I knew from the moment I stepped on the floor and saw him glowering at every person in scrubs who happened to walk by, that he was on my assignment for the night. I just caught that vibe. Sure enough, along with with my Spidey-sense, I got him. He stood outside the door to his room, pestering anyone who came near with the repetitive question of , “When’s the IV guy going to be here?” He would not be placated by the general knowledge that we are a large institution and that there was only 1 IV nurse. This was not to mention the fact that having badgered the day shift for the last hour, no one wanted to even attempt to try to start a line. In spite of that, he wanted his line, “Now!” His need for IV narcotics outweighed our responsibility to our patients here at shift change. He wanted it now. And he wanted us to slam it. Not push normally like we do, but slam it fast, so he could ride the rush.
I looked over my report sheet: severe triple vessel disease, scheduled for open-heart in the AM. History of traumatic brain injury, depression/psychotic episodes, mixed personality disorder, ETOH and polysubstance abuse. I shuddered at the thought of being his nurse post-surgery. There was not going to be enough narcs to throw at him to make him even the least bit happy. The surgery may fix his chest pain, but it would do nothing for his “chronic back pain” nor his near-insatiable need for prescription pain meds I found related in the tales of admissions past. No, he was a nightmare of a candidate for open heart. Thoughts of pouring tons of Oxycodone down his throat all the while pushing morphine to back it up while keeping the syringe of Narcan in my scrub top danced in my head. I shuddered again. It was not going to be pretty. Did I also mention that he had us pretty much figured out from the start and knew every way to twist us into giving him what he wanted.
He got the line. We told him that he only had X amount of narcs allowed in the current time-frame. You would have thought someone had called his mother a whore the way he exploded. Ranting and raving, starting to get a little belligerent. Back in the recesses of my mind I calmly called forth the number for Security, just in case. Lucky for me, this was transpiring while I was dealing with another patient. My charge nurse took the brunt of the abuse and did what nay good nurse does: calls the doc. Bless his soul, he got an extra one-time dose, plus a PCA. Narcosis on demand.
Deep inside however I was a little conflicted. We ended up giving him exactlywhat he wanted: access to large quantities of narcotics. Sure it shut him up for awhile, but was it the best thing to do?
Maybe. Maybe not. If nothing more, we fed the notion inside his head that given enough histrionics and emotion, he would get what he wanted. Like a petulant little child throwing a tantrum was the way to walk out of the store with a new toy.
Since he was going for open heart surgery I tried to do what teaching I could do. When you’re half gorked on pain meds, your comprehension level decreases substantially. Did any of it stick? I doubt it as I came back a little later after having gone over the incentive spirometer to see him unable to figure it out without a little extra coaching.
In spite of all of this drama, to which many is a way of life, I got him ready to go. Fluffed, buffed, cleaned and shined, ready to have his chest cracked like a fresh oyster. As he was getting ready to roll out the door he asked, “So, are they going to give me pain meds down there? Or just put me out?” Nothing had stuck except the one all overarching basic need in his mind. How ER nurses deal I can’t fathom. Right now I’m just praying that I won;t get him.
Have a safe and Happy New Year!