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Tough and Not Very Friendly

Jennifer, RN writes:

My name is Jennifer, and I am a staff nurse. Every day I enter the revolving doors at the hospital, and I am presented with a new set of challenges and experiences different from the last. Little did I know that one day in late November I would have the opportunity to care for a very special person who was facing the most challenging crisis of his life.

In report I listened to words like, “tough,” and “not very friendly,” and quite honestly I was a little apprehensive to enter the room of this angry man. “Bob” is a man in his mid 40s who has spent the greater part of the last five years in the hospital. Diagnosed with cancer and AIDS he has endured more testing and operations than most of us will experience in a lifetime. Bob was admitted with a high fever and cough to rule out tuberculosis and had been assigned to the isolation room on the unit.

I entered the anteroom, gowned and gloved. I peeked through the glass to see a frail man covered up to his chin in a mountain of blankets, shivering. I put on my respirator and entered the room. While I realize the importance of wearing the mask, there’s something about it I hate. It creates one more barrier between the patient and me. Facial expressions, especially smiles, are hidden away. There is something so impersonal about caring for a patient on precautions. Being “locked away,” as Bob called it, being approached by people protected by shields so they can’t catch whatever infectious disease is suspected. All of these thoughts came to mind as I knocked gently on the door and entered the room.

The room was cool and the whir of the ventilation system was enough to drive anyone crazy. Bob barely stirred as I touched his arm with my gloved hand and introduced myself. It was quite apparent I was looking at a gravely ill man. Emaciated and weak, Bob reluctantly cooperated and allowed me to complete my assessment.

When breakfast arrived I made sure that I brought him his tray right away. Often, patients on precautions get overlooked as their trays wait in the anteroom getting cold. Bob didn’t have much of an appetite, but he asked me for some extra jam for his toast. Although he didn’t say anything, he seemed surprised when I returned a minute later with three different kinds of jam. A few minutes later, he called me in again. He needed to be washed and have his linens changed. As I washed him, I could see the disgust in his eyes. This was not something he wanted or something he did for attention.

As the morning wore on, I sensed that I was gaining Bob’s trust and began to try to talk to him about his treatment. It was obvious from the beginning that Bob was beyond frustrated; he was losing all hope. He was fed up with hospitals, blood tests, doctors and nurses. He just wanted to go home. But he lay motionless in his bed, “a prisoner.”

After lunch, I entered the anteroom and looked in on Bob. He sat staring at his full lunch tray. I was wearing my usual attire that day, some silly scrub top with cartoon characters on it, my hair in a ponytail. I knocked on the anteroom door, surprising Bob, and gave him a silly wave and a smile. No mask, no gown, no gloves. Through the glass, I saw a hint of a smile. I motioned for him to eat… eat… eat! He responded by lifting his milk and taking a sip. I felt I had made a bit of progress.

I had been away for at least a half hour when I saw a commotion at the nurses’ station. Three Security guards were outside of Bob’s room! I immediately felt a surge of adrenaline and rushed to see what the problem was. Bob had called the local police from the phone in his room and threatened to commit suicide.

I was far from shocked, however, I was slightly disappointed that he hadn’t confided in me. We had spoken earlier of his discouragement, but never to that degree.

As I entered Bob’s room, the guards went on their way and I was once again alone with Bob. I sat close to him on the bed as I had earlier that morning. He sat on the edge of the bed, bent over, head down. He was so frail, so sick, so thin. I didn’t know where to begin so I just sat. I sat in silence with him for a couple of minutes with my gloved hand atop his cold, bruised, hand. Finally, I said “Bob, why didn’t you call me? I would have come right away.”

He just repeated over and over, “I didn’t know what to do. I just didn’t know what to do.”

When a person threatens to commit suicide, it is very serious, no matter how unrealistic the threat is. It didn’t matter that Bob didn’t even have the strength to lift a fork. His threat was real. I stayed with him for two hours, gowned and gloved from head to toe. As the beads of sweat began to form beneath my mask, I was finally able to begin to gain a better understanding of Bob. The bitterness and anger he had been displaying to the other nurses seemed almost justified.

Bob had come to grips with the fact that he was going to die. It was inevitable, and it was going to happen sooner than he had allowed himself to believe in past hospitalizations. He had already refused any treatment for AIDS, and he was now beginning to refuse treatment altogether. We talked about this and what it meant, not only to him but to his family. After all, it was his 81-year-old mother who was “suffering the most,” being forced to watch him wither away. He said he wanted to “go quick,” so that his mom wouldn’t have to watch him suffer. In fact, he was not afraid to die; he was more afraid of the pain he was causing others.

Shortly thereafter, Bob was seen by a physician who ordered that he be placed on one-to-one supervision, meaning someone would be with him at his bedside at all times for his own safety. I completely agreed. The physician pulled me aside and told me she felt it was necessary to put Bob in soft restraints so that he would be incapable of physically hurting himself. A sense of anxiety came over me. Was I going to have to go back in that room and tie an already hopeless man down? What would happen to the relationship we had formed? I could not and would not do it. I told the physician how I felt, and together we discussed alternatives. I told her about my experience with Bob and the behavior he had been exhibiting for the last ten hours. I told her I didn’t think restraints were the right therapeutic intervention for this patient. If the physician felt it was necessary to apply restraints, she was going to have to go into that room and put them on herself, because I could not bring myself to do it.

We entered the room, and I have to admit, I was starting to get emotional, even angry. Thankfully, Bob was able to make a verbal contract with us, assuring us that he would not attempt to harm himself. It was that easy. The restraints were put away and I settled down.

Bob stayed for the rest of my shift under the watchful eye of a sitter. Before I left for the night, I stopped in one last time to say good-bye. I wouldn’t be back for a few days, and I thought Bob would be moved to another unit by the time I returned. I asked the sitter to take a break so Bob and I could talk like we had earlier in the day. Bob asked if I would be back tomorrow, and I honestly felt a bit of sorrow when I said no. I could tell he was disappointed, but I knew I had made a difference that day. I put my arm around his shoulder and gave him a squeeze. He looked at me and said, “Thank-you, Jennifer.” As I left the room, I heard the thud of the heavy doors and turned and waved good-bye.

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This is a beautiful story. I worked as a hospice social worker for many years and you would fit right in. I just wrote a post about why every nurse should spend some time with hospice. Great article.

[...] Over at Code Blog, guest author Jennifer, RN, makes a difference when caring for a patient described as Tough and Not Very Friendly. [...]

Well done Jennifer…I am RN as well with a background in hospital nursing and am currently the Director of Clinical Services for a Hospice. You are an exceptional nurse. The feelings you expressed for your patient were very similar to the feelings that I had at many patient’s bedsides while working in the hospital.

What a gift you were to this gentleman, and I suspect, he was a gift to you as well.

If you ever decide to try a different type of nursing, some lucky hospice would love to have you.

Great reminder of what it is to be a nurse. Sometimes we forget in the hustle of the day, but this is one example of what a truly compassionate person does for their patient, despite what you may have heard in change of shift. :)

[...] Over at Code Blog, guest author Jennifer, RN, makes a difference when caring for a patient described as Tough and Not Very Friendly. [...]

This is a wonderful story and it really shows that it is so important to take the time to actually get to know the patient, rather than relying on other nurses’ interpretation of a patient’s behaviour.
I had been told in report that a pt was being “surly,” and I’m ashamed to admit that I assumed that that’s what was going on when I entered his room and he ignored my greeting. It took me a few moments to recognize that he had, in fact, had a stroke and could no longer respond to me at all.
I will never again let the opinions of others result in preconceptions about a patient’s attitude.

I love this story. What happened to Bob? You are indeed a caring and compassionate individual and no doubt touched Bob in a remarkable way

Moving and inspiring

Makes me proud of the pofession I have chosen.

Wow. I’m a nursing student. A brand new one. I just learned about restraints and striving for a restraint-free environment. This story has really touches me and makes an excellent illustration of how the skills we learn impact the lives of others. It won’t be practice mannequins….but real patients. Thanks for your story.

As a senior nursing student going through my psych rotation this story really touched me. Isn’t it amazing what a little compassion can do? I hope I never get to the point in my nursing carrier where I just see my patients as an object and not as a person who needs love, compassion, someone to talk to etc…

anyone interested in reading more of my stories can visit my blog http://www.nursingnotesbyjennifer.blogspot.com

[...] next post I looked at was on the blog Code Blog – Tales of a Nurse, and the post was called Tough and Not Very Friendly. This whole blog I find very interesting but this post has stood out to me from the beginning. [...]

Great story, I am studying nursing and I am proud. Thank you

This article makes two good points – reports should be nonjudgmental and spending a little extra time or doing a little extra thing for a patient can make a huge difference in their life.
I have received reports of how annoying or mean a patient is. I just approach the patient like any other patient and typically have no trouble with them. Of course there is always that one patient. But stay professional and polite and thats all that can be asked of you.

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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