It wasn’t a terrible idea – it kind of made sense.
“If the straight cath puts out more than 500 cc, leave the foley. Otherwise, take it out.” I asked her.
The young nurse was energetic and confident. In herself and in her bladder scan that had shown “greater than 999.” She told me, as she walked away, “I’ll just leave it in, there’s no way it won’t put out that much.”
I didn’t take it as disrespectful – who am I, an intern, to be respected? I just let it pass because I didn’t want to be…what, didn’t want to be disliked? Didn’t want the nurses to hate me? Didn’t want to be that kind of doctor? Didn’t want to be pushy and know-it-all?
There’s a reason these algorithms exist – because there’s no guarantee that a bladder scan is correct or equivalent to a straight cath. Only a little came out and she left the foley in anyway because she was sure of it. Ultimately though, she left it in because I didn’t stand my ground and didn’t correct her. Ultimately, the responsibility falls with me. If a CAUTI happened, that would be mine too.
I think what I learned is that there must be a separation. I can sit at the station and get friendly and joke around and be responsive and be liked. But if I don’t think for myself and understand my responsibility, then I’m just a monkey who types in orders other people tell me. That’s an intern, you might joke. But that’s not a physician.