Saturday, July 29, 2006

No Chicken

Sometimes a bed will develop some kind of chronosynclastic infidibular (nod to Vonnegut) subspace quarkpool that causes it to attract similar sorts of patients for a while.

A few months back room 18 was the "chronic renal patient who codes during dialysis" event horizon.

Lately bed 3 has been the "30-something cocaine abuser with chest pain" gravitational zone.

This one person spent a whole day just laying about getting intravenous fluids because of their rhabdomyolysis. The fluids help flush out the muscle breakdown byproducts from the rhabdo. He was fairly quiet during my first shift with him, but when I came back the next day the night people said he was refusing his IV fluids, leaving the unit to go smoke (the hospital grounds are all "smoke-free,") and generally getting a little fussy.

He'd told the cardiac rehabilitation nurse that he didn't want to quit smoking, and added that he would leave the floor whenever he wanted to even if the doctor said he couldn't. He had removed his telemetry monitor anyways.

When I told him they were ready for his stress test he refused it saying that he'd had a lot of them already, one just a couple months ago. (Well isn't that interesting?) He said "if I'd known you were going to do that I wouldn't have stayed," and he also said that I had "suddenly sprung this on him." Like he didn't recall me having him sign a consent specifying the stress test yesterday.

He did, however, agree to wait for the attending doctor to round and formally discharge him. "I need a note saying I was here because I missed a court date," he said. "But don't put anything on it about cocaine," he insisted.

Okay then.

He was scoring very low on my sincerity radar.

The whole thing was a dodge. Hospitalization was a convenient way for him to avoid upsetting little life issues like court appearances and sobriety.

Anyways, he must've lost patience with us because he disappeared. After he was gone an hour or two we considered him to have eloped and we opened up the bed for another patient. I documented dutifully.

Whenever the word "dutiful" or some variant thereof comes up I recall "Dutiful Ducks" by Charles Amirkhanian. We used to have it on our answering machine.

the drano ducks collide

You know the rest. Or maybe it's just me...

The next patient up was a thirty-something cocaine abuser with chest pain. During the initial bedside assessment he practically broke into tears and implored me that upon discharge he wanted to go to an inpatient rehabilitation facility. He said that "this" was going to kill him and he didn't want to do it anymore.

I promised him we would help.

"Why a Duck?"

Why'a no chicken?


may said...

at least he still had a score in your sincerity sounded like a situation that will make the score zero.

enigma4ever said...

great post...nurses have such a way of telling the good stories...

Eli Blake said...
This comment has been removed by a blog administrator.
Eli Blake said...

Oddly enough, a hospital would be one of the few places where I wonder if smoking should be allowed in certain circumstances (though not in this guys case-- I'm talking mostly about terminally ill patients).

The reason why is something that always bothered my father, since he was a young intern (probably in the late 1940's or early 1950's). He took over for a doctor who retired or died or something like that, and there was a patient whose medication and instructions from the doctor included a bottle of gin each day. My father told me that his immediate reaction was, "We can't be giving him that!" and he immediately ordered it discontinued. The patient died a few days later. Apparently he was quite sick and would have died anyway pretty soon, but the only thing he had to live for anymore was his daily bottle of gin.

What he told me was that he learned that medicine is more than just prescriptions and charts and following indications, it is also about giving people hope and a reason to look forward to the next day.

He eventually went into psychiatry and became one of the best psychiatrists in Albuquerque for several decades. I didn't go into medicine at all-- I teach.

But I wonder, whether if a patient is very sick anyway, it would be such a bad thing to let them smoke or drink if that is the only thing they have left to enjoy anymore. Luckily for me, I do neither of those things, but I know if someone who was close to me was really ill, I'd question whether it is productive to exacerbate it by following regulations that just add to their suffering.