Dude, Where's My Hematoma?

So today I had a patient who was two days post-op from a fem-pop bypass. Yesterday, vascular service decided to leave his old, yucky bandage on--breeding God knows what filth--whilst today, a vascular resident came by, took down the dressing, assessed the wound, and bandaged him back up without however, cleaning the incisions.

Then the resident advanced him from clear liquids to solid food, without the intermediate full liquid trial. I don't know for 100% sure since I haven't done any research on evidence-based practice on this matter, but I'm sure there's something to advancing the diet slowly after surgery, so that one's sleepy GI tract doesn't go all wacky-tabacky and vomit waffle chunks all over his nurse.

Luckily, I was in the room assessing the patient as the tray came. I had asked the resident earlier if it was alright to advance the diet and he'd said yes, so I was fully anticipating an order for full liquids. Soooo... apparently no one mentioned to residents that "advance diet" from clears does not mean "give waffles and syrup straight away!"

Anyhoo.

Later on in the afternoon, the patient had an incontinent episode, soaking his leg dressings. Being a dutiful nurse, I took down the dressings, washed them properly, assessed the sites, and redressed the incisions.

In the course of doing so, I noticed a small hematoma on the patient's right thigh. I was quite sure the surgical resident hadn't said anything about a hematoma (I was there when he assessed the patient and dressed the wound) and I didn't remember reading anything in the chart in the attending's note, either. It wasn't a very big hematoma, and I thought it rather unlikely to be much to be bothered about, but, having found it, I now had to deal with it, especially since the family (very lovely, by the way) was standing right there during the dressing change.

I went and dug through the chart--no mention of any small hematoma there, and the resident conveniently hadn't left a note. The attending didn't mention it either. So then I looked for an H/H to see what his blood count was doing; nothing ordered.

So Jamie pages the attending online with a nifty little text message (because he wasn't on CV surgery service and I didn't have any SuperCool Anytime You Need Me Physician Assistants on the flor for this guy) to mention the hematoma and ask for an H/H.

ATTENDING:
[curtly cutting across my spiel]
Yeah, I got your page about the hematoma; I saw it this morning and it wasn't very impressive.

JAMIE:
[doggedly, as she knows this particular attending probably thinks she and all nurses are syphillitic whores]
Uh, okay. He doesn't have an H/H, would you like to get one?

ATTENDING:
[Sounding like teenager saying "Whatever"]
Yeah, sure, that will be fine.

So dude. The funniest part about this story, and the reason I'm even mentioning it at all, is that yesterday the attending came in at 8:00a.m. all huffy because the guy's leg wasn't elevated (it had been, but you know, sleeping and stuff at night shifts stuff around). Any way, he went on and on about it, implying I was a shitty, stupid nurse because clearly, I somehow didn't comprehend the importance of elevating extremeties (just as somehow, his residents don't get how to properly order advance diet and dress and assess surgical wounds, but whatever).

That's not all.

I asked the patient twice just to make sure, "Hey, did the attending take down your dressing at all today?"

And the patient, alert and oriented as you and I said, "Nope. Just looked at. Never took it down at all."

Hmmm....

I ask you: Now who's the stupid syphillitic fibbing whore?!