Monday, May 19, 2008

Toys In the Attic

For those of you too young to remember Aerosmith before they got sober, toys in the attic is a euphamism for crazy.

I don't know what it is about dialysis patients. They can be so crazy and controlling sometimes. Maybe it's all the grief and loss. Maybe it's the metabolites building up in their brain. Whatever it is, it's never a dull momement in Dialysisland.

The other day I had a patient whose husband created drama as I was leaving one night. The patient was a little hypotensive after treatment, which is not all that uncommon, but when she got to her room she told her husband she had chest pain. He came roaring out of the room demanding to know what had happened to her, and later insisting that she was allergic to one of the meds I had given her. Before I was able to get to the bottom of it, word had already spread throughout the unit that "that dialysis nurse gave her a medication she's allergic to."

By the time I arrived at her bedside the charge nurse was there trying to damage control and was fuming. I stayed with the charge nurse, trying to get to the bottom of what had really happened. I wanted to make the charge nurse understand that I was there to clean up whatever problem I might have created and that I wasn't going to dump the situation in her lap and then leave. Together we looked at the patients' record. The med I gave was prescribed by the nephrologist and had been given to her before. We checked her list of allergies and the med I gave her was not one of them.

About an hour later as we began to unravel what had happened, we realized that we were the victims of a drama king and an attempt at staff splitting. By teaming up with the charge nurse to solve the problem, we stopped the patient's husband from performing a "divide and conquer" episode with us. I'm glad I made the decision to work with the nurse and function as her ally. As things calmed down she relaxed and we were able to talk through what had happened. I could tell she was relieved that I stuck by her against the evil one and worked as a united front against him. Everything was documented thoroughly. We could feel a lawsuit in motion and thought we'd better have things written down. The next time I saw her she gave me a big smile and a wave. That made me feel pretty darn good about how we got through that difficult situation together.

Today I had a problem with my dialysis machine and was doing what I could to keep it running. Meanwhile the patient noticed I was spending a lot of time punching buttons and began a running commentary about it. "How come the other nurses don't have this problem? You don't know what you're doing. They need to get someone up here who knows what's going on." Stuff like that. I mostly ignored him and went about my business. I learned long ago that dialysis patients have lots of time on their hands and use it to invent new games to try and rattle the nurse. I've learned to deal with the crazy.

Today it took me 12 hours to run 2 patients. That's really way to long but actually it's an improvement over what I was doing before. It's going to get better. Even with all the playground games I already love this job.


mofo said...

you are a saint. 90% of the dialysis patients on our floor are huge assholes.

Nurseknowpp said...

Thanks. You give me far too much credit. I can be a jerk sometimes too. Maybe that's why I can deal with it. I understand them.

Or maybe it's early in my career and I'm not burnt out yet.

I have figured out that the best way to deal with them is do it their way and go about my business. I can't change them. The other thing that helps is what my boss always says - "after your shift you're going to go home and leave him there." Kind of brings home the point about what it must be like for the patient's family to deal with their BS 24-7.