our patient:
- doesn’t take his medication, we inform him about the risks and document. He says he’ll take them ‘later’, never does.
- refuses his insulin, we inform him about the risks and document as well as chart.
- refuses his blood thinners, we inform him about the risks and document.
- turns his phone obnoxiously loud, also talks loud.
- insults us several times every day, gets passive-aggressive.
this is not psychiatry, patient is a young, AOX4, fully competent adult.
Fine, you’re a free man and free to do with your life what you want. But why go to a hospital in the first place if you are going to behave like this?
Yesterday we found him unconscious on the floor, vitals were normal, didn’t hit his head. He is being released tomorrow. Doctor agrees.
I have the feeling we’re going to see him again very soon, but he is the biggest asshole I’ve met in my nursing career.
Why do people behave like this? we are literally trying to give him some quality of life and he attacks us each time we open the door. why?
If any of you is a nurse and has some insight, I’m all ears.
Do please notice that I’m not asking how to deal with people like this: we document, chart and move on, but to understand why in the fuck people are like this.
'cause he’s an asshole, likely with severe issues exacerbating his sunny nature. He could be a minute away from seriously losing his shit and doesn’t seem particularly motivated to live. That’s not normal behavior no matter whether the door says Psych or not.
As hard as it was to deal with Blue Bertha, it’s still harder to be Blue Bertha.
My cousin’s wife was an ER nurse for 19 years and quit her job back in 2022 after dealing with the covid patients that “knew better” for 2 and a half years. This attitude seems to still be prevelant in a certain subset of people. They know they need help but they’ve been indoctrinated into believing things that are not in their best interests. I’m sure tiktok told him he could cure his diabetes with microgreens or some shit and his “research” tops all of the medical and nursing degrees in your building.
I work next a group of guys who are the “know better” crowd. Just a few days back, I overheard a conversation these dolts were having on diabetes.
According to the latest in bro medical science, diabetes is due to the body losing its sensitivity to sugar, causing it to no longer release insulin. Complex carbohydrates should be avoided as they break down to sugars more slowly, meaning the body is subjected to prolonged spike in blood sugar, leading to sugar insensitivity. Simple sugars are only an issue when people consume them consistently through the day, so it’s safe if you eat a bunch all at once. Furthermore, diabetes can be cured by staying on a keto diet as saturated fat causes your pancreas to release more insulin.
What. The. Fuck.
There are fragments here that do sound like reality, but all twisted up in bizarro world. Do you remember the game of 'Telegraph’ as a kid? You try secretly passing a message from one kid to the next down the line, and it inevitably gets garbled by someone mishearing or misemembering - this sounds like that.
I’m maybe not who you’re looking to hear from but I can provide a patient perspective.
I never refused my medications but there was a point where I was rude, mean and difficult. For me it was a combination of things. I was tired of being sick, tired of the hospital and wanted to leave but wasn’t well enough, struggling with loss of control and scared.
I did snap out of it and made a point to apologize to the staff I had mistreated. Ultimately it was a negative expression of everything I was feeling because I didn’t know how to process and handle it appropriately.
Am psychiatric nurse:
This is a psychiatric issue, just not one that requires inpatient care.
Also we don’t discuss palliative care enough as a society eg: you are welcome to refuse treatment and suffer then die of your multiple chronic illnesses, but you will be much more comfortable doing it at home. I’m a DNR before the age of 30 for this exact reason: I wouldn’t do chemo or transplants or any of that either: just let me glide quietly into that good night on a slip-n-slide of benzos and opiates.
I agree with the MD that discharge is the best option. The bed will be much better suited to a patient that is able to perceive inpatient care as beneficial, because this man clearly does not.
DNR before 30
I’m very interested in your comment, as I’m struggling with this at the moment. Kidney transplant and second go-around with cancer. Right from the relapse diagnosis I had a strong feeling I wouldn’t make it, but there were such strong assumptions from literally everyone that you just don’t give up. I think a big part of it is that I’m “only” 40. I keep trying to help them understand what life is like with chronic stuff, but you really just can’t get it without living it, you know?
I have a DNR but I’ve been thinking about stopping treatment for a while. Cancer treatment has been going on 9 months now and I’m just exhausted.
Does your family know about the DNR? What did they say?
Funny story; the DNR was actually a side choice. The main reason I got the advance directive filled out was to bar my family from trying to regain control of me if I an incapacitated. They’re also barred from visiting, or really even knowing I’m in the hospital. I also added the worst doctor I’ve ever worked with to the FUCK NO list cuz hey, while I’m here…
I literally just went on my state website, printed it off and filled it out, then made a doctors appointment and went over it with the social worker, and got it signed and filed.
My dad signed an NDR.
Former ambulance crew, he’s done mandatory for to frail people and hated the torture he was putting them through. He said they should have had an NDR, as the process of sustaining life was destroying them.
When he had a bad incident, he got his paperwork. He doesn’t want someone breaking all his ribs too give him back a life with injuries on top of a chronic and slowly progressing other issue.
I signed a DNR when I was diagnosed with cancer. I worked as a Paramedic for a long time. I just choose personally to not go through the huge suffering if things should go bad. I had the surgery but refused the rest knowing problems for someone young having major poisons pumped into their body. I was fortunate and didn’t have to use the DNR and surgery seems to have worked well for the time being, aside from some disability.
My family was understanding but I have always been open about my beliefs and desires about major illness and DNR with them. I’d suggest a frank conversation with those you love. Expect that someone won’t understand but also know your life is yours and not anyone else’s.
this is not psychiatry
I’d argue, based on your post, that this is absolutely about his psychiatric state. People act like this because their mental, emotional and behavioral health is poor.
Being a functional adult does not mean you have good mental health.
100% this. Patient likely knows he’s the cause of most of his problems. But it’s so much easier to to not acknowledge that. Therefore his problems must be caused by someone else, likely the medical professionals, because they can’t just give him a pill to fix everything.
You see the same behavior in police videos of criminals blaming the cops for arresting them or judges for sentencing them.
I’m concerned about this statement. With the advent of body cam footage we’ve been allowed to see from arrests, often turns out the LEO was untruthful, rather than the arrestee. Further, oir societies create conditions of abject despair, then criminalize abject despair. It’s disheartening to read this especially from anyone in any medical professional community.
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If he’d given up, he’d be apathetic rather than argumentative.
He sounds like a teenager acting out, who wants someone to set boundaries and make him do the right thing, except he’s an adult so they can’t.
Since you mentioned insulin I’m assuming he’s diabetic. Hyperglycemia can cause irritability and mood swings, although I don’t think it can get as bad as you’ve described without some other personality disorder or general being-an-asshole-ness. (Source: am diabeetus.)
fully competent adult
Former paramedic here. There is a subsect of patient like this. It’s psychiatric. They’re admittedly terrible to deal with but they need psyche help as much as they dophysical medical help.
