Saturday, June 16, 2007

Check 1,2,3

When I heard the screaming I thought that somebody was having a root canal like in the 1976 Dustin Hoffman movie "Marathon Man," but it was just some jerkwad of a patient yelling at their doctor.

It was awful. The nurse (not me thankfully) was sick of the verbal abuse, name-calling, and continual hints at threats of lawsuits.

It is very difficult to maintain composure and develop a therapeutic relationship with some asshole who is threatening to sue you for everything you and your great-great-grandchildren will ever have.

I've run Boston. That's easier than putting a smile on for this particular sort of personality-disordered patient. The Newton Hills? I laugh at those. Newton can bite me. But these sorts... rut-roh.

They came in with a gastrointestinal bleed. No transfusions required, hemoglobin and hematocrit steady at 10 and 35, some black tarry stool that was clearing up... the GI doc wanted them out of the hospital and back for a follow-up esophagogastroduodenoscopy in a week or so.

Why would anyone ever spend more than no-time-at-all in a hospital if they didn't have to?

They didn't want to leave. They wanted their EGD right now. And they cussed a lot. By "cussed a lot," I mean they used more foul, despicable, imaginatively obscene and bizarrely profane language than myself and Linda Blair combined.

If we didn't have a tube down their nose or up their ass then we "weren't doing anything," claimed the patient.

(Assuming that criteria, how many of us are ever really all that busy?)

The initially consulting GI doc washed his hands of all this and refused to suffer any more verbal abuse from the patient. He wrote that the patient should be discharged with follow-up from any gastroenterologist later next week, except himself, of course.

He had also advised the nurse to not enter the room unless accompanied by security, lest the patient escalate.

Another GI doc reluctantly came on board, quickly ordered and did an EGD, finding esophageal varices resolved and not bleeding, and then ordered the patient home. This doctor also said that "nobody should have to take kind of abuse" in reference to the patient's continual verbal aggression.

The doctor told the patient to stop drinking alcohol or his varices would progress. For that, the doc got cussed out. Or rather, he got fuckin' cock-punched. Verbally.


The significant other was pretty bad, too. They insisted that the patient needed intravenous fluids, despite the fact that the patient had a good blood pressure, was taking foods and fluids well, and refused IV fluids in no uncertain terms. That is to say, they stated that they "didn't need no fuckin' IV from some stupid-ass cunt nurse."

Okay then.

In this business they were what we call "a nice couple."

Wait until the patient gets the notice from their insurance company that the EGD was non-emergent and not covered. These companies tend to hire people who like to say "no."

And as you know, they also like to record phone calls for quality-control purposes.


N=1 said...

When will it be acceptable to simply stop after the first assault - of any kind - in someone who is not mentally ill - and to discharge them? Why can't EDs fire patients?

It would be terrific if a nurse or doc successfully brought criminal charges against the patient or against the hospital that allows abuse against staff.

As it stands, there is no disincentive for anyone NOT to abuse staff. Not only is it tolerated, it often gets rewarded by moving to the head of the line or getting additional services.
You know....John Edwards should do a full shift with an ED nurse, such as yourself.

Thanks for writing this - it's important.

Amy said...

Heee hee hee. Heeee hee! Heh hee hrmpf. Hee hee! *snort*

Reminds me of an interaction I had with coked-out hermaphrodite who had a few choice words for me regarding my inability to insert a Foley.

Gwen said...

Oh! The insurance claim! Ha!

Joyful Alternative said...

To improve patients' humor, serve stewed prunes. Painkillers are incredibly constipating, and "stool softeners" are worthless.

OK, it probably wouldn't have worked with this guy.

Me said...

You know, it's cases like this that I live to type the discharge summary for - we have a couple doctors who tell us transcriptionists all the good stuff, and we of course eat it up and make sure the report gets typed stat.

Reading this, I see a market for an Ati-Pen... like an Epi-Pen, but with Ativan!