My report was just about finished when my patient — labeled “a difficult patient” — in room 205 requested her pain medicine and her medicine for itching. Pain and itching are not uncommon for a dialysis patient with nerve pain and half of a foot missing from diabetic complications. Report ended about 7:15 PM.
I quickly went to Ms. H’s room to assess her and her pain.Before I could introduce myself, this heavily aged forty year-old immediately began complaining. “They didn’t give me my medicine right. Nobody treats me right here.” I explained to her as I assessed her that I would check her medicine log to determine when the medicines had been given last and I told her I’d be right back.
Angrily she accused me. ” Yeah, you won’t be back until 9 o’clock like everybody else.” I assured her that I would be back quickly.
After promising that I would do my best to be back in a matter of minutes, I thought to myself, “This patient has definite ‘trust issues’ “— probably mad at the world due to her poor health problems, and feels hopeless of ever having a normal life. Perhaps she had grown up with dreams of accomplishing things like many others, only to have her whole life turned upside down by diabetes. So I quickly brought the medicines to her.
She started accusing me again. While I administered the requested and scheduled medicines, she started in again. ”You aren’t giving me the right medicine! You made me wait an hour for my pain medicine!”
I offered to let her look on the computer at the time and dose to lessen her suspicions. The time since report was only about 15 minutes. She continued to complain how I hadn’t treated her right. So I asked her, “Please tell me what I could have done differently? I have three other patients, whom I could have seen before you, but I came to you first.”
She didn’t want to talk anymore. So as I gave her the medicines I told her, “I am sorry you are having such a rough time. I can’t imagine how difficult it must be to have pain and be away from your home.” I paused a moment and added before I left, “In an hour I’ll be back to change the dressing on your foot.”
Again she started, “Yeah, you’re gonna put me off ’till last like everybody else does.”
“I am waiting an hour because I thought you would want to give the pain medicine time to work first before I changed your dressing. Do you want me to go ahead and change the dressing now?”
She decided she would wait for the dressing change.
Dialysis patients need to be weighed daily and after each dialysis to help assess how much fluid needs to be drawn off. She had not been weighed at all, probably because she couldn’t stand well on one foot, or refused to be weighed, or the job just got handed from shift to shift and not done.
What she needed was a weight bed. The nurse tech found one next door, and we told our patient that we would switch beds for her later. A weight bed with a built in scale would make weighing her much easier.
So after assessing and medicating my other patients, the nurse tech and I got the empty weight bed from the next room and proceeded to exchange beds. I was teasing the nurse tech about something as we slid Ms. H over onto the new bed. As I started to pull the old bed out, it wouldn’t move. I realized I hadn’t unplugged it and said, ”Well, I guess it would help if I unplugged the bed first!”
Ahh! Ms. H. smiled!!! The human connection and a sense of humor! I decided, she needed a little more laughter in her life. So the nurse tech and I kidded around some more and Ms. H actually laughed some.
Then it was time to change the dressing, which went smoothly. After cleaning up the room, she told me she hadn’t had a bath in two days. (I didn’t know if this were true or not.) It was time for report but my relief nurse was running late. So I helped Ms. H with a quick bath before my relief came. She seemed more content and wasn’t complaining anymore or accusing me of mistreating her. I finished her bath at 11:10PM.
Next week I asked the nurse who had followed me how Ms. H. had been the rest of the night. The nurse replied that Ms. H. had slept all night. Ms. H. had been moved to another floor, but I had to find out where she had been moved because I was eager to see if she had felt better about her care. When I checked the computer I found out that Ms. H. had been discharged.
My heart sunk when I saw that her address: “The Streets of Raleigh.”Her hospital stay may have been the first time she had slept on a soft mattress in a long time. What did she have to “go home to?” How long had it been since someone had shown her kindness? Looking back, I’m happy I chose to go above and beyond for Ms. H. I had no idea how much she truly needed it.