There are many things any nurse will admit she/he has said to a patient that were half truths. And some just flat out lies. There may have been, for example, one time when a patient had to be rushed off to surgery and I told the family that the surgeon in question was excellent and the patient was in great hands. I had no freaking idea who that surgeon was, and all I’d heard was that he was kind of an asshole. But truth be told, death was pretty imminent for this patient without a trip to the OR so… did it matter?
“Shoot, I’m so sorry but we are out of sprite, the cafeteria isn’t busy right now if you want to try there,” since I’ve already brought you three in the 45 minutes you’ve been here and I’ve got shit to do that actually has to do with medical things.
“Oh I agree that Dr.’s bedside manner may not be the best, but I can tell you she is great at her job.” This is painful to say to patients when their doctor sucks but I only reserve it for people who come to the ER for non-emergent shit that a monkey could take care of. (Or anyone at home with a basic first aid kit and common sense.) If someone is actually sick and their doctor sucks I manage that shit without the patient or family member knowing otherwise, and encourage them to ask a lot of questions…
“My name is Stephanie.” I have a best friend from college named Stephanie. This is my go to name when I turn my ID badge around. Or just take it off. Because if you ever get that feeling you should lie about your name to a patient, do it. I don’t do it often but sometimes it’s necessary. Recently a patient came in by ambulance with a chief complaint of “a bad hang over.” He was my age. (Old enough to know better). The medics were furious. The patient’s family paraded in and crammed themselves 8 deep into a small ER exam room. His mother was there, she was worried about him because after all, it was her couch he’d been living on for 4 months and today he seemed quite lackluster compared to all the other late morning hangovers. Something told me to take my badge off. His mother inquired if I was single, if I had children, how old I was, etc. I realized why he looked familiar- we graduated from high school together. He had lost all his teeth but I still saw the resemblance to a guy in my history class. He flat out asked me where I went to high school. Oh the lies I scrambled for in my mind… military family, moved around a lot, I’m not from here, marines… yes my father was a marine, uh shit…Camp Pendleton, and yes… Maryland! We also lived in Maryland and… Virginia? Yes the fall colors are beautiful there. No I don’t have an accent. Get me the fuck out of here.
“You’re going to be okay.” This is the worst thing to say to a sick patient. It’s the kiss of death. People usually ask this question when they are very scared and very sick. In the early days of my career I told this to an elderly woman in heart failure that we had to intubate. I was the last person she talked to, which is often the case in the ICU. And she of course was not okay. I stopped saying it to patients, unless they were a scared child needing stitches or something non-life threatening. Recently I slipped. A man, Dave, came to the ER for what he called “a little shortness of breath.” His wife was giving me that look of concern that he had blown her off for days. He was breathing pretty hard but trying to casually talk through it. I got him on the monitor and his heart rate was 160. Okay we can deal with that. We tried the usual things, his heart rate came down a little but not much. It was a Saturday morning, they were watching a show on PBS in the room when my friend Beth, another nurse, came in to see if I needed anything. She commented how she liked the show and Dave said we should all be at home drinking coffee and watching PBS. We joked around that I had finally put my hair up in bun so I must be ready to actually work. Dave and his wife laughed, and although he “seemed” fine I was wondering if he needed BiPAP. Beth walked out and I went about tidying up the room and chatting with Dave’s wife when I heard it. “I don’t feel so good…” He had a run of V tach. About 10 beats but that’s all the warning I needed. Luckily there was a code cart in this room. I pulled it over to the bed and took the plastic cover off and as soon as I turned around he said it again and the alarm went off. His color went gray and I knew this V tach wasn’t going to stop. I jumped on his chest, started CPR, and yelled for Beth as loud as I could. If you don’t work in healthcare you would assume one calls for a doctor. But I call for Beth. She is a badass even though she will never admit it. I heard her usual “Aw fuck” from the door seconds later. And then the usual milieu of people came running in to help. We shocked him twice and got him back before intubating him. He was in profound pulmonary edema and I sat him upright. He was diaphoretic and gasping. My face was inches from his. I explained we needed to put a tube down his throat. He said okay. And then he asked me the fucking question. “Am I going to be okay?” And against my better judgement I said “Yes Dave, you’re going to be okay. I put my hair up, remember?” And he smiled. And so did his wife, who had been sitting quietly and surprising calmly through the entire event. But at that moment I needed him to be okay. I needed him to be able to go home and watch PBS on Saturday morning and drink coffee.When I admitted what said to my colleagues they all groaned and called me an asshole. Surprisingly, he ended up going home after about 10 days. He was okay. But I don’t ever want to say that to a patient again. I should know better.
I’ve said a lot of inappropriate things to patients, mostly being funny and only when they themselves had breached the boundary first. And I never say anything sexual, ever. That goes nowhere fast. There was one particular time I said something really inappropriate to a patient out of sheer annoyance and to get him to shut the hell up. He was a military guy, probably 6’4″, very muscular. You would look at him and think he was tough as nails. No. Super pussy. He hyperventilated when I took the tape off of his IV dressing. He requested to be given valium and a norco when he had his PICC line dressing changed. I could go on and on. It was ridiculous. He was in the ICU for an LVAD work up. Seriously? How the hell was he going to deal with that? It’s probably one of the biggest surgeries anyone can have. And he screams at tape coming off his hairless arms. So he had a PA catheter in his IJ. (A huge IV in his neck for those non medical peeps). I had to pull it out. I gave him all the meds he requested and agreed I would come back in an hour to take it out. It was constant bargaining with him. He reminded me of my 2 year old. For anyone feeling sorry for him- don’t. He was like this about everything. Had to have his blinds adjusted just so, the tv at just the right volume, the right ratio of ice to shasta. He could have done all these things himself, mind you. But he preferred someone else do it for him.
I came back at the agreed upon time to take out his line. Mind you, there’s a big dressing on it, but anyone familiar with these will tell you those dressings adhere for a solid 3 hours and then have to constantly be reinforced. So it’s not like it’s super glued. He started kicking his legs all over the place and exhaling through clenched teeth so saliva spat out. Give me a break. I tried to calm him and talk him through it. More writhing on the bed, yelling “ARGH!” at every slight pull of tape. Finally he said “well how about every time you pull the tape I pull that ponytail on top of your head?!” Oh fer fuck’s sake. I couldn’t deal with him anymore. I put my hands down , looked him straight in the eyes and said “I just had a baby. My vagina ripped open to my butt hole. I don’t have much sympathy for you right now. Suck it up.” I removed the line (and the tape) without so much as a peep or single squirm from him. I don’t think there are many guys that would have a response to that statement. He was quiet in his room the rest of the day, and I imagine he was trying to un-see the image of what a 4th degree tear must look like. I probably traumatized him from watching the births of his children later in life. It was probably THE most inappropriate thing I’ve said to a patient in my entire career. I’m not gonna lie, it felt great.