What Was The Most Difficult Patient You Ever Had?

Ruby Vee, BSN · Mar 17, 2009

there are so many candidates . . . .

there was the patient who kept taking himself off the monitor to sneak outside for a smoke. let's call him marvin. we were on the 10th floor, and he'd walk down the back stairway, have his smoke and walk back up ten flights of stairs, put himself back on the monitor and lay there looking all innocent when you went rushing in to see why he was so tachycardic. it got so the monitor techs would just ignore his little vacations from monitoring. then i injured my knee and *i* got to be the monitor tech for six weeks. if it was my butt, i wasn't ignoring it!

every time he took himself off the monitor, i'd page his nurse to let her know. and every time, she'd head him off at the pass. then the charge nurse reassigned the patients at 3pm, and he had another nurse. when i paged him to let him know that marvin had taken himself off the monitor. the nurse said "it's ok, he knows what he's doing." marvin's "vacation" was getting extremely long, and i started to worry. again, i paged the nurse who replied "it's ok. he knows what he's doing."

security found marvin in the stairway, deader than a doornail. it's ok -- he knew what he was doing. he was one of our pulmonologists. he should have known better!

then there was the security guard who arrested at work, got excellent bystander cpr (he was one of our security guards!) and was successfully rescuscutated. he went on to have heart surgery and he was my patient. i noticed him squirming in the bed, looking for all the world like he was trying to pass a stool. when i offered him the bedpan, he said he didn't need it. but moments later, he had an enormous, feces-eating grin on his face as he informed me that "i just sh**! now you young girls need to clean me up!"

"oh, no sir," i said to him.

"but you have to. i've got sh** all over me!"

"no, sir. i don't have to clean you up. my responsibility is to make sure you get cleaned up, but i don't have to do it myself, and neither does peggy (caring for the patient in the next bed.)"

"well, well -- what am i going to do?"

"i'm going to have my friends over there clean you up," pointing out two big, burley male nurses. "but they're kind of busy right now, so you're going to have to wait until they have time."

after we'd all four had lunch, the guys cleaned him up. the whole time they were cleaning him, they were lecturing him about having respect for the nursing staff, and for women in general. "female nurses saved your a$$ when your heart stopped and this is how you treat them?" he was far more respectful of me after that!

i have more, of course, but i'd love to hear someone else's stories!

LilyBlue · Mar 17, 2009

My horror stories usually aren't patients, they are patients' families. We recently had a LOM, fx hip, CVA, lost his ability to swallow, can't even handle his own secretions, yankuered-out-the-yingyang,now having a PEG inserted because wife is not willing to let him die. Wife is a tyrant. Wife keeps a notebook at the bedside. wife writes down everything you do, what your name is, what your shift is, what you look like and what you have on. Wife calls on the bell every five or so minutes - "Will you come in here and look at my husband? He doesn't look good".

Well, no, dear, he doesn't look good - he's fixin to die. He has given up the will to live. The doctors have told you all this ad nauseum.

"Well can he have a private nurse?"

"Sure, you can hire a private nurse, to do his personal care".

"No, I mean you guys supply a private nurse." And she is serious.

The she writes down in her book - 3:37 pm - Nurse LilyBlue (wearing black and white scrub top with red hair) tells me that the hospital will not provide a personal nurse. LilyBlue says my husband is one of 7 patients assigned to her at the moment".

Calls me back in the room to turn her husband five minutes later. (LilyBlue turned husband, I called for her at 3:41 and she didn't arrive until 3:44). back in room every 20 minutes or so.

The wife had a five ring binder filled.

Blee O'Myacin, BSN, RN · Mar 17, 2009

Just in general, I've been encountering angrier patients where there is nothing in the world that can make up for the fact that they waited for upwards of four hours in the waiting room to be seen, and they have to be NPO until testing is complete. It's our ED policy. Even if they get into a bed and have their labs protocoled, it can still be an hour before the doc gets to them. You can bend over backwards and give out all the warm blankets and smiles and accuchecks for the diabetics (who often "crashing" with a bs of 300+...). I've been giving this quite a bit of thought, and can't figure out why it's OK for patients to leave their manners at home when talking to nurses, doctors and others in the ED. I must have said "We are here to help you. You came to us today. Please don't shout at me."

Blee O'Myacin, BSN, RN · Mar 17, 2009

My horror stories usually aren't patients, they are patients' families. We recently had a LOM, fx hip, CVA, lost his ability to swallow, can't even handle his own secretions, yankuered-out-the-yingyang,now having a PEG inserted because wife is not willing to let him die. Wife is a tyrant. Wife keeps a notebook at the bedside. wife writes down everything you do, what your name is, what your shift is, what you look like and what you have on. Wife calls on the bell every five or so minutes - "Will you come in here and look at my husband? He doesn't look good".
Well, no, dear, he doesn't look good - he's fixin to die. He has given up the will to live. The doctors have told you all this ad nauseum.
"Well can he have a private nurse?"
"Sure, you can hire a private nurse, to do his personal care".
"No, I mean you guys supply a private nurse." And she is serious.
The she writes down in her book - 3:37 pm - Nurse LilyBlue (wearing black and white scrub top with red hair) tells me that the hospital will not provide a personal nurse. LilyBlue says my husband is one of 7 patients assigned to her at the moment".
Calls me back in the room to turn her husband five minutes later. (LilyBlue turned husband, I called for her at 3:41 and she didn't arrive until 3:44). back in room every 20 minutes or so.
The wife had a five ring binder filled.

These are the family members where I am certain to show them my badge, make sure that O'Myacin is spelled properly and I too am charting every single time I am in that patient's room. My record is a legal document, hers is not.

Blee

Christie RN2006 · Mar 17, 2009

These are the family members where I am certain to show them my badge, make sure that O'Myacin is spelled properly and I too am charting every single time I am in that patient's room. My record is a legal document, hers is not.
Blee

I have done that before too! I almost had to have a family member escorted out one time and she came up to me and another nurse and asked for a paper to "write us up" and she asked for our names, so we handed her a piece of paper and made sure she had the spelling of our names correct :wink2:

We had a patient one time with a wife that reminded me of Lilyblue's story! Her husband had been paralyzed for longer than I have been alive and had bed sores to the bone. A simple dressing change would turn into a 2-3 hour ordeal! She would contaminate our dressings and just be a complete pain in the butt! She had to cut the tape just right and would stand there sizing the dressing up and cutting the tape for such a long time until she had it perfect. It got to the point that it was so bad that they were cycling nurses through, a nurse couldn't care for him 2 days in a row and even our ANM would take turns caring for him because we were all to our breaking point. The patient was in droplet, contact and enteric isolation and the wife would not follow isolation protocol at all! We would go in to find her eating or drinking in the room and one time I caught her messing with rectal tube without gloves on!! :barf02: She also would hit buttons on the vent :banghead:The wife would demand that we do things certain ways and the pillows all had to be just right. After the patient left, we found 18 pillows in various places in his room!?!

Dalzac, LPN, LVN, RN · Mar 17, 2009

I had 2, both with the same medical problems. Both would come in with ketoacidosis with sugars in the 1000 area. The would never take their insulin and come in a coma. It would take days for their sugar to come down and as soon as they were coherent would start demanding water and ice cream and when they didn't get it they would call you every name in the book added with slinging bedpans. and more verbal abuse than I had ever heard. And then go AMA. after taking a swing at you. I once both of these jerks at the same time. I went home sobbing after they went AMA at the same time.

Last time I heard they both died from ketoacidosis after no doctor would take them. I even remember their names and it has been 10 yrs since they died

MMARN, BSN, RN · Mar 17, 2009

hypochondriach (sp?) 50-something y/o F with hx of bipolar dx with a port for meds. different dx each time she keeps coming to the hospital. (I've had this pt about three times already, and I've only been a nurse for a year and a half) constantly asking for meds, we were her personal servants. nothing we did ever made a difference. kept getting upset because narcs wouldn't be ordered by docs unless she c/o chest pain, knew the game as easily as breathing. c/o stroking out, faked a stroke, stroke team was called, actually faked dysphasia, list of complaints kept growing, pain that kept radiating to left arm, jaw, back. pt went so far as to purge in order to stay in hospital longer for her meds. long story short, hell incarnate.

nitenurse02 · Mar 18, 2009

A couple of pts come to mind.

One is a 20 something frequent flyer who used to go to another hosp till her primary doc quit attending there. Now she comes to us. She comes in with exacerbation of Crohn's although no one has ever seen a bm.

She gets demerol and phenergan and reminds us about 15 min before it is due. Setting her cell phone alarm so she won't sleep through a dose. Right after the phen she will want her sherbert (heated in the microwave for 15 seconds to soften it). She has even conned some of the staff into walking her to the canteen for candy even when she knows that she is on a liquid diet. She demands a private room and if another patient is put into that room she has a fit and the supervisor has to be called. She has run off enough room mates to fill our entire hospital.

This is one of those pts whose name is never mentioned. At most just initials are used. Even when she is in house!!!

LilyBlue · Mar 18, 2009

A couple of pts come to mind.
One is a 20 something frequent flyer who used to go to another hosp till her primary doc quit attending there. Now she comes to us. She comes in with exacerbation of Crohn's although no one has ever seen a bm.
She gets demerol and phenergan and reminds us about 15 min before it is due. Setting her cell phone alarm so she won't sleep through a dose. Right after the phen she will want her sherbert (heated in the microwave for 15 seconds to soften it). She has even conned some of the staff into walking her to the canteen for candy even when she knows that she is on a liquid diet. She demands a private room and if another patient is put into that room she has a fit and the supervisor has to be called. She has run off enough room mates to fill our entire hospital.
This is one of those pts whose name is never mentioned. At most just initials are used. Even when she is in house!!!

Gosh, I would almost bet I work where you do, cause I know this girl! But unfortunately, it's probably just that there are thousands just like her.

MMARN, BSN, RN · Mar 18, 2009

A couple of pts come to mind.
One is a 20 something frequent flyer who used to go to another hosp till her primary doc quit attending there. Now she comes to us. She comes in with exacerbation of Crohn's although no one has ever seen a bm.
She gets demerol and phenergan and reminds us about 15 min before it is due. Setting her cell phone alarm so she won't sleep through a dose. Right after the phen she will want her sherbert (heated in the microwave for 15 seconds to soften it). She has even conned some of the staff into walking her to the canteen for candy even when she knows that she is on a liquid diet. She demands a private room and if another patient is put into that room she has a fit and the supervisor has to be called. She has run off enough room mates to fill our entire hospital.
This is one of those pts whose name is never mentioned. At most just initials are used. Even when she is in house!!!

Seriously, are you SURE you haven't had MY pt from hell before?? Because this sounds just like her! :chuckle

AngelfireRN, MSN, RN, APRN · Mar 18, 2009

Before I got the ax (for asking too many questions, as it were) at my last job (first nsg job I EVER got fired from too :bluecry1: ), we had some that would absolutely drive you to drink.

LOL with bilateral knee problems of several years' duration comes in c/o falling on one of her knees. HOH, noncompliant, and wheelchair-bound, with another LOL pushing her around. Great, you think, she can help with the med list, etc. Nope, just sat there, with her dentures poking out and a vacuous expression.

So, we X-ray LOL's knee, and it's swollen, but no fx is seen, and we tell her what we can do. No dice. She wants to see HER orthopod. It's Friday, and the appointment girl manages to get her an appointment for Monday. No dice. That means she'll have to go across town. No, no, she will only go on Wednesday, and to the office IN town. "Go set that up" she says, with an imperious wave of her hand.

As soon as I manage to unclench my jaw, i ask, "While I'm at it, do you need any medicines, or are you OK?"

"No, I'm fine."

As I stand at the phone, changing the appointment (no WAY was I making appointment girl do that), I feel this tap-tap-tapping on my shoulder. I turn around, and there's Vacuous Expression.

"Well, missy, aren't you going to write for her meds?"

You ever want to slap somebody so bad your hands tingle?

I walk back in and ask which meds needed refilling.

"All of 'em." :banghead:

As I go over her list and verify dosage and times, she explodes "Why don't you have a record of this!?!?!"

I assure her that I do, but that I need to know that SHE knows what she is taking and how to take it. She states that she just "does what it says on the bottle", and proceeds to demand samples of everything I have just refilled.

"I'm sorry, we only get samples of the newer meds, and we don't have any of the ones you take. They are older drugs, and they come generic, so they are fairly cheap."

I leave the room to get doc to sign the script (I am still training), after telling them where to find the bathroom. As I return, I nearly get mowed down by Vacuous Expression, pushing LOL, who has YET to find it. This is her 4th trip up and down the hall.

"OK, LOL, see Cathy? Go PAST Cathy, THROUGH the door, and it's the first door to the right. When you see white porcelain, you're there."

Found out later that she said I offended her with the white porcelain remark, although I was joking. I was so mad when they told me that. After all I went through with that #$%@^, and that was what she did. She was in the office for 2 1/2 hours, I got NO help from doc, and then I get reamed. The longer I go, the gladder I am not to be there anymore.