From March 6, 2009: The worst patient ever

This one is hard to write, because when I start thinking about the various events, I get so angry and stressed out that I forget the order in which things happened. I almost feel like this should be a post of bullet points and general ideas...


I saw his name on the board when I walked in. It was misspelled (wrong first letter) but when I said it to myself I shuddered. And when I saw *my* name next to his, I wanted to dart out of the building and just not return. Having a job isn't worth dealing with *him*.

He spent the first hour or so of the shift in the bathroom. I checked on him every 10 minutes or so. I think I'm glad I don't know what he was doing in there.

When he got out, he immediately got on the call light. "I need Dilaudid (a stronger cousin of morphine) for my pain and Phenergan (an powerful antihistamine that makes you loopy) for my stomach and a breathing treatment right now!"

This is what he says every time. He is a frequent flyer, because he doesn't take his medications and ends up relapsing and making our lives miserable. He rotates around to all the hospitals in the bay area it seems. I bet he hasn't gone 3 months without being hospitalized. He had been transferred to us from another hospital, and claimed that that hospital was giving him everything he wanted.

Well this time the Docs weren't having it. They all got together and decided that, for once, he would not be getting *any* IV pain medication or phenergan. They even listed Dilaudid as an allergy, just to be sure lol.

When it came time to give his meds, I got out the methadone (oral pain med) and he yelled "I am not taking that! They should know better than to give me the pills they don't work and i'm not taking it" "It's better than nothing. If you're in pain you should take it because it's all that's ordered"

"I need to talk to a nursing supervisor and a new doctor i fired my doctor because she isn't giving me what i need and it's my right to fire that doctor so you go get me a new one" (I can't even *tell* you all the random shit he was spouting off)

I was encouraged to write a Responsible Reporting Form (once-upon-a-time known as an Incident Report) to cover my butt and to catalogue his behaviour, as the insurance company was trying to drop his coverage.

I wrote 4 pages of progress notes. I wish I'd made an extra copy so I could give some better examples.

But on with the story. After being harrassed over and over by him I start bringing things up to the Doc, who has decided that if she's "fired" she's not gonna deal with him. Sends up another Doc who's never met the guy before. I wished her luck going into the room.

She gave in a little and wrote an order for intramuscular phenergan. He was happy he was getting at least one drug. But I guess it didn't sink in what "intramuscular" meant.

I drew up the med (in a rather large-gauge needle... I know. I'm bad) and brought it over to administer it. I said cheerfully, "Here's your phenergan!" and started cleaning his arm with an alcohol wipe. Right as I was about to give the shot, he realized what I was doing and swatted my hand away, nearly driving the needle into my other hand. Freaked me the hell out. "What the hell are you doing?" "The doctor wrote an order for IM phenergan. Here it is, I am giving it to you" "It doesn't go in my muscle it goes in my line (he had a central venous access) so you better put it in my line where it goes" "Sorry sir, I have to give it as it was written" "That doctor made a mistake is it that one I fired I don't want that one anywhere near my chart or me or doing anything at all you go back and get the right order" "Okay sir."

I go talk to the doc, who has now had her cherry popped on this patient, and she says "If he doesn't want it IM, he doesn't get it at all. I'm not writing any new orders"

Meanwhile, this asshat is on the call light every 2 minutes, and calling directly to my phone at the same frequency. At one point he calls my phone directly and yells "I don't want that PurpleRN touching me!"

Dude. Why call *MY* phone and then assume you're talking to someone who isn't me? I stopped answering anything after awhile. I just handed the phone to someone else when I saw it was him calling.

I ended up getting off work over an hour late because his jackassery prevented me from doing any charting on the rest of my patients.

Hell, he was scaring his neighbours with his yelling.

There's so much more to say, but I think I'm done with this guy. Unless he dares show up again on my shift....