Nurse and Doctor neighbor by Theresa Brown R.N.

January 12, 2011, 12:01 pm Nurse and Doctor, Neighbor and Friend
By THERESA BROWN, R.N.
“Something there is that doesn’t love a wall,” begins Robert Frost’s poem “Mending Wall,” about two neighbors who meet to repair the gaps and holes in the stone wall separating their properties. They walk on either side of it, picking up and replacing fallen stones as they go.


Jeff Swensen for The New York Times

Theresa Brown, R.N.The poem came to mind one recent day on the oncology floor where I work. It’s a medical oncology floor, where we tend to medical issues that go along with cancer, like giving chemotherapy and dealing with complications of metastatic disease. But it turned out that one of my patients had a serious surgical problem.

Surgical oncology is several flights of stairs below us. Even if they were next door, though, I imagine we’d still be inhabiting different worlds. There’s “med onc” and “surg onc,” and never the twain shall meet.

Except that sometimes they do. My patient, a middle-aged woman, had been admitted because of a blood disorder. She was also having some belly pain, so we did a CT scan. I’ve had patients in much more apparent distress, where the scan turns up nothing more than a touch of diverticulitis. But this patient had a hole in her intestine: a true medical emergency.
The next thing I knew, the patient had been put under surgical supervision, though she would stay on our medical floor for the time being. I listened, trying to learn, as the surgical attending physician talked to the medical attending physician about the patient’s blood problems, and what could be done to make it safe to operate on her. They also wanted to increase the rate of IV fluids, to make sure the patient’s blood pressure stayed high enough.

Later, as I updated one of the doctors on our floor on the patient’s latest status, a dismissive look came over his face. “Surgeons!” he scoffed, a tone I’d heard before when medical doctors talk about surgical teams, implying it’s a specialty staffed by overly aggressive people. I might have joined in his derision, except that the surgical resident newly in charge of the case was my real-life next-door neighbor.

When he had first appeared on our floor, I had greeted him warmly by his first name. It never crossed my mind that this man, who had talked helpfully to me about work, invited us to parties in his home and even taken care of my kids’ sea monkeys when we were on vacation, should be addressed as “Dr.” The familiarity drew looks of surprise from some of my fellow nurses, until I explained he lived next door.

But being neighbors at home allowed us to be more than just friendly in the hospital. It turned a potentially tense emergency collaboration into an easy professional exchange. Did the patient need a bigger IV? Should we put in a urinary catheter? How quickly could they get her into surgery? And perhaps most important, could he talk to the terrified patient and her family?

He asked me to call him on his cellphone once the patient was on her way to the operating room. It’s the kind of request you can make of a friend, or a neighbor — but not something that usually happens in the hospital, where we rely on pagers.

We all work in the same hospital, but surgeons on a medical floor can feel like strangers in a strange land. Medical staff can feel the same way on a surgery floor. We nurses in medical oncology can hang chemo and talk knowledgeably about the risks and benefits of stem cell transplants, but we’d prefer not to take care of surgical patients. Neither group understands the routines and concerns of the other as well as we might, and that gap in experience and knowledge can make staff anxious and aggressive.

“Good fences make good neighbors,” the wall-mending neighbor in Frost’s poem says, and in the hospital we seem to have embraced that idea with a vengeance. Divisions arise not just between the medical and surgical teams, but between doctors and nurses, oncologists and cardiologists, intensive care nurses and floor nurses, and friction can accompany interactions between the groups.

A few days after the operation, I went to visit the patient in the surgical intensive care unit. As I walked to her room in my white scrubs, the I.C.U. nurse grabbed my ID badge, lifting it off my chest, and said, “Who are you?”

I nervously mumbled something about having taken care of the patient on the medical floor and asked how she was doing. The nurse’s eyes slid toward the patient’s room, then narrowed in concern.

Suddenly I understood. The nurse’s look was not one of rudeness or aggression, but of worry. She seemed genuinely torn between filling me in on the patient’s condition and going back into the room, where the patient needed her care.

I nodded at her. “You’re busy,” I said, and she nodded back. I told her I’d come back at a better time.

In “Mending Wall,” the narrator goes on to challenge his neighbor’s belief that good fences make good neighbors, saying:

Before I built a wall I’d ask to know
What I was walling in or walling out,
And to whom I was like to give offence.

In the hospital, it’s as if we’re walling in our worry, and walling out potential threats to our competence. We build walls, and maintain them, to buttress our authority, and to prevent being challenged by staff from other floors.

But then one day I met my neighbor at the hospital, and suddenly the wall was down. And that, as Frost put it in another poem, made all the difference.