My patient, Ms. Q, was on oxygen in the Coronary Care Unit where I was a nurse. She became quite a challenge as you will see.
Ms. Q had a long history of cigarette smoking coupled with a heart attack. On her admission she and her family were instructed on our policy of no smoking and no lighters or matches in the unit.
The dangers of smoking in an oxygen rich environment with two oxygen outlets in each room not only endangered her but the other patients in CCU and potentially the floor outside our doors and even the whole hospital. She seemed to understand.
The situation degenerated when I walked into her room and found a cigarette lighter and a cigarette on her bedside table directly in front of her. So I asked her, “How did you get a cigarette and lighter in your room?” She was on bed rest and was not supposed to get out of her bed until the doctor said she could increase her activity, since she had had a heart attack.
“Someone from my family brought them to me.”
I reviewed the facts and restrictions with her, as well as the effects of nicotine on her heart and the danger of smoking near oxygen. I told her she could keep the cigarette to handle and put in her mouth if it would comfort her but we had to keep the lighter while she was in the unit, until she was transferred out to the medical floor.
I explained that I understood that cigarette withdrawal is very difficult because my mother had smoked while I was a young child. Somehow she was able to stop “cold turkey” when she became pregnant with my youngest sister.
“I’m not going to smoke in my bed, I promise,” she replied compliantly.
“I understand that your intentions are good, but I can not leave the cigarette and the lighter there in front of you. It is too big a temptation. You might forget or go in the bathroom to smoke. It is just too dangerous to leave both the cigarette and the lighter near you.”
Her tone of voice evolved to frustrated, “I won’t smoke, I promise. You can trust me.”
“I understand that smoking is something you do when you are stressed out. I know it is difficult to not have them. But we can not allow the lighter in your room. I can ask the doctor to order something to help you while you aren’t able to smoke, if you like.”
But she surprised me by ripping off her monitor pads, hopping over the bed rail and going into the bathroom to put on her clothes. She flew into a rage, “I’m going home!” she shouted angrily from behind the bathroom door, “You don’t trust me!! You think I’m a liar!”
As I stood outside the bathroom door, I knew I couldn’t just charge into the bathroom. I also knew she needed to calm down and get back on the monitor! I was trying to understand how she must feel. Suddenly I knew what to say.
“What if you were the nurse and I were the patient. What if I wanted to keep my cigarettes and lighter on my bedside table? Would you trust me, someone you had never met, not to light my cigarette? You wouldn’t know me from Adam, would you trust me? ”
Things got quiet for a few seconds. “No, I guess not.”
“Please understand,” I continued, “It’s not a matter of not trusting you, it is our policy not to allow lighters in the unit. We just want to keep our patients safe.”
“Alright, I understand,” she replied as she came out of the bathroom. and allowed me to reapply the wires and monitor pads. At last she was comfortable and in bed. I asked the doctor for an order for something to relax her if she needed it. We didn’t have nicotene patches then before 1984.
This was the first time I had talked someone out of doing something potentially dangerous. I also was thankful that I understood the pull of nicotine addiction. I remember my mother telling me 6-7 years after she had stopped smoking, “You know every now and then I think about smoking just one cigarette, but I don’t.”
As one human to another, I was able to put myself in the position of an angry, frustrated patient while trying to understand what she was feeling and why.
Then I helped her put herself in my position by helping her understand what I was trying to do. Compassion and understanding is a two way street that goes a long way to calming situations.
joyful2beeblogs 
I agree … very addictive is commercial tobacco. The many additives, to create more addiction, etc. I found the same thing, a few years after withdrawal. The urge to have “just one more”. It was vile. The taste, the instant stuff on teeth and tongue. And cough? Coughed my lungs up for about five mins. That cured me of even thinking about “another one”. Thirty years on … the mind still tries. Holding temptation up in the brain. However I do know better now. Cheers Jamie
LikeLiked by 1 person
I am so happy for you! As a nurse, I saw too many people with emphysema and lung cancer to ever want to try it. My Mom was another good reason. Thanks for communicating!
LikeLiked by 1 person
In my opinion, this is what “true” communication is. In order to communicate with others, we have to be able to put ourselves in their shoes and vice versa. If like in this situation, lashing out occurs, we have to know how to go to where the other person is emotionally, and patiently, lovingly, gently, kindly, bring them back up to where we are vibrationally, so that we can once again resonate.
Body language is also key. What is coming out of our mouths has to be the same as what’s showing on our faces. I must say you handled this situation in a very elegant way. I don’t know if nurses are taught these “soft skills, ” but you certainly used them here. Bravo!
LikeLike
Wow! So well stated! I graduated from nursing school in 1972 when things were simpler. I remember a nursing instructor acting like an elderly, grumpy, old lady. She set up the area around the bed like nurses sometimes do, forgetting the patient’s needs. When the “little old lady” wants something she had to call the nurse for it.Then the nurse puts things where the lady can reach everything.It taught us a lesson in understanding.
LikeLiked by 1 person
And this is why you were such a great nurse. I, on the other hand, would have taken the offending items, turned on heels and yelled “bitch.” (And this is why I’m not a nurse!) My mother had an oxygen machine at home for several years. I was dating a chain smoker. It was hard for him not to smoke. Back then everyone smoked (except my family). He’d go outside but sometimes he’s just forget (and I do believe him on that) and light up. I was sure we were going to get blown to smithereens. My mother had to have oxygen for the rest of her life but I did dump the boyfriend but not for this reason. I loved this story.
LikeLike
Kate, it is hard to believe but smoking at one time was considered not only sexy but healthy! Boy were they ever wrong! Thank you for the comment about how I handled the situation. I have grown a stronger and helpful sense of emppathic abilities, which helped me many times in dealing with patients and even my cats. (Now one cat.) I have to admit I have had a few patients I felt like calling bitch. but fortunately didn’t. LOL. I found, even in my own experience as the wife of a patient, that lack of sleep, stress, anxiety can make one behave quite differently than they would normally.
My mother smoked until I was twelve. But thankfully stopped before she had some horrid lung problem. I know that must have been hard for you to live with her and her condition. The strain can be immense.
Thank you so much for commenting! I always enjoy hearing from you.
LikeLiked by 1 person
Throughout her really bad asthma years, I never once wanted to call my mom a bitch. She was the best (although occasionally cantankerous — so like her daughter) patient.
LikeLike
I can understand. She was truly sick. Emphysema is so hard to live with as a patient. I have had some patients with other problems who were manipulative and worse than this one by a long shot. I would never ly call a patient a bitch.
LikeLiked by 1 person
Kate, emphysema is one of the scariest diseases. They must be under tremendous stress and live with so much fear when they can’t breathe. I could understand someone with emphysema having problems emotionally. You must have been a wonderful, loving caregiver to her. That takes infinite patience and love. My patients were there for a few days or weeks and then they went home. Having a family member with any long term illness should be recommended for sainthood! It is so stressful!! I know.
LikeLiked by 1 person
What a beautiful teaching and learning experience. Our mother was a 3-pack a day smoker. She’d had scarlet fever as a toddler, and when she got into her late 40s, her organs started to expand limiting her ability to breathe. At 51, the doctors finally decided to do open heart surgery to see if they could ease things somehow. I wasn’t there, but later learned the doctors gave her a 10% chance of surviving, but she had no choice. I also wasn’t there, but I heard when they opened her up, one or both of her lungs exploded and she died right there on the table, with nothing they could do.
IMO, tobacco smoking is more dangerous than almost any other drug available. It’s more dangerous than alcohol. It’s more dangerous than marijuana.
So why is it legal then? Because government found a way to dispense it, tax it and fill their coffers at the expense of their citizens lives.
And that disgust me to my core.
LikeLike
Totally with you. So sorry your mother had such a tragic life and death.
LikeLike
Wow I can imagine it must have been quite stressful to manage someone feeling determined. And so wonderful to receive the wisdom to speak to her in a way that she could understand. Fantastic.
LikeLiked by 1 person
Wow, thank you! I was,quite surprised when she got rational finally. God was working on both of us.
LikeLiked by 1 person
You are a wonderful nurse. You handled that situation very well.
LikeLiked by 1 person
Thank you, Mags. Even though I retired in 2012, after worsening back problems, I still check on neighbors and offer advice when asked. I must admit that I have wonderful neighbors in my condo building.
LikeLiked by 1 person