Patients We All Know and Love
As I've grown older (and hopefully wiser), I've become more and more appreciative of the human animal. Each and every one of us is different from everyone else, yet somehow, people under duress tend to behave in certain ways that have a consistency that never ceases to amaze me. And in my estimation, nothing causes duress like being a patient in a healthcare setting. Even people who are ordinarily sane, decent human beings tend to wig out a little during a hospital stay. And for those of us who are charged with their care, one thing is for sure---no matter where we go, no matter where we nurse, we will encounter one or all of the following:
The Drama Queen: This patient is usually, but not always, a middle-aged female with "intractable" nausea and vomiting accompanied by abdominal pain that can be relieved only by massive doses of Dilaudid. She has been scoped seven ways from sundown, CT'd, ultrasounded, exploratoried, yet no cause has ever been found. She will lie in the bed, sighing audibly as you attempt to assess her roommate. She has developed carpal tunnel syndrome from over-use of the call light button during her many hospitalizations. She complains incessantly about her clear liquid diet and sneaks candy bars from the ER vending machine when she goes outside to smoke; yet when she is finally upgraded to full liquids (meaning she's close to discharge) she'll manage to have another episode of N/V which guarantees another round of tests, as well as another day or two of "fluff my pillow, bend my straw".
The Stoic: By contrast, this one never complains about ANYTHING........often, to his/her own detriment. The Stoic is the first to get up and ambulate after surgery, won't take anything stronger than Tylenol, and doesn't report increased pain or other alarming symptoms until it's almost too late, like the post-MI patient I cared for some years ago who "didn't want to bother the nurse" when he suddenly became short of breath. I walked into the room on my rounds to find him grey-faced and diaphoretic, his 02 sats in the 70s, B/P in the dumper. I couldn't get him back to the ICU fast enough. He coded on the way down the hall, then again in ICU. He had to be flown to the regional medical center for a four-vessel CABG that same night; I never found out if he made it or not.
The Party Dude: Never lets anything so petty as hospital rules and NPO status deprive him of a good time. He always seems to be surrounded by a crowd of big, burly college guys who sprawl out on the empty bed, leave Taco Bell wrappers and potato chip bags all over the room, and make enough noise to wake the recently deceased patient down the hall. I've seen drunken poker games that left a place in better condition. And when you try to evict said 'visitors' from the patient's room, they all look at you innocently and say, "Hey, there's only a coupla minutes left in this football game, we'll leave when it's over, 'K?" Two hours later, you call Security because the patient himself is asleep, his buddies are all passed out under his bed, and you just KNOW that's marijuana you smell in the bathroom.
The Pampered Princess: Must never be seen with 'bed head' and wouldn't dream of going into surgery without full makeup and all of her diamond rings taped to her fingers. This is typically an older woman whose sense of refinement prompts her to eschew hospital gowns in favor of a satin peignoir. Her bed is covered with stuffed animals and her own comforter from home. What separates her from the Drama Queen is her dignity; she will complain about the "service", but she doesn't abuse the call light and will not allow herself to become a burden on the nursing staff. Unfortunately, her independent streak is sometimes her undoing; she will get OOB to use the bathroom in the middle of the night, put on those ridiculous high-heeled slippers instead of grippy socks, and fall hard on the linoleum floor.....with predictable results.
The Know-It-All: Is almost always related to a medical professional, and her knowledge of health matters is just enough to make her dangerous. She will regale you with tales of "my son, the doctor" and claim that no one else on the planet is as qualified. She also reads numerous "health" publications, which may be of questionable veracity, and travels with a suitcase full of vitamins and potions which you, her nurse, either have to confiscate---with the resulting howls of protest and threats to sic Dr. Wonderful on you---or begin the laborious process of getting them ordered by the admitting doctor and written into the MAR.
The Class Clown: Regards even the most serious condition as if it were the world's biggest gag. Trying to teach this newly-diagnosed diabetic how to prepare and inject insulin is an exercise in patience, as he will sit there and play with the syringes, crack lame amputation jokes, and otherwise act like an overgrown eight-year-old. While the professional in you knows, down deep, that his demeanor is more than likely a cover for his fears, the un-professional in you wants to slap him upside the head and scream "PAY ATTENTION, DIPSTICK! THIS DISEASE IS GONNA KILL YOU!!"
These are but a few of the patients we all know and love. Who are yours?
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,720; Likes: 43,453
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, geriatrics, psychSep 28, '09Mine is the home health patient I had, who swore she self cath'd every 5 minutes. She had enough UTIs to substantiate that, too. She'd conned a doctor at a midwest prestigious medical institute, to give her a colostomy for her constipation!
Whenever she tired of self cathing, she'd call the agency for her favorite nurse - me, to put in a Foley. I'd get there, and she'd say she changed her mind and didn't want it. 2 hours later, I got the phone call for the Foley - again! Needless to say her insurance wouldn't pay for all the visits and somehow I got wound around her little finger and accompanied her and her husband to the big city, to care for her postop following a vulvectomy - don't ask!
After 2 more days recovery in a luxury hotel room 26 floors up, her husband became competative for attention and threatened suicide by opening the stupid French doors leading to a fake balcony. I called 911, and we all got thrown out...
I'm happy to report, post script, that she eventually became sane enough to have the colostomy reversed, and caths only every half hour following intensive bladder training. Her vulvectomy healed without incident (a miracle, given her spare hygiene).Sep 28, '09Somewhere in there between Pampered Princess and Drama Queen...Somebody's Baby. She's young, has several tattoos, a nose ring and a belly ring. She cries when the blood pressure cuff inflates, and jerks her arm away with a scream when you try to start an IV, thereby insuring that you have to poke her AGAIN. She has a needle phobia and can't handle pain. I'm really puzzled how the Tats and the body piercings got there...
And she calls for her Mamma, squirms and screams that she's going to die as the anesthesiologists tries to start an epidural.Sep 29, '09The Dysfunctional Matriarch -- this is the grandma/greatgrandma to an improbably large brood of individuals who all insist on staying with their venerated progenitor around the clock, sleeping in shifts, keep a book listing everyone who's come in the room, what they did, what they said, and then quizing you on "Well, Sissy Sue said X 3 days ago, and now you're saying Y...." Change in condition, ever heard of it?
They will also blatantly ignore fluid restrictions, diet orders, activity orders, and refuse to allow you to turn the Matriarch because she's comfortable....and then go ballistic when things go wrong because of what they wouldn't allow you to do....document, document, DOCUMENT.
Man, I'm just tired thinking about those....Sep 29, '09I'm working on one as we speak.
These are great, folks..........please keep 'em coming!!Sep 29, '09Let's not forget Susie Sundowner. She's as cool as a cucumber all day long. Let 1430 come around, she's popping up from her w/c like popcorn, challenging your facility's no-restraint policy.
And, her son, who loudly denies that anything is wrong with mom. He challenges your every move to properly medicate her and keep her from falling for the nth time this month. Oh yes, then months later, Denying Son calls up and asks you to "do something for her!"Sep 30, '09Quote from liebling5I've got two of them on my unit, complete with families in total denial. They're perfectly behaved for the day and noc shifts, then come unspooled the instant the door closes behind all the 'carpet people' at 1700 and raise hell all evening. And everybody thinks we 3-11 shifters are "just picking on them". Oy.Let's not forget Susie Sundowner. She's as cool as a cucumber all day long. Let 1430 come around, she's popping up from her w/c like popcorn, challenging your facility's no-restraint policy.
And, her son, who loudly denies that anything is wrong with mom. He challenges your every move to properly medicate her and keep her from falling for the nth time this month. Oh yes, then months later, Denying Son calls up and asks you to "do something for her!"Oct 1, '09Stinky Sam- only gets a shower/wash down when he's admitted. You can gauge how long since the last admission by the dirt build-up. His arrival to your unit is announced by the smell as he comes off the elevator. He isn't homeless, dementia or drug addict, he just doesn't consider personal hygiene a priority.Oct 2, '09What about Non-complient Norman?
He's the man in his 70's - 80's, no living wife. Usually admitted because his family practice doctor risks running a lawsuit from the family if he continues to treat Norman. Or, because Norman's son who lives 600 miles away just got home for his yearly visit.
Norman has diabetes, CHF, and probably severe hearing loss, but you can't ever be sure because he's so stubborn and ornery anyway.
He refuses all care by sealing his lips tightly shut and glaring at all nursing staff.
Sometimes he can be coaxed into taking his meds, but usually only after a solid 1/2 hour of begging on the part of the nurse. You personally think the only reason he actually swallowed that metformin was just to make you shut up!
He never wants to get out of bed, he never wants to go to PT, (hell, or even to the bathroom.)
He has a son and a daughter that come spend about 20 minutes a day with him. They usually spend about half of this time trying to convince the nurses that he "really isn't that difficult, he's just very independent." They spend the other half of the visit looking uncomfortable and making inane remarks every now and then about the weather.
Non-Complient Norman will probably be discharged to a transitional care or LTC home. You can't wait for him to go, to be somebody else's problem. However, you also feel a little proud of him, for being such an ornery old codger all the time. You've seen the occasional twinkle in his eye when he's giving someone an especially hard time. You've seen him roll his eyes at his daughter-in-law when she wasn't looking. You know you'd probably be a real pain-in-the-___ if you were laying in that hospital bed too.
You understand each other perfectly.Oct 2, '09Ms. Stupid or otherwise known as Ms. Munchausen by proxy: Cannot read and write, refuses to allow her child to be seen by female doctors; runs around in full course makeup with a crop top and hot pants (weight est: 200 lbs), and demands that her child's IV be changed (all of 6 hrs old, "I'm his mother and I know what he needs. I want it changed now!) then stands at the nurse's station and cries, "my baby, my poor baby." It is all about her and not her child. She tells us how to do our job, and tells the doctor, the radiologist and anyone else she comes into contact with, how to do theirs. When we got testy after the 20th room page to ask for a straw or a new phone (she broke 3), she demands, "I want to talk to the owner of the hospital!"
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