Communication Crisis

Stephen R Covey's book "Seven Habits of Highly Effective People"  states that Habit number 5 is "Seek First to Understand, Then to be Understood."  This is the lesson I learned Friday when the patient who the resident had just put a central line in went bradycardic and hypotensive.  I don't recall perfectly the sequence of events but I was asked by the attending physician to administer 1 mg of phenylephrine.  Yes you read that right, 1000 mcg of phenylephrine.  I questioned it too.  I turned to the resident and asked if that was what she heard and she said "yes, 10 CCs"  So, with some reservations, I gave the whole stick of phenylephrine.  I watched the blood pressure climb but nothing too significant.  A short while later the heart rate dropped and the attending gave atropine. Although the heart rate started looking better the blood pressure was low again so I was asked for a second time by the attending to give another 1 mg of phenylephrine. Being new to this situation I assumed she knew what she was saying since this was the second time she had said the same thing.  I proceeded to push 10 CCs of phenylephrine but before I got halfway she yelled at me, "Stop! What are you doing! I said two CCs!"  To which I responded, "But you told me to give 1 mg!" She came to where I was standing took the syringe from my hand and withdrew as much phenylephrine as she could.  The patient probably got 400 to 500 mcg phenylephrine maybe even a little less.  I went and stood out of the way while I watched the blood pressure climb to somewhere around 250 systolic.  The patient supposedly went into PEA for a few seconds after which the attending gave a few ineffective one-handed chest compressions.  The patient's vitals soon normalized and all was well.  Meanwhile I got an earful from the attending.  Paraphrasing her words she said, "We never give 1 mg of phenylephrine! Why would you give that much?!  We never give that much at once!  I shouldn't have asked you to even do it!  Even if I told you to give 1 mg you should never give 1 mg!"  I apologized to her and told her I should have communicated better. I couldn't get it out of my mind the entire weekend.  I kept shaking my head in disbelief whenever I thought about it.  However, I am thankful for the experience because I know I will never give a drug that I am told to give without verbalizing it.  Hopefully you won't either.