The Nurses

When in doubt, ask the nurses. In my 20 years in health care, I have learned that the nurses are really the backbone of the whole enterprise. The doctors get the glory, but it’s the nurses who are serving the front lines. They are more likely to take the time to educate a patient, to answer questions. They are the patient advocates. Their financial incentives are different—salary vs. piece work. When you hear about hospital quality ratings, it’s usually the nurses that influence the majority of that score. A brilliant surgeon is nothing without the nurses in the ICU. While doctors, as a group, move glacially slow to adopt new workflows (witness the drag-your-feet adoption of electronic health records), it’s the nurses who innovate and pioneer ways to prevent medical errors or reduce hospital-acquired infections.

If you feel you aren’t getting the answers you want or need from your doctor, turn to the nurses. That’s what I did today at the infusion center.

I reported our appointment with the oncologist yesterday. While he answers the questions we ask (and is very quick to respond to and address concerns or issues) he offers nothing more without prompting. He’d be great in a deposition. So I told mom I was going to ask the nurses about the pain she continues to feel in her abdomen. “What are they going to say that the doctor hasn’t already said??” she asked, exasperated at my persistence to get an answer.

My mother has advocated for everyone else, yet for herself she’s shy about being a nuisance, a bother. I, on the other hand, am not. A year ago, I insisted her very busy urology surgeon call me to describe in detail what her original diagnosis was and what her nephrectomy (removal of her kidney) would entail. He called me one evening at home and answered my long list of questions.

Today as the nurse was preparing to give my mom her chemotherapy I asked about the pain. The doctor said the cancer was minimizing. And the liver mets were not the cause of the pain. So what could be causing the pain? Could it be something else? Are we too focused on the cancer to consider other causes?

The nurse reviewed the chart and consulted with her nurse colleagues, and even discussed it with the oncologist. And she came back with a consensus theory: scar tissue. The CT scan shows nothing that could indicate for pain. She believes it could be scar tissue either from the nephrectomy OR from the tumors “disintegrating” in place.

I’ll accept a consensus theory. It’s the best answer I have so far, and at least gives us some comfort. It doesn’t help the pain (only the vicodein does that). But I feel satisfied with the answer.

Thanks to the nurses.

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