Had a good idea to help a patient- told no. When doc suggested it, yes!
I know this is so petty. I am self aware. But I’m still annoyed.
I had a puffy postop cardiac baby that needs to diuerese. They’re on a lasix drip basically putting out nothing. Morning Xray, lungs are obviously wet. Morning labs come back and albumin is 2.2! Cardiac patients, third spacing… giving 25% albumin is something I’ve seen work a couple times to help pull fluid back into the vasculature to make a diuretic drip more effective. I text the NP my idea (screenshot shown). She comes by the room and essentially says, “I told you we aren’t changing up the diuretic plan tonight, but thanks.” Cue an hour later, the attending has woken up and is in the room attempting to do a bag suction to help the lungs, and he asks, “what was the albumin this morning?” I say, “2.2,” and he word for word spits out my plan. The NP says, “ok I’ll put in the orders.” Silence. If I were in her position, a simple, “oh, (insert my name), actually suggested that earlier, let’s do it!” But nothing. I know it’s dumb and I shouldn’t expect credit, it’s just patient care, but earning trust from attendings is so important in the ICU and that would’ve been cool if she would have acknowledged that. How do you feel when this happens?
Also side vent: this patient’s bedscale they came back from OR on didn’t work. They were intubated, THREE central lines, two arterial lines, two chest tubes, epicardial pacing wires, continuous feeds, peritoneal dialysis catheter, MSI wound vac… I told the same NP I didn’t feel safe transferring them to a portable scale. She said, “I don’t see why you can’t do it.”