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A Full Moon at the Hospital

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A story about a confused, sometimes combative patient and how the medical staff deal with these challenging patients.

Specializes in cardiac. Has 10 years experience.

A Full Moon at the Hospital

It had to be a full moon.

While getting report, I overheard bits of other reports. Looked like the cardiac floor I was working had suddenly changed to a psych ward. In room 9 was a dying patient. Unfortunately, half the family wanted us to "do everything", and the others have wanted the patient to die comfortably. Room 2 was overrun with the family from hell. Behind the door of 24 held the melodramatic non compliant cardiac cripple. And of course, there was my patient who only wanted to drink coffee and be left alone. As the day shift finished up reporting off, they mentioned that they were getting together for well earned drinks.

Only healthcare workers truly understand that just because we can keep someone alive, doesn't mean that we should. My patient had severe dementia and for now we'll call her "Sandy". Sandy was tall and had a good sized gut and had complained to the staff at the long term care facility that she lived at that she had pain and pointed to her right upper abdomen. Unfortunately, part of the workup showed a slight elevation in cardiac enzymes which meant that the docs wanted her to be on telemetry. They also ordered IV fluids.

I'm not sure what Sandy did for a living before she retired, but one thing I know is that it didn't include sitting around. When she was sitting, she was always animatedly talking to you or to people seen only by Sandy. Most of the conversations made little sense, but occasionally it did. Sometimes she would do what you requested and sometimes not. Occasionally, if you got in her way or tried to stop her from, let's say, removing the telemetry leads, she would take a swing at you. Some nurses will follow orders without regard to their own safety, but I am not one of those nurses.

The day shift nurse who was assigned to Sandy wasn't one of those nurses either and when Sandy decided that she was done with telemetry, just charted "patient refused". Which would be fine if he had let the MD know. So, on a night that was clearly going to be a full moon, I called the doc to let him know that the patient was refusing telemetry. His response was "No, she can't. She can't refuse." Since I had given up on being tactful years ago, I said "fine I'll load her up on meds and then put the telemetry back on. The MD, clearly the master of his domain, then said "I don't want you to drug her up if at all possible and wait until she's tired or sleeping and then put the telemetry back on." No problem.

I continued on with the care of Sandy and my other patients that night. While charting, I overheard that the family from hell had escalated things and had called the house supervisor. The melodramatic cardiac cripple had awoken and the behavioral specialist who was called had just had a "chat" with the patient after another outburst.

Around nine p.m., while starting an IV, I hear the "staff emergency" alarm go off. For those of you that work for hospitals that are high tech, you already know what I'm about to tell you. On a typical eight hour shift, I would guess that the "staff emergency" alarm goes off at least three to four times. I stopped running to these "emergencies" about a week after it was installed. But that night was special, remember?

I finished up the IV and headed towards Sandy's room, just in case. Sandy knew that she didn't need the IV or the fluids that were infusing, so she yanked out the IV while four staff members tried to stop her including the charge nurse whom I'll call "Biscuit". Now you should know that Biscuit is about 6'2 and 200 pounds of muscle and the kindest man ever. However nice, Biscuit means business and is not easily dissuaded and most of the time can talk people into or out of things at will. Sandy, however, would have none of it. Biscuit assisted her quickly back to bed and held pressure on the old IV site that was bleeding profusely now. Sandy was now in a swinging mood with all of the staff in the room. This is the point where I enter the room and the Biscuit exits to stand out in the hall.

Remember that Sandy came in with abdominal pain so she has only had ice chips in about 48 hours. During that amount of time, she has asked repeatedly for coffee. I ask for the staff to step out of the room and ask Sandy "would you like a cup of coffee?" Sandy immediately says "Hell, yes". I motion one of the staff outside the door to get some coffee and I quickly hand it to Sandy, who is already starting to calm down a little. One of the staff had already paged the hospitalist to my phone. Soon enough, Dr. NoHelpAtAll called back and started to give orders for IM haldol. I repeated the order for the IM haldol and must not have been able to contain my annoyance of the route. This particular MD is quick to pick up on things like that and quickly changed the order to IM or PO, asking if the patient would be willing to take the med PO. I told her "Of course, as long as it's with a cup of coffee". This order is five minutes before the end of my shift, which worked out perfectly for me. The next shift was going to have to give Sandy the pill, coffee and restart the IV.

Although we were quite happy that our shift had ended, most of the staff that night would be back the next. I try to leave work things at work but will debrief with my husband who always waits up for me. Because he's so sweet I try to make him laugh and will change the story some to this end like I've done for you, dear reader. In any event, telling the stories helps me to go back in the next day.

The shift report the next day was not as tense and the moon was no longer full. Sandy was still not wearing telemetry, and no longer had fluids running but did have an IV hidden under a lot of gauze. Not one to sit still, she went for walks with the staff and at one point wanted to be in the family waiting room with about five people visiting relatives. The visitors were laughing with Sandy and everyone was happy. When Sandy tired of this, she wanted to see the rest of the floor but was too tired (she MIGHT have had some haldol). An aide wheeled her around the floor and Sandy serenaded us with songs if you requested it. All I could come up with was "Mary had a little lamb" and she continued the song with "and that lamb was loaded". You've got to love the day after a full moon.

I have worked on a cardiac floor for about 10 years and work part time in research. I like to sew and have sell badge holders and stethoscope covers on etsy.com. I'm a cardiac RN from USA with 10 year(s) of experience.

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4 Comment(s)

"Sandy" can refuse care, no matter what the doctor thinks.

Every nursing home resident has a responsible party who tends to billing issues, finances, and care decisions. If "Sandy" didn't want treatment, she didn't have to have it. Her responsible party should have been contacted when she was sent to the hospital, and the hospital should also be in contact with that person. THAT is the determining factor in whether a patient can "refuse" care or not.

This story put a smile on my face :)

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

great story!

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

We don't call them LUNAtics for nothing!