I knew this day would happen: he would come back to the floor. I recounted our last encounter here. And tonight he was on the census. A cold chill swept over me as I looked over that innocent piece of paper. I knew. He was part of MY assignment.
For those not into reading the back story it is thus: admitted for a CABG due to severe diffuse 3-vessel disease; history of multiple psychological issues not limited to polysubstance abuse and ETOH. Not exactly what I would call a good surgical candidate. Our first match ended in a split decision. He got some of what he wanted, I got a little of what I wanted.
Now after a lengthy stay in the Unit, punctuated by a bout of pneumonia, a PE, septic shock along with the expression of underlying psychosis and delirium as evidenced by agitation, belligerence and violence towards staff. He had spent a long time intubated, more to support him through the wonderful detox process than anything else. He had become very good friends with a variety of restraints. But no longer was he critical enough to keep in the Unit, intubated and sedated. So up to the floor he came.
I knew that right away I was going to have to set boundaries. It was the first thing I needed to do. So in I walked. “Oh yeah, I remember you.” he said. “Can I get some pain medication?”
“Not right not, I’m going to have to look and see when you’re due next.” I responded.
“Yeah, but it’s time. Right?” he countered with.
So I looked him in the eye and said, “Let me tell you what. I will make sure you get what is prescribed, when it is due. Not before. I will do this. Your part is this: no comin’ out in the hall, harassing us, creating a scene any of that. You up for this?”
“OK, but I know it’s time.” he said.
“Let me go look.” Out in the hall I looked. It was a long time until it was due. And out into the hall he wandered.
“I wanted to tell you. I was wrong. It’s not due for another hour. I was looking at the clock wrong” he admitted.
“Alright. I’ll be back at 10…on the dot.”
So I kept going, working my tail off trying like mad to make sure that I was in that room when it was time. I knew that I was walking a fine line, putting my credibility on the line. If I didn’t show, my credibility was shot, null and void. If I came through, I could establish a level of trust that would keep him calm and make my experience a little easier. I looked at the clock, I had fifteen minutes to give meds to another patient and be back in time to give away pain meds. Yeah, right.
You see, if the IV was OK and not kinked, it would have worked out perfectly. But like most things in nursing, perfect is pretty damn far away. I spent a couple of minutes wrangling the IV, re-taping it, flushing it and ensuing it was still patent before giving out some steroids. All of sudden my charge nurse pokes her head into the room. “Do you have meds for Mr. S.? He’s causing a scene in the hallway.” Shit, I mutter to myself looking belatedly at the clock on the wall: 10:01. He’s nothing if not punctual.
“Yep, got ’em right here,” I said hading them over to her. I knew I was screwed, that I had lost the credibility and trust I worked to create. A wave of anger swept over me. Why was I so enthralled…no controlled by this? Was it more than just self-preservation, or was it something deeper? No matter what he thought, I was in control of the situation, I had to be. I had set the boundaries and what I expected. So I headed over to the room. “Didja’ get your meds?” I asked.
“Yeah, but they were late.” he said.
“But you got them. I was involved, but you got taken care of. Next dose it at 2. I’ll be in then. Anything else you need?” I came back with. Nothing but sullen silence. He refused the other evening meds, but did let me check a CBG. Small battles add up to a larger war.
Fast forward to 2am. In I go, give the meds and let him get back to bed. “I’ll be back at 6. I need to do vitals and draw labs, let me know if you need anything.”
At 6, I walk in. Silence greets me. “I bought your meds like I said.” Nothing. He just rolled over. “You don’t want them right now?”
“No” he blubbered, “they don’t do anything anyways. I just want to sleep.” he finished with a whimper.
“No problem. I’m going to draw labs out of your PICC and leave you be to sleep. Let me know if you need the pain meds.” I said.
I realized what he was playing at. Sympathy. He wanted me to feel sorry and say, “Oh let me call the doc and see if I can get something that will work.” No, I was not going to play that game. The docs knew and were aware of the situation. They wouldn’t have given me anything even if I had called. Back at the nursing station one of my colleagues said to me, “Did you hear what he said when he came out to get a drink?
“No, do tell.”
“Yeah, he pretty much said this: I can’t wait to get out of this place. First thing I’m goin’ to do is get a 12-pack of beers, sit down and drink the whole thing.” she said.
Great, I thought, we fix him and he goes back and does everything he could do to ruin all the hard work we did. It made me mad. I knew that it wasn’t an insurance company that was going to eat this. No, it was working folks like you and me that were going to bear the burden. Yes, your tax dollars hard at work. Here we were, paying (indirectly if course) to save someone who really did even want to be saved and who vowed to undo all of it the moment he left the hospital. Now I don’t have a problem taking care of folks who aren’t as lucky as I am. In fact I would like to do more things to help out those who can’t help themselves. But in this case it was all I could do not to tell him exactly how I felt, and it wouldn’t have been in the most socially-acceptable terms. Many people see this as a chance to start fresh, like getting a new lease on life and try to do anything they can to make sure it sticks. They take the lessons to heart and become personally invested in the process. Some don’t. They pass on the opportunity. They’re the ones that will keep getting admitted. The ones that we will again and again until they drop. We’ll keep tuning them up and sending them back out, until they eventually stay for months at a time and maybe get a celestial discharge. If we’re lucky.
But I digress. He got discharged. And hasn’t come back. Yet.
Chalk this one up as a split decision too – ’cause I don’t think you can ever win in this situation.