The Intensive Art

Spending a total of twenty-four hours within a two day period caring for a patient that chips away at your very will to be a nurse is, well, horrible.

This patient has been with as for a month and a half. She had a medium acute surgery that took her about a week to recover from and be declared ready for home. Unfortunately, she didn’t have a home. She was put on a waiting list for a long-term-care facility, and as a result, has been with us for five weeks waiting for a spot; taking up an expensive acute care bed; tormenting us. She is not any closer to finding a spot in LTC.

I said to my patient care manager yesterday, “Isn’t there any way to try and quicken her transfer. She’s REALLY upsetting the nurses here, and we’re at the breaking point.”

“Maybe we can discuss some strategies for dealing with her personality!” She replied enthusiastically.

“We’ve tried niceness, meanness, and everything inbetween. This lady is the master manipulater, and as such, she’s impossible to manipulate.”

Unknowingly, others had been listening to our conversation and I heard a chorus of “I agree” and “It’s true, we’ve tried everything.”

This was interrupted by the intercom going off, it was the very same patient. We all heard her voice; she was screaming, “I’M HOT I THINK IT’S MY THYROID SOMEBODY HELP HELP HELP HELP!!! I’M SO HOT HELP HELP I NEED A FACECLOTH”

I found her in her bedroom looking just fine. She had covered her head in wet facecloths. “Are the facecloths helping?”

“Yes, but I need a dry one.” She has stopped yelling and bursts into crocodile tears. “Nobody cares about me, nobody cares if I just drop dead, everyone ignores me. All they care about are other patients.”

I was tired of fighting with her. Speeches about what is an emergency and what isn’t, why she (a healthy person) doesn’t get as much attention as fresh post-ops, why she’s too healthy for us to be doing things such as fetching facecloths, just haven’t worked. Even hearing a lecture from her roommate about her manipulative attitude didn’t work. So, I just went and got a facecloth. We were all out of facecloths, so I brought a regular towel to her.

She went from melodramatic tears to angry tears, “Why would you bring me this? I asked for a facecloth and this is a towel, how am I supposed to use…”

I cut her off, “…Ms. Notherrealname, it wouldn’t matter what I brought you, nothing would make you happy, so just deal with it.”

She is capable of doing all the following on her own: Walking around the hallway, getting herself tea from the kitchen, getting up to the bathroom, moving herself in bed etc. However, she refuses to do anything on her own. Any attempt to encourage independence results in what I have dubbed her “manipulative sequence.”

First she plays a victim and gives a complete medical history including her non-existent emphysema, constipation, her slight back pain that magically developed moments ago. “Oh, the things they’ve done to me, I can’t breath in this room, and my surgery made me constipated, and how can I walk if I’m so tired all the time.

Then, when that doesn’t work, she tries anger. “I can’t believe the way people treat me here; I’m always ignored. You’re such an evil whore. I’m treated like a dog–no, worse!”

And when that doesn’t work, she’ll try kindness. “Oh, deary, you’re an angel sent from heaven, you have such patience to help me to the bathroom. You’re much better than those other nurses, I’m sure you won’t mind helping me a little bit.”

And when that doesn’t work and we still tell her that she needs to do everything on her own, she’ll just go back to crying. Going to the bathroom takes her almost an hour: fifty-five minutes of that are spend complaining and manipulating.

She is an attention seeker. If nobody has talked to her in awhile, or if she feels her roommate is getting too much attention, she’ll make up a problem (see thyroid issue above).  Yesterday, we heard “HELP HELP HELP HELP” coming from her room.

I run in, and she says, calmly, “I’m choking, I can’t breath, call a code blue”

“You’re talking? And I’ve just seen you take three large breaths! And you’re not even coughing.” I have a puzzled look on my face.

“This is a medical emergency and you don’t even care, you’re just going to let me drop dead.”  She is in tears once again.

Multiply this by twelve hours a day, two or three days a week, over almost two months. I was nearly tearing my hair out yesterday–poised to refuse caring for her ever again. I’ve had enough!

Any advice on dealing with a patient like this? I’m at my wits end. It’s come to the point where everyone just ignores her because if we do, she’ll get up and do things on her own. But nobody wants to ignore her! Nothing we have told her has convinced her why independence is important for her. Every comment is just responded to with complaints and manipulations.

*sigh*

This entry was posted on Wednesday, November 14th, 2007 at 11:27 and is filed under Musings. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.