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Category Archives: War Stories

Run, LuLu, Run!!

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Nicole is a particularly southern NA.  She would honestly say things like “My boyfriend and I work re-po on the weekends,” in as twangy a drawl as you can possibly imagine.  One day she yells to me from the other end of the hall, “LuLu, come!!”  First of all, my name is not LuLu. My nickname is not LuLu.  LuLu is just what Nicole called me because that’s how country she is.

I start down the long hall.

“LuLu!!  Run!!”  I hate running in the hospital.  Nothing freaks out patients (or other staff) quite like seeing a nurse run down the hall.  “LuLu!”

I kick it up a notch and start to jog.

Pamela, in room 17, is no longer in room 17. She’s in Bob’s room across the hall.  Thankfully, Bob is off getting an X-ray.  I look around and put the pieces together.  Pamela had to poo. She got up, wandered into the hall, went in Bob’s room, used the bathroom, and then got in Bob’s bed.  Unfortunately she left a, um, “trail” everywhere she went.  The discovery of the trail was the only reason we discovered quickly that something was amiss.

Now mind you, two hours ago Pamela was a normal, middle-aged lady who knew how to find the toilet and use it.   To you nurses, what would you do next?  Yep, get a blood glucose.  Her “sugar” was really low.  Four juice boxes later, she was back to her old self and had no memory of her exploits.  Too bad I’ll never forget it!

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The Thirteenth Hour

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A twelve hour shift as a nurse really lasts 13 hours.  I get there at 6:45AM and usually finish up at 7:45 PM.  Today I didn’t get done until about 8:30.  Boooh! My feet are killing me! Usually after a really long day my very sweet husband fixes me some food and even brings me a glass of water.  He knows my exhaustion will win out over the need to eat a healthy meal and I’ll go to bed hungry or I’ll eat something horrendously bad for me. He’s not home yet tonight so I’m tempted to go for ice cream or cookie dough!

However, after today’s shift, I may have earned the cookie dough.  It was a long shift and sooo busy that I barely got to breathe.  It was frustrating because I let my patients and co-workers down when I can’t accomplish everything I want to.  Then, to top the shift off, I got a mixture of tube feed (read: baby formula) and gastric contents (read: vomit) on my arm when d/cing an NG tube (read: pulling an 18 inch long tube out of someone’s nose).  Yuck!

By the end of the day I had to refuse to take report on a patient coming up from the Emergency Department because there just wasn’t any time for it.  I was struggling to keep up as it was!  Thankfully I get two glorious days of sleeping in before I go back Sunday.

And, breathe!

A Nurse’s Prayer

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No matter how tired my feet and sore my back, may I always be grateful that I am the one next to the sick bed, not in it.

No matter the long hours, may I always be awed at the birth of life.

No matter the number of times I’ve seen a body pass into death, may I never forget to grieve.

And Lord, when my time comes and delirium sets in, may all my confusions be pleasant!

Drug Seeker – Part 2

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Megan was a “drug seeking” patient who sticks out in my memory.  Drug seekers are patients who use the health care system to acquire more medication, usually to feed their addiction to mind and mood altering drugs.  Of the many drug seeking patients I’ve taken care of, Megan sticks out for her sheer audacity.

Complaining of back pain, Megan and her boyfriend came to the hospital immediately after being discharged from a hospital 4 hours away.  She said she works in health care but that she was mistreated at an outside hospital; they would not address her pain.

Megan was admitted to our Hospitalist service.   After assessing her and reviewing her records, the physician could find nothing wrong with her back.  He knew that her long distance travel, request for specific narcotics, experience in the health care industry, and benign assessment all meant one thing: she may be a drug seeker.

He went to our state’s Prescription Drug Monitoring Program database. He pulled her up and saw that she had been prescribed 360 Percocet 2 weeks ago and 30 Vicodin 1 week ago.  Interesting. She told the physician and me that she had never tried Vicidon.  Assuming she had none left, she had burned through 2 months’ worth of narcotics in 3 weeks. Red flag much?  She was sent home with a taper of narcotics to help her wean off the drug. My guess is that after taking the taper drugs at a much higher frequency than recommended, she crossed state lines and went to a neighboring state.  Unfortunately, states maintain separate databases.  For all I know, she may have already been pulling her scam in multiple states.

Drug Seeker – Part 1

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“Drug seeker” is a term referring to patients who use the health care system to obtain drugs, usually narcotics. I’ve had my share of drug seeking patients but two stick out.  The first is Amelia.  Amelia was on huge doses of Oxycontin and came in complaining of abdominal pain.   She was experiencing such bad constipation from the Oxycontin that she was impacted.  She was treating the abdominal pain with more narcotics, which was not helping.  She was so impacted that she had to use her finger to remove stool from her rectum.  Being impacted is not only gross, it’s dangerous.  Amelia could end up with a paralyzed bowel or a bowel perforation.

Despite the impaction, she wanted the doctors to write her a prescription for more Oxycontin.  The doctors, rightly, said that they would only write her a prescription for a taper (i.e. decreasing) dose to help her get off the drugs without going through a painful withdrawal.  Amelia said, “If you don’t give my drugs, I’m just going to go home and smoke a big fat blunt!”  The doctors told her that they wished she wouldn’t but they sent her on her merry way.

Dying to Be Sick – Part 2

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Earlier this week I posted about a patient who was malingering. This post is similar, but more disturbing.  As with all the stories I post here, I changed enough of the details to keep identities private.

I took care of an 18 year old boy named Tom.  His mother, Martha, brought him in for his ongoing chronic condition.  She claimed that he had been sick since birth.  He had several implanted tubes to manage his condition including two types of feeding tubes and a central line.  He had not taken oral nutrition in years. Instead he received all of his nutrition through his central intravenous line, a dangerous, expensive treatment.  He also seemed to be developmentally delayed.  He had volumes of medical records that were scanned into our e-chart system and Martha also kept a binder of medical records at the bedside.

As our physicians got to know Tom, Martha, and the tome of medical records, they began to find inconsistencies in the chart.  Soon, all the tests they ran on Tom came back saying that Tom was fine.  The physician continued to dig. The chart included a letter from a physician stating that Tom was on a transplant list in a neighboring state.  The shrewd physician dug a little deeper.  He eventually discovered that the letter was a complete forgery.  Our physician contacted the out of state physician who had never heard of Tom or Martha.

While I’d seen patients play up their symptoms, what was going on here was much more disturbing.  This condition is called Munchausen Syndrome by Proxy.  It is a serious psychological disorder and form of child abuse.  Caregivers fabricate symptoms and episodes for secondary gain, perhaps attention or other perceived benefit. Tom had gone through endless tests and procedures, any one of which could have harmed or killed him.  The fact that he was young and developmentally delayed made him very vulnerable.  The physician referred the patient to psychiatric services and I really hope they both got the help they needed.  It unknown how many children are harmed by Munchausen Syndrome by Proxy.  It is thought to be uncommon and hopefully most caregivers don’t get as far as Martha did.

Dying to Be Sick

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For the most part, people don’t want to be sick and don’t want to be in the hospital. However, I’ve learned that there is a small minority of patients who are desperate to be sick. It’s amazing what lengths they will go to.

One woman came in complaining of a bloody nose.  It was enough blood that she was admitted. The patient was on blood thinners which can often cause bloody noses.  She stated that she was on blood thinners because of a problem with clotting. By her count, she’d thrown 5 clots to her lungs (called a PE or pulmonary embolism) in the last few years.  Because you can die from a PE, she was put on blood thinners to prevent further clots. She also had a filter installed in one of her major vessels to prevent further clots from getting to her lung– a somewhat invasive procedure.

The physician caring for the patient started looking at old CTs and other imaging.  Turns out the patient had never once had a clot show up on any imaging. Her blood work also showed no signs of confirmed clot. Digging a bit deeper the physician noted that the patient used to work in the medical field and would know the symptoms of a lung clot: sudden onset of shortness of breath, chest pain, sweating, cough, anxiety, and even “impending sense of doom.” This woman had talked her way into a filter in her blood stream, blood thinners, and multiple hospital admissions with no objective sign of anything wrong with her at all.  After paying closer attention we discovered she would only get nose bleeds after she had been left alone in the room long enough to cause one herself.  They re-tested her blood and discovered that she was still secretly taking blood thinners, perhaps to keep the nose bleeds coming.

She was one of my first malingering patients and I couldn’t figure out why she would be doing such a thing.  Turns out she was a mother of a small child and her husband was serving in the military in a war zone.  She asked the doctor to write a letter for her saying that she was too sick to care for her child and needed her spouse to come home.  I felt terribly for her.  She felt that she needed her husband back so badly that she would risk her own life with unnecessary medications and procedures.   Unfortunately for her, the doctor had picked up on her true motive and couldn’t write the letter for her.  She left immediately. My guess is that she went to another hospital to try again.  Because of the way privacy laws are, her physician would not and could not try to notify other physicians of the ploy.