Friday, March 13, 2009

I learned a very important lesson this week

Don't take the rooms right next to the nurses' station if you can help it. It's where they put all the crazy people.
I'm only taking two rooms at the moment (we eventually progress up to four), but somehow I ended up with not only a patient in methamphetamine withdrawals who I later found out had attacked some of the staff at another hospital, but a girl who post-ictally ( and possibly all the time) was so agressive that the last time she was in our ER, they had to put her under concious sedation to keep her from going bezerk, Wolverine-style, all over the unit. Awesome.
The meth detox guy was actually pretty nice at first- he was just super spaced out to a kind of scary degree. He had trouble completing sentences and was shaking like crazy, and eventually his very sweet, but rough looking girlfriend came and took care of him.
I wish I could say the same for my seizure patient. Apparently, she was a pretty regular customer because she isn't too complaint with her meds. She came in moaning and flailing and vomiting everywhere, and by everywhere, I mean all over the bed and herself. She kept getting out of bed and walking around complete with trail of vomit behind her- at one point sitting down in the nurses' station.
As all this is going on, my other patient starts coming out of his stupor and talking more clearly and angrily about how he wants to go outside and smoke a cigarette. I got an order for Ativan to help him with the tremors and agitation and then I went next door to help with the IV start on my seizure patient, who was already being held down by 5 people and had been stuck three times already, unsucessfully. Even our totally badass medic who has been doing this most of his life couldn't get an IV on her- the other nurses in the room finally started looking for a site in her foot. The whole time she was jerking around and screaming "Baby! Daddy! Oh fuck! That shit hurts! Baby that hurts! Aw shit! Aw fuck!" The first time they stuck her foot she yells "Hell no! Fuck that, give me back my arms!", then she gets one arm loose enough to fly forward and headbutt me in the shoulder while I'm holding her leg. Finally, badass medic tries on her arm one more and gets blood return, and by the grace of God, we get her Ativan before she pulls out the IV.
Just as she starts to take a nice nap, the guy next door is getting more pissed that he can't go outside with his IV and smoke- I calmly explain I wish I could let him but I can't, and that I have his chart up for the doctor to try and discharge him. He does that gabby hand motion at me and his girlfriend yells at him and asks me for more Ativan. I decide this is a good time to go to lunch.
When I come back 20 minutes later, he is livid and yelling obscenties and the police are there, because apparently he tried being rude to the doctor and didn't quite get the same response as he did from me. According to him, when he asked the doctor to go smoke, most assuredly with lots of colorful language, the doctor told him he didn't owe him anything and walked out of the room to discharge him. So he's sitting there screaming "Fuck that! Don't talk to me like I'm dumb! I'm only gonna have white doctors from now on!" (His doctor was white- he was just eastern European). Meanwhile, he has a 9th grade education and no insurance. I don't think you're gonna get that, man. The police officer calmed him down enough to let me take his vital signs and his girlfriend drove him back to the treatment center he came from. As he left, his started bitching to all the patients and family members in the hall who would listen to him, the whole time his girlfriend yelling at him to shut up.
After all this, I have to start a Fosphenytoin drip on my seizure patient because her level was 1.1(!) but- she was taking her medicine! She was just tired! Okay! She finally sort of came to at this point and I let her know that after the drip was done we would finally send her home. She gets on the phone trying to arrange her ride, screaming at the person on the other end for a few hours. She still hadn't gotten a ride by the time shift changed, but I did get her discharge instructions, which simply said- "You have to take your seizure medicine for it to work." Seriously. Nice.


  1. Noncompliance...I don't get it. Why won't people take the medication they obviously need? You handled it the discharge instructions!

  2. hey, Smarty Mc-Not-Related-To-George-W-Bush! What does "Fosphenytoin drip on my seizure patient because her level was 1.1(!) " I want to go to there?

  3. Haha, sorry, jargony enough for you? Pretty much, I had to give her seizure medicine IV because when we drew her blood and tested her drug levels, she was totally full of shit in regards the fact that she was "taking her medicine". Which sucks for me, cause it can be kind of scary to give that way.