Have you ever been in a situation where you let someone's opinion influence your opinion before you have even been able to make an assessment yourself?
I think that might have happened to my yesterday.
My day starts with answering a callbell even before listening to report. A frail patient in Room 1 asks me for another blanket. "Of course" I come back with a warmed blanket put it up against her shivering body and cover her with the remaining linens. She tells me that feels wonderful and asks me my name and if I going to be her nurse today. I tell her my name and inform her I have just come on shift and I have not yet been given my assignment, that I am just going to listen to report after report her nurse for the day will be in to see her. She settles and off I go.
As I leave her room I wonder what's her story. She looks sweet and gentle, enough, maybe a bit unkept, and frail. Why is she here?
Then comes report. Drug overdose is the admitting diagnosis. Was found passed out in a vehicle and someone called 911 and she was brought into ER with decreased level of consciousness(LOC). IV started, catheter insitu, and put on cardiac monitor, and up to ICU she goes.
Glasgow coma scale (GCS) 7 on admission improving to 12 by 0600 assessment. The report I got is that she has a history of illegal drug abuse along with prescription drug abuse and apparently was in ER 4 days ago, and put in 4 point leather restraints. Not a good report and I say to myself, what am I going to be faced with today.
As I was heading towards her room she calls again. I say to her, "well lucky you I am your RN today" We have a pleasant enough chat while I am assessing her. But all the while I am thinking....are you telling me the truth....how much of what u are telling me is fabrication...what really happened last evening. During this time her GP arrives, and assesses her as well. The GP and I leave the room. He tells me that is was not an intentional OD but rather a situation of all of her medication being on board and that she needs to stay so he can sort them all out and figure out which ones will work best for her. Sounds like a plan to me.
She calls again, and into her room I go. "So I get to go home and let my cat in" Yes, the doctor has given you a supervised pass to take care of personal business and that you must return by 1400 hrs. Of course she responds.
My antenna goes up and my gut starts to tell me there is something just not right here.....I ask her about how she manages her medications at home. She tells me she uses a dossett and that she pre-pours a weeks worth and then throws the bottles around the room so she won't take extra. Hmmmmmmm......antenna up higher now, doesn't sound like normal behaviour to me. So I ask her, if you take today's dose in the morning and in the afternoon u go to your dossett and see that there are no pills in the dossett for today are you convince you have taken your meds. No, I take more was the answer. Hmmmmmmmmmmmm....... On her previous admission she was positive for all kinds of drugs, so I ask her straight out...do you use street drugs? NO was the response I don't drink either.....hmmmmmmm. I was working at trying to build a trusting relationship with the patient, so that she would feel comfortable enough to come back from her pass. The time comes for her pass. There is no one there to pick her up...she says she has to go downstairs that they will meet her in front. I am not confident that this is the case. But I can't hold her, I have her sign the daypass form and say...."See you at 2:00"
My colleagues all say she won't be back. No I say....she will come back...I told her 1400 hrs. It's 1350 and no sign of her. Then the call. It's her. She says she can't get a ride back until 1800hrs. Hmmmmmmmmmm.....I make the shift supervisor aware. We decide to give her until 1900, shift change. If she doesn't come back she's lost her bed. I make her GP aware. She'll be back I say to myself. My colleagues are joking with me now.. asking me what planet I am from. It's 1820 get a call from her GP asks if she had returned. No. It's 1840, call from GP he tells me he has contacted her and that she will be in within the 1/2 hr....she had to arrange a ride. HMMMMMMMMMMM ....heard that one this morning. It's 1900 my shift ends. She has not returned.
I so wanted to prove them all wrong. I wanted to prove myself wrong. This pre-conceived notion that she could not be trustworthy, that she would not follow the plan, that she would not return. I wanted to believe she would come back. Even though I was being fed this notion that she would noncompliance.
Naive? Maybe....I just wanted to have faith in her.....I wanted to believe what she said .....but that notion given to me in the morning that I should take what she said with a grain of salt reared it's head. Could I have done something different?
5 comments:
Nope you couldn't have done anything different. No matter what you would have done she still wouldn't have come back.
Its a shame Mary Anne that some peoples lives are so messed up. You did all you could and you tried to trust her.
well FINALLY, i'm able to get through here.
so, when i first read your post, i almost burst into tears, because the woman you describe here could be any one of 100 of my clients in the past few years. and i was reminded of one in particular, a woman younger than me; and i was the only staff who would challenge her when she flew into one of her alcohol induced psychotic rages. When she calmed down, she always came back and apologized, BUT, she would also wander off, and we would get calls from the hospital when they found her beaten up,(they knew where she came from because she would have her social carry meds with our facility's name)...eventually she went into a long term care facility and i have not been able to visit her for a couple of years now...but i have a soft spot for her. Unfortunately, hospital staff are overburdened with people with addictions who they see over and over and over again, with no reason to believe that there is any hope for improvement.
Unfortunately, the stark reality is that the drug of choice is more compelling than any relationship they might foster, or a friendship we might like to offer.
Their friends have given up on them, their parents/children have given up on them. The only reason we don't give up on them is that we are being PAID to be nice to them. I remember another client saying this to me: "You are not really my friend...you're paid to be nice to me." And there is the rare person to whom this horrible truth does not apply...also the sad thing about people with substance misuse issues is that when they DO become abstient, when they "fall off the wagon" their systems are not used to having drugs and then on a dose that would not even have bothered them three months previous, this same does is enough to kill them. So often, when women who have been "clean" (I hate the way we use this word) for 6 months relapse, the high likelyhood is they misjudge the dose, and accidentally take a fatal overdose.
i think part of the reason i have become ill myself is burnout through lack of self-care...i feel things too acutely, and my "heart" just cannot take it anymore...it just breaks my (emotional heart) because i know that there is very little hope for recovery for these "older" women who have been addicted for so long. It is not that you can't trust them, it is that when they are in their craving mode that is ALL they can think about....how to kill that psychic pain, how to fill that emply hole, and they choose the quickest, easiest and most familiar method! *sigh*...i know how frustrating is must be for emergency room nurses and doctors...but what can you do? well, i think you can only do the best you can at the time...look them in the eye, let them know you care, and for those few minutes that they pass through your life, that is all you CAN do. I forgot who it was who said: "One Look, One Word, One Touch Can change your life forever"; you don't know, but the time you spent with the patient in Room 1 will probably hold with her forever your face and the treatment you gave her, and you may never know what positive effect it had on her, but you can be SURE that she somehow remembers you fondly. And that is all you have. And there will be many more just like her and you cannot grieve for her, you just have to accept that you did the very best you could.
sorry for such a long comment; i guess i could write a book on this eh?
Your story is heartbreaking. There but for the Grace of God goes any one of us?
I grew up in Port Alberni, and Qualicum is one of my favourite places on the entire planet...! It's absolutely beautiful there.
Even though there was nothing different that you could have done...
Keep your soft heart.
Don't let it get hard.
later...
Hi there Mary,
Got your comment, thanks for stopping by again....i left you a rather lengthy reply at my Blog.
hope you have a less challenger day today/tomorrow (??)
Take it easy,
cheers for now,
pj
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