For the past year I have been taking care of a patient who is a paraplegic due to spinal stroke resulting from pain injections to the lower spine. To list all of the diagnoses she has would take more space in this forum than is possible. She is 59 years old and for the majority of her life she has been in and out of medical facilities for various ailments. She also has a history of alcohol abuse. The over arching issue with this patient is that she is highly manipulative and completely non-compliant with all of her care and medications. The PCP has even refused to issue any orders or changes to her med regimen (she frequently would request different meds be added to her regimen). They would tell me that she is a huge liability and needs to be removed from the facility. She has a wound vac, has been treated for C-diff 3 times in the last 6 months and sepsis d/t UTI twice in the last 6 months. She is a diabetic who refuses to eat on a regular schedule and supplements her meals with items she buys online such as candy, cookies, marshmallow peeps, peanut butter, etc. Her glucochecks were typically 400 to 600 every morning. She insists on drinking large amounts of cranberry juice ad orange juice. She self caths but frequently refuses to cath on a given shift and will wait until she produces over 1000cc's (usually 1500 plus) despite education re: autonomic dysreflexia. She also orders online OTC meds such as sudafed (she says to pick her up), Benadryl and Nasal sprays (for her deviated septum) Immodium to harden her stools, Fiber Laxative pills. She also orders cigarettes, E-cigarettes, chargers and has been caught numerous times smoking in the facility ( she is on a nicotine patch) Literally everyday for months I was responsible for searching her room for contraband and documenting all non-compliance. Everyday I had to argue with this patient over her request for Xanax when she had just awoken (usually at noon). I found myself becoming extremely frustrated. When she was confronted with the contraband found she would lie and we would find new"stashes" hidden in evermore insidious places (most recently the false bottom of a drawer that she kept her cath kits in) Yesterday, after I caught her for the 3rd time in two days smoking in her room (in front of her family who then lied to my face about it) she was issued a 24 hour emergency eviction notice. I am trying to deal with my emotions regarding this patient as I went from being extremely empathetic and caring to feeling extremely frustrated and angry over her manipulation attempts and lying. I know she has a mental disorder, Definitely an addictive personality ( I also suspect Narcissistic Sociopath tendencies). I also felt angry over the danger she frequently placed staff and other patients, in as well as the amount of time that she took from the other 29 patients I am responsible for with her demands on my time. And, of course, since I was the main person finding all of her contraband and reporting her she went so far as to tell my supervisor that she did not want me around her anymore. Fortunately, I am off today and she will be removed from the facility this afternoon. I feel emotionally and mentally beat up. Has anyone else had to deal with this type of situation? Am I wrong to feel angry and frustrated?
