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March 9, 2006 -- An Associated Press piece today reported that the chief of neurosurgery at an Oakland hospital was "arrested after allegedly throwing a drunken fit when a nurse refused to let him operate," according to local police. The unsigned piece, run on the New York Times site and elsewhere, does not name the nurse. And we could have used more detail on exactly what he or she apparently did to prevent the surgeon from operating. But the report, "Doc May Have Been Drunk in Operating Room," still appears to be a striking example of nurses' patient advocacy. It's the kind of thing that too few members of the public know that OR nurses are responsible for doing to protect their patients.

According to the piece, Alameda County police said the surgeon, Federico Castro-Moure, had been arrested earlier in the week "on suspicion of being under the influence of alcohol and interfering with the duty of officers." This is an apparent reference to deputies' need to wrestle him to the operating room floor. Police said Castro-Moure grew "belligerent" at Highland Hospital after "insisting" on operating right away on a man who had fractured his spine and broken his ankles in a fall, though other surgeons "determined the injuries were not life-threatening." The report says the neurosurgeon started "yelling and cursing" after "staff" told him they needed to get surgical instruments from another hospital. When those arrived, "a nurse refused to allow Castro-Moure to operate until they could be sterilized." The surgeon reportedly "threatened the nurse by punching his fist in his hand," took a swing at deputies "called to intervene," and said: "Do you know that I am a (expletive) doctor, and I'm going to do what I want." We'll resist getting too far inside that remark, except to say that this kind of attitude, drunk or sober, remains a real threat to nursing practice and patient wellbeing. In any case, it is not clear from the report who called the sheriff. Nor is it clear whether the nurse's insistence on sterilizing the instruments was part of a larger plan to stall the surgeon in any way possible, or whether the surgeon might actually have been allowed near the patient once the sterilization occurred.

What this OR nurse reportedly did may well have saved the patient's life. It's also important to stress that it was not the act of a noble bystander, something that the nurse just happened to decide to do as anyone might, but one that lies at the heart of nurses' professional responsibilities. Operating room nurses are charged with ensuring the patient's wellbeing throughout a surgical procedure, including everything from making sure the equipment is ready to, well, making sure the personnel are ready. Indeed, in a January 2005 piece explaining why the surgical robot Penelope was not a "nurse" despite statements in the media to that effect, the Center explained that OR nurses:

  • monitor sterile technique,
  • ensure that the sterile field is preserved,
  • make sure all needed materials are available,
  • ensure that the surgeon is doing the right procedure in the right place in the right way,
  • ensure that patients get the proper medications and solutions at the surgical site,
  • intervene when the surgeon is not up to the task for any reason (common ones include incompetence and intoxication),
  • provide emergency nursing care if the patient crashes (e.g. cardiac arrest),
  • assess the patient generally,
  • intervene or recommend intervention for problems identified, and
  • advocate for the patient generally.

(Emphasis added.) Does this sound like the vision of OR nurses that 20 million U.S. viewers get on ABC's "Grey's Anatomy" each week? JD, the lead physician character on NBC's surreal sitcom "Scrubs," recently put it well in expressing mock admiration for "Grey's Anatomy," making a rare slashing attack on another network's show: "I love ["Grey's Anatomy"]. It's like they took our lives and put it on television." "Scrubs" itself is fairly poor for nursing, but it's also intentionally absurd, which underlines how ridiculous "Grey's"'s ostensibly realistic vision of OR professionals is. But we're confident that after today's AP story sinks in, we'll soon see a "Grey's Anatomy" plotline in which a crafty OR nurse prevents an intoxicated senior surgeon (say, chief of neurosurgery Derek "McDreamy" Shepherd) from killing a patient. Here's a hint: nurses have more at their disposal than syphilis and strikes. Incidentally, the AP piece also shows the kind of physical and psychological abuse that many nurses absorb on a regular basis. This is a subject that has started to receive more attention, but which remains distressingly common and a factor in the global nursing crisis.

Although today's AP item could have included more detail, we thank the news agency for running a piece that highlights critical nursing actions. Our hats are off to the OR nurse who reportedly provided such stellar patient advocacy.

See the AP article in the San Diego Union Tribune from March 9, 2006. See also a more in-depth article in the San Francisco Chronicle from March 10, 2006. On April 5, a follow-up AP piece reported that the surgeon would not be charged. His lawyer argued that there was "no evidence" he was intoxicated; the piece noted that nurses and the police thought he was intoxicated, but said that he had "refused to submit to a proper breath test." In any case, the piece says the surgeon has been "suspended from performing surgery while the state and county investigate."

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