Friday, August 21, 2009

Listen to the Patient: Reflections from a Tuesday at Grady

serendipity: (n) the faculty of making fortunate discoveries by accident.

(n) the faculty of making not-so-fortunate, ironic, Murphy's law-type discoveries by accident. (my definition)

"Take these damn ties off me right now before I jump out of this bed and kick somebody's ass!" this agitated gentleman yelled in my direction. He was in the first bed in room 15, and I had to pass by him to get to my patient in the second bed. "Yeah, YOU, nurse, doctor or whatever you are! I'm talking to you." I guess he recognized my looking over a shoulder as a "you talking to me?" gesture.

"Sir, I'm not your doctor, but I can get your nurse," I calmly replied. Nice, but not condescending. I have learned that pouring on the kindess is the way to go in these situations.

"Well dammit, go get her right now, then. Find my damn nurse and ask her to get my damn doctor! And get this lady out of here!" he screamed back while pointing to the nurse's assistant seated next to his bed. She'd been given the delightful task of serving as a one-to-one "sitter" for a patient that was probably psychotic. "She's plotting against me! You probably part of the plot, too!" At that point, he began thrashing his hands all about in a futile effort to remove the four point restraints that had likely been placed on his limbs for safety while in the emergency department.

"I'm really sorry you're upset, sir," I carefully offered, "I'm not your doctor. . . but as soon as I finish with my patient in here, I'll try to get you some assistance." He didn't like that too much as exemplified by the litany of hard-core expletives that soon followed. He even heaped up a nice, big loogie in his mouth that he then hocked across the room, just narrowly missing me as I slid around the pink curtain separating him from his neighbor. Eeeeeewww.

You'd think that I would be really shaken up by such a thing, but admittedly, I'm not. This was clearly a patient with an active psychiatric illness complicated by something medical--which is why he was on our floor instead of the psychiatry ward. Not an unusual occurrence at Grady, and definitely not one that I felt particularly threatened by. When I first started doing this, I probably would have been somewhere between mortified/afraid ("Oh my gosh! What if this guy gets loose?") and angry/mad ("Oh no he DIDN'T just try to spit on me!! Oh NO HE DI-IN'T!!!") Now, I know how complicated psychiatric illness can be, and I've learned not to take any of this personally. I've also learned how not add insult to injury by further agitating an already agitated patient.

I examined the patient in bed two, and hoped to tip-toe past the loogie-hocker without getting called a female dog or being nailed with some other kind of bodily fluid. He had been ranting the entire time I was in there, and as soon as he saw me again, he focused his attention back on me. "If somebody don't get me out of here, I'm gonna call Mayor Shirley Franklin and President Obama!" (He really meant that.) He tried to grab the phone, but again was limited by the restraints. He glared back at the sitter. "And get this heifer out of my room!" This time I decided not to bite, as I knew it was all a part of whatever had him hospitalized. Instead, I just looked at the poor nurses' assistant with an expression of pity. It was only 3 pm. Boo, it's going to be a loooonnnggg shift, I thought while raising my eyebrows and shaking my head. I quietly left the room.

I could still hear the agitated patient hollering at the assistant as I stood by the nurses' station some twenty minutes later. I did, at least, keep my promise and told his nurse that he needed some assistance.

About 18 hours later, I returned to the wards the next morning to round with my team on the new admissions. The first thing I heard when I walked up was the booming sound of an angry and impulsive male voice. I winced with every profane word that escaped the door to his room. That unfortunate young nursing assistant from the day before came walking down the hall toward me. Another "f-bomb" came flying out of his room, and we all cringed once more. It looked as though she was heading to his room when we briefly made eye contact. "Lord, have mercy!" I said while placing my palm over my chest, "You're assigned to him again? Bless your heart!" Feeling bonded by our shared spit assault, she placed a hand on my shoulder and happily reported to me that today he was under another assistant's watch. We then collectively chuckled as I added, "Phew! I was about to say! Did y'all ever reach his doctors? Whoever it is, they definitely have their work cut out for them!" My team looked amused as they all shared knowing glances and grew quiet. It took me a few minutes and a few snickers to catch on. Finally, I opened my eyes wide and covered my mouth. My intern nodded slowly. "You've got to be kidding me!" I said with an incredulous gasp.

Nope. Not kidding. It was indeed true. After all that, I was his doctor after all. See, if I had just done what he'd initially asked, that is--"found his damn nurse, and told her to go get his damn doctor"-- I would have found out that the "damn doctor" he was looking for was me--close enough for him to spit on--literally.

Take home message: Never underestimate the power of Grady pseudo-serendipity. Oh yeah, and more important, like we tell our medical students over and over again like broken records: Listen to the patient.

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"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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