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.