A Tale of a Night Shift from Hell.

The one where my patient flew over the cuckoo's nest, and the resident refused to order restraints, and the surgeon got upset from being waken up and hung up on me.

This is for all of you who think that night shift is easy because all your patients are asleep, and if they're not, you can just give them sleeping pill or ask the on call team for Ativan or Ambien.

I digress. Because if that was the case, I wouldn't be sitting here at home at almost 9 in the morning, eating a meal that I was supposed to eat about 9 hours ago but didn't because I was so dang busy and caught up in the mess that was Patient Cuckoo.

Mind you, some information has been somewhat altered to be vague to honor this thing called privacy. So here goes the tale:

Once upon a night shift (last night), one of Nurse Cee's (me) patients happened to have altered mental status (for you, laman audience, that's the fancy medically and politically correct term for crazy). The only good thing about the patient was that due to their diagnosis, they're not able to get out of bed to run naked in the hallway. However, arms were still flailing freely and mouth was speaking non-sense in angry and inappropriate terms.

At report, there were many a thing to be done with this patient. Ativan needed to be changed to q 4 hours (because Nurse Cee cannot live on Ativan q 8 hours alone with this patient), Foley catheter needed to be re-inserted (the previous one was pulled out by the patient), banana bag needed to be started. Then, Nurse Cee also found out that this patient was to have surgery in the morning and consent needed to be signed (we'll come back to this later in great details).

To make this hell-ish tale short, Nurse Cee managed to get the Ativan changed. However, her request to the resident on call for restraints was denied, only an order for a sitter was received. And after much verbal harassment from the patient, Nurse Cee managed to get the Ativan into the IV access.

The patient was somewhat more calm (and I use the term "calm" loosely in this story), but Nurse Cee then made a decision that it would be wise to wait until the sitter arrive at 11 pm before she would attempt any Foley insertion, as well as another IV (the current IV isn't good for running fluid). The, ehem, rationale (my nursing school instructors would be proud at the use of "rationale") is that a sitter would be there to watch the patient and can prevent them from removing any line.

In the meanwhile, Nurse Cee also had 4 other patients. 2 were alright, 1 was alright but had a series of tests to be done, and a new admission that came in at the start of the shift with orders of labs, blood cultures, urine samples, and a port-a-cath to be accessed. All of this were almost taken care of while waiting for the clock to strike 11 and for the sitter arrive to sit with the patient.

To make the story short, again, Nurse Cee managed to insert a beautiful IV while the sitter held the patient down. Then off she went to take another patient for a scan. Alas, when she got back to the floor, and just as she was about to give the next dose of Ativan to Patient Cuckoo, she received news that the patient has pulled that beautiful new IV. Her reaction was, "WTH??!!!" The charge nurse's reaction was, "What was the sitter doing?! We had a sitter so this wouldn't happen!" Apparently, instead of watching the patient, the sitter was Facebooking on the portable computer. By this point, Nurse Cee had fumes blowing out of her ears and the inability to decide whether to strangle the patient first or the sitter.

Nurse Cee then informed the resident on call of the situation and requested an order for a BUE restraints for the second time. Haldol was instead ordered, and restraints were denied. The resident's rationale was, "Well, that's "Doctor who shall remain nameless"'s patient, I don't want to restraint "Doctor who shall remain nameless"' patient."

Let me tell you that this "Doctor who shall remain nameless" is a very important and powerful figure in the hospital, who happened to be on the teaching service for a few weeks. The "Doctor who shall remain nameless" is like the resident and my boss' boss' boss' boss' boss'...and so on. Nurse Cee understood where the resident was coming from, but for crying out loud, it would make her night easier if the resident would just get over their sissy behind and order the restraints. DIDN'T YOU HEAR, O FEARFUL RESIDENT, THAT THIS PATIENT HAD PULLED OUT A FOLEY AND IV AND IS REFUSING EVERYTHING??!! What, you want to wait until Patient Cuckoo hit the sitter before you finally order the restraints?! Oh wells, Nurse Cee rest her case. At least she tried--twice. She had to settle with Haldol this time.

So then Nurse Cee had to deal with the consent for the surgery. For you who don't understand, the performing physician must talk to the patient about the procedure and risks involved, and the patient must sign the consent in order for the procedure to take place. Now, the physician is supposed to have the patient sign the consent, but nurses can obtain the signature of the patient ONLY if the nurse knows that the physician has talked to the patient.

Nurse Cee then thought, "Wait a minute, this patient is out of his mind. How can he understand what this procedure is for? Has the surgeon really talk to them? Even if the surgeon did, this patient has no clear understanding whatsoever!"

So Nurse Cee paged the surgeon, and was only in the middle of her first sentence of why she was calling, when the surgeon angrily interrupted her and said that he did not appreciate to be woken up for something that is not emergency. Then dial tone. He hung up on Nurse Cee, and Nurse Cee thought that surgeon was the biggest asshat on the planet. She hadn't even gotten a chance to inform Surgeon Asshat of the situation. But oh wells, Surgeon Asshat was going to pay for it in the morning.

To make this story short, morning came and OR called to ask if Patient Cuckoo was ready. Um, no, he was not ready because consent hasn't been signed because the patient is absolutely not in their right mind and the Surgeon Asshat hung up on Nurse Cee before she could explain the situation.

Thus began the phone calls triangle between Nurse Cee and the OR nurse and the PACU nurse, trying to figure out how to solve this. Surgeon Asshat was paged one more time and Nurse Cee volunteered to privilege of talking to Surgeon Asshat to the charge nurse. Of course, Surgeon Asshat didn't know how to proceed and tried to dump the responsibility to the OR nurse, who then called Nurse Cee again to have her basically inform Surgeon Asshat that (surgeon Asshat) needed to grow some balls and make a decision about what to do here. Afterall, it's the physician's decision of how to proceed when the patient is in this state. Nurses cannot obtain consent unless the patient understands. Nurse Cee wasn't about to jeopardize her license, period.

Nurse Cee informed the Chaplain, the charge nurse, the incoming day RN, and wrote in great details about this whole debacle on the chart. Basically, Nurse Cee covered her ass and Surgeon Asshat can kiss that ass.

This tale does not include the details of how Nurse Cee managed to draw blood and re-insert that Foley from Patient Cuckoo's struggling and flailing extremities. Let it be said that between Patient Cuckoo and the other 4 patients, Nurse Cee had no break, no meal, and no drink last night.

Nurse Cee also very much like to kick the resident who refused to order restraints and inflict more bodily harm on Surgeon Asshat. With those two and Patient Cuckoo combined, Nurse Cee wanted to crawl into a hole and cry in fetal position many many times last night.

The End.