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My Current Rant

Posted Sep 14 2008 4:38pm

My current work and personal rant is why do people ask for help if they're not going to take it? Over the last few days at work I've been having this one smack me in the face and then Gene's sister was hospitalized. Had she been taking her meds like she should have, this latest incident might not have happened.

I don't get it. Sure, I know we all do some things we're not supposed to. We all know the salad is a better choice than the pizza and that walking is a better choice than sitting in front of the TV. But not taking blood pressure drugs? Not using your inhalers? Refusing therapies the doctor has ordered for your benefit in the hospital AFTER you've presented at the ER begging for medical help?

I'm sorry but I don't relate to it and I'm starting to have less sympathy. Don't get me wrong. I would never not do my job to the uptmost of my ability, but where when I was completely new I would have worried and cajoled and practically begged a patient, spending all of my time in their room, to allow us to complete their therapy, now I ask, maybe even twice or three times but then when they refuse I walk away. Hey, I'm breathing just fine and if you're sitting there huffing and puffing and throw away the thing that will make you better, that's not really my problem, is it?

In the case of Gene's sister, I love her dearly and I would do anything for her she'd let me but I don't feel very sorry for her either. She's been told many times how crucial her meds are so if she won't take them in full knowledge that she could easily die from not taking them, then there's nothing Gene and I can do about that. She's an adult. She has free will and along with that comes accountability.

But I admit I still don't quite get it. In the case of Gene's sister, she all but went kicking and screaming to the hospital so at least that sort of makes sense along with refusing to take her meds. In the cases of some of my patients lately, they say they want help and they show up at the ER every few weeks but then while they're in the hospital they do almost nothing to help themselves and they refuse to let us help them. The only thing that gets them out of the hospital is the bags of antibiotics and steroids pumped into them.

But that brings up another point. People never refuse IV's or pills in the hospital. IV's aren't pleasant and sometimes hurt the entire time they're in but no one ever says "I'm not letting you do that." But the same people have no problem saying "I don't like to do nebulizers." "I don't like BiPap."

This isn't a buffet. You don't get to pick and choose which therapies you want and still expect to be well. I can't tell you how many times lately I get called to rooms where people are saying "I can't breathe" but then refuse to put on the BiPap mask, refuse breathing treatments, refuse to wear an oxygen mask, but then act like I'm an asshole because I'm "not helping" them to breathe easier.

For example, I spent a whole shift last week running in between two patients who did exactly that. I would get called in and the conversations would go like this:

Me: Hi! Can I help you?

Them: Can't....breathe....

Me: I'm so sorry. You really look like you're struggling. Let's get this BiPap on for at least an hour. One hour would do you good. Four hours will really make a difference.

Them: Don't like it.

Me: Yes, but it will help you breathe. That's what the machine is designed for (long explanation here AGAIN about how it works, what it's for, personal anecdotes about knowing patients JUST LIKE THEM who were feeling much better within 4-6 hours of continuous use)

Them: No. Don't.... like it. PLEASE.... help me.

Me: I'm trying to help you.

Them: Need... more... oxygen.

Me: You have the most oxygen I can give you.

Them: Need....more...can't...breathe.

Me: That BiPap will give you more air flow along with the oxygen to make it easier to breathe.

And this is where they differ. One patient still refused the BiPap but proceeded to cuss me out and tell me to leave if I wasn't going to do a "g***amned thing to help me". That patient also refused a neb treatment, deciding to stay on exactly the mask they were on at the time, not being able to breathe.

But it was now all MY fault they couldn't breathe well and I overhead them telling their family just that. They couldn't breathe because of the incompetence of the hospital staff.

Denial ain't just a river in Egypt.

The other patient said they'd "try" it which was no big difference since that patient had already "tried" it a half dozen times that evening and each time wouldn't leave the mask on for more than a few breaths before taking it off to make phone calls, watch TV, whatever. That last time was the same old thing. I put the mask on, adjusted the machine settings, made sure the patient was comfortable, and went out to chart that I'd placed the patient on the machine. By the time (less than 5 minutes) I walked back by the doorway on my way to another room, I could hear the alarms on the machine going off telling me the patient had already taken the mask off. BUT, when I came back through a while later, the same patient told me they'd stayed on the machine for "2 hours" and couldn't figure out why it wasn't working. Well, for one, I had only been gone a half hour. For two, I knew for a fact the patient hadn't stayed on it.

Here's a little known fact: therapies don't work if you don't do them. Pills don't work if they don't get swallowed. Injections don't work if they don't get injected.

Funny how life works that way.

I'm too old for that shit. Maybe it's because my knee still hurts every single evening I work but I'm really having a hard time this week dredging up much sympathy for people who refuse to help themselves simply by allowing therapies to happen. But then it annoys me to hear someone who has refused all treatment options then say to me resentfully "Aren't you going to help me? That's supposed to be your job!"

No, sir or ma'am, I AM doing MY job. You're not doing yours.

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