An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.

“What did you learn today?” I asked, fearing the answer.

I was suspecting a recitation about the new methods of documenting nursing competencies, or a delineation of the process by which she helped the hospital maintain its “magnet” status to attract more nurses to work here. Or perhaps she had learned a new set of pharmacy rules that replaced the old set of new pharmacy rules, all designed to make the rapid provision of medications to the patients safer and more impossible to accomplish. This sort of utterly painful garbanzo was what I usually, almost invariably, heard from a newly-minted nurse about her day.

Nurses have hard jobs, and have no authority whatsoever to fight against stupid rules made by the hospital. The doctors actually did have the authority, but didn’t know that they had it, and so didn’t use it. Although the nurses didn’t have the authority to fight the rules, as they got higher up in the nursing ladder, some of them learned they did have authority to enforce rules that others made. So they did. The young nurses were awesome wonderful angels in a difficult situation. The older nurses who had managed to avoid rising up the nurse-managerial tree were godsends, the teachers of young doctors, the saviors of sanity and careers and of patients’ lives threatened by dangerous interns. But then there were the enforcer-nurses: they could be identified easily because they all carried clipboards. Any senior nurse that carried a clipboard was to be avoided at all cost.

But Beth was not in any pre-conceived camp. I am glad I’m not judgmental, prejudicial, or opinionated, because had I been, my world would have been rocked by this young nurse who was clearly outside the boxes that I and everyone else had stuck her in. For instead of reciting useless make-work as her day’s occupation, she instead, to the delight of my ever-increasing internal happiness, said this, which I will translate on the fly for the edification of those who don’t speak Medical:

“Well, first I had a fight with the knuckledraggers [orthopedic surgeons], who were insisting that my patient get a bone scan from unclear medicine [nuclear medicine — part of radiology], even though he was medically unstable. The shadow chasers [radiologists] had found a pleural effusion [fluid collection in the chest] in my patient that was huge. The stupid intern, oops, no offense, missed the effusion when she listened to my patient with her guessascope [stethoscope] this morning, even though I told her that the breath sounds were poor. That bitch sure is one 45C [possessing one chromosome short of the normal 46 human chromosomes and thus likely mentally disabled]. The slashers [surgeons] were all busy and didn’t have time to drain it, so I had to insist. That didn’t go over well. Meanwhile, my patient was crashing [trying to die] and his kidneys were shutting down. I had to get permission to stick him in a one-point restraint [catheter in his bladder] so I could track urine output, and I couldn’t get in touch with the slashers of course, so I ended up having to get a wayward member of the stream team [urologists] to give me the go ahead on something that should be just allowed in any sane system. Thank God that the Dick Squad [urology team] had been rounding in my unit just then. Then the guy obviously needs to be tubed [intubated for mechanical ventilation], and I still can’t get in touch with the damn slashers, so I had to page the gas-passer on call [anesthesiology resident] who along with the vent jockey [respiratory therapist] managed to keep my patient alive. The patient had been all sauced up on happy juice [narcotic pain relievers] so he was pretty much a chocolate hostage [constipated]. That isn’t any good for healing, so I finally got the 45C surgical intern to go bobbing for apples [digitally disimpact [stick finger in rectum[bum] and dig out the hard poop ball]]. He pretty much exploded after that [evacuated his entire colon] in a massive Code Brown [big nasty stool that stinks up an entire ward]. But that solved most of my patient’s problems right then — it took the pressure off his kidneys so his pee started flowing, which helped drain the effusion, which helped him breathe so that his snorkel [endotracheal breathing tube] could be pulled. I almost had to transfer him to the ECU [eternal care unit — in other words, death]. Damn cutters [surgeons] don’t care about anything except operating.”

I looked at Beth with my eyebrows raised. Rarely had I heard such a fluent effluation of medical slang flowing from even an experienced doctor. Never had I heard it from such a spring-chicken nurse. I asked, “When did you graduate from nursing school?”

“About six months ago, why?”

“Ever think of becoming a doctor?”

“What? Are you kidding? Why the hell would I want to do that?” Beth replied.

And with that statement, Beth landed herself a place on my all-star roster of worthwhile people.

John F. Hunt is a physician and author of ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.