Saturday, January 21, 2006

Why I (heart) My Patients.

Oh, for the love of Saturdays. Contrary to popular belief, Saturdays on a hospital floor are notoriously busy, because Saturdays follow Fridays, which are days when whole floors get discharged on day shift, and a whole new floor admitted, half of which comes up from the ED at 11:00p.m. Friday night.

Saturday day shift is the Clean Up Crew, and the Dealing with Overwrought Family Members Who Can't Understand Why Uncle Ned Has To Stay In The Hospital Another Day Because No, We Don't Have a Star Trek Wand Thing to Pass Over Him To Diagnose and Treat the Patient Instantaneously and Send Him Home. If we could do that, Uncle Ned would have been already seen and discharged by one Dr. Beverly Crusher. And also, Uncle Ned would be in outer space, on a spaceship, in the year 3850.

Saturdays are not fun days, and are generally spent playing a very dull, deeply annoying grown up variation of "hot potato" with patient issues, at least if you're cranky housestaff. Example: Blood pressure 80/50? Patient not looking so hot? Housestaff Solution: Call me back in an hour if patient's blood pressure is <90.>Nurse's intuitive response: Uh. Patient's pressure is less than 90. Now.

Actually, I feel right at home, because Saturday day shift is basically like any old weekday evening shift, what with the largely indifferent housestaff, nonexistent attendings, and general all-around piss-poor support. The glaring exception is that on weekends, family members are even more pissed off at nursing staff than usual because You're not the doctor! When the hell is the doctor going to come up and see my father/mother/grandmother/uncle/aunt/sister/pet hermit crab?! To which I must dutifully reply, "I'm sorry, the doctor doesn't see arthropods at this hospital. He may, however, consent to seeing your hermit crab."

Any way, it isn't all bad, so can I admit to a guilty pleasure?

I love doing pain assessments on patients whose pain meds are clearly working:
JAMIE:
So, how's your pain now?

PATIENT:
[lolling in bed, shit eating grin on face]
Ggggggreaeeeattttt.

JAMIE:
No, wait... I mean, is your pain is better now?

PATIENT:
[still with shit eating grin]
Hhuh? Whooz askin'? Oh, uuuh huuuuhn... yeaaah...

JAMIE
[charts "patients pain scale 2-10 from down fom 9-10 post 1 mg IVP Dilaudid pushed per protocol; pt states good relief of pain."]

Happiness also lies within getting a patient's uncontrollable metastatic CA pain under control with some good old-fashioned "lead house officers to physician ordering screen and force them to write proper pain management protocol orders" gumption. I got a snotty attitude in return for asking the HO (house officer) to write decent pain management orders, because why the hell would I want my patient's pain under control, for God's sake?! Can't the patient just suffer along with a morphine order that makes him dry heave and doesn't do crap for his pain? What the hell does this look like, a hospital?!

I also had a pre-crump-looking patient (you know the type, 300 bazillion years old, still a full code, going septic and dropping his BP's on top of it). BP's had dropped from 110's systolic in the a.m. to 80's at 12p.m., and very rapidly thereafter to 60 systolic by doppler. He went from feeling "a little tired" this a.m. to looking waxy yellow looking, low grade feverish, diaphoretic, with that purple look under his eyes that nearly always spells "crump" to me (putty colored noses and grey faces also spell "crump" too, usually of the chest pain variety).

One stat EKG, two normal saline boluses followed by maintenance fluids, and a set of stat labs later his pressure was back up to 98 and bless him, he was looking very perky indeed, peppy enough to sit up, eat his supper and joke with me. He even got up to the commode and pooped without vasovegaling or getting orthostatic, a feat which makes any cardiac nurse's heart beat in wild delight/SVT (I know, we're sick individuals).

And lo, his labs came back. And lo, his 'crit was crappy. So, hemodilution or no, I got an order and hung a unit of blood. Of course, the man was extremely hard-of-hearing, so a typical conversation went something like this:

JAMIE:
[yelling at top of lungs, two inches from patient's ear]
WE. ARE. GOING. TO. HANG. A. UNIT. OF. BLOOD.

PATIENT:
Whaa?

JAMIE:
[screaming at top of lungs; nurses outside at nurses station snickering loudly]
A. UNIT. OF. BLOOD.

PATIENT:
HUH?

JAMIE:
[dogs and small children in neighborhood now whining in protest at decibile level/frequency]
BLOOD.

PATIENT:
CRUD?! Who's got crud?!

JAMIE:
[gesticulating wildly at unit of blood due to expire any second now due to length of conversation]
NO, BLOOD.

PATIENT:
[finally noticing unit of blood]
What in hell is that?!

JAMIE:
[hurls self out window, has fleeting visions of becoming a pantomime in next life as she hurtles towards pavement below]
The reward for making a silent movie demonstrating Hanging Blood 101, old-fashioned captions and all, was when he said, smiling,"Thank you for helping me. I really felt like I was going to die today, and you worked so hard and got me better. I feel so much better now! You did a great job."

Well, I seriously doubt he would have died today, but it's nice to think he thought he good care.

And that, my friends, is why I (heart) my patients.

posted by Ziggy @ 10:42 PM 

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