Biting Your Tongue

[Ruby Vee]

Things I'd like to say to patients (or their families) and get away with:

"I'm so sorry no one told you that drinking a liter of hard liquor a day could cause heart problems. This must be a complete shock to you, having alcohol-induced cardiomyopathy. But did you honestly think drinking that much daily would be GOOD for your health?" Clenched my teeth, bit my tongue and didn't say anything when the patient was going all "Woe is Me!" because of his cardiomyopathy and how unfair life is that this happened to him just when he was . . . .

"I don't know the anesthesiologist who promised you that you would have NO pain post-operatively. But I can assure you that it's not unusual for heart surgery to hurt."

This to the patient and family who wanted the patient to be drugged into oblivion until "he's all better." They never did understand why he had to be "awake and miserable" to do his pulmonary toilet, physical therapy or eat.

"No, ma'am. The surgery didn't make your husband this way. I'm pretty sure he had some memory issues BEFORE he had the surgery. That would be why he was taking Namendia and possibly why he was living in a memory care unit instead of at home with you." Didn't say it, but I was thinking it pretty loudly!

"Yes, Ma'am. I sure he lived through the night. I'm looking at him right now, and he's eating breakfast. I'm sure he'll forgive you for selling all of his things and using the money to buy that Birkin bag you've always wanted. He did look pretty sick last night, what with that not breathing and all."

"Of course you can stay all night, Ma'am. But that pillow you've got under your arm is the one we just took out from under his left side; and we're going to put it under his right side momentarily. If you MUST lie down RIGHT NOW, please go ask the unit secretary for guest linens and don't take the stuff we need here" OK, I have said that, or something similar. But I didn't get away with it. I had to sit in the manager's office and explain all about how I was thinking that the wife might be less comfortable trying to sleep with all the drainage from his wound right under her cheek.

"You're HOW old? And you had to have your Mommy stay overnight? She's 80 and using a walker, and you're expecting her to sleep in this sleep chair? What's the matter with you?"

"You're here to visit your mother? Really? And you can't tell me her last name? I don't care how many times she got married, if you're close enough to be visiting her when she's in the ICU, you're close enough to know her last name!"

"Sir, if that were a service dog -- which I doubt, because I've never heard of a Service PitBill -- you'd be able to tell me what service he provides. And he'd have a service dog vest, not a spiked collar. I'm sorry, but "Spike" isn't allowed to visit, and neither are you until you come back without him." Now if I HAD said something like that (which I would have had I seen them coming before they actually got into the room), it would have prevented all sorts of drama when "Spike" attacked Dad's nurse and pinned him up against the wall.

I'm sure I'm not the only one who has nearly exploded from the strain of trying NOT to say that which is desperately DEMANDING to be said . . . please share!

[calivianya, BSN, RN]

"Who opens your pack of crackers / holds your cup while you drink / feeds you / moves your blankets an inch this or that way / holds your member while you urinate / turns the lights on or off / changes the channel for you AT HOME?!?

You are totally allowed to respond to this behavior. I usually do. Here is what you say:

"I am concerned about the decrease in your ability to do your activities of daily living. Don't worry, it is common for patients on bedrest to lose some of their strength, but we can fix that. I will be happy to put in consults for physical/occupational therapy so they can evaluate you for rehabilitation potential and possibly explore transferring you to a nursing facility for further rehabilitation after this hospitalization is over. I just don't feel comfortable discharging you to your home if you are not strong enough to perform basic care activities for yourself."

Some people turn around real quick if they think they're going to have to go to a nursing facility for rehab if they don't start behaving. The trick is to say it in a very concerned voice and look very worried, so they think you are stupid but concerned about their health instead of trying to manipulate them.

[LadyFree28, BSN, LPN, RN]

You are totally allowed to respond to this behavior. I usually do. Here is what you say:

"I am concerned about the decrease in your ability to do your activities of daily living. Don't worry, it is common for patients on bedrest to lose some of their strength, but we can fix that. I will be happy to put in consults for physical/occupational therapy so they can evaluate you for rehabilitation potential and possibly explore transferring you to a nursing facility for further rehabilitation after this hospitalization is over. I just don't feel comfortable discharging you to your home if you are not strong enough to perform basic care activities for yourself."

Some people turn around real quick if they think they're going to have to go to a nursing facility for rehab if they don't start behaving. The trick is to say it in a very concerned voice and look very worried, so they think you are stupid but concerned about their health instead of trying to manipulate them.

This...

Never had to hold an able bodied member, even with SCI pts, unless absolutely necessary...if you move your arms and fingers, assume the position!

[ICURN3020]

Yes, myself and a few others have had men who ask us to do this for them!!

[icuRNmaggie, BSN, RN]

"wipe me!" from an able bodied pt

I would love to say .......who wipes your ass at home? But I bite my tongue and hand them the tp. Not doing it. No way.

[kiszi, RN]

"I don't want to be a pain.."

-"Too late!"

"Didn't you see my call light?"

- "Yes ma'am, but I was pretending I didn't. What do you want this time?"

"I don't think nurse Betty likes me."

-"It's ok, I don't either."

[VivaLasViejas, ASN, RN]

The 19-year-old preggo with multiple piercings who jerked her hand away when I tried to start her IV and yelled, "I'm afraid of needles!"

The mother who brought her 5-month-old to our ER with a fever of 105 and hadn't given her any Tylenol because she wanted us to see how high the child's fever could get.

The family member who demanded that I give her mother ibuprofen every 2 hours around the clock: "I don't care if it makes her stomach bleed, my mother needs to be PAIN-FREE, don't you understand that??!!" (Nearly bit a hole in my tongue on this one.)

[rachel0609, ADN, RN]

The 25 year old junkie admitted to the ICU because of an infection from shooting up with dirty needles that demands his mom hold his hand and be present for IV placement and blood draws.

[ICURN3020]

The mother who brought her 5-month-old with a fever of 105 and hadn't given her any Tylenol because she wanted us to see how high the child's fever could get.

What an idiot!!!!! Poor baby! The lack of education of some parents is really scary.....

[merrywhiterose]

Other things I would've loved to say or have said to people (Long Term Care):

1. No you can't smoke AND use oxygen.

2. You abused your kids the whole time they were growing up, & you can't understand why they won't visit you?

3. You slept around a lot during your marriage or beat your wife, now you can't understand why your wife is selling all your things & won't visit now that you have to stay here?

4. After being diagnosed with Dementia by 4 different doctors, you still think it's his meds or something we are doing wrong?

5. Please don't stay all day with your family member if you are going to be mean to staff.

6. Yes we allow pets, but we shouldn't allow monkeys. (SERIOUSLY!)

7. NO WE ARE NOT DOCTORS, BUT NEITHER ARE YOU.

[HIPPIECHIKRN]

I used to work in a male prison and I swear the "men" there were the worst about pain. Yeah some were drug abusers in the past and had serious drug seeking behaviors. But really, you didn't think it would hurt once the surgeon cut you open and moved things around? Then they stitched you up. I DID say " It will hurt until it heals". Plus you signed up for the hernia repair/nose surgery/ insertion or removal of hardware.

[MLewisRN247]

I was helping a colleague reposition her recently extubated post op CABG x 3 patient when the woman began to complain and curse angrily at all her chest tubes. She was angry and did not want " all these (choice curse word) tubes" because they hurt and they got in her way. She had a history of smoking, obesity, HTN, DM....the usual cardiac arrest package. I don't know what came over me but I was in able to bite my tongue! I simple stated to her, "You are here because of you! You did this to yourself! You came to us to save your life and that's exactly what we did! So you remember that every time you get angry about having all these, in your words, (choice curse word) tubes!". Surprisingly I didn't get pulled into the managers office. In fact, after that, the patient was extremely appreciative. Do we really have to be that way for people to come outside do themselves and own up to what they do?

[biopsychmajor, RN]

I get the price one and also whether insurance will cover the procedure.