Becoming the Nurse

[Lunah, MSN, RN]

In our ED, it's not uncommon for us to see inmates from the local adult detention center. They are always accompanied by deputies, meaning they need a more private room because of the size of their entourage and propensity for associated drama-either the patients themselves being unruly, or the irresistible urge other patients or family members feel to become spectators to the patient's situation. So even with a potentially high-acuity patient, it's not uncommon for inmates to be placed on the fast track side of the ED where the rooms are private.

One such patient came into one of my fast track rooms as the first patient of my shift, transported by county EMS. From the beginning, it became apparent that jail personnel suspected this patient of faking stroke symptoms to get out of jail. It wasn't overtly stated, of course, but the disbelief could be heard in the tones of voices. Because we'd recently had a patient with similar symptoms from the jail who was found to be ultimately faking symptoms for a little "vacation from incarceration," skepticism was running high.

Such skepticism resulted in a five-hour difference between the time of the patient's onset of symptoms and complaint to jail personnel to the time the patient hit my ED bed. The paramedic who brought the patient in expressed skepticism as well, but there was something about this patient that kept my index of suspicion very high-I just had the feeling that the issue was genuine, and I took swift action in getting our physician into the room. After a rapid assessment (and noting that my patient was also very hypertensive), we had the patient over to the CT scanner and on the table within just minutes of arrival. There was just something in the way that my patient's left arm looked-not just flaccid, but with the hand almost contracted inward-that told me it was real. I'm glad I went with my instincts.

As it turns out, my patient had untreated hypertension and had stopped taking a prescribed beta blocker a year previously, and now had an intracerebral hemorrhage. I administered meds to lower my patient's pressure a bit without dropping it too fast, while our team leader and secretary worked on the unique logistical challenge of flying a prisoner and a deputy with a sidearm by helicopter to a local Level 1 with neurosurgeons on staff.

Then, for my patient, the last straw: the deputies refused to allow my patient to call or contact family so that they could be aware of what was transpiring. My patient wore a look of fear; whereas the deputies seemed to have no grasp of the severity of the situation and my patient's condition, my patient certainly did. After discussing this turn of events with my team leader, I went into my patient's room and got the phone number my patient wanted to call. With my patient's permission, I called my patient's elderly parents and apprised them of the situation.

I understand that the deputies have rules about contact and allowing people to know when a prisoner is going to be in transit or out of incarceration; of course, this is a perfect time for friends and/or family to plan a jailbreak. However, I felt that, given my patient's situation, contacting my patient's family would help give my patient some peace of mind. And, as my patient noted (sense of humor perfectly intact), my patient's entire left side was useless, eliminating the chances that my patient would (or could!) run anywhere.

As the helicopter crew packaged my patient, I told my patient that I'd contacted family, as requested. My patient thanked me tearfully, and told me that sometimes people need just one person like me to be on their side. While I'm sure the deputies were not happy with me (with good reason, certainly), I chose to act for what I perceived to be the best interests of my patient, who had already been treated poorly; I thought my patient deserved just one break that day.

Ironically, my last patient of that same shift was a younger person who came in complaining of dizziness and hypertension. This patient had stopped taking beta blockers prescribed for known hypertension five days earlier. This patient told me the beta blocker made this patient feel funny, and that the patient's spouse "nags" the patient to take it. So I said, "Your spouse is right; let me tell you a little story," and I told this patient (without going into too much detail, of course) about my earlier bleed patient who had stopped taking a beta blocker, which just happened to be the same beta blocker prescribed for this patient. This patient was horrified, saying, "I need my left side!" I said, "You also need your right side, and your whole brain." This patient was so utterly flabbergasted, it was nearly comical-either this patient had never grasped what had been related by physicians about the potential dangers of untreated hypertension, or this patient had been in denial and wasn't open to the teaching at the time. The patient said, "Oh my God, I'll never not take my medicine again." When it came time for me to leave at the end of my shift, I went into the patient's room to tell the patient about the nurse who'd be taking over for me, and to wish this patient well. The patient told me that they'd always remember me, and that they would definitely be taking their blood pressure medication. And as many times as we've all heard patients lay claim to future compliance, saying, "Oh yes, I'll take my medicine from now on," I saw the look on this patient's face and believed it.

In just one day in the ED, I felt as though I'd made a difference in the lives of two patients with very similar stories, and what could have been similar outcomes down the road. I think this was the first time I truly experienced the power of nursing. I work with so many nurses who are the type of nurse who is so memorable, that a person who is fortunate enough to be in their capable, caring hands will always remember them and what they did for them during what is sometimes the worst time of a patient's life. That is the kind of nurse I aspire to be, and in this moment, I became that nurse.

[Silverdragon102, BSN]

I think it is something of a good nurse when we go with our gut feeling

[DroogieRN]

Thank you. Great article.

[Lunah, MSN, RN]

Thanks! :)

[Tnichelle]

thanks for sharing that was a wonderful story

[FutureRN19]

A wonderful article, thank you for sharing it with us!

[emtb2rn, BSN, RN, EMT-B]

Good call Lunah. A great example of why we need to listen to that little voice that "hmmm, something isn't right".

[tebyrd0020]

This was wonderful! Thank you :).

[JustMeLPNStudent]

Good job!!!!

(maYbe I'm PMS'ing but this made me teary...and PROUD to be a future team member!) TY for Sharing

[Lunah, MSN, RN]

Don't worry, it made me teary, too. :) Especially when my patient got teary! I've since found out that this patient did survive the bleed ... not sure how well/with what level of function, though. I guess I might never know!

[JustMeLPNStudent]

That's even better news! He survived and YOU made a difference for both patients....I'm almost certain that they will never forget you!....although I'm still a student (we start clinicals in 2 weeks) I'm recving "little" rewards in making a difference. Stories like yours make me even more excited....Honestly I can't wait to make a difference! Tooting our horn.....WE ROCK! LOL

[Lunah, MSN, RN]

Good luck with your clinicals! I'm sure you'll find allnurses to be a helpful resource as you make your way through school, then the fun of being a new grad. :)