Friday, March 21, 2008

End Game

We stare at each other, gridlocked.
"Please let go, I don't want you to hurt yourself." I plead.
"Well, then stop hurting me." she retorts. I'm slowly prying her fingers one by one off of the arterial line. I look at all the tubes we have her hooked up to, the oxygen mask, her incisions. If I didn't know I was in the hospital, I guess I'd think everyone here was trying to hurt me too. As I'm filling with sympathy, her hand gripping my wrist lunges at me. I instinctively jerk back, but not in time to prevent getting two long scratches down my hand. I think I see some drops of blood pooling to the surface. My 72 year old, sweet-as-could-be patient, just drew blood! I manage to loosen the last of her fingers from the A-line and without loosening my grip I tie her arm down to the bed with a restraint. The next hand quickly follows, though I stay far out of reach from those dagger like nails. Once securely fastened, I ponder this paradox. I tell her we're not trying to hurt her, and now she's tied to the bed like a criminal. I have a feeling she's not going to trust me again. I go to call the doctor and scrub some Purell on my hands. The stinging I feel reminds me of the battle just fought. Well, score one for the 72 year old, I think.
Update: This patient was suffering from delirium, which is pretty common in older patients in the hospital, especially when medications and lack of sleep are involved. She is now doing fine but remembers our little adventure, and thankfully no longer thinks I'm trying to kill her.

Saturday, March 15, 2008

When Patients Attack

"Help! Help!" My patient croaks from her freshly extubated throat.
"What's going on, what's wrong?" I ask my once perfectly sane patient.
She glares at me with all the menace she can muster.
"You know what's going on," she accuses.
"Where are we right now, {insert name here}?" I ask, wondering if this is the dreaded neuro status change.
"I know where we are right now, don't talk to me like I'm stupid."
"I don't think you're stupid {inserted name}, I just want to make sure your head is doing okay." Wrong choice of words.
"Well, that is not.... that is so rude to say my head is not okay. You are just not a very nice person. I want my lawyer. Now. And the police."
I try to smile reassuringly. "{name} you're in the hospital, you hurt your head, you don't need your lawyer."
"I don't trust you!" If looks could kill, I'd be in the morgue.
"Why don't you trust me?" I try to get a reasonable dialogue going again.
"You smile too much." She states, perturbed. I gulp down another grin.
"You can't hold me here against my will!" She starts to panic and I try to keep her from hurting herself as she becomes entangled in all the different tubes and wires we have her connected to. She grabs her arterial line in a vice like grip and I can just envision the bloody mess, not to mention dangerous blood loss, if she manages to pull that out. I grab her hand as she grabs my wrist with her other hand. For a 72 year old woman who's been laid up in a hospital bed for several days, she's surprisingly strong. And while I don't want to hurt her, I can see in her eyes she doesn't care one whit about hurting me. We are locked in place. If I pull, the A-line could go. If I let go, it's coming out anyway. Just as I'm hoping for some innocent passerby to see my predicament and help, my patient makes the first move. To be continued...

Tuesday, March 04, 2008

The business of dying

I see death often where I work. Not the grim reaper with his scythe and black cape. Less fantastical, but just as traumatic, watching someone take their last breath. Here is something I wrote awhile back after just such an experience...

Rasping breaths, the unmistakable sound of death slowly becoming victor, filled the quiet calm of the room. Loved ones gathered around united for a moment in the face of a common enemy, mortality. Every face showed signs of a different struggle, bitterness, anger, sadness and grief beyond words. You could almost here everyone counting the seconds between each breath, wondering which would be his last, half hoping the struggle would just end, yet pleading for one more breath. Just one more. We're not ready to let go, not yet, please.. quiet prayers lifted up to an unseen God. It never got easier, watching a family go through death. Old, young, expected or unexpected, it was never easy. A cold tear slipped down my cheek, I let it linger. It didn't matter if I was too emotionally involved, I wanted the family to know I grieved with them. How can I not hurt with families, when I already know what they are feeling all too keenly? A breath is exhaled. We wait... It's over.