adventures in disaster

Seething

So I had a patient the other day and he was, to put it baldly over the top. He was angry. Unfortunately I didn't realize he was really, really angry. I had walked into an argument I didn't know I was having.
I think we all have had that experience, with co-workers or family. Well, the passive aggressive ones who would rather seethe and exude sarcasm rather that tell you what is making them really angry.
So this patient was in a mini rage about water. He wasn't allowed to drink any more because he had mistakenly been given over a liter and half of water and he was just out of major surgery. Anyone with a little medical training knows that in surgery you get fluid overloaded through your IV's and that anesthesia will slow or stop your bowel function for a short time. So drinking a gallon of water can make you very suddenly very sick with some spectacular projectile vomiting or worse it can stress your heart and cause heart failure making it very difficult to breath.
So we strictly control your water, or we should.
I did not realize that withholding excessive drinking would send this guy over the edge.
It was the first time I have been called a Nazi bitch.
To make matters even worse this guy had some breathing problems . He was becoming so sedated with the massive amount of pain medication he kept demanding that he was breathing very poorly.
I had to ask him to do some breathing exercises.
Now, keep in mind he had already called me a Nazi for not giving him water, so yes, he really handed me my ass over the breathing exercises. I stood there while a barrage of hate rolled over me. He finished up by telling me to go fuck myself,
I ofcourse did the only sane thing possible and gave him another dose of pain medication and a drink of water. Well...he hated me even more for that.
An hour later I had to do an ECG. At this point I no longer cared and I just wanted to get it over with. He continued with his campaign of "wow you are an incompetent bitch with a terrible attitude and you should find a new job cause you suck at this".
I told him why in very clinical terms why I was required to do what I had done. He laughed at me, called me a bitch and again told me to fuck off. I gave him more pain medication.

Now a lot of people would think from this story that this patient was a monster. They would think that I had every right to be offended and cold.
I don't agree.
I failed this patient. I wasn't paying attention to what this guy was trying very hard to tell me. He wasn't angry about the water or the pain medication or even the breathing exercises. He was pissed because he had lost control over his life. He had entered a hospital and we had taken his rights away. That is what was scaring him and that fear made him angry.
He kept talking about "I'm not a baby" and that should have been my clue. I didn't pick up on that and I failed him.
I was cold and clinical. I offered him all the right reasons for why he was being denied the things he wanted. I gave him my intellect but I forgot my empathy.
I thought it was enough that he knew the reasons for things. He didn't care about the reasons, he wanted reassurance that he would get his life back, his autonomy. The right to drink a glass of water when he wanted it and not when I said he could.
He felt bullied and that is my fault.

Thankfully he was a different man a day later and apologized and I apologized to him too.

A hospital is a scary place. Because I spend most of my time there I have lost all fear of it. I forget that for some people they have never been inside a hospital and it's all terrifying.
Sure that patient should have refrained from calling me foul names, that wasn't cool at all but in some way I may have pushed him to it. He wanted some response, even if it was anger and I couldn't even bother to give him that. Though I am pretty hard to piss off, most of the time I find the drug fueled ranting of patients kind of funny. They can be incredibly inventive with the language and hearing an 85 year old little old lady curse like a whore is pretty fabulous really.

A non response or a practical, clinical response can trigger even more anger. It puts even more distance between health care provider and patient. It reinforces that "I have control here" thing that is terrifying them.
I cannot say I will never do this again, I hope I wont and I will try very hard not to but honestly sometimes you get tired or busy or overwhelmed and you just hold on to doing what has to be done until you get to go home.

posted by adventures in disaster @ 10:15 PM