Learn from someone else's mistake #2: The Day my Sense of Humour Died

I told my last med school joke today.

So much for my mark for "Professionalism" for this block of case-based learning.

We were given a case and on one sheet, the information provided said that "vital signs were normal." Then, on the next sheet, the respiratory rate and heart rate were elevated. One person in our group said, "I thought we were told that the vitals were normal!"

My fateful response: "Don't trust nurses."

Ha, ha. I though it was funny. Most of the people laughed, too, and realized that I WAS JOKING, and that comment is NOT exemplary of what I feel about nurses.

Please let me provide context (perhaps my first mistake; I made my comment in the first session with a new group, so they probably didn't realize that I try really hard to respect everybody and every profession and every member of the health care team).

• I know from personal experience, and I strongly believe that nurses are an important and valuable part of the health care team and play hugely significant and essential roles. Without them, hospitals wouldn't function.
• I know that nurses can be a doctor/med student's worst enemy or best friend
• I have several good friends who are currently nursing students, or just became nurses. Heck, I read nursing blogs, I dated a nurse once, I have friends whose moms are nurses, and my mom's a nurse, too.
• I wouldn't wish anything bad upon a nurse and plan to treat them with the respect and admiration they deserve.
• my only exception: when there is incompetence or danger to a patient, then I have no tolerance (but this goes for anyone working in a hospital)

Anyways...the tutor asked me to repeat what I had said. I told him I was joking, and he went on a rant about how his wife is a nurse, how nurses are important part of a team, how what I said wasn't funny, and on and on and on. When he finished talking and I had turned red enough and sunk deep enough into my chair, I blubbered out an apology.

Serves me right - when we were laying out ground rules for this case-based learning block, I offered, "Be willing to give and accept constructive criticism." I didn't expect to have to accept some so soon. The funnier part was that, according to our case, it wasn't a nurse who presented the vitals - it was a paramedic.

Figures. Don't trust param.... i mean, nevermind! ONLY KIDDING! man, I really haven't learned my lesson. (Oh dear, do I have to make it clear that I love paramedics now, too?! okay here goes: that's what I originally wanted to do with my life, and a former paramedic in my class drove me to school today :) )

The tutor did say he was sorry for singling me out and later apologized again, and I had a chance to try to redeem myself and say what I really feel about nurses and that my flippant comment wasn't what I really believe. Good thing it was in a small-group session with only 8 other people.

I definitely am much more aware that I need to be careful with my jokes, because usually they don't emphasize the amount of respect I usually have. Also because this isn't the first time I could've been more tactful. Maybe it was my enjoyment of other blogs where med humour abounds that led me to say things like that...regardless of where it came from, from now on I'll keep it to the written word.

Wish me well in beating down my sense of humour. Class clown, signing out.

**Postscript (10/24/06)**
Our tutor has lightened up a bit; I think perhaps he feels bad for reaming me out. I've noticed a distinct - almost forced - effort on his part to laugh at all the (very sterile and non-offensive) jokes I've made since then.

**Post-Postscript (07/24/07)**
Since I've linked to this post I read it again. Fortunately I've learned from this (and I know better now, thanks Captain Constructive Criticism below who called me an ass). In my review for the block my tutor made mention that I shouldn't be too careful lest I lose my 'endearing' sense of humour.

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Learn from someone else's mistake #1: Humour and patients

It feels good to sit down after an 11-hour shift. And, I get to sleep in tomorrow (that's the good news; the bad news is it's because I'm doing a night shift tomorrow starting at 10:30 pm.)

Story time.

As we left the patient, the doctor pointed to a dressing cart and said, "How about you put some gauze and tape on her cut so her dad doesn't have to hold that tissue paper on it."

"Oooh," I thought, "I get to talk to a patient! No doctor in the room! Awesome!"

I collected myself and grabbed a roll of tape and some gauze, and carefully put it on the ninth-grader's wound in a very amateur and untrained fashion that is probably contraindicated in every way and will cause the nurses to shake their heads and mock me under their breath as soon as they seen it. But as I left, I said the fatal line:

"That should keep your dad from having to have his arm up for the next few hours!" Ha, ha, ha, I thought. A few hours. I'm so kind-hearted, cracking a witty joke and keeping these patients smiling.

The reaction was not what I expected.

The girl's eyes went big in horror and shock.

"A few hours?!"


They had been there for hours already and had seen us walk by their room several times to see other patients - likely including patients who arrived after they did. I quickly learned a lesson from the poor girl's reaction to my offhand comment: When it comes to joking around with ER patients, they don't find it funny if you make a joke along the lines that they have a long time left to wait. Most of them have been there long enough just to see a doctor. Unfortunately, they will likely be waiting there for a while longer as they wait for labs and xrays to come back. But don't remind them. Especially in joke form.

I figure that this could be the first of many mistakes that I post here, mine and others (med school classmates beware). Yes, I have come to terms with the fact that I may do two or three things wrong over the course of my medical education. So I'll try to immortalize them as they come along in what could be a great new VM miniseries. And hey, why not just talk about my mistakes? Here's another one. One that I didn't make.

This I learned from the doc I was following: Never give a patient any definite indication of how much longer they'll have to wait. Not that you should avoid the question or lie to them. It's just that things can get crazy. A patient we were seeing was getting antsy to go home, and he asked how long he'd be. The doc explained, "We're going to refer you to a specialist, Dr. Frist. We've paged Dr. Frist, and she always responds to her pages right away, so you shouldn't be here longer than ten or fifteen minutes." On top of all hell breaking loose in the ER, this also marked pretty much the first time that Dr. Frist didn't return a page. I felt really bad when I noticed him still in his bed an hour later and went over to explain what had happened.

Shadowing doctors is great now that I'm a medical student and not just a pre-med. Maybe it's just the docs I'm working with, but I've noticed a difference. Even though what I'm allowed to do is still very limited, the doctors have that much more respect for me. I've had deep conversations with six or eight doctors where they've gone into detail on questions I've asked about about their experiences in med school, lifestyles of various residencies, pros and cons of specialties. One gave me good advice about going the military route to pay for med school. And I've been so surprised by how much they care about my future.

All the stuff they're letting me do is part of that respect. Even though it's just been little stuff like going to a patient on my own and explaining that we'll need to run some more tests, or reducing a dislocated shoulder, or putting on a cast (the last two under close supervision), it's a good feeling when the patient asks why more tests are needed and I can explain, or feeling the shoulder pop back into place, or hearing the patient say "that cast makes my arm feel better already."

It's also a good feeling that I'm no longer just doing the pre-med thing - watching. Instead, I'm practicing. For when I get to do this for real. For a living. It feels good. If I can choose to walk around an ER for "fun" for 11 hours, and still be willing to go back for another helping tomorrow (during a night shift, no less), I think this might be an indication that I've picked the right career.

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