"How was your weekend?"
When I got my patient assignment this past weekend, I knew it would be rough. Continuous bladder irrigation (CBI), Alzheimer's surgical patient, and an agitated/combative altered mental status (AMS) ER patient. It was the last one that worried me.
At the start of shift, he appeared to be sleeping. While getting his breathing treatment, he aroused enough to sit up, thrash around, and say, "Wait a minute." I had hopes that he would swallow his pills (lasix for his super-crackly lungs, buspar for his agitation)...but it turns out that "Wait a minute" was a default setting and didn't represent alertness. He couldn't do what we asked (like open his mouth for pills. that would have been nice) even when he was agitated rather than sedated. His wife tried to get him to engage, to get him alert. She wheedled with food mostly. "You want a pancake? I have a pancake for you." At this point he was on BiPAP with a face mask, so the rapid response nurse (kind-of like a help-line resource, except he was actually at the bedside helping me) pointed out that it would be a bad idea to feed him (the machine might force the food down his airway, but even without that consideration, we had no indication that he would reflexively swallow the food instead of breathe it in). She replied that we were discussing wishes here; she wished him awake, and hoped that his wish for food would get him there. She also noted that follow-through wasn't really necessary; "You want to go home? You want a pretty girl to walk in the room?" could potentially be as effective incentives, because there was no stated requirement of when that would happen.
We ended up transferring him to the critical care unit (ICU), so I don't know what happened afterwards.
That left me with the Alzheimer's patient--who was actually super cute and spunky--and the CBI guy. Even though the doctors stopped the CBI in the morning, he was still pretty tricky to deal with because he was near-deaf, had severe tremors when he moved,...and he was creepy. It's hard to describe; our nursing assistant noted that it was just a series of small things that made him an unsavory individual. Offering us his orange juice off his breakfast tray, or offering to order us something off the patient menu [our hospital has room service. it's fancy], or laughing at everything I said or did, or commenting on when my dimple shows up. Also, a bunch of stuff about his genitals. Sure, he had a urology surgery, so that was the general area, but one does not need to say that one's tallywhacker has not gotten a lot of love lately.
I didn't know how to address it, because I knew I would have to shout to talk to him, and that just seemed discourteous to the other patients on the floor. Also, I felt slightly guilty, because I knew he thought I was The Best Nurse Ever. Not only did he tell me that, but he also announced that to everybody else, including when I was in the room...which was awkward.
Finally, in the final 2 hours of the weekend shift, a bed became available to transfer him to another floor. I explained to Mr. CBI guy that he was being transferred to his primary floor, urology, and that the nurses and doctors there would be much more specialized and better able to help him and all that. I really talked it up.
He asked if I would still be his nurse.
No.
He asked if he was coming back to my floor.
No.
He asked if I would check up on him.
And I know this sounds heartless, but I said no.
As a parting consolation, I told him that I would look him up. But all I meant was that I would check to see if he was still on the floor. And that can be done without actually seeing him.
Why? Because I don't have to subject myself to creepiness, especially if someone else is in charge of his care.
So unlike most working Americans, I am SO GLAD the weekend is over.
At the start of shift, he appeared to be sleeping. While getting his breathing treatment, he aroused enough to sit up, thrash around, and say, "Wait a minute." I had hopes that he would swallow his pills (lasix for his super-crackly lungs, buspar for his agitation)...but it turns out that "Wait a minute" was a default setting and didn't represent alertness. He couldn't do what we asked (like open his mouth for pills. that would have been nice) even when he was agitated rather than sedated. His wife tried to get him to engage, to get him alert. She wheedled with food mostly. "You want a pancake? I have a pancake for you." At this point he was on BiPAP with a face mask, so the rapid response nurse (kind-of like a help-line resource, except he was actually at the bedside helping me) pointed out that it would be a bad idea to feed him (the machine might force the food down his airway, but even without that consideration, we had no indication that he would reflexively swallow the food instead of breathe it in). She replied that we were discussing wishes here; she wished him awake, and hoped that his wish for food would get him there. She also noted that follow-through wasn't really necessary; "You want to go home? You want a pretty girl to walk in the room?" could potentially be as effective incentives, because there was no stated requirement of when that would happen.
We ended up transferring him to the critical care unit (ICU), so I don't know what happened afterwards.
That left me with the Alzheimer's patient--who was actually super cute and spunky--and the CBI guy. Even though the doctors stopped the CBI in the morning, he was still pretty tricky to deal with because he was near-deaf, had severe tremors when he moved,...and he was creepy. It's hard to describe; our nursing assistant noted that it was just a series of small things that made him an unsavory individual. Offering us his orange juice off his breakfast tray, or offering to order us something off the patient menu [our hospital has room service. it's fancy], or laughing at everything I said or did, or commenting on when my dimple shows up. Also, a bunch of stuff about his genitals. Sure, he had a urology surgery, so that was the general area, but one does not need to say that one's tallywhacker has not gotten a lot of love lately.
I didn't know how to address it, because I knew I would have to shout to talk to him, and that just seemed discourteous to the other patients on the floor. Also, I felt slightly guilty, because I knew he thought I was The Best Nurse Ever. Not only did he tell me that, but he also announced that to everybody else, including when I was in the room...which was awkward.
Finally, in the final 2 hours of the weekend shift, a bed became available to transfer him to another floor. I explained to Mr. CBI guy that he was being transferred to his primary floor, urology, and that the nurses and doctors there would be much more specialized and better able to help him and all that. I really talked it up.
He asked if I would still be his nurse.
No.
He asked if he was coming back to my floor.
No.
He asked if I would check up on him.
And I know this sounds heartless, but I said no.
As a parting consolation, I told him that I would look him up. But all I meant was that I would check to see if he was still on the floor. And that can be done without actually seeing him.
Why? Because I don't have to subject myself to creepiness, especially if someone else is in charge of his care.
So unlike most working Americans, I am SO GLAD the weekend is over.
Let's hope future patients are NOT creepy! Love you!!
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