Saturday, March 25, 2006

when being right is wrong

Sometimes you will have a patient who is violating certain parameters or well "being sick" and you have a choice of treatment. You can feel in your bones that your choice of treatment is absolutely right, all prior experience says "this is the right call" and you can end up being horribly wrong.
I hate it when patients do this. I blame them entirely for being so contrary , so stubborn to respond to a well known obvious treatment by promptly trying to die.
A lot of time there is no good reason for their response but other times you find out that the information you were basing your decision on was faulty.
A surgeon or a doctor made an assessment that was wrong. They didn't bother to take the next investigational step or they misinterpreted what they were seeing.
If you start with the wrong information you will ofcourse continue to make wrong choices...and that sucks.

Being a nurse I can only suggest a course of treatment. I cannot order anything and in all honesty I cannot stop a doctor from making a wrong choice. I can refuse to carry out an order if I think it is harmful but I cannot stop the doctor from doing it himself.
Weird imagery of wrestling a doc to the ground right now.
It's weird to have so much responsibility for the outcome but absolutely no power over the treaments.
I used to fight against this, rail against the limitations of my profession. I was endlessly pissed at bad decisions. Now I realize I can only do what my profession allows me to do. I have to find contentment in doing my job and stop worrying about how others do theirs. Even when they screw up so badly I want to scream and quite possibly whack them over the head and wear them as a coat but we'll get to that later.

I wanted to write today about how dumb patients have become. Despite all the talk and hype patients still don't bother to find out anything, They never bother to ask any questions. They read their little pamphlet or watch the five minute video and their only concern is "will it hurt?"
A hysterically dumb question..ofcourse it's going to's surgery...
They never ask how long will I be ventilated? What does ventilated mean? What is a chest tube? Can I see one? What are all these IV's? What do they do? How am I going to pee? Why can't I get out of bed to use the bathroom two hours after surgery when I am ventilated?
Why can't I get morphine every five minutes until I am unconscious for the entire duration of my hospital stay?
Why do I have to cough? Why do I have to get up, feed myself, bath myself when I am on the ward..isn't that the purpose of the nurse? Why can't someone else be responsible for my recovery? Why can''t they do everything for me and let me lay motionless in the bed for a week?

If you knew that moving made you feel better, that coughing prevented pneumonia and independence is the evidence we look for to allow for discharge you would feel better and stop thinking we were trying to torture you. If you knew what all the wires and tubes did it would be less scary and you would feel more confident, hell maybe you would recover faster.
Patients want to stick their heads in the sand so they can have the option of saying "no one ever told me, it's all your fault this happened". We can only offer up so much education..patients need to join in and become a part of the equation.
And stop lying to us..if you didn't quit smoking don't write down you quit. There is nothing worse than trying to figure out why someone is all over the bed, irritable and antsy only to find out they lied and now are in nicotine withdrawal.
If we had known we could have slapped a patch on you and skipped the freak out.

At work I am compulsively neat, everything must be at hand, organized and tidy. At home I am a slob. I cannot reconcile the two me's. I just know I cannot even start working if my bedside is disorganized. I see some nurses who are slobs and it irritates me. I worry that something will happen, like it did a little while back and I wont be able to find a damn thing. I was frantic and furious and thought about it later. I am a control freak...that's my thing, not theirs.

I am ashamed of my country for whacking baby seals over the head for their furcoats. What kind of asshole would wear a baby seal coat? Do you wake up in the morning and say to yourself "oooh dead baby seal..must wear the dead baby"?
I think if we all made a pact to whack anyone wearing baby seal over the head the hunt would stop. I think if all day complete strangers came up to you and whacked you really hard it would change the way you thought about how you dress.
It wouldn't hurt if some brain trust thought maybe we could make more money dragging tourists out on to the ice to see baby seals than whacking baby seals. It worked with the whales , so why not give it a go?

What kind of world is it when we are murdering babies?
I don't care if you and your children starve , whacking baby anythings over the head to make a living is EVIL. In fact I hope you and your whole family do starve..We don't need you in the world.....what the hell is wrong with you? Why not get a real job? How about getting a highschool diploma? You could be the first one in your family to do it.
Canada sucks and so does the Prime Minister for allowing this to go on.
The only bright spot is the ice is very thin, let's all hope the evil ,stupid bastards fall in and get eaten by pissed off baby seal mothers.


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