Doctor Waltman

I work in the evenings as a charge nurse in a skilled nursing facility. Nursing is something which, if you have no confidence, is a nightmare. There is a culture, an ethic in nursing that nothing can be too exacting. By definition a nurse can never know enough, be smart enough, fast enough, or be sufficiently diligent.

When I started working in this particular SNF I would make occasional errors. Forget to follow up on some piece, for example, noting the need to check someone's INR on the particular date ordered, or ordering a lab, or noting a twice daily order as once daily. So I heard about it a lot. They seem like simple, easy items to write about, but the reason people forget things or get them wrong, is from being swamped. Too busy to figure it out.

My other weakness is physical assessment. I once had to listen to Dr. Waltman lecture me for forty-five minutes about how, if someone doesn't look right, we should follow our gut instinct and call the doctor; if he or she doesn't respond, be persistent. This was in reference to a resident that didn't look great to me, but I certainly hadn't put in the category of "send her in!"

What I was unable to explain to the MD and to the muckamucks was that when you're operating in the realm of fear, common sense, intelligence, gut instincts and honesty go out the window. I developed a near mortal terror of Dr. Waltman. He is one of these old time homey docs that drags the charge nurse around with him to see his residents, listen to a twenty minute health history interview [what color was the house in Massachusetts where you grew up?] and supervise his breast examinations.

So I was not really being myself, Arlene: I was being the Character "Arlene the Charge Nurse" and trying to play a part, trying all the time to guess what the right answer was instead of just giving my answer. Dr. Waltman would ask, "how is his skin", and I would say, "It's okay--as far as I know." Hot button. He hated that, "as far as I know." "It's such and such," or "I don't know, I haven't seen it," were ok, but no "as far as I know." The more I gave the wrong answers the worse it got. One time he asked me, "how long have you been a nurse?" I go, "am I a nurse?" He goes, "How long have they been paying you to be a nurse?"

One day I came in at change of shift in the afternoon, and there was a new admission that came in on days that looked like hell. Clearly he was circling the drain. The Unit Manager had spent two hours poring over the chart, and I hadn't seen it. So I didn't feel qualified to answer Dr. Waltman when he called up, I answered, and he asks, "Do you have any concerns about Mr. Dunfore?" I immediately handed the phone to the Unit Manager who would, naturally, have the Right Answers.

Whoo, fatal mistake. He told the Unit Manager to tell me that I had one hour to assess Mr. Dunfore and call him back with my assessment. Well, I wasn't going to let this doctor dictate how I was going to spend my time, and he wasn't my boss [now he's the facility medical director, but then just another associate.] So I ignored his demands. Things didn't go so hot with that, and I just kept wondering how I was going to escape from this tyrant. Naturally, I prayed about it a lot.

One day I woke up one morning with this incredible "Aha!" I had been trying to jump through some type of invisible hoop, win the doctor's approval, and getting more and more weaselly all the time. I had an epiphany: the doctor was trying to figure out if he could trust me. It was all about trust. He just wanted me to be honest. If I had been honest, when he asked me if I had any concerns about Mr. Dunfore, I would have said, "Yes! Why did you send me someone who is clearly dying?"

Immediately I began to be both more confident and more honest. I didn't let my dealings with Dr. Waltman be about me, only about the residents. I started to offer my opinions. Many times, I found out my point of view concurred with the doctor's point of view. We established a relationship of trust. I trusted the doctor more and he trusted me more. My stock stablized and started to climb.