Sunday, January 30, 2011

Sunday night/Monday morning jam:

I'm going to be writing an article on dealing with difficult patients, and need categories I can slot various patient types into. Suggestions are welcome in the comments.

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DAMN YOU ALTER JO. I'm letting the bison meatloaf rest overnight, in an attempt to get it all to come together, but damn you! Jo's boyfriend doesn't eat beef; he's unable to, considering that nobody in his family has done so for more than a thousand years. So they eat bison. And I've got two poundses of the stuff, Precious, sitting in the fridge and freezer, on her recommendation. If this doesn't turn out, I'm fingering you and RatBoy.

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Somehow, without meaning to, I've gotten tasked with working out a diabetes education program for our patients with strokes. Considering that the majority of our stroke patients are poor and diabetic, this will be a challenge. The main problem is going to be writing up instructions in a fashion that people with only a fourth-grade education can understand, without it being condescending or oversimplified.

Nurse Ames will be helping, but still: the majority of the responsibility falls on me. Yikes.

How did this happen, again?

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The NP for the stroke service introduced me to the new resident group as the local expert on drugs and STDs. Hi! I'll be your Big Ol' Ho today!

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Is it unreasonable for me to want to hike the UK for my forty-second birthday? That's a year from now. I'm starting tomorrow, looking for people who can put me up.

Or maybe New Zealand. I've always wanted to go to a place where you could dig down into the beach sand and end up with a hot tub. There's something about visiting the youngest habitable spot on the planet, geologically speaking, that appeals to me, even if I don't have any history there.

Why can't Kiwiland be closer to The Old Country, so I wouldn't have to choose?

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Not safe for work or Mom. Or maybe safe for Mom, because My Mom is pretty damn cool.

Oh. My. GOD. (fuckit!)

I want a Hello Kitty merkin. This might be why I'm having so much trouble on OKCupid.


Kaye said...

Difficult patients:
Language/communication issues
obese(difficult for nurse's back)
Smoker in ICU who yells about wanting a smoke
Diet sabotaging parent of diabetic child

These were just off the top of my head...

Rubenesque said...

Now I have a girl crush on Amanda Palmer. And a big grin on my face.

IMQTPI said...

Hey Jo,

Longtime lurker here - de-lurking momentarily because you've hit on two subjects on which I have some personal experience!

Re: Diabetic Stroke Patients, check out for truly "useful" information. No, I'm not the author nor do I receive any compensation for recommending it, but I am an avid follower.

I'm not a stroke victim (thankfully), but I am T2 diabetic.

Anyway, to put it in it's simplest terms: Test-Test-Test and avoid carbohydrates like the plague!!

Re: Hiking the UK vs NZ (En-Zed as the locals call it). Hands Down: Kiwi-land wins the toss! Check out It's a bus-pass that takes you to various Youth Hostels all over the country and you'll get to see the more "Adventurous" side of New Zealand *and* do it totally "on the cheap."

I did it when I was in my 30's (and felt totally ANCIENT compared to other "kids" on the bus). I did it solo and had a TOTAL FREAKING BLAST!

Warning: The accommodations *ain't* the Ritz Carlton (not by a longshot!!!) - but I don't regret a minute of it!

PurpleRN said...

The "difficult patient" I hate the most is the "Oh, and...." patient.

Example: I come in at the start of shift and take the water pitcher to refill it. I always ask: "While I'm out of the room, is there anything else you need or anything I can get for you?" Usually the answer is "I don't think so. Water should be it."

Until I get back to the room. "Oh, and I need some juice and graham crackers." "Anything else while I'm out?" "No, that's it."

Come back, "Oh, and I need clean slippers"

They're always sweet as sugar and "apologetic", but after awhile you get the feeling they're doing it on purpose.

Judith said...

Retired nurse and lurker here: if you ever decide to come to NZ - well, I have a spare room!

Penny Mitchell said...

No, no, no, no. A bunch of us are going to PARIS in May of 2012. You have to go THERE for your 42 birthday.

I sat through this video. YOU OWE ME.

SkinnyNurseB said...

1) Pt's who ARE nurses/md's

2) Pt's who self-diagnose

3) Pt's that exaggerate whenever anything is done to them, accuchecks, SL starts, etc

4) Manipulative/attention-seeking/psych pt's

Anonymous said...

When making meatloaf I usually use two meats, like pig and chicken, pig and bison, pig and elk, and some eggs, and some kind of starch usually rice, always an egg, used water chestnuts a couple times, but if you do that you reaaaallllllly do have to use an egg, you can use breadcrumbs, teriaki sauce on top instead of ketchup is good too.

You do get dumped on a lot. Why can't they just get the DM educator from St. Holy Gaucamole to run across the street. Really now.

Difficult patient category - Threatening family member seems to be a recurring theme in my practice.

Love the uTube Vid. Though I must say given my level of boredom and personal angst right now I probably didn't need the craft ideas : )

sherry Nelson said...

you buried the lead.

boyfriend. is that right. *grin*

CQ said...

I think you should go to Iceland. It didn't used to be cheap, but it might be now, since their economy imploded awhile back. Even so, you can find all levels of lodging. Being situated astride the North American and Eurasian tectonic plates, it is continually being reformed, with the result that there is hot water everywhere. The landscape is awesome, in the original sense of the word. Be it cold and desolate there is always hot water at hand. Reykjavik is happening. Most everyone speaks German and English in addition to Icelandic. We traveled to the north (Akureyri, Husavik) and back by bus. The Reykjavik Grapevine has a calendar (

John said...

Having patience and a smile on face is the only suggestion I can give from my experience. I've been in lot of strange situations during my nursing carrier and these two things helped me a lot. BTW, great post. I really enjoyed reading it

messymimi said...

Bison meat is good, but it makes a better "hamburger" soup or chili.

As for where you go, make sure it counts. 42 needs celebrating like nothing else.

Moose said...

*sigh* not again.

Low carb diets are not the be-all end-all for all diabetics. Just like everyone else on the planet, food intake and its results vary for a variety of reasons, even with diabetes in the equation.

Also, low-carb diets are almost impossible to do if you are poor. I eat a diet that is mostly normal carb vegetarian, not by dislike of eating tasty, tasty animals but because I cannot afford much meats, even on sale. The same $5 for that chicken could go to 2-3 lbs of cheeses, or even more of potatoes or pasta. Which is going to last longer? The smart shopper is going to skip the animal parts.

ION, dont' forget your drug seekers, hypochondriacs, and "there's nothing wrong with me!" after they came to the hospital after $major-issue [fell off the roof, heart stopped, hit by a freight train, etc.] :-)

Dude. My captcha word is "person".

JacquiBee said...

You can visit with us in Kaiapoi NZ if you don't mind a fold out couch. We only have earthquakes sorry, no hot springs on our beach but we could take you to Hamner springs or Mauria springs for the hot stinky water.
The cat is also avaliable for cuddles. Actually we may have to move out but Im sure that we would have room anyway.

clairesmum said...

Ok now I have learned a new word! I had to look up the song lyrics to be sure I was hearing what I thought I was hearing! This is definitely a song that I do NOT want to pop into my head during a boring staff meeting!But it sure made me grin!
Travel - anyplace you want to go is a great place to go. I would guess that the logistics of a trip to Kiwiland are more challenging, require more time off and more money, etc than a trip to the Old Country (guessing in Europe). My vote would be do the biggest trip this summer if you have the cash and time, so they don't get eaten up by something else. Or, the idea of doing the MOST important thing first - but that means deciding which is most important.

Judith said...

Hey, with JacquiBee in the South Island and me in the North Island (Hawkes Bay) you'll have New Zealand covered!

Elyse said...

That video has my fashion loving molecules in an uncomfortable dither - the kind of dither that makes me wonder where my vintage knitting books and size 2.5mm needles are and it is 12:28am in Los Angeles! I think I needed it, though. Dreaming of pearl cotton in ecru and jasper chip beads.

Difficult patients - I will think on that one as most of the usual categories have already been mentioned above.

Jo said...

Another vote for NZ :-D I'm just outside Wellington, so if you do end up coming this way then I'll happily take you to LOTR sites (and, of course, the sofa bed is available) :-D

woolywoman said...

Lets see: 1) ignorant. can be stupid or unschooled. unschooled will learn when given the opportunity. stupid doesn't want to learn because then stupid couldn't live on beer, Cheeto, and refined sugar) frequently in DKA, or renal failure, or CHF, or stroked out

2) crazy subtypes: crazy mean or crazy sad. neither can care for themselves very well, but crazy sad doesn't throw things at you

3) huge: only a problem if you don't have a lift team

4)tragic: can be hard to take care of, but not difficult per se. However, tragedy can push people over the edge of crazy

Those are the main ones, I think.

Sunflower RN said...

I was in England last summer because all the guys that I had ever dated kept saying "not now". I was (and still am single so I said "what the hell" and I went. There is alot to be said about doing it alone. I had family in the south of England and used that as my base. I will say though, that a trek around England would take a long time. It took 7 hours by train (going at 70 mph) to get to Inverness from London.

That said, if you look into Easyjet flights, you can get some really great deals (like under $20) to fly around to different spots. I, being me, would do it again, but rent a cottage in a spot I would like to see and stay there for the trip.

I would also recommend that when planning your trip, that you fly out as close as possible to where you will be. I got a cheap flight to Paris and took several trains to get to and from England. The way out wasn't too bad, but on the way home, the thought of going through Paris was enough to drive me mad. So buck the trend and find a flight right to England and forgo the long sidetrip to wherever. It looks small on a map, but getting from point A to point B when you are exhausted is a lot to cope with.

Also, keep track of when you are eating and having BM's. A serious case of constipation is only not expected but puts a serious crimp in the enjoyment of the voyage. Looking for lactulose in a strange place is an adventure all it's own.

I say go where you want to go. I had a blast not being understood in places that purport to speak english. Even my relatives only understood about 50% of what I said.

The trip was worth every dime. Go one step up from the cheap hotels and hostels. Ask for a double room as the singles really bite. It is not a huge price jump, but the difference in comfort is well worth it. Also might save you from a case of bedbugs.