Saturday, January 31, 2009

Plagal Cadence

First he wanted the test. But he didn't want to consume the bowel preparation for it. So we postponed the tests. Then he complained about that.

"I'm sick of this," he said. "Ever since I came here, all of you people have been giving me an attitude."

"Well, it's probably you, then," I said.

His jaw slacked and he said "What?!"

It was beautiful. I wish you could have been there.

"If you think it's everybody else, then it's really probably just you that's the problem," I said calmly and quietly, arms at my sides, voice relaxed. I've been through this sort of thing before.

He told me to fuck off and said I had an attitude. Then he complained that nobody ever explained anything to him.

I told him not to talk that way and I assured him that I would explain things. I would have anyway. He demanded another nurse. I said "No" and told him that if he wanted anything, anything at all, he had to go through me. He demanded a doctor. I said "No."

Eventually we came to terms; he drank the prep, got the test, and he became my favorite patient of the day. He felt better after explanations. I told him that I was just the kind of nurse that he needed. At first he didn't believe me, but that turned around.


Another patient had a sitter because of expressed suicidal ideation. They were crying and complaining that "someone over by the window wanted them to jump out." I gave him (the patient, not the apparition by the window) Ativan, telling him that If he relaxed a little maybe he wouldn't suffer so much. He liked Ativan.

"If people who aren't really there are trying to hurt you, call me right away and I'll take care of it, Okay?" I told him. The sitter watched.

"Then what will you do?" the patient asked me.

"I'll politely ask them to leave. And if that doesn't work..."

"What?" he asked.

"I may have to get a little rough with them."


My next patient was a demented old guy who started the day in four-point restraints. I got him down to two, leaving the ankles on, pretty loose, because he didn't seem to care about them. He pulled out one intravenous during the day. After I put another one in, he pulled the tubing apart and got blood all over, but the IV site was still fine.

He wouldn't eat. Some people just stop eating. They could starve from dementia.

He got Geodon and Haldol.

His family was at wits' end.


Lastly: a young woman, high-school age, who had gotten into a knife fight with her fourteen-year-old little sister, who won. That left her with a punctured lung but other internal organs were okay. Surgery and a left chest-tube to water-seal. A visit from a nice police officer.

She was my "normal" patient.


Ruth said...

Aren't you glad you don't have really hard stuff to do like try to hide what you stole from investors in two sets of books?

donna said...

Hmm, if you think everyone around you is the problem, you're the problem.

I'll have to remember that when everyone is annoying me. ;^)

wunelle said...

I love your little play-by-plays.

I use a version of your explanation with my coworkers:

It's possible that NPR and ABC and CBS and NBC and MSNBC and CNN and WaPo and NYT are all crazed, left-wing organs and only the lone Fox News is really giving the skinny about what's going on.

In the same way as it's possible to do the calculations that show the sun and the planets revolving around the Earth. It's possible, but as an explanatory device it's just a hell of a lot more work.