Thursday, December 20, 2007

What the sick role should be

Back in sociology, we learned about 'the sick role'. You know what that is. It's when you wake up for work and you feel like hell. You maybe roll out of bed, and maybe you make it to the shower and maybe you throw up and maybe you take your own temperature or just see yourself in the mirror. You hem. You haw. You sound pathetic. You feel pathetic.

You might be lucky enough to be able to do something like call in to work (or you might be a single parent, who has to soldier on, regardless). If you're anything like me, you may feel utterly like hell, but you also feel a relief, too. Because today you get to lay on the couch and drink juice and maybe quilt (your mileage may vary here), but mostly doze off and on with Buffy the Vampire Slayer episodes (mileage varying again here) back to back.

Because you're sick and the sick person's job is to do sick person things.

Like nap. And slurp hot soup. And drink juice. And water. And pop a few ibuprofen. And nap more. Maybe you are lucky enough to have a significant other who will fetch juice for you from the grocery store. And tissues. And will maybe even feel sorry for you.

The sick role carries over into the hospital, too.

I have one patient tonight. She's complicated. A back surgery that was doing very well until it suddenly went horribly, horribly wrong with some virulent microbial and fungal infections in three different places in her body. She's sick. She is very, very sick.

I feel great about the care I've given this patient for the past three days. I spent the first night chasing her hypertension and tachycardia and trying to do so with nipride instead of sockin it to her with the propofol. Night two was preoccupied with neuro issues and tracking down what grew where in which petri dish. Tonight began differently, though. Talked with her neurosurgeon, got some tests ordered for the morning. Other than that, she's doing WELL. Which is fabulous.

I had time to do the royal treatment tonight. Not just a bath, but a shampoo and full fluff and buff with lotion and baby powder and range of motion with leg and foot massage. The whole nine yards. I do not get time for this often, and it was nice. Cos you know? I am a huge proponent of nursing being all about the pathophys and critical thinking skills. But you know? I actually just like taking care of people, too.

And then there's the patient up the hall (not mine, thank god). This patient has lived here for roughly six months in the past year, bouncing in and out as frequent fliers do. She can walk and talk and is hemodynamically stable and has 2 piddly litres of oxygen via nasal cannula. If you have your ABCs (airway, breathing, circulation), you don't need to be in the ICU. Someone made this point to me the other day, and it is true.

But certain physicians here are allowed to admit to the ICU for patients who have nothing more complex than a hangnail. So Whatsername's back.

And she LOVES the sick role.

We do take care of this patient; it's why she comes here. Not just handling her Medical Issue du Jour (which hasn't been critical for five months). We do wipe her butt for her. We do dress her. We do bring her food and drink and all her medications on time. We take her shoes off for her. We give her a walker and a commode chair and dump her poo when she's done. We walk her with a walker around the unit, but do not force the 6 feet to a flushing toilet. We listen to her bray "Help! Help!" every half hour or so. We hear the call light every fifteen minutes or less.

Sometimes when you walk in to answer the call light, she wants you to scratch her back. If you're male, she will ask you to scratch her butt. (She has enough fine motor dexterity to write, for example, but butt-scratching is beyond her abilities.) Sometimes it's cos her legs hurt. No matter how much pain medicine you give. Sometimes she simply forgets why she calls you.

I consider the several hours with my patient as time well spent. I can't stand dealing with Whatsername down the hall. I hate being in that room. I don't mind helping the other nurse in the slightest, that's not it.

It's the bleating and the sense that this person really WANTS to sound pathetic.



Demanding and thankless.

Even though my unconscious patient won't have any idea what I did or who I am. I won't get a thank you from her, nor do I expect or wish for one. Her family won't thank me for what I've done for her, either, because it's 0300 and they're asleep and have no idea how often I'm in my patient's room or how carefully I am watching her condition and making small little changes to her drugs or changing dressings or measuring chest tube ooze or all the stuff I futz over. I don't even care.

What's maddening to me is that loving the sick role thing. And.


Let's assume that I buy the idea that it is sensible and sane to approach people, life, everything as what it IS as opposed to what I want it to be or decide that it should be. This is JustCallMeJo, the lazy buddhist speaking here, yes, but isn't that a rational idea? I mean. We don't have what we want, we want what we can't have and we don't want what we do have. That's what we humans are, right?

Doesn't it seem like an interesting idea to try and live with the idea, just for awhile, that maybe approach things with fewer expectations of what should be....and try to look, really LOOK and accept what is? It's a good idea, I think.

I am finding that this is very, very, very hard. But I'm trying.

But why shower the fuss and the chart-reading and detailed critical thinking skills and slather on the lotion and the foot massages on the patient who has NO IDEA what I'm doing for her....and I get annoyed with bleating Miss Itchy Butt? What difference does it make to me that one loves the sick role and the other is getting a constant infusion of Milk of Amnesia?

It's not just me. I am one of several nurses who walk out of Itchy Butt's room with expletives on the tongue. We talk about it. Why is it that she hits a nerve?

Isn't that ...just.....odd?


Lisa said...

I think sometimes we like our unconscious patients b/c we can just do for them and really it just makes us feel good. Miss Itchy-Butt has expectations that drive our actions and sometimes, most of the time probably, we would do what she wants but maybe an hour from now or maybe even right then if she hadn't asked. I don't know what it is about those patients but they do get under your skin!

RehabNurse said...

Ms. Itchy Butt is just one of those patients who is desperately in need of a neuropsych consult. Yes, we love neuropsych in rehab, because they get in there and have time to dig out why Ms. Itchy is acting so crazy. Some of the things they tell us make our lives so much easier, once we know them, because you know Ms. Itchy is not going to directly tell you what she needs!

The other nice thing is that they can recommend a nice, appropriate psych drug if Ms. Itchy is way too anxious and all the redirects, etc. are not working.

The Ms. Itchy Butts of the world are a danger to themselves and others (especially employees) if left unattended.

Susan said...

I feel you. Whenever I have a patient like that, and I'm in their room in response to the 4th call light in an hour, while they struggle to recall what they needed what sends my BP into orbit is that the faces of my other patient(s) flash before me. Patient(s) who are not getting any care at that moment so that I can, essentially, entertain this person.

Why does hit a nerve? Cos you're human, and don't you dare feel bad about it.