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. Nurses Announcements Archive Article

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?

Specializes in Peds and Well baby.

Ms. 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!"

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

The Doctor's Mother - Admitted to a hospital/facility where her son works. Normally no trouble on her own - it's her son who is the problem. Despite the fact that another doctor is handling her care, son scrutinizes every order in the chart, heard mumbling "That's not right. They need to be doing more." Son also pops up at the nurse station to announce that his mother needs something (usually trivial). Mother usually leaves the call light alone usually, but son has to fetch someone immediately. Son wants to call in a microsurgeon when mother slips and gets a skin tear from trying to catch herself.

One wonders what is happening to son's patients while he dictates all aspects of mother's care instead of leaving it to the people who do it for a living.

Specializes in LTC, assisted living, med-surg, psych.
What 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.

We've got one of these on my ICF unit right now, only he's meaner than cat dirt and smells worse.........and he has somehow managed to worm his way into my heart, because underneath all that is a lonely old guy in a lot of pain, both physical and emotional. He's become my 'project'---I've been advocating for better pain control and medications that calm him without knocking him out, plus I pay special attention to him by sitting down with him at dinner and talking with him. I know I'm never going to turn him into Mr. Nice Guy, but if I can help de-escalate him when he's wound up or prevent him from getting wound up in the first place, it's well worth the effort. So far, it has been.......it's a work in progress.:loveya:

Specializes in Cardiac/Telemetry.

I've had ALL THESE PATIENTS!! Geez. We really are strong people!

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

Freddie the Freeloader - Usually male, mid-20s to mid-30s. Shows up in ER when his welfare money runs out but the month hasn't. Claims to be either suicidal or hearing voices, but both are bogus. Very good at duping people who don't know him - in fact, it has become his primary means of survival. Sometimes overheard telling his buddies over the phone, "I'll tell them I'm suicidal for a couple more days, and by then my check should be in." Usually wearing far nicer clothing than someone in his economic situation should be. Has an awful lot of people to call for someone supposedly living on the street. Complains about the beds and the food at least once per visit.

i had a good laugh reading this blog. i always have a pleasure of working with drama queens, who says " you have to spoon feed my medications one by one.." pleaseeeeeeeeeeeee :selfbonk: they dont seem to have problem with spoonfeeding their own food.

Specializes in psych, corrections, case management, med.
Freddie the Freeloader - Usually male, mid-20s to mid-30s. Shows up in ER when his welfare money runs out but the month hasn't. Claims to be either suicidal or hearing voices, but both are bogus. Very good at duping people who don't know him - in fact, it has become his primary means of survival. Sometimes overheard telling his buddies over the phone, "I'll tell them I'm suicidal for a couple more days, and by then my check should be in." Usually wearing far nicer clothing than someone in his economic situation should be. Has an awful lot of people to call for someone supposedly living on the street. Complains about the beds and the food at least once per visit.

A very close relative to Tommy Thug, who uses many of the same ploys, then intimidates the rest of the patients (and staff) into letting him sleep all day, run the TV and give him His chair on the unit

These descriptions are priceless, but seriously. What kinds of patients would be a joy to take care of. If we think of the process of getting better as a team effort, where everyone is working together, including and especially the patient (at least to the extent they are able), how would this patient be described?

Specializes in LTC, assisted living, med-surg, psych.

That's easy! This is the patient who takes a genuine interest in what's going on in his/her body, asks questions, and is prepared to take responsibility for his/her own wellness. Such people are WONDERFUL to take care of......and all too rare in a culture whose reigning philosophy is "I want what I want when I want it" and where almost everyone wants someone else to "fix" them when poor decisions lead to health consequences.

What about The Mammas boy? We will call him Mamma's Boy Mike.... an otherwise healthy individual who is hospitalized for a routine problem that should not take away his independence.

This is a guy in his 20's or 30's whos mamma sits with him around the clock, questions the nurses every move, and who waits on him hand and foot. She will press the call light to tell you her baby is in pain or that he needs a snack. Or if she can't be there she will call repeatedly during the shift to ask how her son is doing and when he got his last pain medication or if he "ate OK." When you try to transfer the call into the room so she can ask him herself, she says she already talked to him on his cell phone but she just wants to "make sure." She will even wipe his bum him after an episode of messy diarrhea or blot his lips after his meal. Wierd wierd wierd. (I swear I had this pt tonight after working a particulary wierd eve shift) Did I say wierd?

Specializes in LTC, assisted living, med-surg, psych.

OMG!!! You've had that patient TOO?:smackingf

And yes: that is weird!

Specializes in OB, critical care, hospice, farm/industr.
We've got one of these on my ICF unit right now, only he's meaner than cat dirt and smells worse.........and he has somehow managed to worm his way into my heart, because underneath all that is a lonely old guy in a lot of pain, both physical and emotional. He's become my 'project'---I've been advocating for better pain control and medications that calm him without knocking him out, plus I pay special attention to him by sitting down with him at dinner and talking with him. I know I'm never going to turn him into Mr. Nice Guy, but if I can help de-escalate him when he's wound up or prevent him from getting wound up in the first place, it's well worth the effort. So far, it has been.......it's a work in progress.:loveya:

God bless you, Viva. If I am ever sick, I hope I have a nurse like you.