Wednesday, June 17, 2009

Out of this World

I'm on MOD-2 for 13 shifts, and in the middle of my fourth shift--they run from 8pm to 8am--and reminded of a bumper sticker I saw last year which I am modifying for this rotation: "Worst. Rotation. Ever."

But, that is not the entire reason I'm writing now (from work in the hour and a half before I start admitting from the ER). The reason I'm writing now is because the supposed "lupus cerebritis" (but really psychotic) new admit needed a lumbar puncture and I was helping Charlene (my intern from the ICU last month) while her supervising resident admitted another patient with her other intern. Seemed normal enough. To start.

Charlene tried the lumbar puncture a couple times, as I'm standing there all gowned up in our sterile blue garb. Of course I had to find an extra head cover because the patient wanted the one in the sterile kit (first clue of impending crazy?). She asked me if I could try next. I sterilly move the table out of the way, the bed was high up in the air so I didn't have to bend over as much; I re-evaluate the landmarks and re-direct the needle to try to slide it in between the vertebrae to get the cerebral spinal fluid. I hit bone and redirect again.

During this time, I reassure the patient that she is doing well. She is courteous and says, "thank you." Then the tenor of her conversation changed, "I have to go. We're going to be late for the party. It's 11pm and we need to go. You need to finish this procedure." I'm trying to concentrate on getting the fluid, and reassure her and ask her to stay still and remind her she has a needle in her back. And then she says, "I'm leaving. I'm going to go." In the split second while I try to decide if she's serious, she sits up and begins grabbing her personal items. I pull the needle out of her back just in the nick of time. Blood starts streaming down her back where it had been jostled by her movement. Fortunately, she wears only the blue bouffant cap, an untied hospital gown, and Depends (which catch the dripping blood), so her clothes are spared.

When she grabs her stuff, she also grabs Charlene's white coat and pulls out Charlene's phone, books and papers from that night's work out of the pockets. "Ma'am, that is my coat," Charlene is calmly reminding her as the patient yanks it back toward herself, "No it isn't! It's mine. I bought it." The nurses threaten to call security and try to reason with her (though she's entirely unreasonable). She's out of bed now and Charlene tries to pull her coat from her and they struggle back and forth in the 6-bed hospital room. Then the patient takes a swing at her, gouging Charlene's hand with her finger nails, and Charlene lets go of the coat.

She storms out of the room muttering nonsense as her 72 year old mother gets out of the way (she's been through this before and sometimes has to lock herself in her car when her 40 year old daughter gets out of hand at home). With blood dripping down her back making a red stain on her white Depends, she makes a bee-line for the elevator. "Someone has to stop her," her mother says defeatedly as we stand there and watch her go, afraid to get into an altercation with her.

Security comes up the other set of elevators after she's already taken the main elevators down, "What's going on?" they ask a little late. We explain. "Is she on a hold?" This means has psych or the ED placed a "psych hold" on her meaning that we can hold her against her will for the protection of herself or others. She is not on a hold. Yet. We page psych and the ER to see who can place one on her fastest and send security after her.

Then we wait.

We wait.

Where is she?

Her mom is concerned, but calm. Charlene wants her coat back. We bandage up her wounds. I'm still a little stunned and ask Charlene how badly her team wanted this LP. Not bad enough to try again. We order haldol to have on hold for when (if?) she is returned.

She is. Three security guards escort her down the hall (now in a wheelchair), still clutching her personal belongings and Charlene's white coat. They tell us they found her at the outpatient clinic a block away and mention that she had blood dripping down her back. They also come up to Charlene and tell her the patient had her badge also, in a somewhat accusatory tone.

The patient has calmed down, apologizing even, but making no sense, "How do they get her into the galactaca when it is all round without windows?" And when we asked her if we could put a bandage on her back, she said, "No, I'm just going to let it bleed for a while." And then when she's all tucked back into bed, she asks, "What does combative mean?"

Charlene's got it under control for now. I return upstairs to relate the saga to the rest of the on-call team and Mark, the night float intern, and continue coveting a root beer float until the cafeteria opens at 11:30 pm. Mark says I should have taken pictures during the coat tug-of-war. He's even willing to reenact it with Charlene. But we settle for a computer stick figure picture for the time being.

{ X ]
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Blogger sunseasurf said...

brings "neurological deficit" as a contraindication to LP to a whole new meaning.

11:44 AM, July 02, 2009  

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