Do. No. Harm. We hear this phrase through school, on medical TV shows, more than likely on the news. I know that myself, and really anyone else in the medical (or really public sector/service) field know that this is the center of our universe. But, dear ones, there lies a complete and total conundrum in this statement. I am held to a higher standard, I do no harm, I practice what I preach. For lack of a better phrase, the buck stops here. I want to show you a glimpse of what it's like working in this field, yet again. But this time, I want to relay to you the dangers we face, with absolutely no pun intended. These were situations of little to no comic relief.
I've been wanting to write a piece like this for some time. After going to a Critical Care Symposium and spending a decent amount of time in talks about disaster preparedness, and the like, I realized that many things we face are NOT OKAY. This point was driven home that much further whilst visiting a friend and meeting their acquaintance who happens to be participating in a National study on violence in the workplace. Did you know that nursing actually is one of the MOST dangerous professions? My first thought was policemen, firefighters, FBI agents, you know-- the real stuff! Little did I know that statistically speaking, my profession is actually one of the most dangerous in rankings for the United States (obviously there are other jobs that may or may not have been included in this study). I digress.
When I think back on these next few stories that I am going to share, maybe you will agree. Maybe you won't. My biggest plea that I wish could ring from the rooftops, mountaintops, cliff sides, what have you-- is DO NO HARM. But please, realize that this standard does not ONLY apply to people in professions like my own. It also applies to YOU. Yes, patients sign a paper upon being admitted to the hospital, saying that they will conduct themselves in appropriate ways... I hate to break it to you. This more often than not, does not happen. I myself have been in dangerous situations where I questioned humankind and asked myself-- If I am being held to a higher standard, why aren't you?
Here we go..
Clickety-Clack
It was a pretty typical day on my medical unit, ages ago, and I was hustling and bustling my tail like you wouldn't believe. Nurse to patient ratios out of the wazoo and all I wanted to do was have a drink of water and maybe go to the bathroom, once, heaven forbid twice! Obviously, as life goes, when you get caught up and you seem to have a wee grasp on things, something has got to arrive to shake up your world. Am I right? Or am I right? My charge nurse headed up the hall to let me know something wonderful was happening-- JUST KIDDING! In fact, I was getting an admission from the emergency department,. Blah blah blah, something about foot pain, blah blah blah. As we all do (do not lie if you're a nurse!) I waiiiiiiiiiiited for the ER nurse to call ME with report. (Sideline: report is what we use in the medical field to quickly discuss a patient's status, allergies, etc. when they are being sent to a different level of care).
As sure as the sun rises, my phone rang with a deafening call. "This is Jacquie." I announced, quite nonplussed. My disinterest made the nurse on the other end of the line huff a bit. My bad. I can't help it some times, I should, but when you're drowning in 20 feet of water and you have cement blocks tied to your feet, it's a bit difficult to be thrilled with yet another cement block. Tied to your bum. Or something of that sort. Either way! "This is (so and so) and I have (so and so) patient for you, here for foot pain, uncontrolled, level of 10 on the verbal number scale. Xray and MRI are pending, is the room ready?" All other details aside, the most important question-- is the room ready? "Yes the room is ready, but you are more than free to take your time." This makes my comrade laugh, the phone hangs up, and I am aware that regardless of my busy situation, I've got more responsibility coming.
When I round into my new patient's room, I literally walk into a big stink. No, this individual was not passing awful gas, his aura was pulsing with something that made me want to throw up. I could not pinpoint what it was that he was feeling, but I knew that something was wrong and it wasn't good. He was quite cordial, extremely tall, and a tad impatient. Fair enough, he came in for active pain and he wanted more pain meds. This being a common theme in the hospital-ing world, I informed this man that the doctor was putting in orders at the moment and I was unable to pull any meds from our dispensing machine (especially narcotics).. Duh.
He was okay with this report of mine. So I let him know that I would return in few moments with personal belongings for him to make his hospital stay more comfortable. I stepped out of the room and rounded back in, in less than five minutes-- I kid you not. This very large, intimidating man was pacing the room. His foot IV was clacking across the floor, a sound I still cannot forget. The air had changed and his pacing grew insistent. His motions were larger. Louder. Each action was laced with anger. I heart began to beat faster, because that gut feeling was back. It shouted for me to get out of the room as quickly as possible.
Scary air or not, I wasn't going to leave. Something wasn't right. I knew it wasn't. But I also don't just walk out on people, no matter how difficult, conniving and angry you may be. So I stood my ground. "Is everything okay?" I asked, obviously a loaded question. 'What in the world is taking so long! I am IN PAIN, that is why I CAME HERE. WHY AREN'T YOU DOING ANYTHING ABOUT IT?' I took a very deep breath, set this man's things down that I had collected, and put my big girl panties on (so to speak). "Sir, I understand you are in pain, if there was a way I could override that medication, I would. But unfortunately, that is not in my jurisdiction. I would be happy to call the doctor to see if the pain medication would be the first thing on his to-do list." This seemed to suffice, somewhat. He sat back down and said okay.
Oddly enough, he was shaking. Breathing fast. Face was red. I knew, as per report from the ER nurse, that this man had a very large dose of pain med before coming to see me. I left the room to call the doctor, knowing that this situation was a ticking time bomb. I didn't know when it was going to explode, but it wasn't going to take long.
I don't really know what happened next, or how much time had passed since our last conversation, but loud crashes, screaming and cursing echoed down the hall. I half ran, half walked, knowing that the time bomb was officially breached and letting out puffs of steam, little by little.
Oh no. No, no, no, no. When I walked into the room, my new admission was throwing things, hitting the wall, screaming and cursing. As soon as my presence was known, he turned to me, and I knew I was in trouble.
Oh God. A plea, a prayer.
Here we go.
'Why haven't you done anything to help me? Isn't that your job. All I want is Dilaudid. [Aside: this is one of our BIGGEST issues in healthcare right now, this pain med is tearing apart people's lives]. It's your job to fix this and you are doing nothing!' It was at this point I knew I had to make a choice, talk or run. So I talked. "First off, I understand that you want pain medication, but I cannot just give it to you that easily. The medicine you want has to be titrated. It may take away your pain, but it also has the power to kill you. I can understand the doctor taking his time to figure out what dose is safest for you, seeing as we'd rather prefer to help you than hurt you. So if you could please be patient with us as we try to remedy this, I will do whatever I can to help you in the mean time." Well friends, this wasn't enough. This man puffed up to the size of a bear. He got up and walked towards me and began to step closer and closer. Naturally, one backs up so as not to be run into. This is what I did, this was the problem. I didn't have my hospital phone in my pocket, I did not have a cell phone.
This realization hit as soon as my back hit the wall and I realized that I was stuck, literally stuck, in a corner. This man was between me, and safety.
Oh God. Became my plea.
What he said next was slurred, almost incomprehensible, save numerous four letter words. His shouting and screaming must have rung out down the hall because it was then that I heard feet. Loud persistent feet running down the hall. As I was looking up into an angry face, veins pulsing and bulging out of his neck, I was wondering who was coming to help. As my patient put his hands high up in the air, all I could think was
oh no, he's going to hit me. My breath caught and I braced myself. My brain didn't want to make sense of the situation, but rather brace for what was going to come. I'd never braced myself for someone to hit me before. It was not pleasant feeling as if I had no choice.
As sure as the sun rises, someone shouted
NO! And came bursting through the door. If I could explain the sight to you, you wouldn't believe me. But I'll try. My very pregnant boss, all of 5 feet ran in, placed herself in between my enraged patient and me screaming
DO NOT TOUCH HER!
This reality check caused my patient to take a few steps back and momentarily pause. I couldn't breathe. So my boss continued to save my tail, my face, my life.
You will NOT talk to us in this manner, you will not harm our staff, you are welcome to leave right now. Do you understand what you signed downstairs, you will NOT HARM my staff!
My patient decided that we weren't worth his time, he sat down on his bed, screaming and cursing, attempting to rip out his IV threatening all sorts of things that I cannot even remember. I carefully walked over, feeling like the mouse that helped the lion, and pleasantly asked if I could take out his IV in order that he didn't hurt himself. He agreed and I hurriedly, carefully, did my job with my hands shaking. Adrenaline was pumping loudly through me, my ears hearing nothing but ringing and the sound of my own blood rushing about.
As soon as I had his blood tainted IV in my gloved hand, this man grabbed his coat and literally ran off the unit. It was then my mojo came back and I called security. "There is a man in the hospital who needs to be escorted out. He just left the medical unit and is angry. Make sure he doesn't hang around."
About a half hour later, security came up to the floor and requested to speak to me personally. They reported that they found my patient wandering around the hospital, yelling and cursing, basically standing out like a sore thumb. They had to handcuff him and escort him out. They added that he should not come back again.
If he came back in today, he would be arrested. I breathed a sigh of relief, walked straight to my boss' office, and hugged her with every inch of love I could muster. She put her life and her unborn child's life in jeopardy to make sure I wasn't hurt. A woman can never forget an act of valor like that. Never.
Here's your next gem.
The Man in the Cowboy Hat
I had heard through the grapevine that there was an exceptionally difficult patient down the hall who was just wrecking havoc on the staff. Another gem requesting pain medication by screaming, shouting or cursing and expecting it as soon as possible-- that is, before it was actually safe to give another dose. Sure enough, the nurses banded together and would take turns administering his medication. His assigned RN was so burnt out from his disrespect and character that she would have a near panic attack before going in the room. I took it upon myself to administer the next dose and hopefully relieve some of her distress. We share the load. We help each other. That's just what we do.
Let me tell you friends, I did
not know what I was getting myself into.
I walked into this patient's room, smiled, and offered him his medication as per his request. He briskly nodded and then flicked his head toward where his IV was-- as if to tell me this is what you are going to do, without actually saying anything. So I went about my business and set up his med. As I was prepping everything, his voice took on a different tone, discussing with his family and friends at the bedside how horrible we were, how terribly incompetent we were as a hospital, and that we were totally worthless human beings and the bane of his existence (to put it nicely). Obviously, I bit my tongue, held my breath, and let him know right before I administered his medication what I was about to do.
After he got his rush from the medicine going straight to his head, he turned to me, looked me dead in the eye and said a very awkward, even angry, thank you.
I smiled, said not a word, nodded and left the room in a hurry. I got that sick feeling in my stomach that I had felt only months before, and unfortunately knew too well.
This one is going to be trouble.
Like clockwork, a commotion started down the hall. Now, I knew that this person had some background that made them emotionally labile, but I wasn't expecting the next few moments. I saw this patient walking (with a vengeance) down the hall. When he got to the nurses' desk he slammed his fist down with a resonating BANG! I looked up calmly as my heart began to race, feeling blessed that people cannot see this internal mechanism.
Calmly, slowly, I addressed him, as if I were talking to a child about the throw a temper tantrum of epic proportions. "I want to leave, now, you guys aren't helping me any more than I get when I leave here. At least when I leave I can have as much pain med as I want. Come down the hall now, take out this
!@#*$&% IV because I'm leaving." Obbbbbbviousssslyyyyyy, there are a few more steps that need to happen before he could leave--safely. So I happily, almost chirpy, stated 'I would be happy to let your nurse know that you are ready to leave, so if you wouldn't mind, please go back to your room so I can have them meet you there to take out your IV safely so you can go. I will also need to call the doctor to let him know.' Crazily enough, this seemed to suffice. This man gave me that same odd nod, turned on his heel, and briskly walked down the hall.
Having learned the way things go in the unsettled patient department, I immediately called the doctor, nurse and security.
Here we go again. I thought with an exhale that was far from relieving.
I don't know what transpired between this man, the doctor and the nurse, but I heard screaming coming from down the hall about 15 minutes later. It was the patient practically running down the hall.
"I AM GOING TO LEAVE NOW, TAKE OUT THIS (*&#^$% IV OR I AM GOING TO RIP IT OUT!" I turned to his nurse who was trying to get his papers together, silently asking her what I should do. She sighed, totally exasperated, 'Just take it out Jacquie.' So I did. I walked up to this man who was radiating anger, slowly slipped on my gloves, and took out his IV. I smiled a halfhearted smile. At this, he slammed his hands down on the counter at the station and screamed.
"I WONDER WHAT WOULD HAPPEN IF I JUST WALKED UP IN THIS PLACE ONE DAY WITH MY SHOTGUN AND TOOK OUT ALL OF YOU!" He paused and turned to me, "except you," he said, "you've been nice to me, and I like you." I froze. I can handle belligerent, but threats concerning fire arms. This woman doesn't play. At that, the patient left to go back to his room to get his things. My boss called the cops and they showed up almost immediately.
With the blue uniforms form the cops, the black uniforms from security, I could just stare. It was almost childish, but I was frozen to the spot. I didn't know what was going to happen next.
As if on cue, the patient came hurrying down the hall, as if he was outrunning something. "I hope you know I would LOVE to shoot this place up, it would be amazing! BAM! BAM! BAM!" The cops were following to make sure he left.
Of course he paused at the nurse station to drive home his point. He raised his arm, pointed it straight at me. "Get that look off your face, I don't mean you. I wouldn't shoot you." Because, that made the whole situation better.. Not.
With this last exchange, the cops gave him a very insistent push toward the door. This sent the patient into a fit of laughter, "SEE YOU SOON!" He screamed.
I turned to the cop and I asked 'So?! What are you going to do about that?!' His reply...
Nothing mam, he doesn't have a firearm. And it wasn't a direct threat. We can't really do anything.
It was my turn to get serious. 'Then you better pray he doesn't come back in here in the future. Because then we are ALL going to be sorry.'
I let my words sink in. The cop made a face, turned on his heel, and left to follow the screaming.
--
You tell me friends.
Do. No. Harm.
I understand the standard.
But sometimes..
I truly wonder..
About
everyone else.
