Pissant …

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SOB 22-yo male patient is on Facebook bragging about manipulating the nurses on the unit into giving him drugs. “I’m so fucking good at making them think I’m in pain.” He threw his toast at a CNA this morning because it, “Wasn’t fit to feed a fucking dog.”

He leaves his phone on and logged in to Facebook when he goes to sleep at night …

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Probed by aliens …

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I had arrived early for my day shift to cover the emergency exit of another RN. One of my assigned patients was Dotty, a late PM shift admit, a 93-yo who fell at her home in a retirement community and broke her hip. She was scheduled for the OR sometime that day, but even unfixed she wasn’t in too much discomfort. I had looked over her PMH and saw that she was a relatively healthy woman for her age, was somewhat HOH, and was only beginning to exhibit some very mild cognitive deficits.

I was in her room about 0545 quietly changing an IV bag before she awoke, when the door opened and three medical residents came in. One of them greeted her by her first name, asked how she was doing (“I’m FINE!”), and then proceeded to tell her that they would be sending her for an MRI and a bone scan, running a CBC, a Chem-10, and some other labs, and making a decision as to what surgery she would need before scheduling her for a possible THA or IM-nailing sometime during the day. They told her that she would be held NPO but that Nurse Dux would make sure she was comfortable while she waited.

The resident (a 5th year) asked her if she had any questions (“I’m FINE!”), then said he’d see her later after surgery and they all exited. All I could see of her as they left was a pair of enormous eyeballs peeking over the blanket. Since she was now wide awake, I asked her how she was feeling and told her I would be taking her vitals. I was completely startled by her next comment.

“Did you see them too?”

“The residents? Yes, Dotty, I was right here next to you.”

“No, the ALIENS! They were right here in this room! Did you see them?”

Needless to say, I was startled. Believing I might be witnessing hallucinations and the onset of delirium, I asked her, “Dotty, are you telling me you you’re seeing things?”

She looked right at me. “You must have seen them! There were three of them. They were really tall, really green, and they were speaking some space language I couldn’t understand. Will they be back? You won’t let them probe me, will you?”

Resisting the urge to laugh out loud, I just smiled, and sat down at Dotty’s bedside. I held her hand while I explained what had just happened. The “tall green aliens” were three of our Orthopedic residents on their morning rounds. All three are over six-feet tall, and they were dressed in green surgical scrubs and hats. When they came into the room they didn’t turn on the light because the hall light illuminated her just fine—but left them backlit at the doorway. Scott, the 5th year BMOC, didn’t introduce himself or the others, and peppered her with rapid doc-speak – which she couldn’t understand at all.

They got no usable information from her, conveyed no understandable information to her, and had no idea that they had just frightened the bejesus out of this sweet elderly lady. They could have done many things differently – turning on the lights, introducing themselves, sitting down, making sure she had her hearing aids in and her glasses on, making sure she was awake and not in pain, and so on. But that’s not what medical residents are taught to do by attendings, and it would be years before they learned it on their own (the odds of them ever asking for guidance from an RN? slim to none …).

Dotty did settle down as I talked with her, but I sure didn’t fault her for her interpretation of the morning’s events. The pictures of those residents on the unit bulletin board now sport antenna and space helmets courtesy of this RN. I’ve been told that one of them thinks it’s disrespectful. Warms my cockles, it does.

Get ’em up, move ’em out …

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As a Med-Surg nurse, you take the assignments they give you. Some days you win, other days you resign yourself to being amused. Today’s line-up of patients, one any med-surg nurse would envy –

  • “Toga Boy,” a 20-yo who refuses to wear clothes, whose current girlfriend sleeps in his bed and spoon feeds him, and who has spent the last three weeks wrapped in nothing but a sheet.
  • “The Dripper,” a 34-yo woman sporting an insulin drip, IV parenteral feeding drip, IV fluids drip, and patient-controlled narcotic drip.
  • “Mr. Demento,” a seriously demented 80-something who spent last night mooing at the staff. Today he’s arguing with me about the “tall wooden Indian ladies” in his room who are playing with shotgun shells and shotshell boxes and who are going to blow their fingers off unless I stop them.
  • “Hoss,” a 57-yo Hispanic guy who fell off either a horse or a house, we’re not sure, because all he says over and over is “Fell off hoss! Si!”

At least she’s not blaming the nurse …

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“I want to talk to my doctor, now!”

“Maureen, did you need something? Your doctor is in surgery right now, so it might be a while before he can get here. What can I help you with?”

“You can’t help! I’m having a side-effect from the damned surgery!”

“What’s happening? Can you tell me how you’re feeling? Has something changed?”

“My butt is swelling! My butt is much bigger than it was before surgery!”

“Let me look, maybe I can help.”

[RN checks patient’s butt. It’s exactly the same size it was before she left for her hip surgery.]

“Maureen, I don’t see any unusual swelling. Is your bottom feeling itchy? Maybe it’s just the dressing that feels irritating. Dr. Fitch will be looking at that and changing it in the morning. Does your bottom hurt more now than it did last time I was in?”

“I WANT HIM TO KNOW RIGHT NOW THAT THIS SURGERY IS MAKING MY BUTT LOOK BIGGER!”

Road Runner …

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On our hospital paging system we have a variety of message choices, among which are “Bedpan,” “Blood sugar,” “Assist,” “Turn patient,” “Equipment beeping,” and so on. If a nurse passes any room and hears beeping, she’ll go in, identify and usually fix the problem as necessary (adjust an IV, restart suction, tell the patient to take a few deep breathes, lunch is on its way, etc.). That way the beeps are fixed and we’re not continually answering “Equipment beeping” pages.

Now normally, the unit’s nurses will just go in and take care of the problem on the fly, and we’ll only tell you about it if it is something you need to chart or put on your to-do list for later in the shift (like a bag of IV fluids that will need replacing). But for the past few days, my fellow employees have been entertaining themselves by telling me, “Room 58’s beeping again,” then walking away laughing.

It’s the damned patient. He’s an 85-yo dementia patient who sits in his bed intermittently going, “Beep! Beep! Beep!” all frickin’ day long. But honestly? I’ll take a beeper over a spitter any day of the week.

Well, it all depends …

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It’s 0830, and I’ve got to get Marcus ready to leave by 0900. He’s 77, and is being discharged to a skilled nursing facility for rehab after a right total knee arthroplasty (RTKA). He pages me – he’s anxious to go home, but he’s in an immobilizing splint and a wheel chair, and needs help getting dressed. I tell him I can’t help him get dressed because I’m finishing up his discharge paperwork and have a new post-op arriving any minute.

“Marcus, I’ll send in Jeff (my nursing student is my CNA today) to get you ready to go.”

“Why can’t you help me? I really want your help getting dressed.”

“Marcus, I’d love to help you get dressed, but I’m about to get a new patient and I still need to finish your discharge paperwork so that I can go over it with you. I’ll go run down Jeff and get him in here ASAP.”

He looks past me to the doorway, and then whispers, “But I need help getting my underwear on.”

“Jeff’s pretty good with underwear, let me see if I can find him.”

“But Dux, they’re my naughty undies.” That pretty much stops me in my tracks.

“I’m sorry, I’m not sure I heard you. You need to put on your underwear, right?”

“My naughty underwear.”

Now this guy is a grey-haired 77-yo who uses a wheelchair when he can’t use his walker (and that was before the surgery). He’s morbidly obese, and quite hard-of-hearing. His daughter is coming to help transport him back to his skilled nursing facility. I’m going to pretend that I didn’t hear what I just heard.

“Well, if you’ll just show Jeff where they are, I’m sure he’ll be able to help. Are they in your bag?”

He reaches into his overnight bag on the bed, rustles around for a few seconds, then pulls them out to show me. I am now staring down a black, silk micro-thong that my patient is waving in the air.

“Can you help me put these on so I can get dressed?”

“Marcus, while I would love the opportunity, my new patient just rolled by the door. Jeff has special talents when it comes to underwear – I’ll get him in here ASAP.”

I see my student as I walk out the door, and I grab his scrub top and pull him into the break room. I tell him what’s going on, but I can see that he thinks I’m pulling his leg. He heads down to Marcus’s room to check it out – and within ten seconds he walks right back out of the room and up the hall. By this time I’m up to my elbows in puking post-op, so I can’t do a damned thing to help. A few minutes later Jeff wheels Marcus fully dressed into the hall, and his daughter takes him away. By this time, the whole floor has heard about the black thong, so I ask him how the hell he managed to get it on him.

“I didn’t. I just told him that since he was still dribbling, I thought he should wear the “nice blue pants” [Depends] I brought him so that his naughty undies and all the other important stuff wouldn’t get wet and shrink in the cold.”

Marcus must have been quite the ladies man at Middleville Haven.

Mickey …

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Last week I was paged by one of my patients.

“Nurse! I need help!”

“What’s up Mickey? What can I do for you?” The man was post-op day 2 for a left AKA (above the knee amputation), so I figured he needed some help with his crutches and went into his room.

“Hand me that marker.”

“What marker?”

“That whiteboard marker!”

“Mickey, why do you need a marker? If there’s something you want to change [on the in-room patient note board], I can do that for you.”

He struggled up onto his crutches and reached out his hand. “Just give me that damned marker!”

I handed him the marker, and he put it between his teeth [so much for getting it back]. Then he turned on his crutches and began to thump out into the hall.

“Mickey! Where are we going?”

He stopped outside his door and turned around. With his fist, he erased his name from the name board outside his room, almost falling in the process. He then grabbed the marker from between his teeth.

“Lost my leg, so now I gotta change my name.” On the now-blank name board he printed in large letters “ILENE.”

I should have seen that coming from a mile away.

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