During my very first year of practice, while I was working the night shift, I had to float to a different floor. I normally worked on a med-surg floor, but that night I was sent to work on the neuro floor. I was pretty nervous about it, not being very confident in my skills, but everything went okay. It was a busy night.
As dawn came and it neared time for shift change I scurried from room to room filling water pitchers, tidying bedside tables and recording Ins and Outs. I popped into my very last room and found the patient wide awake.
"Mr. Smith," I asked, flowsheet in hand, "how much have you had to drink tonight?" "I swear Miss, I ain’t had a drink since Thursday."
Hee hee. True story. In our profession, misunderstandings are a very great risk and really you cannot predict what you say that will be mis-heard, misinterpreted or misunderstood. We have all heard about the family member who became irate after peeking at the chart and reading, "Mr. Jones is SOB tonight." That’s an old one, but probably true.
It is not only misunderstanding that impedes communication between healthcare workers and healthcare workees. Now, I attribute the number of children I have been blessed with to a kind and benevolent God. But there is a nurse in Brooklyn, NY who may be just a little bit responsible too. Not blaming anyone, you understand, it’s just that sometimes when a patient "verbalizes understanding,’ they may not actually be getting it.
After I had my second child and went for my six week check up the nurse came in to give me instructions on how to use a diaphragm.
"Do you," she asked, "know where your cervix is?"
I nodded dutifully, although I had only a vague idea that it was tucked away neatly somewhere and didn’t get in my way. She squeezed the diaphragm (the demo model) from a perfect and somehow beautiful round Barbie colored bubble into something that looked like a big goofy cartoon grin. She continued to give instructions, but all I could think was, ‘Don’t get the giggles, don’t get the giggles.’ I wasn’t very old, you know, and it did look pretty funny.
The next thing I heard, when I’d gotten myself under control was, "You can tell it’s your cervix because it feels like the tip of your nose." What she must have seen was a serious faced young lady paying close attention and poised to verbalize understanding. What she could not see was the hee-hawing, knee slapping, tear shedding, hysterically laughing me inside my brain imagining a little nose somewhere or the other.
Then I had to fake clear my throat as the unruly and disrespectful imp in my head thought to herself, "Ah. Ah. AH-CHOO!" and I very nearly burst out into wild peals of inappropriate laughter. It didn’t help that as she talked she continued to squeeze the diaphragm up and down so that it looked like Mr. Happy Smile was laughing too.
I blame the receding tide of post-partum hormones for much of that incident, although it still makes me laugh. But, and I wonder how much of it had to do with the whole picturing a nose scenario, it was not very long before I was once again happily ante-partum. Happy and a little bit surprised. Huh? Did I miss a step? Who nose?
We must all have some stories of times we have misunderstood or been misunderstood at work. It’s practically a set up deal. We’re talking to stressed out people, or people who are not feeling at their best about complicated things in a vocabulary which is unfamiliar to them often in a noisy and distracting environment. The real surprise is that we are ever understood at all.
Why just a few months ago in the very busy place I work, with fifteen TVs blaring and 15 conversations going on and telephones ringing and pumps beeping I thought I heard one of the nurses ask a patient, "Have you had any side saddle sex?" ‘Hmmm,’ I wondered. And, ‘hmmm,’ again.
"Is side saddle sex contra-indicated in a patient with that particular diagnosis? Or is it, maybe, recommended? And if so, what exactly IS that diagnosis?" I wondered. I was making a bee-line for that chart – I HAD to know – when my brain finally kicked in and I realized that what she had actually said was, "bad side effects."
Not sure I don’t like it better the first way. AH-CHOO!