The Field Trip When my MD Could Not Fill the Shoes of an RN
Recently, one of my clinic patients asked me to administer his intramuscular medication injection. I appreciated the vote of confidence but had to tell him he was mistaken in thinking that my skill would surpass that of our nurses’.
“Trust me,” I told him. “You’re in better hands with them.”
It reminded me of the time, some years back, when I inadvertently found myself “impersonating” a nurse for a school field trip. And soon found myself in way over my head.
Years ago, our family was new in town. When my child’s teacher found out I worked in health care, she asked if I would help out on the three-day, out-of-town, multi-class field trip. “We need someone to act as the nurse for the trip.”
I explained that I wasn’t a nurse, but I’d be happy to lend my medical skills for the duration of the trip. After all, I was a doctor. How hard could it be?
I would soon find out.
After introductions, the school nurse — who would (wisely, on her part) not be accompanying us on the trip — took me aside. She showed me the medication log and gave me a locked tackle box containing the medications. So far, it seemed straightforward enough.
Until I realized tracking down children on multiple buses at irregular stops and making sure they took their medications on time was harder than being an intern cross-covering three pagers. I chased down teachers to help me find kids, doling out pills and water until all my checkboxes were marked off. Until it was time for the next round.
I cringed inwardly, thinking of all the “four times daily” inpatient medication orders I’d blithely signed off on over the years. Note to self: always try to find an alternative with a less frequent dosing schedule if possible.
Finally, at the end of the first day, we arrived at our destination for the night. The kids would set up with their sleeping bags in the gym, and, bless them, the community center had provided cots for the parents and teachers.
I completed the last evening round of medications, double-checked I hadn’t missed any, and locked up the medication tackle box for the night, stowing it under my cot. At lights out, I collapsed on my sleeping bag, looking forward to the rest.
I fell asleep as soon as my head hit the pillow, to be awoken sometime later by a whispered voice.
I rolled over and put my arm over my head.
The voice got louder. “Nurse…nurse!”
Oh, wait, that’s supposed to be me. I didn’t know this job was going to come with night call.
I opened my eyes to find one of the teachers hovering over my cot.
“Yes?” I mumbled.
I was notified unceremoniously that a student had vomited. I wondered what she wanted me to do about it as she stared at me expectantly.
Oh, right. I was the “nurse.” I had another moment of inward cringing as I recalled all the times on rounds I’d summoned a nurse because of emesis and then moved on to see my next patient.
I followed the teacher into the bathroom and tended to the child, who thankfully appeared well and told us she felt much better now. I took her temperature and sent her back to bed before retreating to my own cot. But mere minutes after my eyes had closed, there was a parent at my bedside. “Nurse…”
And so it went — multiple children up vomiting throughout the night. For some reason, the other parents thought I needed to be summoned each time. As a parent myself, I was no stranger to vomit, but I marveled that the others thought there was some special need for “the nurse” to witness it each time. I wiped brows, took temperatures, and reassured the other parents that tucking the kids back into their sleeping bags seemed the best next step.
In the end, perhaps 10% of the kids were affected by whatever GI virus swept through the group. It was thankfully short-lived, with everyone feeling better within 24 hours.
In the end, I realized the only thing my physician training helped me with was my ability to function the next day on little sleep.
I kept to the schedule in the binder and administered the medications, checking off my boxes. Another skill I had learned in internship.
The second night, I was called to assess a child with chest pain. It turns out being an oncologist for adult patients in one’s day job is absolutely useless for evaluating healthy children on a field trip. The immediate differential diagnosis that popped into my head by default was pulmonary embolus, SVC syndrome, and mediastinal mass. Then I oriented myself to the fact that this was 1) not an adult and 2) not an oncology patient. I could most likely dismiss the first two causes.
The child appeared healthy — albeit embarrassed their parent asked for my help — but did endorse ongoing pain.
Running on fumes due to the previous night’s sleeplessness, I did the only thing I could think of — called the pediatrician on-call back at our local hospital. As the child’s parent listened to me summon the pediatrician to the phone by using my “doctor” title and the conversation that followed, they slowly backed away, nudging their child to step back as well.
You see, back at introductions the morning of the trip, I had identified myself to the other parents as “the nurse.” In my head, the words had quotes around them. It would turn out the other parents hadn’t picked up on this, as, in general, air quotes aren’t audible.
After a few minutes on the phone, my colleague assured me the child was likely fine, and this wasn’t an initial presentation of childhood lymphoma. I hung up and turned back to the child and their parent. But before I could say anything, they were halfway back to their tent.
My heart sank. I realized they had sought me out (or rather, sought out the nurse) for reassurance — not a call to the hospital and a scary discussion of improbable causes of the child’s symptoms.
The final day of the trip came, and I made it through without any other blunders — and, thankfully, no more vomit.
That evening, we arrived back at the school parking lot, and I handed over the medication box to the school nurse.
“Any problems?” she asked.
“Not a one. Except — ”
“I didn’t appreciate enough everything that nurses do.”
While this story is a lighthearted anecdote, my larger purpose is to honor the wisdom, caring, and leadership of our highly skilled nurse colleagues. May 6 marked the start of National Nurses Week, so I hope this story served as a reminder to take extra time to recognize our nurse colleagues, many of whose daily work goes unsung.
originally published on Doximity’s Op-Med