Thursday, January 17, 2008

how much do i need to take?

Accesses for hemodialysis fail; every single one. They all eventually need to be revised or abandonded in favor of creating a new one. The issue then becomes how do dialyze them in the mean time.

A patient currently on my service is having access issues. We tried to de-clot his graft with this slick endovascular device that is like a squishable egg beater. When we were done, we didn't think it was going to work and that he'd need to be revised in the operating room the following day. But he still needed to get dialysis. So I had to place a quinton (a non-tunneled central venous catheter).

Before having to place the quinton, I was his room with my attending so we could let him know what the plan was. From the start he was belligerent and not listening. He was yelling at his wife. Then my attending told him to not yell at his wife like that. He proclaimed that we weren't helping him and he was going to leave. He stated that we never explained anything to him and he had no idea what was going on. He just kept going on and on...

I'm sure having renal failure and getting dialysis is a very frustrating life. I can't even imagine how much so.

A few hours later, I was back at his bedside, ready to place the quinton. He kept touching the sterile field and his groin so we had to keep re-prepping. I kept trying to explain what I was doing, since he was awake and all. But every time I opened my mouth, he would just start yelling, stating that he doesn't understand what we're doing. Keep in mind, it's been explained about 10 times at this point.

"Sir. Do you want me to explain what I am doing right now, or not?"

"I don't know what's going on or WHAT you guys are doing."

"Ok. I'm going to take that as a no."

I placed the quinton without any problems. Accessed the vein with one stick, so he couldn't even complain about that. I warned him when I had to stitch it in. And, yes, I used lidocaine. I told him when I was done and he literally sat up and started yelling "PRAISE GOD!" and waving his hands around my face.

"Here! Let me praise you some more! You need lots of praise, don't you?"

"No, sir, I don't need any praise. I'm just trying to take care of you. I don't need any thanks for it."

"You're not trying to take care of me. I don't know *what* the hell you're doing. And you can leave now."

"Ok. Well, please try to remember to not eat or drink anything after midnight so you can have your surgery tomorrow. The dialysis nurse will be here soon. Can I get you anything?"

...

"Can I have some ginger ale? please."

So I bring him his ginger ale.

I can usually take patient abuse pretty well. I know they're sick and I'm a safe target and all that. But he got under my skin. Don't know why. Should I have set better boundaries? Told him to be quiet? I know I could have handled things better.

3 comments:

Felix Kasza said...

> He proclaimed that we weren't helping him and he was going to leave.

Next time, let him leave, if he cannot keep a civil tongue in his mouth. We should not be rewarding rudeness and such -- think of it as evolution in action.

Cheers,
Felix.

KELLY said...

seems like you handled it well. don't fret, patients abuse us nurses as well. it drives me crazy when the patients start refusing certain parts of their treatments...if you don't want us to care for you, why did you come?!?! okay, maybe that was harsh....
Here's to a better week!

lights n steel said...

Felix: What is the role of a trauma surgeon? 90% of the time, to reverse Darwinism.

Kelly: I think that *so* many times when people refuse stuff! NOT harsh. But I agree... let's have a good week! (He's gone!)