You know it's going to be bad when one of your patients is complaining about another patient he met in the emergency room.
You know it's going to be worse when you can hear the complaining patient all the way down the hall, being wheeled up in a stretcher, bitching about how, Goddammit, he pays fourteen hundred dollars a month for insurance and ought to be in a private room.
You know it's going to be unbelievably horrible when you try to explain to the patient that the reason he's in a semi-private room is that this is ICU overflow and he's got an expanding hematoma, and all he does is say, "That's a good line, cunt" and then ask you if your hair is *really* red.
Of course, he came in positive for benzodiazapenes, cocaine, cannabinoids, alcohol (BAC 1.2), and opiates. He's morbidly obese, has diabetes, has had five heart catheterizations, multiple gut surgeries, and is hypertensive. He's noncompliant with all of his medications, but still complained about the food and the pills I had to give him.
The black eye he had from getting drunk and falling over improved neither his appearance nor his mood. His family doctor, who showed up and humored him, didn't improve my mood.
You can talk all you want to about being assertive, setting boundaries with your patients, and laying down the law. Sometimes it just doesn't work. Sometimes you have to get out of the room before you either say something unforgivable or actually hurt the person in a red fog of rage.
But we showed him. Yesterday we assigned him a nurse who'd been the charge nurse of a busy county emergency room. By ten o'clock he was behaving.
Call me a wuss, but I really hope I never have a patient like him again. If I do, I hope I have a good supply of morphine and a ball gag.