Saturday, May 20, 2006

Therapeutic Communication

"Roll over" I said.

"So you can see my incision?" he asked.

"No, so I can kick your no-good ass," I replied. "You've been giving me grief all day, and I've had it up to my moustache with your antics."

"Gobsmacked" would be the best word to describe his expression at that point.

The call bell system was dead. The cable was dead. The plumbing was under the control of some evil spirit. All of this had happened on the third day of his having to be flat on his back due to a low-pressure headache, and he was fed up. So he called the operator, the receptionist, the concierge, the assistant to the assistant to the President, and complained.

The one person he didn't call was me.

For two days he'd been cursing at nurses, throwing things, and generally making a pain of himself. The last nurse to take care of him had exited the room with some speed as the sound of smashing crockery came from behind her. This is a nurse whose dad was a Merchant Marine, so it's not like she couldn't handle it. But she couldn't handle it any more. So I went in to resite an IV that was giving him trouble, cussed right back at him, and got him for the full twelve hours the next day. Seems he liked my style.

I pointed out to him, at varying volumes and at some length, that he was paying me to make his life easier. Why, I asked, would he pay a lawyer to accomplish in two weeks what I could manage in two minutes if he simply gave me the chance? Why risk being branded a whiner when I could get him what he wanted (short of fixing the cable myself, which he seemed to expect) with a minimum of trouble and effort? Why, essentially, did he insist on being the most difficult of difficult patients--one with a legitimate complaint who says nothing until the pot boils over--rather than answering my questions honestly and letting me *make his life easier*? I'd tried to draw him out earlier, a number of times, and he'd simply waved me off.

Screw therapeutic communication. Sometimes it doesn't work. Sometimes it does, true; there are times when a patient simply needs a listening ear and somebody to say "Uh-huh, and then what?" over and over. But--and this is a big and delicate but--there are times when you have to throw it out the window and be blunt. Speak the language, as they say. Walk the talk.

He gave me cookies and a hug and an apology. I walked out with a smart remark and a toss of the head. We understand each other now; even if there's another crisis in the middle of the night tomorrow, I know he'll behave like a human being rather than the whistle on a teakettle.

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In other news, I'm rereading Bill Bryson's book on Australia. If you hear that I've cleared out my savings account and taken up a job travel nursing, you'll know what to expect: bulletins from the billabong.

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The Cat seems to love the Feliway Comfort Zone diffuser I got her. It's a pheremone-squirting widget that you plug into an electric outlet--supposedely, it combines "friendly pheremones" in such a way as to make cats happier and more relaxed. All I can say is this: after four hours of having the thing putting away, The Cat laid down in the middle of the floor and purred, allowing me to rub her belly. That hasn't happened in nine years. Maybe the neurologically-damaged Cat just needed some Happy Kitty Smellatrons; I dunno. I'm not questioning the results. (Mom: Try it for Astro.)

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The MBTs are, so far, a revelation. I'll let you know how they continue to work out.


may said...

you are after traveling if you plan to work in australia, right? because they pay less. i was an RN in queensland before i came here, and the place is perfect, but the pay is lower. i don't recommend it to asian nurses too as aussies in general are not really ready for brown skinned people hanging around their bedsides.
i hope you find the perfect place to work there.

Yolanda said...

I can so totally identify with this post as I have been an RN for 22 years. I love reading Bill Bryson too . He cracks me up.What are MBT"s ? If they are shoes Lord knows I need a comfortable pair.

shrimplate said...

Sinetimes when I talk to a patient, I whisper, whisper very quietly.

And then I go away for a little while.

Nurse Practitioners Save Lives said...

Therapeutic communication is sometimes a crock of crap. Patients just have to hear it like it is. Too often, we have walk on eggshells. I get soooo tired of it.. I'm sympathetic when I need to be, but whiners who think they're at the Hilton really piss me off..