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.


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.