No more nitro for you

2 Jun

nitroDear Patient,

You have been in PCU for 2 weeks. You have had a 2dECHO, an ECG every day, continuous rhythm strip monitoring, blood pressure  checks every 4 hours times 24 hours for the past 2 weeks. You are on 3 liters of oxygen at home and in the hospital even though I checked you on room air your saturation was 96%. You have had a CT of the head, chest, abdomen and pelvis: all negative. You have had ultrasounds of all four extremities all negative for blood clots. You move your bowels everyday. Your urine output is adequate. Your lungs are clear. Your heart sounds S1 and S2 with the absence of S3, no murmers, rubs, or clicks. There is no neck vein distention and no edema anywhere (fat tissue is not edema).  You have positive pedal pulses palpable even after your heart catheterization which revealed nice clean coronaries.  You have upper GI series with small bowel follow through: normal. Of course you had an EGD and a colonoscopy: normal.

I have six patients of which you are one, although that is not really your problem. It is my problem, considering, one patient in end-stage  heart failure, one is in respiratory distress on and off the biPAP, one is confused and keeps ripping out IVs and bleeding all over the place and one is probably septic.

So I am sorry that I refuse to give you sublingual nitro anymore that keeps me in the room for lengthy periods of time reassessing your pain, your blood pressure and another stat ECG. Especially since you then turn around and eat a huge lunch that consists of a saltless hospital food burger and fries. And I realized after 3 consecutive shifts with you that it does not matter if I give you nitro, maalox, tylenol, or any other PRN medication that you have on board: they all work the same for you. It is the placebo effect of getting something that takes away your pain so I refuse to keep slipping that small little sublingual pill called nitro under your tongue!

The Maalox  and Xanex work just as good lonely patient: I am sorry I can not just hang out with you all day, because you never seem to have chest pain when I am in your room listening to you complain about how you just do not know what is wrong with you.

And even though you did not mind the huge work up that you just went through last admission (one month ago) that was all repeated this admission:  I am sorry that you have an internal medicine doctor and a zillion specialty consults that can not figure out your real problem. I get this feeling you do not want to go home for some reason: and I feel sad for you.  If you could just tell me what is going on maybe with the help of the social worker we can find out why you want to stay here. All this invasive expensive testing is a hazard to your health.

Love,

Your Nurse

Disclaimer: I am a firm believer in the fact that lengthy stays in the hospital with no identify-able acute illness is hazardous to ones health.  I am not burned out from patient care. I love my job. I do find irritation from time to time when I am super busy with acutely ill patients that need/demand my presence and prescribed interventions and feel overwhelmed by patients that need/demand emotional support but are otherwise healthy and figured out the best way to get the nurse in the room is to put on the call bell and express chest pain 10 out of 10: even as you enter the room and find: the patient in no distress, not short of breath, skin warm and dry: cardiac markers negative time 30 sets, no ecg changes and a totally benign assessment. So you do the whole chest pain work up routine again and it sucks up all your time and inside you find yourself angsty worrying about your other sick patients. And this repeats every 2 hours. I would love to be able to provide emotional support but unfortunately: airway breathing and circulation on my other sick patients left me with little time for this particular situation.

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6 Responses to “No more nitro for you”

  1. LLogan June 11, 2009 at 10:10 #

    Very well stated!!!!!!!!!
    Can I print it out, sign my name, and hand it out to patients that fit the description? : )

    • seejanenurse June 11, 2009 at 13:34 #

      Sure but beware of the side effects of the truth! 🙂

  2. Covey November 2, 2009 at 04:18 #

    I stumbled into this site while verifying a medication as I am a medical transcriptionist, and I have to say that my day just got a little bit brighter because I type pretty much the same stuff day after day and see repeat patients come up all the time. It’s good to know that I am not alone in my frustration – reading your comments made me chuckle because I understand from a different aspect where you’re coming from, even though all I have to do is type what the doctors say! 🙂

    • seejanenurse November 2, 2009 at 14:06 #

      Dear Covey: Thank you! I am impressed at what you do for a living. I mean, I always listen to radiology dictation reports when I need the results before the transcriptionist has a chance to transcribe the dictation and sometimes they are just sooo fast, I kind of get mesmerized while listening. What you do is irreplaceable to everyone in the hosptial so thank youuu! I am also tickled to give you a chuckle, I hope you come back. You should read my post about dictation dream I think you will relate! 🙂

  3. BigDad May 9, 2010 at 06:19 #

    This just simply sounds like a made up “bitch” about a job you are tired of. That’s all. I’ve known WAY too many nurses in my own family and in the work place that fit this description. All whine about how “bad” patients are. If after just a couple of days of observation with this described patient…the doctors would release them. Not two weeks. That’s blown WAY up. Especially when it’s so PAINFULLY obvious there’s nothing at all wrong with them. Sorry, once again, I’m not buying this one. You just wanted to “vent” is all.

    • seejanenurse May 10, 2010 at 03:04 #

      Hello Big Dad,

      I can only wish that you were right. The truth is, sometimes patients are painfully “over worked up” as evidenced by “defensive medicine”

      Of course, I vent here all the time, I will never deny that, and I find nothing disturbing or wrong with doing so.

      I happen to LOVE my job! I am not tired of it at all. I am a super star telemetry nurse, caring and educating my patients for 12.5 hours a day times 3 days a week.

      I HOLD their hands, and rub their backs, I clean up poop, and help little old guys shoot pee pee into a bottle.

      I MANIPULATE heart rates and rhythms with drugs. I alter fluid volume states with fluids or diuretics.

      I SHOCK people back into normal rhythms when they are on deaths door.

      I assess social status for home care needs.

      I start IVs on the hardest sticks the FIRST try.

      I NEVER get tired of advocating for my patients, even if I have to actually cry or bitch someone out to get what I need for the patient.

      Don’t tell me what I am tired of: You do not know me at all. You do not have to buy anything, I never asked you too. But if you did know me, YOU WOULD WANT ME AS THE NURSE FOR YOU OR YOUR LOVED ONE.

      *and this is a blog and i am a nurse and i am a literary artist- take that as you wish Big Daddy

      Love,
      Jane the Nursling

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