Right, my bad.

As the gentleman wearing overalls, no drawers or shirt is settled in bed for after transport from ER:
Yes, Mr. COPD, I have to ask you all these questions over again. I am aware that you have gone over this approximately 15 times since you've been hanging out in our wonderful facility. But I have to do this. Again. No, the computers don't "just transfer" the information.

I know you waited 7 hours in the ER while in your so grateful words "the fat bitch just sat her fat ass behind the desk drinking Coke and eating chips." Not to mention the fact you couldn't see the drama unfolding across the ER from you where they were running a code to save someone's life, but they didn't look busy to you. I know that this was going on...you see us nurses kind of stick together every now and then, the nurse I got report from gave me the head's up all about your "displeasure" about your current situation. I guess I shouldn't point out that you called EMS to bring you in. For shortness of breath, cough and "coughing up yellow crap," that had been ongoing for 7 days. That would be rude of me to do and my verbal filter is still working. I know you want to sleep. I just have to get this history from you, take some vitals and look you over. How long's this cough been going on? Getting anything up? Not lately? If you do I want a sample, here's cup. I'm going to put you on some oxygen too. The amount of oxygen in your blood is kind of low and your lungs don't sound so good. No, I don't have a mask, but I'll try to track one down for you. Yes, I know your nose is stuffy, unfortunately this is all I have right now.

Guess what? They're going to come draw more blood from ya'. Do an EKG, try to give you a nebulizer treatment so that you aren't wheezing anymore, probably another chest X-Ray. That and the docs want you to be on telemetry. What? Oh yeah, the little sticky pads we put on your chest. We use them to watch your heart, make sure nothing bad is going on with it. Y'know, try to keep you alive at least one more night. And every time you tear those off, someone will be back in to re-attach them...it's our job. I know you would have left already if you had a way home, you've told me 3 times already and you've only been in the room 20 minutes. And yes, I think it is a little late at 0200 to call your daughter, but you dial "9" to get out.

So you have a list of meds? Great, that reduces the number of questions I have to ask you. But I have one more, when did you last take these? Oh, the only thing you've taken in the last month is your pain meds and stool softeners? What about that nice list of blood pressure meds? At least a month? Right, guess that's why your BP in the ER was 180's over 100's.

You know, we nurses hate it when you preference the question as "Don't freak out about this..." It's like hearing Jim Bob say "Hold my beer, this is going to be cool." So you want to take 100 Valium. OK, you have my complete attention. When? Not now? Later? Right, why? Oh, your life sucks? I guess I shouldn't tell you about the little old lady across the hall who may not last the night. Or the guy who had a massive heart attack last night and is lying in the ICU with a machine breathing for him. Yeah, you have some heavy-duty medical problems, but if you took care of yourself, y'know, be active in your health care, not expecting all of us to do everything for you, it might not be so bad. Death? No, in spite of everything I've been through in the last 18 months, I still have an allergy to pine boxes. So, do you feel like doing something about it now? No? OK. Do you want to talk to someone about it? No? Fair enough. Mental note, let still-wet-behind-the-ears intern know that we probably need a psych consult and I need to keep a close eye on him tonight.

OK, that's all for now. Yes, you can go back to sleep. But I'll probably be back in awhile.

A short while later at the nurse's station after RT came back and phlebotomy was waiting for me:
What? He refused the nebs? OK, I'll call to get them changed to PRN. He refused the lab draws? OK, I'll let house staff know, not much we can do right now.

And another short while later...
When do the docs come in the morning? Depends how many folks they have to see. Out by 9:30? Maybe, but I doubt it, they're a little worried about that nasty little pneumonia you're brewing, not to mention your lungs sound like a half-empty aquarium in a sandstorm. Again, I won't be so rude as to remind you, that you called EMS to bring you here though. I know, we keep waking you up, trying to do tests and whatnot, because after all, it is a hospital. It's kind of what we do, y'know, get you feeling better.

To the oncoming day shift nurse:
So that's about it. He refused AM labs, I already let the docs know. And yeah, he has a little SI, but he says he isn't going to act on it right now. Any questions for me? OH, almost forgot, he's going to try to leave, one way or another. My money's on going AMA. I put the form in the front of the MAR for you. Good luck and have a great morning.

Never found out how he left...unfortunately I don't particularly care.


  1. therapydoc said...
    Those are the kinds of patients that you want to be especially cloying and effusive with so that they wonder why in the h. . . you do care, and of course, you don't, which is what really annoys them.

    They never come to therapy, btw.
    shrimplate said...
    If they had the kind of self-interest and insight that would prompt them to seek therapy, they would probably be more active in their own medical management. They might, for example, take their medications.

    Alas. So many people do not.
    jen said...
    ahhhhhhhhhhhhh, hits too close to home. excellent post
    Laura said...
    Damn it's hard to care when we have patients like this. But for every one of these guys you have a dozen sweet little old ladies and old guys who think you are like an angel from Heaven because you helped them have a big poop!

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