Monday, July 4, 2011

Too Sweet

"Hey, can you go to pedi side and find me numbing cream so I can start an IV?" A nurse asked me.
Uh, sure... it was an odd request, but interesting. I came back to see the child it was for.
Just kidding, it was for room 9, a man in his 60's. The nurse and I walked in to see his glaring face.
"Now I'm gunna tell yous right now, I ain't gonna be nobody's pincushion. There won't be no stick stick stickin', you got that? I won't do it without numbing cream, so yous better go and get it now. And after this, tell the doc I'm ready to go home."

"Well, sir, I just brought the numbing cream. Please be patient with us because we're trying to help you." I said in my most calming voice. He glared.
Oh boy.

The patient has a baseline blood sugar of 400mg/dl every day. For normal people, the range is 70-100mg/dl. He came in today because his sugar hit over 500. Having such a high baseline is extremely dangerous and can cause raging infections and organ failure. His limbs were swollen to at least twice their size, scaly like old tree trunks, and darkened, like he had stuck them in molasses, then Oreo cookie crumbs. There were numerous open sores, like ulcers, pink and unlikely to heal. He didn't seem to care, though, and thoroughly resented being in a hospital. "I'm fine," he snarled, "can't wait to sign myself out of this ****hole."

It was already late in the evening, almost 2100, but in trudged some family members and a young toddler as we were going to begin the process. He ignored us now (thankfully) and started cooing to his grandson.
Grandpa: "Come 'ere. You's a bad boy, y'know that? A bad boy. But it's ok, if anybody messes with you, you say **** 'em."
"**** em," the boy repeats
Grandpa: "Ahaha, that's right, **** them"
Boy:"**** them" (stop saying that! says the mother)
Grandpa:"Pay 'em no mind. you can say **** them too"
Boy:"**** them."
Grandpa: "**** 'em."
Boy: "**** 'em."

The nurse I was with was losing his cool. He had young children at home. I watched the red slowly creep up his face at the exchange. "**** 'em!" "**** 'em!" "**** them all!" "**** them all!"He was still searching for a good vein, finally finding one on the wrist. He cleaned the site, but couldn't take it anymore.
"Excuse me sir, there are some very sick patients next door, please stop yelling- they don't need to hear that."

Our patient jerked his hand away, and shoved his blanket aside, pulling out his penis. "I'm gonna pee. now"

I ran for a urinal, and he peed, nonchalantly, in front of everybody. Finished, he handed it to me with a huff, as if it disgusted him, then went back to cooing at his grandson. The urine dipped positive for lots of proteins (bad sign for kidney filtering), ketones , lots of glucose, and blood.

I handed my 'numbing cream' to the nurse. It is actually quite cool- a refrigerant, if you will;

It temporarily freezes the area of contact, turning the skin white, distracting children from the pain of an IV insertion.

"**** that's cold!"
He barely felt the IV, which is good, but unfortunately it was only good enough to draw some labs, not good enough to use for fluids.

The nurse went out to the hall and recruited another nurse. We returned for round 2.

The patient rolled his eyes, yelled loudly about how terrible this place was, flailed, but to no avail. The doctor came in once more to cajole him and his family did too.
"I'm a let you know- this is the LAST time I'm gonna get stuck, you hear that?"

The nurse looked for a site, cleaning the skin with an alcohol wipe. Filthy! He showed it to me. Sixteen alcohol pads later with furious scrubbing, the alcohol wipes were still coming back black and dirt-like.
"What are you doing? Scrubbin my skin off?"
"Sir, it needs to be sterile."
"You don't need to scrub so hard."
"Well, sir, it's dirty." Oh boy, this nurse had a snarky sense of humor.

He jerked his hand back again and screamed some profanities. "Sir," I ventured, "we are really doing this for you- you really don't want to develop an infection, ok? We're trying to help you. It'll be over really quick, and look, we'll use the numbing stuff again."

He pulled the blanket down again. "I'm gonna doo doo."
"Come on, sir, are you really gonna whip that out in front of everybody?" The exasperated nurse asked. The family took this as a cue to say good night to grandpa.

I rushed out to look for a scat pan.

Coming back, we were to try again.
"So, where are you from?" I tried to distract him.
Grandpa: "Down South."
"Oh, I love it down there, people are so nice."
"You got that right," he smiled, "where you from?"
"well, I grew up right around here."
Grandpa: "really??"
"yeah, hard to tell, right?"
Grandpa: "I grew up here. I got the **** outta here when I could, boyyyy, ain't never comin' back. I'm here to see the family, then gettin the **** outta here."
"I see."

By now, the nurse successfully inserted an IV in the finger and drew the rest of the labs. Unfortunately, he was going to need another IV site- perhaps by ultrasound. Speak of the devil- the transporter was there to take him to x-ray and ultrasound. He left the room and we all looked forward to trying again when he got back.

I sprayed the numbing canister at the back of a co-worker's scrub pants and heard a yelp as the cold seeped through. I think I found a new toy. :-)


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