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.
Showing posts with label abuse. Show all posts
Showing posts with label abuse. Show all posts
Thursday, January 17, 2008
Monday, January 7, 2008
grandpa
Every academic program has at least one. An old surgeon, usually a former Chair of the department, who at one time was a legend. Perhaps even one of the greats of surgery. And if they weren't great, they knew the greats.
We have one of those. He goes to every M&M conference and adds his two cents to an interesting discussion, usually with data and practice patterns that were cutting edge thirty years ago. We all listen politely, giving him the respect and deferrence someone of his years and experience deserve.
When I was an intern, he still operated. At the time, he would only operate with the chief resident because, more often than not, he was not capable of doing the operation himself due to his tremor. But he had enough experience that he would be able to walk a chief through it. He doesn't operate anymore.
There is a clinic that he staffs for the residents once a week. (Don't ask me what he does the rest of the week, but he still comes to work.) I wish we could just divide up those patients amongst the rest of the attendings in the division. I'm sure his bedside manner was acceptable when he was younger, but you just can't talk that way anymore. Allow me to provide some examples:
Number 1: "You're much too fat. Just look at these rolls. [Grabs rolls of fat on the abdomen and shakes them.]" Then he turns aside to whatever resident or medical student is in the room and says, "We could put her in a cage for two weeks, not feed her, and she'd be fine."
Number 2: "You're too fat. What do you eat? Tacos and beans all day?"
"I'm not Mexican. I'm Bolivian."
"What do you eat then?"
I could go on, but the other examples are just as bad and all in a similar vein. As much as we respect him for the phsycian and surgeon he was, someone needs to sit down, talk to grandpa, and take away his keys. He can't drive anymore.
We have one of those. He goes to every M&M conference and adds his two cents to an interesting discussion, usually with data and practice patterns that were cutting edge thirty years ago. We all listen politely, giving him the respect and deferrence someone of his years and experience deserve.
When I was an intern, he still operated. At the time, he would only operate with the chief resident because, more often than not, he was not capable of doing the operation himself due to his tremor. But he had enough experience that he would be able to walk a chief through it. He doesn't operate anymore.
There is a clinic that he staffs for the residents once a week. (Don't ask me what he does the rest of the week, but he still comes to work.) I wish we could just divide up those patients amongst the rest of the attendings in the division. I'm sure his bedside manner was acceptable when he was younger, but you just can't talk that way anymore. Allow me to provide some examples:
Number 1: "You're much too fat. Just look at these rolls. [Grabs rolls of fat on the abdomen and shakes them.]" Then he turns aside to whatever resident or medical student is in the room and says, "We could put her in a cage for two weeks, not feed her, and she'd be fine."
Number 2: "You're too fat. What do you eat? Tacos and beans all day?"
"I'm not Mexican. I'm Bolivian."
"What do you eat then?"
I could go on, but the other examples are just as bad and all in a similar vein. As much as we respect him for the phsycian and surgeon he was, someone needs to sit down, talk to grandpa, and take away his keys. He can't drive anymore.
Sunday, October 28, 2007
the yeller
Most surgical residencies are set up where you rotate on one service, say vascular surgery, for a while, and then you switch to something else like cardiothoracic. The purpose of this is to create a well-rounded general surgeon.
I am currently on a rotation that deals with the liver and pancreas. We do some of the biggest surgeries there are, like Whipples. The only thing bigger would be a liver or heart transplant, really. Which means that almost all of our patients are very, very sick, and/or have a very bad cancer. There is a reason there is the old surgical dictum of "Don't f--k with the pancreas," yet we do on a nearly daily basis
The surgeon in charge (we'll call him Dr. P) is a yeller. Maybe becuase of all the stress of these big operations? But even outside the OR (operating room), he yells and treats people like sh-t. You know, condescending, insulting, that sort of thing. They say he's calmed down over the years (after he had a heart attack), but it's hard to imagine how things can be any worse.
A few days ago, I was in the OR with Dr. P a few days ago. It was a routine surgery for him, really, but one that required the organization of a lot of staff to run machines that were out of the sterile field. We were doing an RFA for metastatic renal cell carcinoma, which meant we needed to use the ultrasound probe directly on the liver to find the tumor. Then we needed to use the radiofrequency machine to fry it. Each machine is run by a separate person, and when we needed them, neither of them were in the room.
We paged them. And waited. It was probably only a minute or two, but in the operating room, if you're just waiting for something, it seems like an eternity. Then the screaming began. "Where is Carl? I want him in the room NOW! Get him in here NOOOW!!!! And write his ass up!!!!"
Once that starts, it just perpetuates itself. The yelling continued. At the scrub nurse. At anesthesia. At the circulating nurse. The only person that didn't get yelled at was me. Which is good, but I'm stading there, doing my absolute best to read his mind about what he wants me to do so I don't get yelled at. The silly thing was that the patient was fine and the only reason the tantrum occurred was because an entire slew of people weren't standing behind him ready to jump the second he spoke. Yelling can be a normal thing when someone is dying just because of the stress of the situation. But when you have to wait a few minutes because someone had to go the bathroom or something?
There is just no reason to be that way. None.
I am currently on a rotation that deals with the liver and pancreas. We do some of the biggest surgeries there are, like Whipples. The only thing bigger would be a liver or heart transplant, really. Which means that almost all of our patients are very, very sick, and/or have a very bad cancer. There is a reason there is the old surgical dictum of "Don't f--k with the pancreas," yet we do on a nearly daily basis
The surgeon in charge (we'll call him Dr. P) is a yeller. Maybe becuase of all the stress of these big operations? But even outside the OR (operating room), he yells and treats people like sh-t. You know, condescending, insulting, that sort of thing. They say he's calmed down over the years (after he had a heart attack), but it's hard to imagine how things can be any worse.
A few days ago, I was in the OR with Dr. P a few days ago. It was a routine surgery for him, really, but one that required the organization of a lot of staff to run machines that were out of the sterile field. We were doing an RFA for metastatic renal cell carcinoma, which meant we needed to use the ultrasound probe directly on the liver to find the tumor. Then we needed to use the radiofrequency machine to fry it. Each machine is run by a separate person, and when we needed them, neither of them were in the room.
We paged them. And waited. It was probably only a minute or two, but in the operating room, if you're just waiting for something, it seems like an eternity. Then the screaming began. "Where is Carl? I want him in the room NOW! Get him in here NOOOW!!!! And write his ass up!!!!"
Once that starts, it just perpetuates itself. The yelling continued. At the scrub nurse. At anesthesia. At the circulating nurse. The only person that didn't get yelled at was me. Which is good, but I'm stading there, doing my absolute best to read his mind about what he wants me to do so I don't get yelled at. The silly thing was that the patient was fine and the only reason the tantrum occurred was because an entire slew of people weren't standing behind him ready to jump the second he spoke. Yelling can be a normal thing when someone is dying just because of the stress of the situation. But when you have to wait a few minutes because someone had to go the bathroom or something?
There is just no reason to be that way. None.
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