Do This, Not That
“It’s not about me.”
This is my personal mantra that I adopted several years ago. I don’t know how it came about, I think it may have been an epiphany. And it has saved me. Saved me what, you ask? Time. Frustration. Anger. These 3 words and a contraction, when repeated in my head, allow me to take a step back, take a deep breath, gather my thoughts and act rather than react.
Let’s face it, it’s no fun to be sick, injured or in pain (not an epiphany just a fact) and patient responses to the aforementioned phenomena cover a wide range of emotion and behavior (read bitter, angry, rude and accusing). When faced with these types of behavior, one’s natural reaction is to become defensive and a defensive nurse is not something you want.
She came to me late in the evening, too proud to call an ambulance, too far away to take a taxi, too weak to take a bus. She waited for her son to come home from work all the while hoping she wouldn’t grow too tired to breathe. She arrived with her bag of medications, her convertible walker/chair and her “overnight” bag.
She accepted my help to move her from the wheelchair to the stretcher. She accepted my help to change her into the hospital gown. She was gracious and polite in answering my questions related to her medical history and reason for coming to the emergency room. She instructed me on how to fold her clothes and position them in her overnight bag. She told me where I could place the blood pressure cuff, EKG electrodes and pulse oximeter. She told me “I’m a hard stick, they always have to use that machine to find my veins”. She allowed me to assess her arms for the presence but in her case absence of veins* (I did find 2 but one was sclerosed and the other too small and fragile, it would blow at the mere sight of a needle). I informed her I’d get the doctor and ultrasound machine, she was asleep before I exited her room.
The doctor glided in, ultrasound machine in tow.
“Use this arm and make sure you only use Chlorhexadine swabs, 5 of them. I don’t want no infections and I always end up with one every time I come here……Hurry up, I’m tired. I haven’t been able to breathe or sleep well……that 18 will blow my vein, only use a 20…..aren’t you done yet? It didn’t take the last doctor this long to start my I.V…….don’t put that needle down then use it again, get a new one and use more Chlorhexadine…..here, let me clean it, you’re not doing it well enough….”
With the I.V. secure and blood work on its way to the lab, it was time to solicit a urine sample, a sterile urine sample, by means of and I & O (in and out) cath.
“Oh, no! You’re not putting a foley in me, I won’t allow it. You always give me UTIs whenever you put a foley in me.” (This is the emergency department, I have never seen this woman before in my life so the “you” in this instance is a collective one)
She would be receiving lasix, a foley would be so much easier AND would allow her to sleep without the frequent need to pee interuptions she’d soon be experiencing. No foley. She instructed me to gather cleaning supplies, “Get the short towel and use warm water from the faucet, I don’t like when it’s cold down there. And don’t use that soap that you use to wash your hands. Get the soap bottle from the closet with the blue top. I’ll clean myself because you don’t do it right. And don’t forget a second dry towel!”
She let me help her sit up ”not too fast, I’m tired and old and don’t move well. Ouch! Not so rough!” (She was close to 300 lbs, a certain amount of force is required to lift someone of this heft).
“Now get out. I’ll call you when I’m done.”
Whistle, whistle, whistle. Fingers tapping, fingers tapping, fingers tapping. A quick peek behind the curtain. “I said I’d call you when I’m done!”
Attention paid to other patients, a quick swig of water and a brief hazing of a med student later I returned to her room. She was asleep. Guess she’s done cleaning herself.
“Heat up that betadine, remember I don’t like to be cold down there.”
It’s not about me, it’s not about me, it’s not about me…….played in a loop in my head as I prepped her for the I & O cath. And my thoughts wander from a time when I thought she had a sense of pride in wanting to keep herself clean to a time when I thought that she may be ashamed of her filth and odor to when I realized that she didn’t trust me (the collective me) to properly clean her. That kinda pissed me off. So I guess it IS about me. Ha.
*I always believe patients when they tell me they’re a hard stick but I also always look for myself because it never hurts to. Plus I wouldn’t want to lie to the doctor when s/he asks me if I’ve actually looked for a vein.