I came home from Vegas with a bug. Not literally, of course, a germy warfare in my body. Thankfully, I felt great during the whole vacation but about 3am, 6 hours after we got off the plane, my stomach exploded. Crazy stuff. My head was splitting so at first I thought it was just a migraine, which I rarely get, but after talking to a couple of people, apparently it's a little virus going around: killer forehead headache, vomitting, and joint/muscle aches for several days.
I still felt horrible yesterday and this a.m. I woke up about 5am with the same achy feeling. I was just sitting here at 8am thinking I either needed to get a little more shut-eye so I could work tonight or I needed to decide if achy headachey miserable-ness was worthy of calling in the first day I was supposed to be back from vacation. Renee saved me. She called with a miserable sound to her voice that I was afraid was bad personal news. Happily it turned out to be a request to change scheduled days but not because of family tragedy, just bungled schedule vs. family weekend getaway. She desperately needed me to stay home tonight and let her work so that I could work tomorrow night for her.
Hmmm...I doooooon't knoooooooo...let me think REAL hard about that one.
Isn't it lovely when a good plan comes together? I don't have to haul my achy whiny self into work and she gets to go on her family weekender tomorrow.
Life is good.
I am looking forward to working this weekend. I miss the drama. Like I've said before, I hate drama in my personal life but I love it at work.
There've been some discussion on RT blogs lately about that small segment slice of patients who either "use" the system or otherwise make hospital personnel crazy and it reminded me of a story I haven't told yet, a big part of one of the last nights I worked before leaving on vacation that made me happy to leave on vacation. Now I'm refreshed and ready to be thrown back into the game.
One of the last days I worked we had a guy who kept calling for breathing treatments. That's fine. No problem. But he kept calling for them every one to two hours. We didn't give them that close together but the fact that he was constantly calling was getting to be a nuisance. I was Assess/Treat so I went up to check it out and do the latest PRN call.
Hmmm....as I looked over the chart and saw a history of mild respiratory problems, the nurse, and the nurses' aides overhearing the topic, unloaded their frustration filled me in on the situation. Without labeling the man, I'll just lay this out. The man was newly diagnosed with a mild form of respiratory disease. He was very high maintenance to the nurses and aides, constantly asking for resp tx's, pain meds, and Coke. Not the nose kind, the in the red can kind. Needing stuff isn't a problem. The man had come in to the ER a week before in a state of respiratory distress, which had been treated aggressively with steroids, breathing tx's, and a new medication regimen. His breath sounds had been clear for a couple of days. All of his vitals were now normal with the exception of his heart rate which was up from his normal 80's into the 120's. Hmmmm....
Again, needing therapy or anything is not a problem. Not asking nicely didn't win him any friends. Anytime he didn't get what he wanted immediately, as in if the nurse or aide didn't drop what they were doing in that second and get what he needed, or if respiratory took longer than 10 minutes to come give him the requested treatement, he called the charge nurse to complain. Then he got on his cell phone and called person after person in his family to complain about the hospital and his care and to cry, literally, about how sick he felt and that he couldn't breathe. Hey, I get it. I have asthma. I know how scary it is to not be able to breathe. But part of the problem is the boy who cried wolf syndrome and being able to tell the difference between having a chronic disease and being in exacerbation of that disease. While he had come in in respiratory distress, it was hard for us to believe he still was in actual physiological distress. Clear breath sounds, low respers, high sats, and not one sign of distress. Actually, it was the opposite. The man would get up to get his own cokes from the kitchen if the aides didn't bring them fast enough. He also often visited the kitchen for snacks throughout the day, walked the corridors of that floor, all without the oxygen cannula that he refused to let them wean when he was sitting in his bed. Did you get that? He'd walk the floors, go to the bathroom, make trips to the kitchen all without the oxygen or shortness of breath and with high sats but anytime he was in his room and the nurse or an RT tried to take him off oxygen because of his high sats and lack of distress, he immediately went ballistic and said he couldn't breathe without it and that we were denying him care. He also talked non-stop on his cell phone both in his room and during his walks, all with complete sentences and no noticeable shortness of breath, and again, without an O2 cannula which he didn't use at home anyway.
So this is a long story but to cut to the chase, I had a long conversation with him, assessed him, and found that his heart rate was now in the 140's. Okay. The origin of that became clear when he became short of breath while talking to me, even though when I stood outside the room for about two minutes before going in and introducing myself because I was listening to him talking on the cell phone with his wife, all in complete sentences, no audible sounds of distress of any kind. After my assessment I still found no symptoms of any distress but he raged and sobbed at me that he wasn't getting good care and that the doctor had told him that he could have treatments any time he wanted them. With that, he pulled from his bedside stand an albuterol inhaler, Combivent inhaler, and an Advair, ALL of which he took several puffs off of. He then told me that he'd been forced, by our negligence and slowness, to rely on all of these "other rescue inhalers" in our absence and then demanded that I give him a duoneb treatment immediately, telling me again that his doctor had told him he could have treatments any time he wanted.
So now that you're laughing your ass off...here's what happened. I nicely explained that all meds have side effects and that he was driving his heart rate up by overmedicating himself and that the same overmedicating was also the source of his complaints of being jittery, nervous, and "not feeling good". I explained that Advair is a maintenance drug not a rescue inhaler. Explained that Combivent is the same as Duoneb and that Albuterol is one component of the Duoneb that he was getting every four hours. I then explained that with the Q4 schedule we could go up to 1 hour before or 1 hour after but that we could not perform Duoneb treatments every hour on the hour. I swear to God I was nice even though I secretly snickered behind my hand and couldn't wait to get back to the tech room. I figured there was med confusion which is normal especially in someone new to the game. I also REMOVED all the inhalers, Advair, and his Spiriva and took them to the nurse to go on her med cart.
He wasn't happy about that all and promised to get me into trouble with the doc.
So I promised to come back at the three hour mark from the last treatment and give him another neb IF his heart rate cooperated.
After all that, I charted a full page progress note explaining exactly what I'd said and done and why. I charted the clear breath sounds, the respers, and the ability to talk at length, the lack of supplemental oxygen except when he demanding it, no tripoding, no signals of distress. I also charted that as respiratory we'd be happy to help the doc in any way she needed us to to make the patient feel more comfortable with his care.
While I charted, the nurse got a phone call from a member of the man's family. The gal said that she was a nurse at another hospital and wanted to check on his condition. Both his nurse and I spoke with her. Then she told our nurse that he'd been driving the whole family crazy with phone calls, that she'd told him he couldn't be in too much trouble if he could talk so long and often without being short of breath, that she'd told the whole family to turn off their cell phones and get some rest, and that if anyone needed to be called in the middle of the night to call her. She also said that she'd be up in the morning to read him the riot act and take his cell phone away from him.
Okay, yeah. I admit it. We loved it.
I turned the patient over to a day RT with the story so she woudln't get blind-sided and when I came back on that night I was told that the doc came to the respiratory dept specifically to tell us that "I never told him he could have tx's just any time he wanted! I ordered Q4, he gets Q4, and thank you for taking away his inhalers. I had no idea he was using Advair like that."
Oh yeah. We loved that too.
Now that's the kind of stuff that's fun. After it's over. It's not that I think the dude was a bad guy, just high strung, high maintenance, and stubborn. He was definitely the kind of guy who once he had something in his head one way not even reason is going to talk him out of it. And even though it took up 45 minutes of my time on a busy night, it's a great story, isn't it?
I do have a lingering sympathy for the family though. At least we can send him home...
