Friday, February 27, 2009

Compassion...

Found out today that I'd pissed off a patient and he managed to complain to my boss. Was yet another chronic, obese, bastard who didn't feel like going to his dialysis appointment one day. So a day later, c.o.b. goes into the ER of Suburban Luxury Resort That Has A Starbucks But No Water Hookups And Bills Medicare with chest pain.

I actually do understand that a life shackled to a dialysis clinic is a hard life. But the choice is to go or land in the hospital. I don't doubt that this is a painful thing. You will not garner sympathy by acting surprised at this turn of events, however.

I asked him, "Why didn't you go to dialysis on Wednesday?" He sniffs, "I wasn't feeling well." "Well, um, you're in the hospital now, how do you feel?" "Lousy." "I'm sorry you feel lousy. Why didn't you go to the ER yesterday?" "BECAUSE. I. WENT. TODAY."

Big fat duh. He's one of our frequent-flyers. He knows damn well how to work the system. He lives closer to one of the less luxurious hospitals, but he drives a half hour to the ER of Suburban Luxury blahblah because he knows they'll admit him. He finds me rude because I'm supposed to meekly treat him and not call him on the fact that he's milking Medicare for all its worth.

I was dialyzing the bastard at 10 o'clock at night while he was in his hardwood floor-ed single room watchin the flatscreen tv. He's got a free hotel room with predominantly twentysomething cute RNs to wipe his ass for him and a fresh cup of Starbucks every morning in his private room. He didn't like me and loudly told me so in those words. I said I was sorry to hear that, but my affect showed clearly I didn't care. I put his fistula needles in and I didn't do it gently. So he complained about me.

My boss asked what happened, heard the story, and then shrugged. "These patients are often ....difficult." Proceeded to tell me her favorite asshole patient story. "We just have to be mindful of our bad days, too." I nodded. Yeah, I know. C is a nurse too, and not a saint. We have "bad" days when we tell irresponsible people that they're irresponsible.


Which leads me to Head Nurse's blog about compassion. Head Nurse (also a Jo) was picked at for "not having compassion." She's defending a nurse's right to blog snarky.

The other day I dialyzed a Vietnam vet, who took high doses of daily methadone, smoker, chronic pain. He sounded like he had Tourette's, but I'm sure that wasn't a formal diagnosis. Everything f*ck this, d@mn that, sh!t this and that. I stretched his legs for a half hour. They were as tight as lawnmower belts. Slow, gentle plantar- and dorsi-flexion. It helped him. I just felt like doing it. Think I'm an angel and he's this poor, sad, sick man? When I was done with his legs, he told me his ass was hurting him. I just looked at him as if he knew better than that...and he did. "Sorry, I don't do ass massage." Sheepish, he nodded. "Well, thanks, that helped my calves a lot." "You're welcome."

I told my bf the first part of the story and he thought that was really "sweet of me" and "nice of me to do that". I told him the second part of the story and didn't know what to say at first. Because in the real world, I don't do nice, selfless acts for poor, suffering people. Or at least, it doesn't work that way most of the time.

The general public doesn't know what to do with nurses. There's is a greater stereotyping for nurses than there is for MDs. People expect docs to tell them what they want to hear, and to have Dr. Marcus Welby bedside manner, to be right all the time....but they also expect that docs be compensated well for this. Nurses are either dumb doctor-secretaries or saints/angels.

I'm none of those things. I have my own scope of practice that is collaborative with that of medical doctors. You don't want me diagnosing your weird condition, but you also don't want the majority of (non-surgical) MDs coming anywhere near you with needles or catheters. I don't do things to be saintly or angelic. I get paid to help treat patients to improve their health, to educate patients on their health/illness/diet/medications and to alleviate pain and suffering.

Yes. I get paid to do those things. I could get paid to do other things. But I choose to be a nurse.

If you're a patient and you're a dickhead to me, your expectation that I smile and sweetly take it is erroneous. I can stick really big f*cking needles into your fistula and I don't have to do it gently. If you're that stupid to verbally abuse a nurse that you KNOW has to put two 15 gauge needles into your arm, well...maybe you'll learn for next time. I can tell you bluntly what will happen to your body if you ignore medical advice. Take a swing at me and punch a pregnant nurse in the stomach and expect me to tie you down in leathers and I'll make it tight. Try to choke me, and I will put my hand around your throat until you let my throat go. Call me every name in the book and expect that pain medicine you want to not be my top priority.

I get paid to treat you. I don't get paid to be verbally or physically abused by you.

Why is that difficult for the general public, and for my patients?

I don't tend to blog about the gentle things I do. Thank you cards I've received from patients. Hugs and hand-holding. Times I've gone toe to toe with a doc on behalf of a patient. Can't even tell you the number of times I've shamed surgeons into giving pain medicine (aPALLing the number of times that's been necessary). Times I've helped to successfully treat patients, when my care over a shift has clinically improved the patient's outcome. When I've identified problems before the problem gets worse. All the preventative care I do, all the times I feel like a patient or a family member has come away understanding a disease process or medications or whatever because of the time I took to talk with them.

I don't do that cos I'm normal and I get paid to do a job, and like everyone else on in America, I gripe about what bugs me about my job.

I don't know else what we nurses need to do to fix these stupid perceptions. But we need to do somethin.

2 comments:

Strong One said...

Heh heh.. I'm not even going to comment on the public's warped perception of nurses and the nursing world.
:)

RehabNurse said...

We need to emphasize what it means to be a "Registered Professional Nurse" (underscoring the professional part).

Some of the folks I work with wouldn't know professionalism if it bit them...they bring all their baggage to work and expect everyone else to deal with it...and the million and one "emergency" phone calls during the day.

Hello, kiddies, this is not an airport...leave your bags at home!