Wednesday, August 20, 2008

Adult Temper Tantrum

My last day of my externship was a very interesting one. When the 42 year old in chronic afib who refuses to take his Coumadin because it is "rat poison" (no shit Sherlock) is the least interesting of your patients, then it has been an interesting day.

One patient we had was a woman in her early 50's who was released one morning and came back later the next day for the same kind of pain she had been told was not a heart attack and that Ibuprofen would relieve. So naturally, the MD told her that she would be weaned off of morphine and that she would not get any Phenergan at all, but if she actually threw up she would get Zofran. Soccer Nurse and I stood outside her door and heard the MD explain all of this to her, then the MD came out and discussed everything with us, especially her drug seeking behavior and not to call him for any additional morphine because she wasn't going to get it from him. We smiled and said it wasn't a problem.

The next four hours were filled her calling for "something for her stomach." Naturally, she didn't get anything because she didn't throw up. So lunch time rolls around and we get another call from her. We walk in and on the floor there are peas and potatoes scattered all over.

Soccer Nurse asked what she needed and she said my favorite quote of the summer," I throwed up." Soccer Nurse walked gingerly through the minefield of peas and potatoes and asked where she threw up. She pointed at the floor and said as if we were dumbasses, "I throwed up there on the floor."

It was obvious that this woman took her spoon and threw food from her lunch tray onto the floor. Soccer Nurse pointed out that there was no way that could have been in her stomach because it was intact and no stomach fluids were seen. I think he threw in a comment about doubting she swallowed her food whole without chewing, but I may be making that part up.

I loved working with Soccer Nurse for so many reasons and his lecture to her about her behavior was priceless. He made it clear that what she did wasn't acceptable, nor was he fooled by her claims, so no, she wasn't getting any Zofran. He also pointed out she created a safety hazard with the food on the floor and now he had to call someone to clean it up. He was calm, professional and stern. It was FABULOUS! I on the other hand stood there with my eyes wide open trying not to say, "WTF do you think you are doing? If you are going to drug seek, don't do it for Zofran."

It was my first and not last Adult Temper Tantrum.

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