Governor Abbott’s sister-in-law is a physician in Austin. She’s internal medicine, works with a group that visits a few hospitals around town, or she did two or three years ago when our paths last crossed. Her name doesn’t matter. Not knowing her on a personal level but having taken orders from her as a nurse, on a couple of occasions, and still not being an expert on her practice or anything but having seen her do her job—talking about her job performance is useful in the context of judging how well the governor himself is doing his, handling pandemic in the state.
We had a revealing interaction once a few years ago, not me and the governor but me and his sister-in-law, at my prior hospital or the one before that. So, like, she reminded me, at that time, that we had actually interacted years earlier too—me calling her in the middle of the night to get orders. My first name is not common and she remembered it and remarked this time, in person, about putting a face to the name and all that. Anyway this time in person she was behind the nurses station doing some charting and the reason for approaching her was that my patient—our patient—was going south.
So, like, it wasn’t like TV or a movie, people running here and there—no code was called, that was my call actually and there was no reason to make it. Calling the rapid response team as a precaution might have been appropriate, in hindsight, that won’t be debated here. The problem was developing slowly, the patient wasn’t critical and we had time. It was a problem beyond my training to resolve or fully understand. The patient was African-American, not that that’s important here, a former University of Texas football player, again not that that’s important. His blood pressure was dropping, that was important. An IV was started, he’d gotten a whole bag of fluids and his pressure was still going down. So, like, the physician who happens to be the governor’s sister-in-law looked up at me, listened to my explanation of what was going on and after that it was pretty much textbook all the way. She checked her computer for prior vital signs, checked his labs and looked at her notes, a handful of folded sheets of paper taken from her white coat pocket. She picked up her stethoscope and went to the bedside and did a head to toe examination. As it turned out this guy had an internal bleed.
The thing about the governor’s sister-in-law is that she’s a good doctor. That’s said with 20 years experience as a RN, having taken a lot of orders, having seen a lot of MDs—the good, the bad and the scary. It’s also said given that nurses like to rag doctors. Working with physicians, taking their orders—not only listening to the decisions being made, but having to carry them out—you get to be a pretty good judge of physician foibles and competency. The governor’s sister-in-law more than passed muster.
Most of my experience has been in pediatrics and my occasional practice, for whatever reason, is to imagine people as they were when they were kids. Hearing about this lady doctor’s powerful brother-in-law—and checking her out later, out of the corner of my eye—in my mind’s eye she was a kid back in middle school, sitting at a table alone doing her work.
A little introverted, and quiet, good at math and maybe science or drawing, she kept her own counsel except maybe mom. And kept on trucking through medical school, graduated about ten or fifteen ago, during a less diverse time, not at all easy, especially coming from a family of modest means, American-born descendants from Mexico, Wikipedia tells us. And the way nurses judge physicians, it comes down to a basic question: Would you want that doctor taking care of you or would you want him or her writing orders on your child? My answer is most definitely yes. Because, me standing there telling her about the patient going bad, what was important about this physician's response was what she didn’t do as much as what she did.
She didn’t keep on charting. She stopped typing at my approach. She didn’t tell me to send blood to the lab. She didn’t say, “I’ll put him on my list.” She didn’t tell me to do the head to toe myself. She stopped what she was doing, made eye contact and got up to examine the patient. She’s a good doctor and a good person too. She is probably also under considerable pressure not to fuck up, as the governor’s sister-in-law, and all, the same way the governor is under pressure not to fuck up because he’s the governor. Anyway, no code got called. The governor's sister-in-law took care of the problem before it became an emergency. The thing that nursing teaches you, and taught me, is that the best way to deal with an emergency is not to have it in the first place.
Get to the patient early, like the governor’s sister-in-law did with the ex-Longhorn. With kids especially there’s nothing you can say as explanation to a mother or father who has lost a child and the best way to handle that conversation is not to have to have it, which is an impossible standard but one to keep in mind with COVID-19. The best way to deal with a viral outbreak is to lock down—extreme measures are called for—call the code—or better yet, don't have the outbreak in the first place. The learning curve can be steep.
An example of how everyone was so caught by surprise involves, once again, the governor's sister in law, the MD. Many physicians, internists like our lady doctor, are part of private practices, of maybe a dozen MDs, or advanced practice nurses, mostly internists, who have contracts to see patients at different hospitals around town and must travel between those sites.
Ditto some of the specialists and many, many surgeons. They travel between campuses. And just because you have a medical degree, you know, or a nursing license, and no matter how well you scrub your hands, you can still be a disease vector, and despite the gowns and gloves—and the masks—you can be a carrier. And had people thought of that beforehand, maybe, but maybe not, because what we’re seeing now is unlike anything we’ve seen before. This is some dystopian shit.
So, like, that's why it's good to know there are good doctors out there. It’s important because it really is like your mother told you back in the day. You can be judged you by the company you keep. And the governor is presumably keeping good company, with the First Lady and her sister. And let's hope he's listening to their advice.
No comments:
Post a Comment