So I have another question, and I don't know anything about an intensive care department, nor do I know where to start looking up stuff. I don't need much, just for fleshing out a bit of banter between one of the senior surgeons and my MC. They know each other well (over several years, they are friends), and the surgeon starts talking about everyday happenings, in a jesting way. So what could the surgeon tell my MC to cheer him up? Any special lingo he would use, or gossip to impart? Please, I'd be much obliged
Surgeons are a breed apart. The ones I have met converse in medical terminology like so: "My car broke down and I had to have it towed for three hundred dollars". "That is a sucking chest wound!"
I don't understand... What are you asking? It sounds like you just want small talk. What does that have to do with the ICU?
I write military, and there is a whole world of lingo within the units which doesn't make sense if you don't know the ropes. So I was thinking that for surgeons in the ICU it would be the same. I mean every department (my own job notwithstanding) has internal jokes.. and that's what I want to include. Just one or two.
Oohhh. I get it. But I can't help you. I've only visited an ICU twice, and the doctors and nurses didn't even talk to me.
Banter is the same as most places, for example they might talk sports if they aren't talking about patients.
The doctors and nurses i know tend to have a sick, and i mean sick, sense of humour - as with cops, and indeed soldiers they deal with the worst humanity has to offer by laughing at it. Thus some of the annectdotes they come out with are pretty offensive if you arent in that mindset the two that readily spring to mind are a) the sick fuck who decided to shag his cat (like you do), cats arent designed to recieve an adult male inthat manner and the poor thing died and promptly went into spasm and he presented himself a casualty (that's A&E for our American bretheren) with said cat still attached to his male appendage and asked them to perform a "catectomy" (i'm not sure i believe that, but its a good sick story all the same) and b) the joiner who had got into the habit of , shall we say 'stimulating' himself with a random orbital sander , until whilst in a state of high arrousal forgot to take the sanding disc off first, and gave himself an impromptu circumcision
Huh. I hope these are stories (as in: I am a sailor and this is a true story ).. but I needn't take my inspiration from the worst of the lot, do I?
They might talk about procedures they've had to do over the years. Like, Robert: "So, ever heard of the time I had to sew a guy's ripped off arm back onto his body?" Phillip: "Holy shit, man!" Robert: "True. Clean off with bones and blood all. Hoo-wee that was a mess. Wanna know how he lost it?" Phillip: "Yeah, how?" Robert: "Electric saw." Then on to the grisly detail. For some added dark humor, they're discussing this over a pleasant meal.
As in "you know the only difference between a fairy tale and a war story ... one starts once upon a time and the other starts 'no shit bro, I was there'
Nurses and doctors tend to have pretty grim senses of humor because they mostly banter with each other. To make someone feel better about themselves, often times they'll recount someone who had it way worse. Obviously they leave out any identifiable details. They like to talk about their patients, both good and bad. They talk about how sweet the old man in one room is and how stupid the guy in the next room is for his self-imposed medical problem. in my experience, it's usually more the nice stuff. Most people thing ICU is usually bloody from car accidents or stabbings. The majority of people in it are drug overdoses or old or obese people. At least where I was from. "I was up all night fighting the grim reaper." "Old guy tried to die on me eight times." "I restarted that guys heart for the tenth time and when he comes back from another heroin OD, I'll make it eleven." "Dr Something and I must have cleaned a gallon of lard from that guy's heart." "We removed the tumor caused by his smoking. He celebrated with a cigarette." These are all things I heard my entire childhood. My mother is a CRNP and does ICU on a regular basis. Doctors and nurses tend to rotate. Nobody as far as I know is ever exclusively ICU.
My first reaction was that surgeons wouldn't have time to be doing small talk. They have rounds, surgery, emergencies to check up on, and are frequently late to meet their appointments because they have so much. From my experience volunteering and being in an ICU, I haven't heard the workers making small talk on their patients. If they have to discuss, it's either to get help on something or to blow off frustration. From what I've seen nurses and doctors are so satiated with the ill that they would rather talk about other things (that and their hours are long and you gotta keep your sanity by talking about more than just medical terminology kind of things). If the two people in your story were to talk about stuff like that, I'd say it'd be about past procedures. Maybe the doctor is so chill that he would anonymously refer to what other kind of patients he has and what procedures they have to do, but with HIPAA doctors err on the side of caution.
4th year M.D. student here. Surgeons in community hospitals often have nurse practitioners (APRNs, CRNPs) or physician assistants (PA-C) rounding and doing the scut work for them. Essentially during their rounds, they go quickly from room to room and make executive decisions, which they then dictate to the mid-level who then does the orders or whatever. In the academic hospital, its much the same between attending surgeons and residents, with the exception that the residents are the ones often managing the patient day-to-day more or less independently (whereas the mid-levels are simply doing what the surgeon tells them to do). This leads to various times where the attending will more or less berate (even humiliate) the residents for doing something stupid. Several examples of the latter in my mind. So depending on the type of hospital, the small talk that is patient-related would be like: Surgeon: Hey Betty, what is the deal with that guy in 322 Nurse practitioner: Well Dr SO and So extubated him, turned off his IV fluids, and gave him lasix. Surgeon: So what are we doing for this guy? Nurse practitioner: Nothing. His labs are normal this morning except his hemoglobin is still a little low at 9.8. Surgeon: What was it yesterday? Nurse practitioner: 10.2 Surgeon: Well he got half of lake Michigan in IV fluids so its probably dilutional. Who else is down here? Nurse practitioner: Well there's Mrs. Smith in 323...... ------------------------------------------------------------ Or a recent example I was given (this is a true story - don't think badly of doctors because of it): Surgeon: Hey you med student Me: Yes ma'am? Surgeon: Do you have any sardines? Me: (staring blankly at her for a moment) uh... no... why do you ask? Surgeon: Shamu in room 2 is out of her bed. I figured it would be easier to get her back in if I danged some bait over the stretcher. ------------------------------------------------------------------------------- As far as small talk goes, surgeons tend to discuss interesting cases, complain about the emergency department, complain about other services, etc. Complaining about the E.D. is very common among all in-house specialties for reasons which are rather complex but in a nutshell involve the fact that the E.D. physicians will consult them for things that they believe are asinine. ------------------------------------------------------------------------------------ Surgeon to surgeon: Surgeon 1: Busy night last night? Surgeon 2: Yeah. Had a 32 year old guy cutting a tree in his front yard, son of a bitch sawed off the branch he was standing on Surgeon 1: Lol gotta love natural selection. He still alive? Surgeon 2: Yeah, had a grade II tear of his thoracic aorta. (Turning to the surgical intern) Hey you, what's the difference between a type I, II, III, and IV tear and what's the management? Surgical intern (deer caught in headlights look): Uhhhhh ------------------------------------------------------------------------------------------------------------------------- Surgeon to nurse: Surgeon: What's his BP today? Nurse: It's been low, in the 90s, high 80s again. Got 2 liters overnight. Surgeon: Damn. [Pause]. He still have low sodium? Nurse: Uhh no its totally normal. Surgeon: Doesn't he have COPD or something? Nurse: Not that I can see in his problem list. Surgeon: Does he have any medical problems? Nurse: Says here he has high blood lipids and used to- Surgeon: Cool, I'm gunna consult medicine and they can sort this garbage out. ------------------------------------------------------------------------------------------------------------------------- Also by the way, most ICU patients are seeing multiple physicians at once. Typically the physician in-charge (attending physician of record) is an intensivist. Consulting physicians often converse with the attending or other consultants everyday.
Nurse Practitioner for 30 years here, including 20 in independent private practice. This is insulting: Maybe you are in a state where NPs have less autonomy. That attitude won't serve you well at all if you end up practicing in this state.
Wow... I'm sorry... definitely didn't mean to offend. By "executive decision" I really meant the doctors are just seeing the patient themselves real quick after the NP and then dictating what the plan will be (didn't mean that the NP was a robot who didn't get any input or something). Also know that i'm merely describing my own (obviously limited) observation from 8 or so hospitals in the Midwest including large academic hospitals. NPs and PAs do have pretty good autonomy here as far as being allowed to write orders, prescribe certain drugs (not schedule IIs like oxycontin, adderall, etc.), assist in surgery, etc. under the license of an MD or DO. In surgical specialties here though, NPs aren't actually performing surgeries or managing ICU (medical or surgical) without supervision, I think you still need to be a doctor to do that AFAIK.
Sorry, it's a pet peeve. Apology accepted. Unfortunately, resistance to advanced practice has resulted in a hodgepodge of practice levels by state. In this state (WA), the only limits on my scope of practice are my assessment of what I can and can't do. Not that you'd find an NP doing brain surgery, but more than a few manage ED patients independently, including surgical procedures. A lot of the surgery docs have PAs (not independent in this state) that assist including including closing. Nurse anesthetists practice independently. We also have no restrictions on our prescriptive authority here though there are extra fees and hoops if you want to prescribe above level 2. I've paid and jumped the hoops but don't need it in my practice. I need my DEA number so pharm manufacturers and distributors in other states don't argue with me about my prescriptive authority when I order for the practice. Yeah, lots of hospitals use NPs for admission and preop H&Ps, so in that sense you can say some do the more mundane things. But a lot of NPs here practice like any GP would. Many are chronic care, pediatric, geriatric, and OBGYN, including midwifery, specialists. Some function as GPs. If the NP (or the advanced practice nurse) is making ICU rounds, it's not with the MD. It's because the MD is doing something else. The job you were describing, following the MD around in the ICU, that wouldn't happen, though in some settings the charge nurse follows the doc around. In the ICU though, the nurses taking care of the patient can tell the practitioner, be it NP or MD, the status of the patient and that nurse can manage the orders. Many of the surgeons and ICU docs do have NP and PA assistants they work closely with managing their patients (neurology, cardiology, burn docs, etc). So I suppose it's possible they make rounds together though I've rarely seen that. What you must have figured out now, by your 4th year, is you don't do what the nurses do and the nurses don't do what you do. We work together doing different parts of the patient's care. In my case, I have a foot in both professions. Like a lot of NPs, I am a specialist that physicians call on as a consultant. I specialize in infection control and occupational infectious disease so I'm there to manage the blood exposure or the incident with the measles patient that just sat unnoticed in the waiting room for 30 minutes. I've built a contracted employee health service around that specialty. I'm the sole provider in my practice.
