All in the head

Sometimes work just makes me stop and laugh. I have the craziest patients ever. I often thought that if I worked in a field of nursing with young, vibrant patients who were relatively normal, I would’ve stuck with it and not gone on to medicine. But actually I think the crazier patients really reassure me. They make me feel normal and like I’m not actually psychotic, it’s just in my head.
Yesterday, for example. I approached one patient and as I came up, he said in a very loud voice so everyone in the vicinity could hear,
“Now THAT is one GOOD-LOOKING girl!”
I was sort of embarrassed as I handed him his medication and he leaned over and squinted, trying to read my nametag.
“Heather, LPN. What does LPN stand for?”
The guy next to him groaned.
“Come on, Ray, give her a break.”
“hmmm…. Liquid…. Propane….”
I interrupted him. “It stands for little pretty nurse,” I said.
“Haha!” He rocked back on his chair. “That’s a good one! Little pretty nurse! Well, I’m not asking your age, that wouldn’t be polite, but I don’t know if I should call you a lady or a girl, you look much too young to be a nurse!”
“I’m 24.” I told him, “Which is much too young for you, by the way, so don’t get any ideas.”
“Are you kidding? 24? Why, I thought you were about 16!”
He started laughing and elbowed the guy next to him.
“I know! Sweet 16 and never been kissed!”
I had finished with his medication so I just gave him a withering look and walked away.
Later on I had to come back and see him again and I swear, it was like he saw me for the first time.
“Well, hello! I’ve never seen YOU here before! Where did you fall from? Are you an angel fallen from heaven?”
He looked down at my nametag…. “Heather, LPN. Hello, Heather! Well, what a nice-looking girl you are!”
A bit later in the day one of the other nurses came rushing towards me.
“Heather, can you go to the front door? Mr. Roland is out of control and I’m trying to get the doctor but Mrs. Taylor isn’t breathing…”
“Sure, no problem.”
I rushed to the front door and Mr. Roland, sitting in his wheelchair with a couple of nurses fluttering around him, was like a seething giant about to explode.
I put my hand on his knee and crouched down to meet his eye.
“What’s the problem, sweetheart?” (I couldn’t remember his first name.)
“Get the hell out of here!” He shouted and lifted his leg to kick me.
I leapt out of the way just in time. Well, maybe that approach wouldn’t work. He had a gash on his head that someone had put steri-strips over, and there was a massive purple bruise under his eye. He was talking nonsense, saying he wanted to get out, but he was so unsteady on his feet that he couldn’t stand up. I came up behind him and put my hand on his forehead to feel the temperature, then leapt out of the way of his flailing arms. No, he wasn’t hot, or sweating. I tried to think of the things that make people suddenly aggressive and psychotic. An infection could do it, but he didn’t have a fever. The fall on his head? A stroke, acute pain, drug interactions, alcohol, dementia, there are several possibilities. But with him in this state we couldn’t even examine him. There were already people staring. Another nurse came down the hall.
“The doctor finally gave me an order for an IM tranquilizer.” She said, pulling me aside. “See if you can get him out of the lobby and towards the nursing station.” (IM means intramuscular)
To make a long story short, it took a lot of negotiation, including bribes (“Coffee? We’ve got your son on the phone to speak with you…”) to get him out of the lobby.
At the nursing station there were people everywhere and he stood up shakily and held the receiver to his ear to talk to his son, shouting and flailing around. Suzanne, one of the other nurses, had drawn up the medication in a syringe and was standing off to the side.
“I don’t know if we can do this.” She said. “He’s wearing about 3 layers. We’ll have to get all those sleeves off so I can get it in his arm.”
“No way.” I said, pointing at his butt. “Go ventro-gluteal. We’ll hold him down and just get his pants down a bit and stick it in.”
Mr. Roland was shouting and throwing punches. One of the other nurses had nail marks on her arms and decided it was time to back off permanently. We waved over a couple of male nurses and Suzanne and I came in and I grabbed his arms and hung on for dear life and Suzanne got that needle in and he roared like a cornered bear and threw us off, but it was in. I felt like a superhero. We all retreated a few feet back and watched as it slowly began to take effect. One of the guys came up behind with his wheelchair and I approached cautiously.
“Here, Mr. Roland, have a seat.”
He slowly slumped down, mumbling, “Get the hell away from me. I don’t want anyone to touch me. What are you doing to me?”
And that was that. An hour later the doctor had seen him and he was sitting calmly, eating fruit salad.
And I was down the hall with my patient Phil who between gasps told me he couldn’t breathe and he was sick of suffering and wanted to die right now. I turned his oxygen on and went to get a bronchodilator and by the time I got back he was breathing normally and when the other nurse asked how his breathing was, he said it was no problem. But we checked his O2 sats (a measurement of the amount of oxygen in the blood) and they were at 86% (normal is 98%) and suddenly his chest was heaving again with the effort.
Crazy guy. I think if I couldn’t breathe I’d let everyone know.
So anyway. This week is week of the heart for me, and I’m wondering what’s going to go wrong. Week of the stomach I was nauseous and throwing up, week of the lungs I had bronchitis and was coughing away…. Hmmm….. maybe it is all in my head after all.