Lies and Other Inappropriate Things I’ve Told Patients

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?

Other lies:

“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.

B*#ch Better Have My Lamp

I went through both of my pregnancies while working in the ICU. Being tired and hormonal while working around death and severe illness has its challenges. The breaking point was towards the end of my second pregnancy when I came into the unit one morning and heard someone singing. It was a female voice, not particularly good but not really that bad either. It was just a high pitched melody that I felt vaguely familiar with but couldn’t place exactly. My patient was next door to the room where the singing was taking place. The curtains were pulled and I had noticed on the main monitor that the patient in the singing room was pretty bradycardic. So yeah that pretty much summed it up: slow heart rate, singing, curtains pulled = someone is dying. I went about my business with my patient next door and the singing stopped for a while, then picked up again. It was a slow morning and I kind of kept to myself, not really inquiring much about the singing room except to say to the nurse with a nod “So, withdrawing care in there?” She responded with “Yeah, kinda sad story- Oh shit! I forgot to put up the sign!” We had these lotus flower signs that we hung on the door when someone was passing away to alert staff (mostly me and a couple other staff members) to keep their voices down around grieving families. When my own grandmother was passing away I still remember wanting to scream at a nurse who was talking loudly for hours about her son’s bitchy girlfriend. And years later I understand how this happens, in a patient room it’s one environment, and in the hall and nurses’ station it is our home away from home. I never want to be that nurse, but alas, I’m sure I have at some point because, well, I’m kind of loud.

So lunch rolls around and I cover the singing room’s nurse for her break. I get the story. The patient was a woman in her 70s who had a massive stroke the day before. She was on comfort measures and the singer was her daughter. The monitor in the room had been turned off at the daughter’s request and she had asked that when her mom’s heart rate started to drop that someone come tell her it was time. Morphine drip was going but not being titrated, the patient was comfortable from what anyone could tell. Good enough. I parked my 8 month pregnant ass at the desk near the monitor and wouldn’t you know, I watched her heart rate drop from a solid 40 to 38… 35… pause…35…pause…32… shit, now I have to go in the room. Keep your shit together… I opened the door and I saw the singer for the first time. She was in her early 50s with shoulder length blondish grayish hair. She had on jeans and flip flops. She didn’t look stressed or overly sad when I told her that her mom’s heart rate was dropping, just accepting and sentimental, like the way one looks at christmas photos from 20 years ago when the family still got along and hid the dysfunction. I asked if she needed anything, she smiled and said no. As I closed the door behind me the singing started again. I still couldn’t place the song, but it sounded like one a mother would sing to her child.

I walked straight to the bathroom and lost my shit. I’m not a huge crier but sometimes it gets to you. I held my ginormous pregnant belly and hoped that someday my daughter would still love me enough to sing me songs on my deathbed. All I could think was that the ICU was getting to be too much for me, it was too sad. Maybe I should work in a clinic? Or Starbucks?

Thankfully the singing room’s nurse came back a little early, so she didn’t pass away on my watch. I ended up walking out to the parking lot that night with her nurse, and while we were commiserating on which physician/nurse/aid had irritated us the most that day she blurted out “Can you believe that woman today? She had 6 kids and that daughter was the only one who showed up.” How was this possible? Well, it turns out that woman who lay dying while listening to the sweet song of her daughter was a huge bitch. I mean huge. She had abandoned those 6 children at young ages and ran off to god knows where. Just didn’t want to be a mom. She came back eventually when they were adults but it didn’t sound like there were many open arms to welcome her. Then she became a bit of a hoarder and kept her family heirlooms meant for other people. She lied, stole, and in general was an angry, bitter person. One particular story the daughter shared was of a niece whose mother had passed away and left her a special lamp. This lamp somehow ended up at the patient’s house. She had a huge garage sale and a family member happened to come over and saw numerous valuable heirlooms (including the lamp) strewn carelessly on the front lawn. The family member confronted her and it got messy. The niece was alerted and called her, pleading for this lamp and saying she could come into town over the weekend to pick it up. She was told “Too bad, it’s already been donated to Goodwill.” Her whole family knew she was dying and the singer was the only one that showed up. Who knows what was being said behind the closed curtain in between the songs.

And like I said, I’m not much of a crier. A lot of people grieve in the ICU, and I try my best to keep my shit together because it can be really heartbreaking. Oddly, I may have been the only one who cried about this bitter woman’s passing. Her daughter allowed her to have a beautiful death, much more than she apparently deserved. After the nurse finished telling me all the sordid details, I laughed and said “What an asshole.” And I knew that I wasn’t going to have to work at Starbucks after all, at least not for a few more years.

So let’s reframe this…

Ok I’ll admit I had the best intentions when I set up this blog. What I had in mind was a professional sounding (no curse words) discussion of how to elevate nursing back to the high achieving, intelligent, and caring profession it was when I started out. Or at least what I perceived it to be at one point in my career. I was inspired a couple months ago when those Chatty Cathys on “The View” made idiotic remarks about nurses and the whole nurse community banned together in a way that revitalized everyone’s motivation to improve our profession. I’m not gonna lie, that was pretty impressive. The facebook page for “Show Me Your Stethoscope” had something like a million members within 4 days, and people were going nuts. I thought we were on to something. But a week later I had to adjust my facebook feed to block the site because all I got were ridiculous before and after weight loss photos, images of odd medical related tatoos, and people doing numerous futile surveys: “Roll call everyone! What’s your educaton – ASN, BSN, MSN? And what state are you in? GO!” I was also surprised to discover many health care professionals don’t know how to spell stethoscope despite the spell check included with most any electronic device these days.

So back to the old grind it was. And I thought about how much nursing was beginning to beat me up. And I even considered (for a very short time) following up on one of the many opportunities my new facebook friends from the stethoscope site offered me… Nerium, It Works!, Rodan and Fields, Young Living, etc. Yes I actually got private messaged about these wonderful opportunities to be my own boss and leave nursing behind forever. But it wasn’t for me. Here, is what I realized, is also not for me: a professional sounding (no curse words) discussion of how to elevate nursing back to the high achieving, intelligent, caring profession it was when I started out. Fuck that.

Nursing is great and nursing is fucking horrrrrendous. It kicks your ass almost daily. It drains you to the point you don’t want to talk to your family members about it because you have nothing left when you get home. And it sucks that when my 3 and 4 year old run up to me when I walk in the door they know not to hug or touch me until I take off my “yucky work clothes.” Because dammit sometimes all I want to do when I come in the door is hug them tight. I would love to be able to unsee half the shit I’ve dealt with. In my ICU career I have dealt with more shit (literal shit) and dead bodies than anyone not living in a war zone can imagine. And my ER career? Don’t even get me started. It ain’t pretty people. Oh yeah and let’s not forget about our administrators, because they are sooooooo helpful when I work 13 hours straight without a lunch break – again – and I’m not sure if I’ve peed or not. But dammit I better have my white board filled out and ask my patients what “Excellent Care” means to them and what their goals are today. Uh. Yeah.

At the end of the day it’s the funny shit that keeps me and I think a large percentage of us going. Because there is so much negativity in nursing- the death, the tragedy, the life changing diagnoses, the anger, the assholes (literal and figurative). If I can laugh I can be kind. Like the 82 year old woman who came in on BiPAP dressed immaculately and smelling like roses with perfectly coiffed hair… when I was trying to pronounce her last name she pulled the mask off her face and said “It sounds like “sex a lot”, you’re never too old honey! Just call me Maxine.” Her lips were purple by the time she got all of that out. And I loved her immediately. I also had a woman who brought in her daughter for really stupid shit but then proceeded to wander around the ER and ask 3 different staff members for a maxi pad. AND put on her call light to ask again. Then proceeded to tell me that “it’s only just a little brown spot right now but later today I’m sure it’s going to cut loose”. I didn’t love her. But we sure did laugh about that for a couple hours.

So yeah, I’m going to reframe this site a little bit. There is probably not going to be any elevating here. And my ideas of high achieving since the beginning of my career can now be considered survival skills at this point. There will definitely be curse words, because the term “cuss like a nurse” didn’t just invent itself. Mostly, there is a lot of funny shit when dealing with humanity in a stressful time. And there is beauty when encountering individuals at their most vulnerable moments. We need both to survive this career.