I had an epiphany today

33 I've been a medic for 16 years and a nurse for 6. I had a funny thing happen today. I happened to be working on the ambulance but it could just have easily been on the unit. I personally hate long winded posts, so get ready because today I am GUILTY. I was transporting a late 50s guy who was being transferred for EP study following a NSTEMI (r/t recurrent Vtach). I asked him what meds he took and he said "it's none of your business, you are just giving me a ride". I was dumbstruck for a second and my impulse was to "inform" him that the state of Colorado required that I gather medical history, allergies, medication and perform a full assessment on every patient, but I didn't. I stopped and smiled to myself, realizing that this guy had made his choices and I would leave him to his problems. Of course I just read his chart.

I felt like telling him that the 4 vessel CABG he received 7 years prior was a miracle of modern medicine that few people in the world would have been lucky enough to receive. I didn't want to rub it in his face that two vessels were 100% occluded, the third 90% occluded and his LIMA was the single vessel providing all of the blood flow to his heart. I felt like telling him that by failing to even see his doctor once or quit smoking was a slap int the face to the surgeon who had dedicated his life to curing cardiac disease. I felt like telling him that I knew his Na was 139, his K 5.2, Bun 24, creatinine .9, and the significance of his troponin of .12. I felt like telling his the report of Vtach that I had received was clearly rapid Afib, and that I knew 50 ways (OK 10) to save his life if his EF of 30%, septal and apical hypokenisis failed to sustain him. But I didn't.

He was a tough guy, 6'4", worked as a trucking supervisor, 260lbs, handlebar mustache and had a ring tone from one of the the Cling Eastwood spagetti westerns. I wanted to tell him that yes, Clint was a badass but he won by being the clever trickster, not by being a dumbass, and that that he wan't being clever at all. A clever man would listen to his doctor, or quit smoking. Is there anone in America who doesn't know this is bad for you? But I didn't. I treated him with courtesy, gave a report and dropped him off. In my younger years I would have been ******, but now, I just feel sorry that he wasn't smart enough, or got enough hugs as a child, or for whatever reason he seemed unable to face his problems and take action to stay alive. I guess I just realized that to be a nurse, is to take people as they are, and treat them the best we can.
How true! I'm all for giving not just patients but people in general plenty of space to be who they are. While I know how annoying it is to have your unit and crew casually called upon to provide 'taxi service', you were right to recognize that you weren't going to be changing this guy in the however many minutes it took to deliver him to his destination. Rising to the occasion here was about treating him well, and it certainly sounds as if you did so. Kudos.

Wow, an epiphany! Was it like this?

those patients are my whole unit at rehab. they all know more than you and wont be told whats what by a 25 y/o nurse, despite my bsn. so go ahead and skip your clonadine and have a stroke.

Another patient with all the answers, but its your fault when their answers don't work.I feel for the guy. I'm a little over a year removed from smoking. Quitting smoking is THE WORST.....period, end of story. I actually can emphasize with this type. It'd make all the sense in the world to quit but.......forget it, not happening. I had an epiphany of my own today. No more outrageous OT. I got three patients, all heavy needs, none of which will be here in three months (one doesn't know yet he is positive for HIV, but has other issues too) and I am taking care of them while doing 20hrs OT. Blah, no way I am anywhere near as compasionate as the situation warrants. One guy trying to come to grips with the fact he'll lose a leg but I'm just my reg. tired self. Not that I've been mean or anything but.........eh, there would have been better people than I for that assignment. From now on, I'm not letting the hospital make me feel like they need me to save the day. Too much of that lately. Nice problem to have I guess but still..........

Life is lived forward and understood backwards.

Quote from dthfytrLife is lived forward and understood backwards.

I have to say though that having worked in both psych and in a drug/ETOH detox........I have heard sooooo many times, "I have quit heroin, Crack, alcohol and opiates and it was hard don't get me wrong, but I just can't seem to kich the cigarettes--that is the hardest one. I want to so bad after all I've done to get clean--but just can't"......... tobacco is a serious addiction. And it sounds like, by the response you got, this guy is angry. He most likely will be nasty to everyone and really its his own anger at himself and he turns it and is nasty to you and others trying to help him. My guess is he knows how close he was to dying and how lucky he is to be alive and either doens't feel like he deserves what a miracle he got or is too embarrased to go back to the doc and admit he has not quit smoking and is probably still eating crap, etc. --so now he is angry with himself and instead is taking it out on the world around him.Okay so that is just the psych nurse in me talking. Maybe he really is just an ignorant jerk. Maybe. But I like to try to give people the benefit of the doubt. I can't help it I am a "glass-half-full" kind of gal! LOL Just try to remember that your patients may not always know just how much you (all nurses) are a part of their care, a huge part of why they are alive. It's nice to be appreciated by our pts and their familes. For them to know all that you do. But yeah you are gonna get some that just don't get it. At the end of the day you know.

Great post, mentalhealthrn.

What a great post!

what a dumbass that guy was!! argh...so frustrating!!"you're just giving me a ride..." whatever dude. i wish you could have said, "i'm a nurse...you know what rhymes with nurse? HURSE. and that's going to be your next ride if you don't tell me your medical history!"

I would want you as my nurse.I think we would all do much better just supporting people as much as they will allow and giving them the best care we can without having expectations for their behavior.Everyone has their reasons and demons.Let us not **** them off and drive ourselves crazy trying to fix things.Give them the education and support and then accept them whether or nto they do what you think they should.

I doubt anyone will agree with me... but literally food for thought on your epiphany as it relates to my practice.Our management has us so focused on patient satisfaction scores that we can't do right by our patients.. tick them or the family off and you can be fired!.... So my epiphany is...-diabetic... sure eat that burger and fries that your family brought you while you are in for DKA,-CHF and dialysis pt.... I'm sick of rationing your water here that you don't ration at home and argue with me for... here is the water ... have at it-The once a week DKA 'er 20 year old that demands the dilaudid.... "I had it dc'd... if you'd stop forcing your body to eat itself for food you wouldn't be in so much pain... no more dilaudid on my watch, take your insulin at home and you won't need to argue with me again. "-The family... "no I won't call the doc for ""xy and z"" because you now have a google degree and still have no clue-"you sure as heck can go smoke after your heart attack... pack your belongings.. because housekeeping will have your room cleaned an the sick ICU patient being held in the ER will be in your room on your return. -management... my favorite... "no I'm not bringing out the recliners, pillows, blankets and drinks to family to camp out for the night... my patient is sick and the family is exhausted and no one will sleep... so no good will come of it"PS all thanks for the thread hijack... I'm interviewing to get out of the ICU and I'm saving that last statement for my exit interview... all of the above I say and do on a daily basis.... I'm not fighting the masses anymore.