Wednesday, November 15, 2006

In Which Nurse Jo Calls Bullshit.

Anybody who's worked in a hospital in any capacity can tell you that the nutjobs come out right before the holidays. Not *during* the holidays, mind you--that's when the really sick people stay at the hospital rather than heading home--but just before.

I had fourteen patients (counting admissions and discharges) in two days and only one of them was not a nutcase. Unfortunately, Non-Nutcase Guy went home the same day as his admission. He was that healthy. I wish he'd stayed; I could've used the company.

Every nutjob save one had a neurological condition of some sort that defied all manner of scans and testing. One was demonstrating both la belle indifference and arc-de-cercle, but the latter only if she knew someone was watching. Funny thing: the only thing that cured those compulsive backwards archings was repeated injections of Dilaudid.

Another had real problems with formal neurological testing but was functionally fine. Babydoll, if you're walking around in your room with no trace of the shuffles or the sways, you ain't gonna have that bizarre of a neuro exam five minutes later, when the doc walks into the room.

Why, *why* do people always try to fool neurologists? Why not cardiologists or orthopods or thoracic surgeons? Is it that we don't understand the brain the way we do joints and hearts? Or is it that some folks have a special place in their hearts for neurology and its adherents?

I have, in the last two days, been confronted with a patient who claims to be allergic to water. And every antibiotic known to man. *Every* one. They all cause laryngeal edema and laryngospasm, two things that can kill a person if we don't poke a hole into their trachea somewhere south of that swollen, closed-off larynx to allow them to breathe.

But no, I was told, there's no need to put a tracheostomy tray by the bedside. Because, you see, if the patient in question merely holds up this electrical widget to their temple, it will cause their brain to produce chemicals that will keep their laryngospasm from getting bad enough to kill them.

No, really.

I had a patient who claimed to have an anaphylactic reaction to tomatoes. And severe and constantly-changing food allergies that could kill at any moment. And who required a special diet so that their energy fields wouldn't undergo a conversion to a negative polarity.

No, really.

This was, of course, the same patient who managed to put away two Big Macs (which have no tomatoes but which do include Thousand Island dressing, the main component of which is...oh, never the hell mind) in ten minutes, when she thought I wasn't going to notice.

And the one who was allergic to cotton. This allergy was, according to the five-page list of allergies that accompanied the patient, diagnosed by spiral CT scan.

No, really.

And the one who had the rash and hives and difficulty breathing when given oral Dilaudid, but who could handle the IV form just fine. But only just before he went outside to smoke. Because the nicotine from the cigarettes helped calm down the anaphylactic reaction.

No, really.

When I admitted the patient with the oxygen saturation of 88 percent on room air, I tried to put oxygen on her. "Don't do that," she protested. "I'm allergic to oxygen."

I gave up. I left the room on some pretense I don't recall just now.

One of the orthopedic residents found me in an alcove, laughing until the tears ran down my cheeks.


Anonymous said...

Ha! This is priceless! I once had a hospice patient on the hospice unit, breathing out of the top one quarter of one lung, who demanded I take him out to smoke. And when I told him I would be right with him, he yelled, "I'm gonna call the ACLU! I replied, I'll get you the number. In a minute. When the same guy went home, he demanded a lounge chair and new curtains paid for by hospice, and oh yes, a ride to the beauty parlor to see his girlfriend get her hair braided. Can you say "entitled?" At least I usually don't get the neurological weirdos.

Anonymous said...

Tell the patient with the widget that you are allergic to electrical signals.

Anonymous said...

Sounds like you had a lot of fun this weekend. What a bunch of loons!

overactive-imagination said...

Sorry to laugh at your pain but that was really funny.
I'll make the sentiment that I hope things get better but since Thanksgiving is next week.........I won't hold my breath and I'll look forward to more great posts like this one.

Judy said...

You're making me really glad my NICU babies can't talk!

We do get the occasional virgin birth, but at least we don't get all those funny allergies.

shrimplate said...

Jo, I too have seen and blogged about patients who claim to be allergic to water, of course in full acknowledgement that their own bodies contain a significant amout of this compound.

Cardiologists actually do see a rather large number of obvious fakers who claim to have "chest pain" that is only relieved by 4mg of IV Dilaudid every hour or two, since they're "allergic" to morphine and nitro. People who have had negative stress tests at five other area hospitals just lately. Hospitals which of course allowed them to go out to smoke unmonitored anytime they wanted to.

Tele units are full of these people. ER residents know them by their first names. I can only imagine the amount of money and time these people draw from the system.

Since our hospital has a big neuro unit, we also see our share of "siezure" patients whose symptoms are only relieved by substantial amounts of Oxycontin "for their headaches," and copious amounts of ativan and xanax for "their nerves."

Usually these people are of the type that only see others as a means to their own ends. Really bad personalities, if indeed they even have any personality left at all and have not completely transformed into drug-seeking androids. They treat nurses poorly unless they have drugs in hand.

I seem to get stuck with a lot of these patients. My charge nurses think I'm "better" with these patients than some of the other nurses. I'm most likely not, but I do have a knack for defensive documentation.

Anonymous said...

I know what ya mean about the crazy ones hitting the units at holidays. Ever notice they come out in droves on a full moon??? One of the hospital's I worked at a couple of years ago it seemed like I always got the ones drug seeking, coming off the 5 day drunken binge...oh and throw in pyschotic and bipolar off meds for God knows how long. Seems the charge nurse thought since my boyfriend at the time had all those problems I could handle them better! I wound up dumping the job and the boyfriend! One person can only handle so much insanity in their lives at one time!