The Chain of Command

When we were kids in school we learned about the chain of command. As the students, we were the peons and had to have permission to even use the bathroom. The teacher had all the power we could see over us, but she didn't have all the power she needed to help her do her job, this is where the principal came in, who had to determine if the teacher was as crazy as we thought or not. No matter what kind of child we were, each of us defied the rules, and at least once, the principal took our side. But sometimes the chain of command gets screwed up, and then problems arise.

The nurses station was buzzing with phones ringing, voices yelling and white coats creating a blur as they passed. As they walked, the interns, brand new from med school and our own batch of young doctors, griped. "I cannot believe the nurse wouldn't give my patient denture cream!" A blond, skinny doctor said in disbelief to her colleagues. She wore high heels and too much makeup, and looked much younger than she probably was.


"I cannot believe it either, I mean what the hell is her problem, the woman needs denture cream!" Another doctor, a short brown haired-boy said. He also looked too young, but was wise enough to wear scrubs. The third doctor, looked to be about thirty years old, he stayed quiet and watched his colleagues intently. He held the patients chart and laughed to himself, but said nothing to the others.


As they entered the patients room to discuss this mishap they stopped and stared at the patient speechless as the elderly lady they were worried about smiled at them, showing off a full pair of natural teeth, complete with a gold tooth on one side.


My pager buzzed endlessly in my pocket, but I couldn't seem to escape from a certain patient. She had something wrong with her, but no one could identify it. I kept thinking back to a scrubs episode where a patient kept thinking everyone was a clone of themselves and trying to hurt her. Her lip trembled as she rambled on and on about going upstairs to a unit that didn't exist. She kept talking about promises that doctors made, and kept talking about doctors screwing up her care. I approached the nurse as soon as I escaped, who rolled his eyes. So I took action. Wearily I walked over to the case managers desk and sat down next to her. She looked over at me. "What?" She grumbled, looking back to her paperwork.

"I need your help." I said, my voice shaking and knowing full well that I could get in a lot of trouble for doing what I was about to do. The case manager looked at me and took off her glasses, studying me. I took in a deep breath, then continued. "I have this patient, who hasn't had a psych consult, and I think she needs one. Also, her nurse seems to think she is crazy, so none of her needs have been met yet. And I am not sure who can call for those or what can be done, but I know you are a patient advocate, and so am I. Can you help me?"

She nodded and put her glasses back on. "I need a patient name and medical record number."

"So you can help me?" I asked.

"You bet your ass I can." She replied.

Thirty minutes later a psych team came to her room and new labs were drawn. The patients needs were met, and she felt better about her care, even if she was crazy, and without a doubt she had some psychological issues. No one knew it was me that told on the nurse about the patient. No one knew that I had overheard the interns arguing over something ridiculous, but the aide that I had to tell on knew that it was me, and for once, I regretted the chain of command, for this information getting slipped.

"I'm not taking report from you, your a bitch." She said, her acne scarred face sneering at me as she scratched the table with her dirty nails and chipped nail polish.

"That's fine." I said, handing my report sheet to one of the male aides. Anger and despise came over me and I felt meaner and nastier than ever as I watched her. Finally my eyes turned to the aide I had handed my report sheet to. He looked at my report sheet and a smile crept across his face.

"You even have their medications on here?" He asked. I nodded. "And their place of work, and their stories?" He looked at me and smiled. "I'm gonna switch shifts just to get report from you." He said. I smiled and clocked out, without a report to give I was burning time.

As I walked out the charge nurse tried to send me back to the break room, but when I explained the situation to her she sighed and apologized. I smiled at her and thanked her for her hard work, then walked out of the hospital, which seemed to be empty.

As kids we never realized all the things we did until it was bedtime, when mom and dad tucked us into bed and asked us about our days. It wasn't until we laid awake wondering what problems tomorrow would bring because of today's actions. As adults, we do the same thing, but our problems don't include apology letters or time out. As adults the repercussions of our actions are much, much bigger...