Monday, May 02, 2005

In which Jo meets Satan and Satan wins

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.


Anonymous said...

Oy oy oy. What a charmer. The noncompliant alcoholics are the bane of my nursing existence!!!

Unknown said...

Yes, I have seen this type before! Thank goodness not too often. I hear from other nurses about "difficult" patients in report and then take a deep breath and plunge right in. I found that if I avoid the patient, it feeds into their tirades. It makes for a bad day sometimes but often I just kill them with kindness and they will give up. They usually have an underlying problem and no one will talk to them about it. Once they figure out that they can't "scare" you away, they will often relax enough to trust you with what's really bugging them. And then again, some people are just assholes and no amount of niceness will make any difference. Those are the ones you have to walk away from to maintain your sanity and your license.