Share your "problem patient" stories!

[nitenite]

I know I've had pt's I couldn't wait to get rid of. Some are just plain boors. This is the thread to share your stories about THOSE pt's.

Wish I could find a magic book that tells me what makes an able-bodied pt suddenly incapable of basic self-care once they enter the hospital.

Recently I had a pt who could feed himself, brush his teeth, wipe his ass, etc(this was an older male who just had his toes reattached after cutting them off while edging his lawn barefoot) suddenly lay on his call bell every ten minutes wanting me to fix his hair, feed him jello or give him a drink of water. These were all things he could do just fine by himself. He was also really nasty to me if I didn't come the second he rang his bell. Sorry pal, I had a critically ill patient next door and getting her on the bedpan before she soiled her bed is more important than combing your hair. Anyway, he'd complain about the food, whine that he was cold(and then complain he was hot when I gave him a blanket), whine that nothing good was ever on TV and then he'd yank his hands away when I checked his vitals.

This man was NOT suffering any dementia btw, he was perfectly a/o the whole time.

But wait! It gets better! If his family was around, he'd be all sweet and polite to me only to turn right back into Captain Jerkwad the second they left. I've never been so glad to discharge somebody. From what I've heard....he isn't taking the antibiotics we sent home with him. He'll probably be back in the ER with a raging infection pretty soon. :hdvwl:

So, how about the rest of you? Ever have a pt who made you practically tear your hair out?

[HollyHobby]

I'm almost always able to find some well of compassion for even the most difficult patients. There have been a few, though, that even I cannot tolerate. These patients are all frequent flyers; if I only had to care for them during one hospitalization, I could manage it. But when they come in over and over and over again...

I met Ann (not her real name) when I was in nursing school. She is a tremendously obese lady whose multiple medical problems are all direct results of her obesity. Now, I am not prejudiced against obese people: some of my favorite family members and favorite patients are obese. It's this lady's behavior that I can't stand. Evidently, her personal goal is to manipulate as many people as possible to satisfy some sick need.

Another student was assigned to Ann, and when I went into the room I found that student carefully hand-feeding the patient. Ann was on the phone (her phone-using arm seemed to work just fine) and would accept bites of food in between sentences. Nursing students are very easy to manipulate, so this was no big accomplishment for Ann.

A few years later, Ann was my patient in home health. Although the patient was fully ambulatory, she chose to never leave her bed. She had a TV at the foot of the bed and another one at the side of her bed so she could easily continue watching TV if she rolled over. Meanwhile, our tax dollars paid for a woman to come in and cook for her. I was there to manage her diabetes, because even though she was completely mentally intact, she refused to check her own blood sugar, take her own insulin, or comply with her diet. I was eventually able to discharge her from our service due to noncompliance.

A couple of years later when I was working in ICU again, Ann became such a frequent visitor that we'd cringe every time we heard she was in the ER. Her obesity had led to chronic respiratory failure and she ended up trached and required a vent numerous times. One night I went into her room and found her walking around the room, as far as her vent tubing would allow. A few hours later, when she pooped all over herself, she claimed she was too weak to roll over in bed, so it took 6 people to get her cleaned up. As we did, we discovered fried chicken hidden in her fat folds. (Presumably, her family snuck the chicken in to her.) I now live a thousand miles away from her, so I don't know what happened to Ann.

Where I work now, Dr. C was another such patient. He was an elderly doctor who'd had a CVA and actually was pretty sick although I have to point out that his mind was completely intact. He despised nurses and the focus of his life was to make us miserable. He'd shout for help constantly, then when you got close enough to the bed, he'd punch, claw, and pinch. He cursed and belittled any nurse who came in the room. He treated his own family members the same way; his children told us he'd always been like that and they had never liked him. I hope I don't upset anyone by saying this, but we were glad when he died. (His family was glad, too!) He was such an evil man. Sad story, really.

Currently, my problem patient is a gentleman who comes in every week or two with hepatic encephalopathy. He's been rejected as a candidate for a liver transplant because he is completely noncompliant. He, too, is an evil person. When his ammonia level is very high, he's not too much trouble because he's semiconscious. Once you give him enough lactulose to cause a torrent of diarrhea and his ammonia dips below 200, the evil comes out. He verbally and physically abuses the staff, throws things (including his own poo) and generally pitches a fit up to the point where he goes AMA. After speaking to his girlfriend- I can't even imagine how messed up this woman must be- I've learned that this abusive personality is his baseline.

He was readmitted last night. I work tomorrow and am seriously considering calling in sick because it's my turn to take care of him.

[HollyHobby]

Okay, I didn't call in sick- I wouldn't have done that, but it was tempting- and I didn't get assigned to the hepatic encephalopathy gentleman. As fate would have it, I was wishing (within two hours into my shift) that I could change my assignment and take him instead.

I had the sweetest little old lady, who was covered in bruises from head to toe as a result of the dementia/coumadin combo. She was fine one minute; the next minute when I checked on her she was covered with blood. She'd pulled out her IV, of course, and it must have been an excellent IV indeed because her gown was just soaked with blood. It looked like the Texas chainsaw massacre in there. Pulling out her IV apparently caused a bowel explosion, because she was sitting in a river of poo.

I called for assistance. My fellow nurses could barely stop laughing long enough to help me. It looked like I'd beaten the poor lady with a baseball bat, maybe cut her a few times, and left her sitting in poo.

A few hours later, the sweet little old lady began demanding the attention of the police, because "something is going on and you're not telling me!" It had something to do with a puppy that was being killed, and some children who were all liars. She didn't progress the the hitting/kicking/biting stage (at least, not on my shift) but it was a long night indeed.

[iNurseUK, RN]

I nursed a patient who had Munchausen's. She had at least 16 abdominal ops from 9 different hospitals that we knew about. Her consultant at the hospital I worked at at the time had clearly stated "NO FURTHER EXPLORATORY SURGERY"

Guess what? She was admitted over a weekend and a further laparotomy was carried out. It showed multiple adhesions from previous (unneccessary) abdominal surgeries and the patient developed peritonitis and ultimately fistulae.

She was on the ward FOREVER. It took hours to dress the fistulae with stoma bags, paste, wafers etc. Within 10 minutes she would pull the dressings off and scream for a nurse.

She made formal complaints about pretty much every nurse on the ward including the Sister in charge and we dreaded having to care for her

She was on the call bell every five minutes. We knew she was a Munchausen's but her over-protective parents were also complaining 24/7 that we were neglecting their dear daughter.

Eventually she was transferred to another hospital. God help them.

[HollyHobby]

Until just now I had blocked this patient out of my mind, but I once had a trached and vented patient who repeatedly yanked her vent tubing off her trach because she knew it would get a faster response than pushing her call light. (We were quick to answer call lights, but a vent alarm brings everyone on the run.)

I told her I knew she was perfectly capable of pushing her call light. She must not pop off her vent, it was dangerous because she could dislodge her trach, and if she did it again I would tie her down. She promised up and down she wouldn't do it again. I believed her. Stupid me.

So thirty seconds later, her vent is alarming, I run in there, and she'd accidentally pulled her whole trach out.

Once we got her airway reestablished, I tied her hands down, and she was livid.

[AngelfireRN, MSN, RN, APRN]

Hey, nt your fault. You warned her. She brought that one on herself.

[HollyHobby]

Yeah, but I should have known better.

[GitanoRN, BSN, MSN, RN]

HygieneQueen.... I must confess I LMAO for about 5min. with your story, for the simple reason, when I was working on med/surg. we also had a Houdini, thank you for sharing your story. In addition, my story is not related to my patients, is a couple that came in to ICU looking for a pt. they said, I ask the couple the pt.'s name and they said "Well they call him Bubba" I stated to them I need a full name or at least a first name, the woman said- "Like I said we know him by Bubba, and he is missing the Lt. eye, or George is the the right eye? well you know he has a fake eye in his socked and he has a limp from" the woman then began telling the long version of the story on Bubba's limp, I finally stop them and told them I need a name I can't let you in without knowing the pt. and you need to understand here in the V.A. we have thousands of pt.'s missing an eye & limping from a leg, the woman then said, "Well that's understandable but we need to see Bubba" this went on for 1/2 hr. & finally they gave up and left. On my way to the cafeteria I found the couple telling the story all over again without missing a beat to a nurse supervisor that use to be in-charge of my floor, she looked totally frustrated with them, when I saw this I couldn't help myself and began to laugh uncontrollably :lol2:. Moreover, on my way out, at the end of my shift, I heard 2 familiar voices talking to another nurse stating the same story this is 5 hrs. later! and as I pass by them the nurse who just came in for her shift looked totally confused ... I felt so bad for her and I went to the couple and said "Oh! I been looking for the 2 of you, you know bubba was discharge this morning! They seem ok with the answer and off they went. Later on I found out that the couple lived next to the hospital, and they pulled this stunt all the time

[smurfynursey]

When I was an aid on a hem/onc unit, we had a patient that was very...particular. She had advanced disease and was only allowed clear liquids and hot chocolate (specific oMD order). When I was in doing vitals she asked if I could get her some saltines...I said I didnt think so (saltines are apparently clear liquids?!) and that I would check w/ the RN. She said, yes....plllleeeeeaaase dooo. *insert shoo-ing motion here*

[HollyHobby]

I have tried to forget about her, but I must tell you about the "chicken pox lady". She was without question the most difficult patient I've ever had, and the only one that caused me to have an actual meltdown.

As we all know, chicken pox in an adult is serious business. Especially when it's in the lungs and the brain. CPL (chicken pox lady) had all this, plus she was hep C positive, and had herpes, plus she was five months pregnant. And she was bipolar and borderline personality. And she was an IV drug addict. And her boyfriend was constantly trying to sneak more IV drugs to her- I had to call for security to keep him out of her room. I had to check the fetal heart tones (I am NOT an OB nurse!) every hour. (I don't know what happened to that baby, and I don't want to think about it.)

She'd had 3 previous children, which she'd immediately given up to her mom to raise because she was incapable of caring for herself, much less a baby.

Jeni was supposed to get this patient, but she said she couldn't since she herself had never had chicken pox and couldn't risk being exposed. So I got CPL.

Since CPL had chicken pox, our policy was that her nurse could not go in any other patients' rooms, and no other nurse could go into CPL's room. So I was on my own, wearing full isolation garb, all night. Once in a while, one of the other nurses would make faces at me through the glass door; that was the extent of the support I received.

CPL would sleep for about two minutes, then wake up with a shriek, jump out of bed, yank off her nasal cannula, announce she had to pee, and scream in my face like I was a demon from her nightmares (which maybe I was). It would take me 15 minutes to get CPL to the potty, convince her she was in the hospital, coerce her into putting her oxygen back on, get her back into bed, put her gown and leads back on, get her calmed down, etc... etc...

Then two minutes later we'd repeat this process. All night long. Over and over. And over.

At four am, CPL actually slept. I staggered out of the room, soaked in sweat, and said, "I need to go outside for a minute." I broke down and sobbed. I wanted to die. I couldn't stand it for another minute.

Ten minutes later, I got my act together, garbed up, and went back in. That was the longest night of my life.

About a year later, my dear friend Jeni said to me, "Remember the chicken pox lady?"

I said, "Oh god, I'll never forget that." I shuddered.

Jeni said, "I lied when I said I hadn't had chicken pox because I didn't want to take that patient."

[GitanoRN, BSN, MSN, RN]

HollyHobby, That was so wrong in so many levels...for her to do that to you However, I commend you for hanging in there and for giving the best nursing care to (Chicken Pox Lady) my hat goes off to you:yeah:

[HollyHobby]

Thanks, Romano. I still love Jeni and consider her one of my best friends, ever. But part of me still wants to kill her. :)