I was in the hall outside a patient's room with a new crop of interns and residents. As usual, they had all made rounds first thing in the morning, checked on new lab results, examined their patients, and were now ready to report everything to me, the attending. And, as usual, these bright, eager residents, though anxious to do a good job, hadn't thought to talk with the nurses taking care of their patients.
I patiently started my spiel. "You dart in and dart out. Your impression of your patient is like a snapshot. Your patient's nurse has been here for 12 hours. Her impression is like a video. You can't tell me you've made rounds unless you can tell me the nurse's name and what she has to say." I continued, "Say this to the nurse, each time: How are things? Anything you're concerned about? Anything you think I should know? Any orders you think I might want to change?"
My residents seemed surprised by this notion. I called the nurse Susan over. She told us the grandmother of one of our pediatric patients had unexpectedly died the night before, so the parents were anxious for discharge so that they could mourn and arrange the funeral. She also suggested we could stop IV fluids, since the child had just had a good breakfast.
This was all news to the residents.
I'm the daughter of a nurse. When I went off to medical school, Mom told me, "I don't often give unasked-for advice. But I will tell you this-a smart doctor listens to the nurses." That advice has stood me in good stead for the past 25 years as I practiced pediatrics.
My mother grew up on a small farm. Her dad farmed; her mom did sewing. All the children did odd jobs to help make ends meet. When she finished high school she went to work as an inspector in a nearby factory. She had a dream that she could save enough money to go to nursing school. After two years in the factory, she was almost ready. Then her little brother needed an operation, and there went all of her money, until an anonymous donor in her small town gave the needed money for nursing school. She never found out who it was but always suspected the town doctor.
She thrived in nursing school, and afterward she moved to a town that needed hospital nurses. In that hospital (in the closing days of World War II) she met my father, a handsome young sailor, sick with pneumonia, just mustered out of service.
When I was a kid, I was fascinated by her stories. I remember her excitement, telling me of the first blood transfusion she helped with, the first time she gave a dose of penicillin, of taking care of patients in iron lungs during the 1952 polio epidemic. I loved putting on her navy wool nurse's cape and pretending to wipe out disease.
When I was in high school, she was head nurse in the local ED. She looked so capable in her starched white uniform, lace-up Clinic shoes, and white nurse's cap with black velvet ribbon, I was sure she could handle anything.
She could diagnose at 40 paces, we all said. On weekends, I was allowed to come and watch. You never knew what would come through the door. When I was in college, and doing premed observations with local physicians, they would invariably suggest that I could learn more from watching my mom than anyone else. "She's seen it all," they said.
So when I went off to medical school (at the same school my mother attended), I was always conscious that I was walking the same halls she had trod 30 years earlier. When she came to visit, I showed off the new big city ED and she oohed and aahed at the equipment. In the NICU she beamed at tiny babies who wouldn't have survived when she was a student. When I didn't know what to do (such as what size umbilical artery catheter to ask for with my first 1,200-gram preemie), asking the nurse would put me on the right track. And when I spent my first week in practice as a pediatrician, I wished she were my office nurse, to help me with all of the real world issues I hadn't yet learned.
So here I am, after 10 years as an office pediatrician, four as a hospital administrator, and 12 as a pediatric hospitalist. Last night I took care of a patient with critical hypocalcemia, discovered only because an astute nurse noticed some subtle muscle twitching in the middle of the night. She was sure something wasn't right, even though the patient said he felt just fine. She called me, and I listened. A smart doctor listens to the nurses.