Monday, March 18, 2013

Malarkey: How to Put It Over Effectively.

For some reason which I have been, as yet, unable to discern, those members of the public who are most inclined to attempt malarkey at the hospital choose neurological afflictions as their mode de malarkification.

I am SO TIRED of people who insist--insist!--that there is indeed a brain tumor, right here (points to right temporal lobe), despite the evidence of repeated MRIs to the contrary. I am equally as tired of people who have trouble remembering on which side they ought to be weak. And I've had it up to my moustache with folk who think that squinting is a facial droop.

So, in the interest of having something actually fascinating to deal with, I've come up with a list of things that malingerers shouldn't try, because we've seen them all before.

Numero Uno: SQUINTING IS NOT FACIAL DROOP. Seriously. I have all these fun little tests that I can do to prove it to you, plus: I watch you when you think I'm not watching you. Oh, and I read the charting from your forty previous admissions, so I know what you're likely to try. How many times do I have to say this, anyway?

Number Two: If you're gonna have weakness, make sure it's not distractable.

Number Two, subsection A: If you're gonna fall over, do it on a hard surface once in a while. We have a name for what you're doing: it's astasia-abasia, and it means we know you're bullshitting.

Number Two, subsection B: The same goes for upper extremity weakness. If you pretend to pass out, seize, or otherwise suffer an alteration in your level of consciousness, you bet I'll hold your hand about a foot above your nose and then drop it. If it misses your nose, I know you're faking.

Number Three: Telling me that you're allergic to morphine and "all NSAIDS" will not get you the IV Dilaudid you want. I weep for you, the Walrus said, I deeply sympathize: Dilaudid is the best shit ever in the history of the universe, and I certainly understand why you want it. However, you won't get it. Nor will you get Phenergan IV, or any of the other cool drugs, like Stadol. Here; I'll help you fill out the AMA paperwork.

Numero Quatro: Threatening to sue me won't work. Don't try it. Besides being rude and laughable, it's out of character for your illness for you to be able to holler unslurred words at me.

Number Five: This might bust up the angel-at-the-bedside myth about nurses, but: We Judge By Appearances. If you have no teeth, a heavy backwoods accent, track marks on your neck, and smell like an ashtray, we're going to be very, very cautious about what you're reporting in terms of symptoms.

Number Five, Addendum One: Likewise, if we read in your chart that you're on your fourth revision of a gastric bypass, have recently gotten out of rehab for the third time, and are allergic to morphine and all NSAIDS (see above), we're gonna lock up the narcotics.

Number Five, Addendum Two: In the same vein (no pun intended), we automatically double or treble the amount of alcohol use you admit to. That's why you're getting Librium with your scrambled eggs.

Number Five, Addendum Three: Yes, I will search your bag, your bed, your closet, your pockets, and everyplace else you could hide a stash after your family visits. I know these rooms better than you do, so don't even try.

Thank you for your time. We at Consolidated Research and Healthcare, Inc. know that you have a choice in healthcare providers, and we thank you for choosing us. We hope, wherever your final destination may be, that you have a safe trip. We hope to see you again soon, perhaps even in a sober state.

21 comments:

Anonymous said...

I love this! I work in an ER and see all this too. I love to do the arm drop over the face too:)

bobbie said...

And remember ~ the absolute FIRST test we do for "suspected" brain tumors, seizures, etc., is a lumbar puncture.
By a first year resident.

Wendy said...

I'm not in the health field, but I've seen my share of health-related malarky. I love this!

Laina said...

When I still worked in the ER, I saw an ER attending stop a seizure with an ammonia capsule beneath the nose.
This all brings back lots of "fond" memories!

PediNP said...

Don't forget the fly of men's underware. Found a stash of heroin in there once...just sayin'

Awesome post!

Penny Mitchell said...

And here I was, thinking, "Maybe I should apply to nursing school again." hahahahahahahahahahahahahahahahahahahahahahhahahahahahahahahahahahaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

shannon said...

A lot of this is seen on the Hem-Onc floor I work on! Nicely put!

Rachael SparkFire said...

So true! So so true. I am only a sophomore nursing student and I already completely agree.

just joined your site via GFC!

Scrub Ninja said...

Do you get any of the people who have sudden coughing fits whenever a nurse walks into the room? Apparently that weird respiratory condition is resistant to nearly all cough medications, and can be treated only by a combination of Tussionex and phenergan with codeine.

Anonymous said...

As the wife of a patient with a legitimate allergy to all codeine products (no oxy, no vicodin) and a cancer survivor to boot (so lots of chronic pain in the past, and could at her worst take enough oral diluadid to knock over an elephant and still be coherent), I applaud this. We had people, no joke, trying to find out how much pain meds her oncologist prescribed her (yes, she was prescribed 4mg q 3 orally. No, we won't share). Yes, she also had standing orders when inpatient for a pain pump with a basal rate of 1mg/hr. with .25 bolus up to six times an hour. But she was also in some mega heavy duty pain, and never got high. If you're not rocking, keening, unresponsive to outside stimuli unless it's forceful, and preferably nearly vegetative with the pain, you don't get fun drugs. And stop asking if we will share! LOL

Thank you to those nurses who knew we weren't kidding. And to those that kept the dingbat with a healed skin cancer removal (stage 1A) on their nose from getting enough "vitamin D+" (as they really called it!) to have a nice flight in their bed. Y'all are the first line of defense against the people that make it harder for really sick people to get what they need.

BTW - we disposed of enough of those 'extra' pills after she recovered to make most addicts weep. I shudder to think of the street value of it. And would do it again, anytime.

Anonymous said...

I want to come work with you. We can't refuse "that d drug, can't remember exactly but it's the only thing that doesn't make me stop breathing" nor can we search. Just give drugs drugs drugs. Oh and did you know that if you push undiluted benadryl you get the same rush as heroin? Me either until an addict requested and explained why.

Anonymous said...

anybody remember the 'therapeutic trial of barium" from The House of God? a good cleanout can work wonders...
i work in elder home care, so don't see this stuff too often - tho i know i have clients who are quite effective thespians when in acute care or SNF.

Anonymous said...

so this totally explains the bloody nose I had during a video eeg. I couldn't figure it out- I was in the bed,yet after the seizure i had a bloody nose and no one could tell me how it happened. apparently i punched myself in the nose. with a little help from my nurse.

Footie said...

Its being some time since I worked in an ER, but we also had
One. Feigning unconsciousness, and
Two. Pseudo fits.
For most of the repeaters, we threatened them with the red haired irish nurse, which triggered many amazing recoveries. It sounds like you have a similar therapeutic efficacy

My Little Doc said...

Great list, I think this should be given to all Nursing Students as part of their training. Bravo!!!

Livvie G. said...

I'm a nursing student and I can definitely appreciate this list!I'm going to remember the arm above the nose trick. :)

Summer said...

I particularly love when they give you the list of what they're allergic to and then "what works". The "what works" list is usually one word.

NonUrgentEmergencies said...

Personally, I greatly appreciate it when my patients take a second to get my attention to tell me they are having a seizure. I mean, it must take some concentration to dramatically flail one's arms and legs in the air and talk at the same time, right?

Kimberly Holton said...

As a neuroscience nurse, I love this!

Sue said...

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Thank you,
Sue

Natalie said...

As a Neuro nurse, I greatly appreciate ALL of these things! It's funny when a patient is getting enough Valium, Dilaudid, Norco, Benadryl, and a 75mg Fentanyl patch and still "hurt all over". UGH. I also love catching a patient with a NIH of 14 who forgets they are in a camera room pour themselves water and read when they demonstrated they could do nothing of the sort upon admission. =/