“When did you urinate last?”
Ms. O looked at me blankly.
“I’m going to press over your bladder,” I said. I reached under the hospital gown and pushed over her pubic area. My fingers felt a soft swelling. Ms. O winced. “I think you’d feel better if I passed a tube into your bladder and got rid of the urine.” I didn’t need a doctor’s order for a straight catheterization—in and out. Ms. O nodded her head.
Back in her room with the supplies, I raised Ms. O’s bed so I wouldn’t have to bend over, draped her with a sheet and placed the catheterization tray between her spread legs. My hands, encased in sterile gloves, guided the thin, rubber tube into Ms. O’s urethra. Dark amber urine flowed from the catheter into the specimen container.
As the last of the urine trickled out of the tube, Ms. O sighed and said, “That’s such a relief.”
“Let me get rid of this,” I said as I gathered up the soiled equipment. “Be right back.”
In the dirty utility room, I sorted out the recyclable parts from the cath tray and tossed the disposable items. I measured the amount of urine before flushing it down the toilet. I tried to sort out what to do about Ms. O. What could be going on with her? She could have congestive heart failure, pneumonia or some other illness that would get worse without treatment. And no one would be home to notice her deterioration. She might become so weak that she could fall, maybe break a hip and then lie on the floor for days—be found dead. If she were lucky, a neighbor would find her in time and call an ambulance. If Ms. O survived hip surgery, she might not recover fully and off to a nursing home she would go.
I leaned against the cool tile wall. What was Ms. O’s doctor thinking? How could he have known Ms. O was retaining fluid? He ran in and out so quickly? Had he even bothered to listen to her lungs? Ms. O needed to stay in the hospital for a work-up to find out what was wrong and treat the problem. She shouldn’t go home until she was well enough to care for herself. What should I do?
Since I was employed as a staff nurse and reported to the nursing department, I should inform Mary, the charge nurse of my findings. She would go up the chain of command, relating my concerns to the nursing supervisor. The nursing supervisor would contact Ms. O’s doctor. What if the doctor dismissed my concerns? Would the nursing supervisor back down and let Ms. O to be discharged?
I could always bypass nursing altogether and call the doctor myself. Surely there was nothing wrong in that. I would report my findings and let him decide what needed to be done. That way it wouldn’t seem as if I was telling the doctor what to do.
With this decision made, the tightness in the back of my neck relaxed. I returned to Ms. O’s room. “Close your eyes and rest for a while.” I told her. I dimmed the lights and left the door slightly ajar.
Heading towards the nursing station to make the phone call, I reflected that hospitals had not changed that much since I graduated in 1962. Long corridors with patient rooms on either side, dirty and clean utility rooms and a nursing station at the end of the hall. What had changed was nursing education. I had attended a three-year nursing diploma program in New Jersey run by the Grey Nuns. Formally known as The Order of Sisters of Charity of Montreal, they “trained” me along with forty-three other females in my class to be subservient to physicians, all males at that time. When a doctor sauntered into the classroom to teach, we stood up, chanting in unison: “Good Morning, Doctor.” In the hospital, I would rise from my chair if a doctor entered the nursing station. Besides enforcing nightly curfew, weekly dorm room checks, and pressing us to attend daily mass, the nuns sent an implicit message: never question a doctor’s authority.
My first job after graduation was at a large inner-city medical center. I can only imagine how surprised—and maybe delighted—the physician felt when I stood as he lumbered into the small lounge off the nursing station. He happened to be a resident not much older than I. After he left, the other staff nurses encircled me. Never stand for a physician.
In the mid 70s I returned to college for a baccalaureate in nursing. An innovative professor at the university, who started her own home health agency, had quite an impact on our large group of mostly seasoned nurses. “Nurses see the whole patient, not just the disease entity,” she said. “You don’t exist just to follow doctor’s orders, After all, nurses spend more time with the patient than doctors do. You must serve as the patient’s advocate.”
We were also primed by the women’s rights movement to take responsibility for our practice, to challenge the blind authority of doctors and hospital bureaucrats. At that time I worked in a small branch of a Health Maintenance Organization (HMO) near my suburban home. Spurred on by my professor I asked the administrator if we nurses could schedule our own patients for education and monitoring. “I believe we could resolve patients’ problems and reduce visits,” I told him.
He agreed. We negotiated a fee of five dollars for a nursing appointment since this was an extra service not covered by the HMO. One middle-aged obese, diabetic schoolteacher came to see me every two weeks for a half-hour visit. I suggested she pack a lunch to avoid the school cafeteria and take evening walks with her husband. She lost weight and so did her husband. Eventually, her diabetic medication was discontinued. The experience of having patients make an appointment to see me, and their willingness to pay for the visit, prompted me to become a nurse practitioner. So there I was back in school again. One year done and one to go before I would graduate and be eligible to sit for the NP certification exam.
Now, thinking about my desire for autonomy and independence, I realized I was about to fall into old habits. How in the world could I permit the doctor to interpret my information and make his own decision? There was no way around it. I had to give this doctor a clear message: Ms. O shouldn’t be discharged. At the thought of confronting him, my neck felt like an icy hand was gripping it. I slowed my usual brisk gait as if by dawdling I could put off making this call. I knew I had no choice.