My Mask

Every doc in medicine knows about the "mask" or the "poker face". Some aren't very good at it, others are excellent. For medicine, you have to develop one, it's essential. We use it everyday, it's pounded into us to remain cool, calm, and (most importantly) non-judgemental...and if not that, then at the very least, put on your mask.

A diabetic patient pulls off his/her shoe revealing a bloody, mummified foot.

A 13 year old girl tells you she was impregnated by some 28 year old guy.

A grandmother making poor excuses for her child, while her grandson lays in the hospital bed bruised and beaten.

These are some of the memorable reasons I've had to put my mask on. I won't speak for others but I'd bet that every doc in and out of practice can easily name at least a dozen times where they've had to use it.

Today my mask slipped off. Not for the reason you would think, it wasn't some horrible abuse case, or a dieing child...the reason kind of even surprised me, in retrospect. It was a co-worker, a nurse, that knocked it off, I suppose she caught me off guard. I was going to go into this ti-raid on how exactly she did it, but the basic gist of it is that she told me false information about the patient, and then set me up in rounds, in front of everyone (patients included), to look like an idiot.

I've seen similar things happen when she's dealt with other residents. In working with her, I've ran into "instances" with Becky (I'll call her that) where I've really had to fix that mask on HARD. I should know better than to get sucked in, but this was two days in a row that she had done this to me. The first time I fumed about it all day (but kept my cool), in the second instance, instead of remaining calm and cool as I should have, I reacted emotionally. It wasn't much, but I basically interrupted her and asserted how what she was saying right then to the attending was a 180 from what she had told me 30 minutes ago. As she went on, I shook my head in anger and disagreement. Why was she doing this to me?!?!?! I still have no idea. My mask was definitely off. Becky then went on to disrespectfully question the attending's decision right in front of the patient's parents (a BIG doctor-nurse no no, we are supposed to be a team, not undermining each other). Unlike me though, Dr. Smith remained absolutely calm, he didn't yell at her as I was itching to. He calmly sighted study after study that backed his decision and beat her into submission with calm, POLITE, logic...that was very impressive.

After we were done with that patient, the attending took us, the residents, around the corner, out of view of the nurses. He told us something I thought I knew, should have known. He said, "There are some excellent nurses on this floor, Becky isn't one of them. Working here I get to know these nurses very well, this isn't the first time Becky has done this and it won't be the last. I take what she says with a grain of salt. As a doctor, you can't get sucked into that stuff. Your objective is caring for the patient and fighting with this nurse won't accomplish that. You have to know how to get the most out of nurses like Becky, you have to get her on board with your plan. That's why I took my time explaining things to both her and the family, she now understands what we are doing and where we are coming from. You can't fight with nurses like her. You can write an order or give treatment to a patient however you want and if the nurse isn't on board with the plan or has decided you are wrong, it's not going to work no matter how good the treatment is. You have to be above that."

That doc is a very wise man. He could have ripped me a new one for arguing with her in front of the patient (which I probably deserved), or ripped her a new one for arguing with him in front of the patient (which she definitely deserved :P) , but instead, he was like a father in front of two bickering children. He stopped the argument, got to the heart of the problem, and diffused the situation (even teaching me a lesson from it) all the while being calm and patient. I hope someday I can embody the calm, logic, and wisdom that he did yesterday. It was a excellent lesson, don't mind your mask, BE your mask.

Newbie Doc