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.

What I wish patients would do:

Lose 100 lbs. (The many that can afford to lose those pounds).

So Happy Hospitalist is a rabid anti-smoker and he lectures his patients on their smoking habits. That's good. I applaud that. Smoking gets under his skin, and it pisses him off that Medicare covers the serial intubations of smokers who continue to smoke. That pisses me off too.

What pisses me off is morbid obesity. Like smoking, morbid obesity is a choice. No, nobody did hold a funnel to your orifice. The argument that you don't have the emotional control means only that you need to be responsible and OBTAIN self-control. If you have an eating disorder, seek therapy, not my sympathy.

A full 37% of the American population is obese. Not 'overweight', not 'wish that damn 7 lbs would go away'....no....rolls of fat obese. Can't get oxygen into their bodies while sleeping because of obesity-induced sleep apnea.

I was at a hospital yesterday dialyzing a patient who is so obese, her bed needs to be constructed inside the room. She is unable to leave this room. There are TWO patients currently at that hospital that we dialyze this way. It's actually not uncommon anymore.

The patient barely spoke to me yesterday because she hates the whole dialysis process. She begrudgingly answered my questions and consented to do things like moving her arms so that I could get to her vascatheter. The one time she did speak to me was to complain about the bland food. "Your diet is killing you, Mrs. RollsOfAdipose." "You think I should eat that food?" "I think you are in the hospital because of your weight. You are unable to leave this room because you're eating yourself to death. You need to change your lifestyle or you will die here. A few vegetables might be what you have to do to get out of where you put yourself." She was mortified. And was infuriated at the suggestion that soon, she would need to actually leave the room to go down the hall to dialyze. "I can't sit in a chair for 4 hours."

The old....I'm so fat I can't sit up excuse.



In the meantime, I haul a half ton worth of machinery to her so that we can get all the damn potassium and protein wastes out of her blood so she doesn't die.

One nurse I respect told me a story that she was bathing an obese woman one time, and found a Twinkie in the woman's rolls. The woman giggled and told this nurse it was part of a game she and her husband play: find the food.

I don't actually make this stuff up.

If you're over 30 BMI (and you are neither very pregnant nor a bodybuilder), you need to stop the madness. Unless you're Mother Teresa or Albert Schweitzer, you don't deserve dessert every day. You need to eat some vegetables instead of Big Macs. You need to cut your portion sizes down by two-thirds. That's not debatable, much as you'd like that to be told to you in a more sugary sweet way. You're fat. You did it to yourself. You choose to stop, or you choose to die slowly, painfully in a medically protracted and undignified way. Period.


I have no sympathy for the 'helplessly' obese people that big. The vast majority don't have an eating disorder. They have Entitlementus Americanus Lazii. A lousy economy might be a partial cure for that.



I'm tired of my taxes going to paying for specialty beds to be built in your hospital room. My taxes pay for your insulin. They pay for your CPAP machines. Your weeks and weeks of inpatient hospitalizations. Your dialysis treatments, your heart surgeries. Worst investment my taxes ever made.