My Night In Hell

I usually like it when I'm getting report at the beginning of a shift and the day shift nurse tells me how patient so and so is mean or crabby or hard to get along with. Yes, you read that right, I like it. I take it as a challenge. I make up my mind right then that I'm going to charm the socks off of that particular patient. Somehow it is just fun for me. I know, I'm weird!  It's a rare thing when I can't pull it off. Not that I'm so lovable, I just go way out of my way to bring them around. I jump through hoops if necessary and love every minute of it. Maybe it's some deep seated need for approval that I have or something, I don't know, but I really enjoy it. So, yesterday while getting report on a patient and hearing what a nasty guy he was I was anxious to get at him. He was in the cath lab for an angiogram as I was getting report. I was told how nothing suited him, that he was screaming for Morphine every 20 minutes and that he had the night shift nurse in tears the night before. I wasn't worried, not in the least. I began my rounds waiting for the cath lab to call me report on Mr. S. About 30 minutes later Jerry from the cath lab called. Mr. S. had had open heart surgery in July of this past year. He was back in the hospital in December complaing of chest pain. That had cath'd him then and his grafts were all good and no new areas of ischemia had been found. He is known to like his morphine. Heck, most of our patients like their morphine and it's not unusual for people to come in complaining of chest pain because they've made a life out of the pursuit of narcotics and have learned that chest pain is their  best bet for getting them. Jerry informed me that the cardiologist had indeed found some new blockage in Mr. S's LAD. He would be going for angioplasty in the morning. Jerry is the nicest guy in the world. When he offered his sympathies that I would be the nurse getting Mr. S. I had a moment of pause. Wow, this Mr. S. must really be something if even Jerry thinks he's a tough customer. I would soon find out what I was made of. Mr. S. hit our unit and the hell began. They use the femoral artery in the right groin for angiograms. It's very important for the patient to lie flat for 2 to 6 hours(depending on which method they've used to seal the artery) after the sheath has been pulled to allow the artery to repair itself and not hemorrhage. They are not allowed to lift their headsoff the pillow or bend the affected leg. We monitor them very closely for the first hour. Mr. S. was immediately lying on his side and pulling his knee to his chest. I was scared to death that he was going to bleed. I used every ounce of kindness and charm in my body to get him to cooperate with me. He wasn't buying what I was selling! A very important fact here is that  the only IV access they were able to get in him was a small 22 gauge IV in his left thumb. This is NOT good. He came back from the cath lab with Normal Saline running at 100 ml/hr. The cardiologist had written for me to start Heparin(anticoagulant) and Integrelin (anticoagulant) drips. Oh great, I had one little IV site. This guy had zilch for veins. I tried several times to get another line in him and had others try too. No dice. I finally figured out a way to piggyback the three bags of fluid and all was well. For an hour all was well. When an IV is occluded, it beeps. His pumps beeped all night. if he moved his hand the tiniest bit, the fluids wouldn't run in. It was driving me crazy. Add to this the fact that he wanted morphine every 20 minutes. He didn't use his call light. He screamed at the top of his lungs, "NURSE!" "NURSE!" I would walk into his room and remind him that he'd just gotten morphine and couldn't have it again for an hour and a half. He called me a liar. Swore and be damned that I had NOT given him any morphine. Then he would promptly fall into a morphine induced stupor for 20 minutes until the beeping IV would wake him up and he would once again bellow "NURSE". In between all of this fun stuff he would say he had to pee. I won't go into the fun I had helping him go in the urinal. Some things are just better left to the imagination! Then, he wanted me to put his TV on channel 31. So, I did. "NO you idiot, that's not what's on channel 31 at my house", he yelled at me. "OK", I said, "What's on channel 31 at your house?"  "I don't know the name of the station! You're stupid! Give me back the remote control." It was about this time that I decided in my warped mind that what this guy really needed was a pillow treatment!  Keep in mind that I had four other patients to take care of and was getting an ER admit. Out of the 9 hours I was at work I was in his room for at least 6 1/2 of those hours. At 10:00 I heard his familiar bellow "NURSE I NEED YOU". I walked into his room tofind him sitting on the side of his bed with blood all over him and the floor  and his gown up around his waist. He had pulled that precious IV out of his thumb and was asking me if I could "straighten it out a little bit". I am ashamed to tell you that at that moment, my eyes filled up with tears. I just wanted to sit down and cry like a baby. I yelled for help and the cleaning up commenced. I tried again to get IV access. No go. Two other nurses tried to no avail. I called for the house doctor to come up and try. I should have known better! In walks this young kid!  I explained the situation with this patient and that he was on Heparin and Integrelin and was going for plasty in the AM. I told him how many attempts we'd made to get a line in and he says to me, 'If you nurses can't get it, I won't be able to." I am so not a violent person. I wanted to hit him. He asked me if we'd tried his legs. "No, I haven't tried his legs. We can't put one in his legs without a doctor's order." So he says, "well, now you have a doctor's order." Usually at this point the doctor asks for the IV equipment and HE puts the IV in the leg. Not this joker. He stands there looking at me. By this time the room is full of nurses, all of them just standing there watching. At the end of my rope I grabbed the IV catheter and threaded it into a vein in his leg. All I can say is that God must have been finished testing me for the day, because that catheter slid into that vein slicker than snot. I got great blood return and the world turned right side up. And do you know what that doctor said to me? "Thanks for getting that." The big wuss!  We all agreed later that he was afraid to try it and miss with all of the nurses standing there watching. By this time it was 11:00 and the third shift was coming on to relieve us. I have never in my life been so ready to get out of Dodge. As I was leaving I told the charge nurse that if she gave me this guy on Friday night I would quit. She laughed, she thought I was kidding.   So, ok, I've met my match. This guy can't be charmed.    

Immediately after posting the above one of the night shift nurses popped up on my buddy list. I asked her if Jeannie had any more trouble out of Mr. S. after I left. Guess what he did? Yep, he pulled out his IV at 4 am. You'd think the guy would realize that he can't get IV morphine without an IV!