Thursday, November 07, 2013

It's never a good sign when. . . .

It was shaping up to be a pretty good day. I got up a little early, packed my lunch, put the dog outside, left for work on time, and made it to work without incident.

Where I walked in to find a patient, destined to be my project for the day, sitting on the floor of his room, screaming. And kicking and tantruming. Like a three-year-old. Refusing to get off the floor. Floods of tears. Demands that we call varied and sundry people.

I've got such a hangover from that day that I still can't form complete sentences.

Here's all you need to know: functional exam, drug-seeking, requesting Dilaudid (of course). Fourteen chart notes by the end of the shift just on my part. Approximately twelve hundred words from the various therapies. Screaming. Crying. More screaming. More demands for Dilaudid. Refusal of blood tests, vital signs, drugs, and therapies.

Drama.

I have had bad days before. Never ever have I had a day that made me question why on earth I became a nurse. (Not that I'm seriously questioning it now, but at about 1700 on that fateful afternoon? Definitely.) If somebody had made a cartoon of my leaving work, there would've been little puffs of smoke coming off the ground under my sneakers.

At one point the patient told the docs that we had left him on the floor for an hour as he screamed for help. (Note here that he did not fall; he simply sat down and refused to move.) The attending shot me a look, to which I responded with my best BlankStupidFace.

I just. . . .I just. . . .don't get that shit. And I don't play into it, either. Late in the day, the patient refused to answer the simple, yes/no question of whether he'd like to go to the bathroom. I told him to use his words.

Yes. I snarked. But I have had it with crazy junkies who fake strokes. I've also had it with attending physicians who, faced with a clear MRI, a gorgeously normal CTA and CT, and perfectly fine bloodwork (all collected before my little prince had his meltdown) decide to order vasculitis panels, autoimmune panels, and umpteen other tests to determine if there's a physical reason for The Cray.

Boo, this patient is acting out and acting up. He is so far off the chain that the chain itself is lost behind the horizon. He won't accept treatment no matter what we do, so let him go. Let him go home, sans hydromorphone, and do his thing.

And for God's sake, don't bring him back. In a town this size, there are certainly some acceptable medical facilities that are not ours.

19 comments:

Anonymous said...

When they make me King, I will institute the three strike rule as in felons. Three presentations as you describe with no positive diagnosis will buy you a ban from our hospital. Add to that (since I am King) three admits for bonifide diseases that result in return admits for the exact same condition DUE TO Non- compliance buys you the same ban.
It's good to be King

messymimi said...

That does sound like it's almost enough to make you want to quit. You went into this business to help people, not to babysit addicts.

traumadrama said...

ridiculous. this is about the point where i get tempted to leave the AMA paperwork sitting on the table or to sprinkle brochures from other facilities around the room "accidentally".

Brooke Lawson said...

You're absolutely right about the whole babysitting comment. I have a feeling once I graduate nursing school I will have many of those days where I feel as though I am babysitting a three year old and not taking care of an actual adult. I will want to quit but I know I will enjoy my job too much to do that by everything I have heard and researched.

JEN said...

THis is why healthcare is so expensive. Can't they just give him a kick in the bum instead of ordering all these expensive tests!

Anonymous said...

This is my day every day...but he's 9 and is high functioning autistic with ADHD, anxiety, ODD and PTSD. I do wonder how he'll be as an adult though. :(

Anonymous said...

patients screaming for attention. This is why rooms have doors and I close them. Recently had a drug seeker with horrendous PVD who left AMA multiple times prior. Finally, he graced us with his presence and off came a leg and then some more of it as complications kept piling up. He screamed for more and more meds as he could barely hold his head up. We attempted to be prudent and keep him breathing. A week later the med/surg nurses had other plans and drugged him until he STFU. It worked!! A little too well. I guess there are consequences for crying wolf one too many times.

Anonymous said...

ooooh. give him the new Dilaumed.
http://www.gomerblog.com/2013/11/look-alike-sound-alike-medication-praised-er-physicians-everywhere/

Alfreda Hindbaugh said...

Oh my! Sounds terrible! But, the way you write also kind of makes it sound hilarious! Sorry. And I love the term 'The Cray.' Definitely apropos!

Daniel said...

This is a sad situation indeed, i bet this is not what you had in mind when you decided to enter the medical world, but hang in there, it will get better.

shannon said...

In my little world, I will give you the sans Dilaudid because you say your in pain, but I did just hear the alarm to let you know times up. It's your life, but please take your drug seeking elsewhere, I have really sick patients to care for, this is an Oncology unit, not a Sickle Cell unit.

Heidi said...

The attending shot you a look, as in ... the attending was inclined to believe this psycho? Say it ain't so.

Enid Mueller said...

This is a sketch of my typical patient. And staff.

Tabor said...

I don't suppose it is appropriate protocol to through ice water over his head?

Anonymous said...

I keep hearing it will get better...well I am not believing it any more. I see this every day in the MI/drug/alcohol rehab, mind you this is not detox. The behavior just increases daily and with enough threats from clients I wonder why I even both,,,to many excuses and not enough backing on nursing. I can't wait to set that license in some drawer and retire....

Anonymous said...

Make it so.

ymendez87 said...

I know the feeling for sure! Med seekers are pretty much the death of me. There is nothing more annoying than a patient who is rude, demanding, and screaming for pain pills the very second they can have another one when they are really just addicts. I think there should be a limit to what doctors order although I know that pain is subject and doctors treat " symptoms" but if they are requesting for pain pills an we know they are true addicts, doctors should try other forms of pain interventions like Lidoderm patches etc before ordering narcotics.

Gary said...

Hiya,
found your blog just recently (via a search on nursing school advice), and have been enjoying reading it. I'm about to start nursing school myself this fall, so I'm trying to find entertaining nursing blogs to help me keep my sanity.

Anyhow, just wanted to say that this post reminded me of a wonderful book. It's called Romancing Opiates by Theodore Dalrymple. Dalrymple spent part of his career as a doctor at a prison hospital in the UK and got tired of hearing all the excuses people make for addicts. Very interesting reading.

Anonymous said...

Wow, so this is what nurses reallyy think,. I have a fiance, whom I have to continually see judged, and denied proper medical care because he looks young and healthy. Unless, you truly look at his medical records, which ER docs and nurses, never really "have the time to do" b/c they need to make money, and move on to the next patient, but if we sought an attorney, one infamous branched hospital in Texas would be facing millions lost due to medical malpractice. You see, he was brutally raped and beaten by three armed mean, and nearly died whhile he was being beat with full sized shopping cars-sorry,,, Texas felons will use anything they can get their hands on, when it comes to robbing people- repeately on his spine and forehead. The ER saw no broken bones, but neglected to tell us that we really needed an MRI to explaiin his daily screams for a year for a totally ignored hairline fracture. He is Hispanic, and though he is nearly in his forties, but looks twenty, no doctoro or nurse would even medicate or address he was injred. A metal shopping cart is basicallyy metal rods crushing every bone in your vertebrae when they are used as weapons. I have had to see him continually discriminated, and its because of nurse and doctor attitudes like this, which think they are smart enough to play God, or not rishk their license when it comes to genuine issues of pain and injury. But when a doctor is faced with medical malpractice for neglience is when a a "medical professional" may actually decide to be compassionate, and think twice before ignoring a patient's genuine cry for help. I took him to three doctors, before a whole year elapsed, with him in agonizing pain, every single day,, before a separate doctor admitted they had made a mistake in underestimating the severity of his injuries. Afterall, doctors ad nurses are so smart and "efficient" they have to use the same "profiling" skills cops use, which is look, and discern-Hispanic, man in twenties, able to walk on two feet-except he was in his forties, suffering in agony for over a year, had an improperly healed hairline fracture, with pinched nerves along his spine, hobbling, and near close to wanting to kill himself for the way you wonderful medical patients thinks a person with true chronic pain is miraculously going to have that pain disappear after some time. You see, the only doctors and nurses able to wor,k are those who are not disabled, they don't feel physical pain, they don't know how difficult each day is to live, when your constant struggle is to live with pain, and when you are being denied the medical care you need, then you reach an agony which is harrd to want to live.