the site director heard about it and personally called the urology resident to give him a talking to about how inappropriate his behaviour was.

    The moral of the story (in my humble view) is that no one should be an asshole to his or her coworkers. Not even a urologist.

  2. I'm always taken aback by some people's unwarranted asshattedness. It surprises me that rational adults can waste their energy with unproductive dickishness.

    I wish I had an advocate like your site director. Unfortunately, we peons of the hospital don't get much support from the powers that be.

    I can guarantee, though, that when I'm a physician, I will NEVER behave so poorly to another worker, no matter how stupid I think they are being.

    Jerk urologists.

    (Is it something about their field?)