Well, the Big Guy is at it again.
I literally see hundreds of patients a year.. but it just so happens that the very patient who prompted me to create this blog was mine again over the weekend. :) This time it was just to have a dialysis port put in. He remembered me and that fateful day he had a rapid response. It turns out he coded a few days after that when he was in the ICU and they were able to bring him back. He also remembered what an asshole that Dr. was who didn't want to help him when he knew he was in trouble. He actually filed a complaint against her. (*clap* yay for him!) One thing about nurses is while we tend to stick together with each other and Drs. in the teamwork sense, good nurses are patient advocates above anything else. He also thanked me for listening to him and for staying with him when he was scared he was going to die. Three Peaches guy told me all about his time in Vietnam, how he enjoys fly fishing, and all about his family. He also told me he loves 50s rock and roll and at his funeral he wants that kind of music playing and how he wants his life to be celebrated when his time comes. I'm so glad he had the time to think about those things and to share his thoughts with me. It really helped the whole nursing experience come full circle for me to be able to get to know him like that. :)
And now for the worst of the worst...(if you think I'm some sort of nursey angel, prepare to be very disappointed. LOL)
Guy in his early 30s with a trach. I guess he had throat cancer or some kind of shit. I don't know and I didn't have time to read his chart thoroughly, and frankly? I don't really give a flying fuck why the trach is even there. He's on Q4 hour 2mg dilaudid, enough god damn benadryl to put down a fucking horse, and the max dose of ativan. Fucker should be high as a god damn kite and instead he walks around the unit pushing his IV pole around, looking in everyone's room, listening to everything that's going on, asking nurses questions about other patients (helloo HIPAA violation!), and basically following me around annoying the hell out of me.
So I was going around checking on all my pts. (I had 6, as usual) and I notice my frail 94 year old lady's color looked a little off and she was shivering. Temp: 99.8 Took out my little pulse ox (just bought it on amazon for 70 bucks) and it showed 75% on her finger! whaaa? noo that can't be right. Put it on her big toe.. 76%
oh fuck. Bump her up to 6L (she was on 4) Grab a hospital grade pulse ox: 75% Page respiratory. Blood pressure: 122/76 heart rate 136 (normal sinus cardiac rhythm). Grab charge nurse. He says to page her Dr. before calling a rapid response. Dr said see what respiratory says and if they think she needs a rapid response, call it. (Honestly, if the charge nurse were not there I just would've called a rapid response right then and there. Rapid responses are meant to prevent code situations and I had an awful feeling we'd be calling one.) Respiratory put a mask on her, got her up to 95%. I grab an automatic BP cuff and set it to check bp every 30 mins., and continuous pulse ox monitoring.
Then I look and see trach man is standing right outside the door. "Hey is she going to be okay?" I answer, "I'm doing my best to help her be. You doing okay?" (note how I did not say "can I help you with something?" lol) He says, "I can't take this pain anymore from this trach, I can't sleep one more night with it in, I'm going to take it out!"
My response, "Don't take it out, you won't be able to breathe. I will page the Dr." My response was calm because, frankly if he had ripped his trach out, I would have prob watched him for a few seconds, blinked, finished what I was doing, then casually looked at my phone for a few seconds before calling respiratory for the guy who was about to collapse in about 30 more seconds. Not that I believed his threats to take it out anyway.
Dr. calls back and I tell him what's going on and he says, "I have 3 traumas I can't see him right now, I know this guy and if I go in there I will be stuck in the room with him for an hour. Tell him I will have ENT see him first thing in the am to address all his concerns. So I tell trach man this and he throws a tantrum. "Why won't he see me? THAT'S IT! I'm taking my trach out!" DUDE, you have the fucking trach for 6 months and all of a sudden NOW you can't take it anymore? Seriously? Fuck you, you needy little bitch. (Kind of reminds me of a toddler acting up when the infant gets too much attention.)
Page the Dr. 2 more times and he doesn't call me back. Finally after a third time he calls me back. I tell him trach man wants to rip it out and he's very upset. Dr tells me he's still busy, I say, "Can't you send a resident?" He says, "Oh they won't be able to handle him, they are all too new." *pause* then I said, "well are there any you don't like?" It was at this point the Dr. started laughing and said "okay, I will be right up." Then trach man's wife called, so I did what any good nurse would do. I tattled. The wife called to ask me if he was in his room yet because he's not answering his cell. Then I said he was going in the room now because the Dr. is coming up to see him. Then I explained his pain and the trach, etc. and that I am just warning her he might be upset when she talks to him but that the Dr. is on his way. Wife says, "Oh he always does that. He's like a little kid. I love the man to death but he's addicted to dilaudid, and he's very attention seeking. I feel so badly for you nurses who have to take care of him. I know how he is, I will try to calm him down when I talk to him, thanks for letting me know how he's been."
I found trach man and told him to go back into his room because the Dr. is coming up to see him. Then trach man says "my tongue ith tharting to thwell" if it were anyone else I'd be freaking out but by this point I knew he was an attention whore and he was exaggerating/pretending and I had to get back to my lady. So then I told him to mention it to the Dr. since he was coming right up and that he had his limit of benadryl so the Dr. will have to write a new order for it.
Dr. orders an extra dose of dilaudid and an extra dose of benadryl and puts the guy on cardiac telem for overnight so we can make sure he doesn't overdose. 45 minutes after the aide goes in to check vitals he says, "I need a sleeping pill". Oh yeah, RIGHT he's already maxed out on dilaudid and benadryl lemme give him a sleeping pill. LOLOLOLOL I go into the room to give him his IV bag of omeprazole, he says nothing about a sleeping pill to me. THEN 10 minutes later he hits the call bell and says "Where am I?" "aide answers you are in XYZ hospital" then he says "Why am I here?" she said "your nurse will be in"
Okay Mr. Attention whore, you've just given me just the right ammo. I walked into the room, said "Are you feeling ok?" he says "oh I'm fine except...*frowny face* I can't sleep. Can I have a sleeping pill?" So I said "Oh heavens no! You sounded so confused a few minutes ago when I heard you asking where you were over the call bell, it would be irresponsible for me to give you any more meds! You're already over the limit on 2 things!"
That's right motherfucker, you and your biiiiiiiig mouth.
Doesn't he then call 10 minutes after that looking for ativan? My answer? Still NO.
130am rolls around.. 1 hour and 45 minutes to go until my shift is over.. asshole calls AGAIN.. "when can I have my dilaudid?"
I knew damn well he was due at 200am but I was running out of time, plus he had an extra dose in him from bullying the Dr. a little while before. I still hadn't charted my assessments, hadn't done any chart checks.. I had a ton of shit to do and I was going to be DAMNED if I was going to be there one fucking minute past my shift.. 12 fucking hours of this asshole was ENOUGH.
When is your dilaudid due?
0315am motherfucker. That's when it's due. So I actually told him 0315am.
I love caring for people and helping them but it royally pisses me off when people try to manipulate me and compromise the care of people who REALLY need help. My lady who had the low 02 sats made it through the night- no thanks to dipshit. It's only by the grace of God that poor lady didn't end up going to the critical care unit that night because thanks to him, I wasn't able to watch her nearly as closely as I ordinarily would have. And now on top of everything else I get to feel guilty because I'd love nothing more than to kick one of my patients right in the ass.
Sometimes being a nurse just sucks.
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