I know that my patients hurt. I know that they are 'under the influence' of meds when they come to me following a surgery. But, my experience has been that the nice folks continue to be nice, the assholes are the same as they ever were. Most of us lie somewhere in between.
Today, I had a 40-something female gastric bypass patient (302 lbs., 50% BMI) , who was overwhelmed by nausea. It was the same situation as had happened to her in previous surgeries. I felt bad for her. But, she berated and insulted me. 'Don't give me anything! I don't want to be sleepy or out of it! Whatever you do, do not give me more medication!'. Me: "I have not given you anything. You're still feeling the effects of the anesthesia". Two minutes later: "I hurt! Do something!" Me: "I can give you Fentanyl, it's less nausea promoting than other meds." 'Whatever--just give me something!' I give the med. "What the hell did you give me? I'm getting tired! I told you not to give me anything that makes me tired!'" Me: "I gave you the pain med you requested. Do you want me to hold all meds so that you don't get tired?' "Hell, no. I don't want to hurt, dammit! What's wrong with you?" Then: "I'm sick! Help me!" Me: "I can give you some anti-nausea medication, but it may make you a little tired" "No!" Me: "It's important that you not put stress on your surgical site by straining." "Whatever" Two minutes later: "Hey, dammit, I'm getting tired. What the hell did you give me?" Me: Sigh... (having thoughts of 'I'll show you tired...')
Next, the family waiting area coordinator called and asked if I would speak to the patient's husband. Yes, I would. First, he let me know that he 'works in surgery here' (surgeon? nurse? PA? tech? maintenance? hmm...). He had many questions, everything from what I was giving her for pain and nausea, in what amounts, if she was retching and how much and what it looked like, if I understood the implications of retching and vomiting in gastric bypass, etc., etc. (I wonder if he understands the implications of being away from my patients while I answer his questions.)
I put her (and her husband) on the fast track to the floor...
Note to my patients and their family: I know how smart you are. You probably read all of the patient education material and then Googled the procedure/condition/disease and copied things off, maybe in color. If you work anywhere near a hospital, you even asked any doctor or nurse you could about the surgery. You talked to that woman on the bus who had the same thing done. But I know a few things, too, things that Google doesn't cover. You act this way because you care. Well, I care, too. I do this professionally, day after day. I clean up the blood and the puke, recording the findings, wipe away the mess on your loved one, touch them and comfort them, reassure and protect them. I so totally care. Flexing your new knowledge or behaving in an intimidating or challenging manner only serves to somehow satisfy your needs, not your loved ones. I am the one helping them right now. Let me do it.
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