Hard to Say Goodbye

Every now and then a patient touches you so much that you are sad to see them go. Recently I was taking care of someone that was going through such hardship, as he had ALS. He was on the steady decline, yet always had a smile, always had a thank you. I was shocked at how well he and his supportive family were handling everything. Such life was there, such love and support.

I was sorry to see him go, even more sorry a special man like that has such limited time left on Earth.

Bon Voyage!

I am leaving for Zambia to complete my fellowship. I hope you will come over to the new site to check out what I'm up to as I'll be gone for the next 6 months.

Betsy In Zambia

Pain Management

I recently was not pleased with an encounter with a covering resident who was there for the night shift. I was just finishing my last 12-hour shift of 3 days in a row, and I had been fortunate enough to have the same patients for all 3 days. That is always very helpful for a nurse as you REALLY get to know the patients and can understand them better which leads to better treatment. You really understand when they are describing their pain, and you get a good grip on how to treat it.

At the end of my shift one of my patients informed me he was in a ton of pain. Now, he was receiving 4 mg of Dilaudid by mouth every 4 hours, and I had noticed that he was never drowsy, and would smile and get out of bed and walk around when pain was under control. However, he was also quite the stoic and wouldn't always tell you right away how much pain he was in. He most certainly had a high tolerance for both pain and the medication. I immediately paged the doctor on call to come check him out when his wife called me into the room because he was in too much pain. I walked in the room to see him breathing rapidly, tears in his eyes, and refusing to move from the chair he was in. (It had taken 3 days to get him to be comfortable showing me how he was feeling.) Something didn't seem right to me, and even if everything was okay I needed an order for some IV Dilaudid fast.

The doctor came up within 15 minutes (thank-you) but then argued with me over how much pain he was in. I had managed to get a verbal order for 1 mg of IV Dilaudid, but I wanted to give him 1 more mg as he was still very uncomfortable 15 minutes later. The doctor fought me tooth and nail. He said the patient was comfortable (even though 1 minute prior I had seen for myself he wasn't) and he wasn't going to write it, that he was fine. Instead he wanted to just give a new order of up to 6 mg by mouth.

I understand his concern of not wanting to over-medicate the patient, but I don't understand the need to make a patient in that shape wait another 30 minutes for pain relief when we have the means to stop it in 2. I also was furious over the doctor feeling like he knew the situation better than I did when he has known the patient for all of 3 minutes and I've been taking care of him for the past 3 days.

I wish he would have listened. I'm sorry the patient was in pain 25 minutes longer than he needed to be.

Why Would A Patient Lie?

Recently one of the nurses I work with caught her patient lying. It seemed so ridiculous as to why she would do it. It made no sense to her care, and she had no idea that we had caught her in her deceit.

Sometimes patients who are diabetics hate testing their blood sugars. I can't blame them as I don't think I would particularly enjoy it myself. But, to keep themselves healthy they are required to check it multiple times a day. When a patient is admitted to the hospital they put away their own testing equipment and the nurses will use the hospitals equipment to do it for them. Sometimes a patient will prefer their own equipment and to check it themselves, so we are happy to let the patients do that. The nurse will simply ask the patient to report their blood sugar at the appropriate times. Patients will often have better control of their blood sugars when managing it themselves in the hospital because they know what works for them.

For this patient we were sending off a chem panel everyday which included her glucose level. She didn't know that we were checking her glucose when we drew her blood every day as it was done in the laboratory. Well, after a couple of days it became clear that she was lying when reporting her blood sugars to us. The lab would show us a value >250, and she would say it was 90. No, it wasn't a glucometer problem, she was choosing to lie. When reporting her own numbers as normal she wasn't receiving the insulin that would correct the hyperglycemia.

I have no idea why a patient would want to lie about their blood sugar, especially since it can have immediate harmful effects and long term can do serious harm to the body.

Not A Pleasure Palace

On our unit we seem to see a lot of the same people over and over again as their illness is chronic. We have one patient that we don't always look forward to seeing, as he will often leave AMA, refuses to listen to doctors, and lastly has gotten more than a little fresh with the nurses. It has been a while since his last admission, but the stories still get told on a regular basis.

On his last admission he stipped down completely naked in the bed. When the nurse came in he asked her to perform oral sex in very crude language. Of course, the nurse wasn't going to put up with it and immediately went and got the resident. After a chat with the resident the patient seemed to shape up for a bit. What is funny about this whole story is that when talking to the patient the resident was overheard to say, "Sir, this isn't a pleasure palace. This is a hospital."

Pants?

Overheard on the unit:

The nurse says to patient walking around on the unit "Darling, are you a little cold? Because you forgot to put on your pants."