* * Anonymous Doc

Tuesday, July 26, 2011

I may need more sleep. I got into a screaming match with a patient last night. She'd left the hospital-- walked out, IV still in her arm, no papers signed, she just got up and walked out-- while her parents were in the cafeteria. (She was 45 years old, so we're not talking about a minor here.) I get a page from a nurse. I call back. "Your patient left. You need to find her." Like I'm a detective. I come up to the floor. "Your patients can't just leave," the nurse yells. No kidding. "You need to control them." What am I, a prison warden? I go to her room, her parents are there, eating dinner.

"Can you call her on her cell phone and tell her to come back?"
"When we're done eating."
"Can you call her now?"

They call her, and she comes back, angry at me for making her return to the hospital.

"I can't breathe in here. There's no air."
"The air is fine."
"No, it's not. I have breathing problems. I need air."
"The breathing problems are why you're in the hospital. You need to stay here."
"No, I don't."
"Then you need to fill out some paperwork saying you understand the risks of leaving, and you need to let us remove the IV from your arm."
"I do not."
"Yes. You do."
"You can't tell me what to do."
"You can't leave with an IV in your arm."
"I'll pull it out myself."
"That is a terrible idea."
"Not as terrible as this hospital."

And then the nurse comes by again. "You need to quiet down your patient. Other patients are trying to sleep." Thank you, nurse. Helpful.

"I'm going to pull out the IV right now, and then I'm going to storm out of this hospital and never come back."
"Do not pull out the IV, and if you want to leave, I will get the paperwork."
"I'm not signing any paperwork."
"Yes, you are."
"No. I'm not signing anything."

Meanwhile her parents are still eating their dinner, in the room, saying nothing.

"Is she always like this?" I asked her mother.
"Don't you talk to my mother. Don't you dare talk to my mother."
"I'm trying to figure out if you've had a mental status change, or this is just the way you normally behave."
"This is the way I behave, doctor. Why? You don't like the way I behave?"
"No. I need you to calm down, so we can remove the IV, and then I will gladly let you leave."
"Why? You don't want to treat me?"
"You want to leave. I'm trying to let you leave."
"Now you're saying you're too good to treat me."
"That's not what I'm saying."
"No, now you're going to treat me. Now you're going to be stuck with me."
"Fine. You still need to calm down."
"No. I won't calm down. And I am not leaving."
"Fine. Don't leave."
"No. I am leaving."
"Fine. Then I will get the paperwork."
"I'm not signing any paperwork."
"I need to call the attending, because I can't deal with you anymore by myself."
"Call anyone you want. I won't be here when you get back. I'm leaving."
"You need to stay until we can remove the IV."
"You're not removing anything."

And then I jumped out the window. Or at least I wanted to. I left the room. Her parents calmed her down. The attending laughed and told me to have her sedated.


  1. The title for that should have been: "The Day Reverse Psychology Almost Worked."

    Those were some mental gymnastics though.

  2. Speaking as a nurse evaluating her peer, that nurse you were working with was a jerk. Her/ his ability to think critically is extremely lacking. As to the pt, call security to get that pt back to bed and then start slamming Haldol (loading dose and all that). Or Ativan. Give some Vitamin H to that nurse as well.

  3. I thought oppositional defiance d/o was supposed to go away after childhood...maybe the error in reasoning is thinking that childhood ends when the pt grows beyond 18 years of age.