more medicinal laughter

 
More vignettes from the hospital life. On the deeper side.

One of my patients was very anxious to go home. We made sure he had supplies, and that his prescriptions would be filled, and that he had a ride. Then I find out the discharge from the hospital will be delayed to sort out continued care at home. He's not happy, and even though I explain how all the appropriate people are doing what is in their power to get this set up, he tells me to tell them to get a move on. I'm considering calling in a mediator at that point, because I'm frustrated, and he's frustrated, and I was running out of constructive things to say. Basically. Read between the lines there. So I talk to the discharge nurse, and to his primary team, and we decide to let him go and we'll call him with the information he needs. I pass the news on, and he's happier. Crisis averted. His sister comes to pick him up, and I'm actually able to give him the needed discharge information. Hurray, crisis solved. Then he states that he doesn't have any of the pain medicine prescribed. So I page the pain doctor who actually conveniently is sitting across the desk from me, and tell him how this patient is super anxious to go and needs pain medicine. He pulls some strings and gets them written and placed at a pharmacy in the hospital. But hospital transportation for some reason can't take him there. So the charge nurse runs over to the pharmacy to get the prescriptions, except the patient decides he can't wait any longer and leaves. I call the sister as she is pulling up to pick him up, and explain where the medication is, except she states she can't wait any longer either and leaves without the medication. I'm upset that all of our work is being wasted, so I slam the phone down. The pain doctor calls her up and explains how the prescriptions can only be picked up in person due to the nature of the medication. I don't know what she said, but when he hung up the phone, he just looked at the ceiling for a while. Then we started laughing; how dramatic real life can be.

I walked into my patient's room at change of shift to meet her, and get slammed with some pretty heavy stuff. She had an ileostomy placed, which means that her intestines are emptying into a disposable pouch through a hole in her abdomen. I remember in nursing school thinking that an ileostomy would be the hardest medically-necessary change to deal with. Well, she thought so, too. Except she didn't want to deal with it. Cussing in every sentence, she told me how she couldn't see how she would wear her normal clothes anymore, how she didn't understand some of the things the ostomy nurse [someone who specializes in the care and education about ileostomies, colostomies, etc] told her, how she didn't want anyone to visit her, how she was upset that the doctor assigned to her that day was a guy when she had asked that her healthcare team be all female and how it didn't matter that he was gay, how she felt that the ileostomy and how it worked was gross, how she couldn't have orgasms anymore [as a side note from the scene unfolding here, that is NOT a side effect of ileostomies. just in case I'm scaring people away] but what does it matter because (according to her) who would want someone with this..and she lifts her shirt up. You are probably thinking...how is this funny? well, let me explain. Her situation is not funny. My situation, as a young single Mormon girl functioning on 5 hours of sleep, just got pretty funny (in a twisted sort of way). In the back of my mind, I was imagining her primary doctor introduce the new male doctor, and how she might have said, "I know you requested an all-female team, but he is the one we have available today, and besides, he's gay"--and how this was an awkward gesture of trying to answer her requests. I was thinking how a lot of things she was throwing at me were just exactly not the things I am familiar with--from medical to moral to emotional issues. Realizing how ridiculous the situation was helped keep me sane enough to do what was needed:  hug her and listen and talk. I'm hoping that someday she'll look back on those 3 hours and say, "Oh that poor nurse. I think I overwhelmed her" and then laugh.