Last night was a perfect example. I walked into a patient's room to give him a breathing treatment and he said, "I don't want that damn thing." He flailed his arms and tried to hit me.
I was blunt with him: "I have kids that behave far better than you do."
I left and charted a refusal. I don't care if he was short-of-breath or not. Fortunately for him he wasn't SOB, but he did have a harsh, audible, prolonged and forced expiratory throat wheeze when he was all worked up, which he was at that time. And for that reason the patent's nurse, Wren, called me to the room.
"I think he really needs his treatment," Wren insisted.
I studied the patient again. "What he needs is s spanking."
"You shouldn't talk like that in front of the patients."
"This guy isn't having anything close to bronchospasm. He sounds bad and that's about it. Even his doctor told me he's like this at the nursing home. As soon as he calms down he'll fall asleep and he'll be just fine, just wait and see. And if you guys just leave him alone he will calm down."
"Why don't you just give him a treatment?"
"Because I have patient's who want my services and I'd like to live to give them. I'm not going to stand there and risk my life and force a treatment down someones throat when he doesn't want it or need it." My voice trailed with that last part.
"All you have to do is put a mask on."
"And he keeps ripping it off. The day RTs gave him a blowby all day, and he won't even tolerate that now. Besides, like I said, he keeps trying to hit me."
I paused a minute while she tried to insert her syringe into the IV port, and the patient jerked his arm away. "GO AWAY!" The patient ordered. I grabbed his arm forcefully and held it down while she did her job.
"See what I mean. I'm not trying to be mean, it's him. I know this guy, he's been here all weekend. I've studied him. Trust me when I say he's not short-of-breath, he's simply anxious."
Wren smiled. "I see."
Later on we had time to discuss the patient, and laughed. I told her about my God theory and she agreed with me.
Later in the night I visited Sin who took care of the patient a few days earlier, and Sin told me he had a tryst with the patient, who shouted, "I don't have no use for your f#$%ing God! Get the F#%^ out of my room!
Sin said, "He has no reason to be good. He didn't believe if he was good he'd go some place good, like Heaven. There's no incentive for someone like that to be happy at the end, so they take it out on everyone around them."
"So you're saying he's scared."
"Yes. And people who believe they are going to Heaven do not get scared. I mean, they get scared, but you know what I mean."
"Yep, I agree with you."
"Whether you believe in God or not, it's a proven fact that people that believe in God, for the most part, are good as Angels. And I think most patients fall into this category."
I told him my favorite end-of-life stories are when people go out still doing something they love. I remember this one lady who loved doing Genealogy, but her computer broke down just prior to her coming to the hospital."
"Do you know how to fix computers?" she kept asking me. She was in CCU and I know she knew she was going to die. Doctors told her her heart was going to give out any time. She was cheerful and happy as ever. And she simply continued to work on her little projects.
I know they say it's not good to get close to your patients, but I'm telling you that's not always possible, especially when they are so sweet and innocent.
My grandpa, I was told, checked out while he was making a to-do list.
Many ladies whittle to the end. I'll never forget this one long-time patient of whom I participated in many interesting conversations. A couple days after she was discharged I was called to the front desk. Her husband was there holding an afaghan.
"She wanted you to have this," he said. I smiled and waved to her out in the car. I didn't have time to visit at that time.
A few days later I read her obituary. I think of her every time I use the afaghan.
I see many terminal patients reading books. I think, "What more could there be for you to learn? What good would this knowledge be?"
I know the answer now. God can use the knowledge.
At the funeral of a my wife's uncle last spring, his son spoke through tears and said his dad gave him a book in which the author claimed to have studied the Bible and was convinced that "what we learn in life we use in Heaven."
He said, "I guess God needed a carpenter. I'm sad that it had to be my dad, but I'm happy for him too."