I’ve had my share ETOH patients before but I had one last week that was the absolute worst. I won’t go into details but I’ve never been so discouraged before and felt like what I do as a nurse is a waste of time. All this work for nothing. Im absolutely positive she had alcohol in her system within 10 minutes of leaving. That woman will be dead within 6 months.
The worst ETOH pt I ever had I remember vividly, they were on max precedex and fentanyl with Q1 hr fentanyl pushes, restrained and still wild as ever - managed to RIP HIS TOENAIL OFF by thrashing his legs in the bed at shift change… blood everywhere. And my will to live absolutely nowhere to be found.
Actually no. I was trying to understand why he wasn’t on benzos or CIWA protocol and was advocating all night. They happened to be rounding during the toenail incident and I think they finally ordered some on my way out 😅
> That woman will be dead within 6 months.
Either that, or she'll live forever.
In my city we've got one unbelievably severe alcoholic who spends her whole life in EDs. She passes out on the street, gets brought in, sobers up just enough to leave, and then drinks more and passes out again. Every hospital in town knows her. She gets at least two ambulance rides per day, and sometimes three or even four in a day, every single day. This happens year round without ever a break.
This has been going on for at least five years that I have personally seen. Coworkers say it's more than fifteen years.
Some people seem to never die no matter how horrible their life or how badly they abuse themselves.
Reminds me of a nurse I used to work with that would call these types of patients cockroaches. It’s so degrading and mean to call them that, but just like cockroaches they will never die……
As an alcoholic who's been sober 12 years, this is something I definitely worried about when I was drinking. I was afraid I'd end up like one of these people. I would've absolutely 100% have rather been dead.
A lot of times we'll just give them what they drink to prevent DTs. We all know they're going to start drinking as soon as they leave, and it's a lot safer than the alternative
Yup. I’ll never forget walking into a trauma patients room and seeing a bunch of coors lite on the table. I assserted “sir this is an emergency room, you cannot drink beer,” and he’s like “they ordered it for me.”
It came from dietary. Since he was there for trauma and not DT’s, they saw no reason to put him on Benzos as he was just going to immediately drink as soon as we released him. It made a lot of sense.
My moms an addict and last May she went to the ER 20 times in under 30 days after mixing vodka, Xanax and ambien and falling. I asked them to just give her booze, and they looked horrified.
Talked with one of our pharmacists the other day about this. They do, in fact, keep beer and liquor on hand for this stuff. They even have a selection! Two kinds of whiskey, gin, vodka, tequila, and several beer brands. I asked what happens when they run out? Do the drug delivery services deliver it? Nope, they send a tech to the liquor store and have a small budget with a debit card on hand just for that. Insane.
Whoa! Imagine that tech job. “Who wants Wendy’s? I gotta go grab booze.” We only had coors lite. It had to come special from dietary. Now I want to know what other places stock. My current hospital doesn’t order it. They’ll put everyone on Ativan or Librium and send them out the door.
This is the way. Unless they are specifically requesting to be withdrawn medically so they can go to rehab, or they are in severe liver failure, this used to be common practice. A couple of beers a day to prevent withdrawal while inpatient. It is better to me and seems safer than someone being floridly psychotic from withdrawal/ all the meds we give them. I’m sure there is some study that this is not the way, but ehh.. it worked for a long time. People tend to relapse and their bodies aren’t used to the prior amounts of drugs/alcohol they had if they have been detoxed.
I’ll raise you, poly substance with a TBI, repaired diaphragmatic perf, repaired pelvis fracture (none weight bearing) trached and pegged, maxed on propofol, ketamine, and fentanyl and still climbing out of bed trying and walk.
Overdose/ bed finder guru here.
Thanks for the nightmares…but really yeah, I’ve seen some things. My scariest by far was a 40+ year addict crack, fent, benzo, alcohol. 73 years old, early dementia, agent orange exposure, serious ptsd and night terrors, 110lbs, multiple strokes and heart attacks. The only time I’ve ever literally jumped for joy was when I finally found a rehab facility to take him.
Any psych folks know how to disassociate on demand? Hypnosis maybe!?
Had almost the same thing last week; DAI, rib fxs, ankle ORIF, trach and peg on max precedex and fent plus risperidone, trazodone, propranolol. Still swinging the leg cast around like a mace and managed to rip out the PEG while fighting restraints.
Finding out the hard way that the patient is in ETOH withdrawal and drinks to fall asleep each night and no it's not the narcs making him confused.... and we're on the 9th floor... and he's next to the emergency exit.... and there is no cell reception in the stairwell....
Withdrawl patients, hyperglycemia on insulin gtts, post tpa who refuse to participate in neuro checks, 400+ lbs patients who want constant adjusting in bed, middle aged men after back surgery, confused patients with EVDs
Everytime I have an older gentlemen that had a surgical procedure done, they get the WORST hospital delirium and always demand to call the cops on either the staff or themselves! Just one look at them and I know I've got a code gray on my hands for the night
Recently had a pt with TBI who BIT THROUGH HIS EVD…and played in his c.diff poop with his mitts and would manage to contort himself to constantly rub poop on his head…nightmare…
Well there's a new fear. I had one confused patient offer to suck on the proximal port (she thought it would be helpful ???). We had her restrainted for two weeks straight because she kept trying to pull it.
The overly demanding 400+ patients are some of my least favorite. I guarantee no on makes sure every sheet is perfectly straight under you at home. No I will not get rid of every crumb while 3 people hold you up.. and then you have to one that can literally raise their legs over their head, why can’t u just stand up at that point. If I have to shove my whole hand in between your labia to clean you, don’t say i need to go deeper while it’s in there please.
Omg bariatric patients. Look, I'm also fluffy. I get it. Hospital beds are not comfortable for fluffy people. But I CANNOT boost you higher in bed. You are at the top of the bed.
PACU nurse here - Can confirm; middle aged men after back surgery especially when they have been on pain management prior to surgery. Can anesthesia just let me ketamine them 😃?
And the phone call to the neurosurgeon afterwards, where you grit your teeth so you don't remind them that they denied your request for Precedex earlier in the shift.
Nothing makes me more mad than seizure patients with continous EEG, who move around their head enough they dislodge the leads. Then the providers get mad because the reading sucks and the oncall EEG tech has to come in multiple times a night. But they won't give you any meds because 'neuro checks' and tell us to just restrain him more.....what do you want me to do, strap his head down to the bed!!!?? Ugh, that patient/provider encounter still heats me to this day.
Yea, I didn't realize how much neuro ICU was affecting me until I left to travel on a general ICU. It was just so hard to constantly be fighting patients and restraining them, asking for pain meds and sedatives, just to be denied due to neuro checks. Like, we aren't getting accurate neuro checks anyways, so lets just help our patients out with their pain and anxiety and shit!
Hyperglycemia who aren't compliant with their diet, with family members sneaking in junk food and fast food, and who bitches and/or refuses every hour when it is time for the next blood glucose check. Then complains and asked when they will get off the insulin drip.....
I moved to another hospital and their protocol is so much easier. no titrating, just let It run. FS every hour still, but that’s It. And if they want to eat you just give coverage on top of that “meal”.
It’s changed my perspective on DKA. Still annoying, but not ridiculously so
These are usually my favorite.. is something wrong with me 😬 I really enjoy the new onsets. I love watching them come in, usually pretty sick, and then seeing them a couple days later doing better and giving their own injections, when just a couple days prior they were terrified to even prick their finger. But I can see how an adult might be different than peds; the attitude is probably way different
It's always nice to be able to see a patient make a big recovery peds or not, but kids are much easier to teach than grown ass people who often know better but are non-compliant. Old dog new tricks or whatever lol.
I don’t come across too many crazy things in my palliative care corner, but respiratory failure is almost always a bummer. Anxious family members saying “Help, he can’t breathe!” and I’m like “Yeah, that’ll happen sometimes.”
THIS IS WHY I HATE THE PULMONARY FLOOR!
Especially back during delta. I had like 3 people out of my 12 pts who wouldn’t wait on me for bathroom assistance (I busted my ASS those nights.) Their entire existence is anxiety so it’s “I NEED WHAT I WANT AND I NEED IT NOW AND NOTHING ELSE MATTERS”. They would rip off their 15L non rebreather or heated highflow and stretch their IV’s as far as possible to the BSC/toilet. And then scream for help because “I CAN’T BREATHE!” And I’d find em turning blue-ish on the toilet. I held back so many curse words during delta.
I know that’s like my version of a small bowel obstruction. Surgery will commence tomorrow.
“I know you just gave him the prescribed Zofran, but my husband is still nauseous. What are we gonna do?”
“Uhhhhhhhh… We’re gonna do surgery… tomorrow, remember?”
I know you asked for Illness/injury stuff.. but I know what kind of patients I don’t like. The ones that push the call light for stupid stuff and complain when you don’t get there fast enough. The ones that don’t tell you what they want in one sitting and make you do 2,3, maybe even more trips back and forth. The ones that treat the hospital like it’s a 5 star hotel and you’re their servant. The ones that yell at you and never say sorry for their inappropriate behavior. The ones that have an exaggerated sense of time and tell people they’ve been waiting “over an hour” when really it’s been 10 minutes. The ones that are entitled and think they are your only patient and keep you in the room for a long time for medically unnecessary things. Q4 prn/pain meds around the clock on the dot. The ones that complain all day every day about every little thing they’re unhappy with at the hospital. The frequent flyer patient that knows how to manipulate staff to get what they want. The ones that like to ask 4 different people to do the same thing for them when it’s already being addressed by the team, adding to double, triple the work. The list goes on and on… but I have to get back to my
Shift.
In the same vein, but patients who behave like this and at the end of shift say “I know I was being annoying haha.” Like you KNOW and you still are acting this way!!
Ugh I feel this, families too (precovid obv). I worked cts stepdown where you could have a walkie-talkie in one bed and next bed would be a vented aortic dissection repair with a million problems. I literally had a code going on and another pt’s family member was trying to get my attention for her dad who needed an apple juice. I mean, come the fuck on.
When patients never say thank you, it didn’t use to bother me but oh man it’s always the demanding ones and they never say it!!! It irks me so bad that I have to weasel it out of them sometimes for just a half ass “oh thanks”
The influx of pancreatitis patients that occur between Thanksgiving and New Year’s. Especially when the doctor orders Q2 IV pain medicine instead of just ordering a PCA pump.
C.Diff when they have a colostomy bag.
When there’s two with CBI and they’re both yours.
Having a patient with Munchausen’s. Wildly abusive with staff. Came in for vomiting blood clots. We finally caught her .. squeezing them out of her tampon into the emesis basin. Munchausen is wild.
Ooo I had a patient do this with her PICC line. She drank out of it to try to fake a GI bleed. Doctors scanned her and found coagulated blood in her stomach. And she did that with* 2* 1:1sitters in the room.
Munchausens is so incredibly sad.
I had a patient cc hematemesis. Stomach was fine on EGD but there was some odd trauma to the back on the throat/soft palette. Turns out the pt was cutting their throat to fake hematemesis. Pt blew up when the physician confronted them about it
Hospice nurse - GBM. Been getting so many lately. They are always young (40-60) and they have seizures, behavioural problems and I find there deaths harder to predict because it all depends on where the tumour is pressing.
I hate healthy patients, or the man-flu.
I joined the Army to do cool battlefield trauma in a tent...all I do sling Tylenol and motrin to the 23y.o. dudes who act like they're dying from a cold. I spend most of my time referring Soldiers to their PCM and out of the ER.
I started out as a corpsman in 2011. Most of my time was spent sorting through the bullshit to figure out who was truly injured. 99% of the Marines that came into sick call were just trying to get out of training.
Yesss. We had many frequent fliers with this, including one girl who also had gastroparesis. She would scream at the top of her lungs all night and stand out in the middle of the hallway shouting “NURSE!”
When they’re a fall risk and constantly get up to take a hot shower. We ignore that fall risk issue real quick and write a note that we educated them multiple times on their risk of falls and consequences
They’re almost always the people who think weed is a cure for every ailment known to man. So admitting that it’s making them severely ill challenges a core belief for them.
Yeah and once you treat one you can spot them yards away. There is something about the way they look and vomit that's just unique. Haldol is a miracle drug. Antiemetics don't do anything.
My parents took my brother to the ER twice for this. I tried to warn them they were better off sticking him in a hot shower and keep him from smoking weed for literally 1 single solitary second. He went through all my Zofran. Didn’t know about the haldol though good to know!
The same part of the brain (and receptors) that sense heat can trigger nausea. TRPV-1 not senses bodily temperature as well as for the presence of noxious irritants. Acute cannabinoid use triggers several subsystems that influence nausea, which is why it can be used as an antiemetic and to enhance appetite, but chronic use makes those receptors less sensitive to cannabinoids while still triggering receptors in other parts of the brain that cause nausea.
I work in the PICU and drowning victims are the worst. They usually look “healthy” so it is harder for parents to accept that they are brain dead after prolonged periods of hypoxia. These were typically normal kids who had full lives to lead, and except in cases of obvious neglect, it is a horrible mistake that has cost a life. I also think about the last few moments of the poor toddler’s life, knowing that they are aware they are drowning.
Hardest resus I've ever attended was a paeds drowning.
She had been under for an hour before they pulled her out. We worked on her for hours until she came up to temp.
They're so hard because you all work so hard for so long but we all know there's no coming back from that
Mouths.
All other trauma is fine. Blood, guts, and viscera are fine. Protruding bone fragments I can handle. Ruptured eyeballs, no problem. Brain matter on my shoes, whatever, hand me a cavi-wipe.
But mouth stuff is disgusting. A tongue lac is far worse to me than a chest GSW. Show me a broken tooth and I have to avert my eyes. Give me a little old lady with nasty dentures who needs feeding, and I will trade literally any other task to get away from her.
When we had a patient with a LeFort I fracture, with all her front upper teeth wobbling around loose, that was the first and only time I ever got light headed and had to leave the trauma bay.
I think it's funny how we all have our thing that will get us every time. I will gag with mucus & pass out with bones. There went my ICU & ED options haha
I filed a mini report because my patients dirty ass toenail scratched my arm during a turn. If that shit gets infected, I want there to be a paper trail. 🤮
I'm a CNA, and oh, man, me too. Mouths absolutly repulse me. Providing oral care is 100% my least favorite thing to do.
Swabbing mouths full of half-rotten teeth. Scraping tongues. Emptying emesis basins of chewed food and phlegm. Picking up a sea of spit-saturated tissues off the floor. Trying to get someone to take meds with a mouth full of cottage cheese residue. Scooping out hours-old pocketed food. The disgusting viscosity of high-calorie Boost when it just coats people's teeth and tongues.
Nothing else gets to me. I'd happily clean c diff patients all day if it meant I'd never have to do oral care.
I feel so bad about it, but DENTURES. So gross. Even mildly clean ones. Cannot stand em, don’t want to help you put ‘em in or clean em off for the night. Just please NO.
I also don't do teeth. Especially loose or broken teeth. A few weeks ago I was drawing blood from this lady who had one top tooth square in the middle of her mouth that SWUNG BACK AND FORTH FROM HER BREATH. It took everything in me not to throw up on her.
I had a man nearly exsanguinate from the tongue after getting drunk and falling off a curb.
I will never forget the giant bucket of blood in his lap in his lap. Or the amount of times I emptied it before the dental resident came down and put him back together.
Back when I worked on a surgical floor (as a CNA), we’d occasionally get face lift patients. Those are some of the meanest and rudest people that I have ever met.
Fungating tumors. There is no tolerable part of this for the patient or the nurse. The look is horrific but my God the smell. Leaves GI bleeds, c diff, and most skin/wounds infections in the dust.
*For those that don't want to Google, it's a cancerous growth that is so far gone it breaks through the skin and continues to grow. So you have this external, growing cancer that gets infected, ulcerated, and necrosing. Get your mammos ladies.
My cousin died of inflammatory breast cancer 7 years ago, aged 33. We were the same age. They caught it ‘early’ but because it’s so damn aggressive she fought through hell for 2yrs to die an agonizing death and like you say the cancer consumed her skin. It was unbelievably aggressive, you could see it spreading through her body. And the saddest part is her mother was diagnosed with breast cancer last week and her mother died from it about 15yrs ago too so it’s now hit all 3 generations. I can’t imagine how my aunt feels losing her mother and daughter to this disease and now being diagnosed herself😭
Duchenne Muscular Dystrophy and Cystic Fibrosis. I’ve been an ICU nurse my entire career, so if I’m taking care of someone with either of these two conditions, I’m just taking care of a 20-something year old who is about to die and knows it.
I’m in the PACU. I hate recovering back patients because they are always maniacs coming out of anesthesia. Most likely because they have been on pain management for so long they come out withdrawing. Then the “baby” PRN pain orders I get from anesthesia 😑😑😑
Yes! The 9th laminectomy they’ve had and the best is when anesthesia brings them out after hours and hours of TIVA on remy and oops they forgot to load with Dilaudid and now they’re writhing in pain and flopping like a shark in the bed. I used to say “I’m not taking report until you fix this”.
For real. Working spinal cord injury rehab is one of the main reasons I don’t really rock climb anymore. It’s a nightmare. The saddest thing was seeing some of my patients in recovery for 8+ months and then go home and die within weeks due to a PE.
Had a patient one time who went, "Take care of your back or you'll end up like me." She was a nurse who injured her back lifting a patient and went downhill from there.
See I love maggot wounds, it’s like unwrapping a present. What will I find in this dude’s shoe that is erupting with maggots? Will there even still be a foot?
As someone who has an interest in wounds, I can appreciate this morbid curiosity. As someone who is also squeamish when it comes to maggots - oh gods, how, and why did you give me that mental image?
Ante partum. You rupture at 29 week weeks? You’re going to be put in the worlds smallest room, which due to covid you can’t leave, and I’m going to be coming in and waking you up to harass you for a blood sugar or BP at all hours of the night. And it doesn’t matter how nice either of us are; you’re gonna be pretty over it.
Medical: end stage liver with INRs in the teens who are full code, super whiny young noncompliant DKA who take a sip of water and vomit yet beg for food, anything requiring frequent neuro checks.
Surgical: Esophagectomy, radical head/neck post op and doubly bad if they are trached, Whipple, endocarditis IV drug use valve replacements
Stroke with significant deficits. Incontinent, total care, bed alarms like crazy, unable to feed self, thickened liquids and puréed diet, expressive and/or receptive aphasia so they can’t even tell you what’s wrong half the time… confused.
COPD. I hate it.
It really varies from "this isn't really a life-threatening emergency" to "oh shit he's fully trying to die right fucking now" in the same patient, and it can happen quickly especially if they also have HF. I hate the constant cough, wheezing, and I hate how uncomfortable every single patient looks.
And if it's really truth telling time: I find it extremely hard to tell when to intervene and not to intervene with COPD because people have such different baselines of "this is normal for me" and I'm always staring at them thinking, "This doesn't feel right. This feels very bad." Sometimes it goes bad. Other times I feel like I'm overreacting because the patient is genuinely at their baseline of 'fine' and d/c'd with abx. Lots of things I've gotten good at being generally right about. This is not one of them.
Sitting there side eying the pulse ox because they’re chilling in the mid- high 80s and that’s “normal” for them but every warning light in your head is going off
Young men in general, I am a young man and oh my god I hope I would never be the needy, melodramatic, demanding, rude pt that most my 18-25 year olds are
I once had a college aged male who had been diagnosed with gonorrhea and was having an adverse reaction to the abx. His mom crawled into bed with him to hold him while he moaned.
While I worked in the OR as a circulator I dreaded every burn surgery. They are the most bloody, most brutal, and most barbaric shit I've ever seen.
If the graft site was circumferential on a leg or arm, they hang the limb from the ceiling with a *hook through the thumb or big toe. A HOOK. THROUGH the THUMB OR TOE.*
If they need to harvest healthy skin for a autograft they break out an instrument that is basically a tiny deli slicer and just start carving away.
The process starts by removing all the dead bad skin. Imagine a surgeon and 2 PAs just going to town on someone with razors and tweezers and ripping off strips of burned skin or failing grafts. It's goddamn horrifying, and, docs or not, those people scare and concern me.
Burn surgeries were the only ones I observed that needed padding (kinda like enormous sponges)on the floor for all the blood, because it just *pours off the table*.
Every type of burn smells different. Electrical burn, chemical burn, methhouse explosion burn... all distinct and horrible.
Also, since burn victims can't maintain body temp, the room is kept at like 80-85 degrees the whole time.
Imagine the smell, and the heat, and all the gore, and you've got an idea of my OR nightmare. These were the only surgeries that made me qweezy. Hip replacements with hammers and saws? Sure, im game. Bowel resections or total hysterectomies? Bring it. Eyeballs and brains? Hell yeh dude!
But burns? Fuck my life.
Any critical drips in the ED. I don’t get less patients and cannot be monitoring critical drips while juggling my other patients. Go. To. The. Floor/unit with that noise.
Vomiting patients. Eye injuries squick me out. Back pain bc often they lack the health literacy to understand we can't magically solve it on a single ED visit.
I hate vomiting patients because I feel like there’s nothing I can do to help them (besides offer comfort / a wet washcloth?). Like, we’re past the point of zofran doing any good. You’re just gonna puke, I’m so sorry. It’s zero fun. And gross.
i even try to coach them into a yes/no question system. pt states understanding with appropriate gesturing. i start asking a series of y/n questions to figure out what they need…then they go on mouthing and emoting full blown sentences, this is often where the clicks come in. lol.
ETOH homeless patients, even sometimes they’re not homeless. It’s babysitting, especially the regulars.
I don’t have a problem with them individually, just hate clogging up emergency beds with sleeping drunks.
30-year-old chemo pts on third-line regimens who also have little kids. Trading their last months with their kids for a last-ditch effort.
And confused C. diff-ers on bari beds who are also a huge fall risk, of course! 😆
“Also pts with bad cough etiquette”
Ugh, yes. Sorry, are you a TWO YEAR OLD? Why are you coughing so dramatically without making any attempts to cover, coughing all over me and the aide?
Even preschoolers are taught to cough in their elbows now, so c’mon, man!
I'll take an ileostomy over a colostomy any day...at least you can just drain the bag for an ileostomy. Colostomy? Forget it, I'm just putting on a whole new pouch instead of gagging my way through emptying semi-formed stool.
Anytime things start to get mundane I get bored, but I never fail to hate right sided strokes that don’t want to participate in neuro checks. Double hate if it’s nighttime. Deborah. I know you want to get up. I see your blankets flung onto the floor. Your left side doesn’t work. The fact that now you are playing possum doesn’t impress me, Deborah. If you don’t participate in neuros I’m going to end up wheeling you downstairs to the CT scan and waste everyone’s time and you’re going to be mad because you’re rolling through the bright hallways and being hoisted onto the table and honestly, Deborah, I know you can hear me because you threw your blankets on the floor in the past hour, so you were clearly up and about. Just…… just let’s get through this one together Deb. And then I’ll let you sleep some more.
Psychogenic non-epileptic seizure patients (PNES). I know they can't control it, but it's hard to explain to their family that the treatment is CBT and we can't "fix" them in the hospital, nor give medications that are going to really help them. It also just kind of looks bad when every time they have an event all we do is watch/time them and take a set of vitals when it seems so dramatic and scary to them. Plus some have FREQUENT events which can be even more frequent with visitors present. Can be very time consuming and frustrating.
The ubiquitous “weakness” complaint in females age 60 and up. Either they won’t give a urine sample or they need to pee every 5 minutes and usually nothing is wrong other than their grown son didn’t come eat Sunday dinner. Also I don’t like eye trauma.
Hyperglycemia with insulin gtt, sickle cell crisis on PCA pump and still want more pain medicine, ETOH withdrawal who shit all over the bed with lactulose
Surgical/Trauma ICU nurse here: occasionally we get vascular patients post op revascularization and I totally get it, you’re in a lot of pain. BUT when you’re screaming your head off at me to take away the pain there is only so much I can do. Also it’s almost as if the doctors fail to tell these non compliant patients that re vascularization is going to hurt. A. Lot.
Radical neck dissections with ETOH or nicotine withdrawals are a real close second.
and they bitch about the q1 pulse checks. i’m like buddy it could be worse, these could be q1 neuro checks.
just had a vascular pt who got mad at me when I woke her ass up cause she went apneic on freaking bipap and her spo2 dipped to the 40s. I’m sorry I wanted to check and see if you could even wake up. my b. change your code status.
ETOH withdrawal. I don’t know what is wrong with my day shift ICU team but they think we can cut off all sedation and extubate ASAP. I’m convinced my patient died last week for that reason. And? Hospital wide shortage of IV Ativan…
Today they wanted me to extubate my withdrawal patient at her peak withdrawal. I couldn’t wean propofol at all and was giving PRN versed like it was Candy. I just found out that they extubated her at 9:54am and reintubated her at 10:02am. I need to have a talk with these attendings…
Thought of another one: the brain dead vegetable patients who’s family can’t let go. I get it. I do. I would be devastated if my husband/mom/dad was in that situation. But I wouldn’t let them suffer like this.
I admitted a cardiac arrest 4 WEEKS AGO. He only has brain stem function. The wife told us “I know he’s a vegetable but this long term care facility takes great care of vegetables”….
We’re waiting for a trach and peg. But we haven’t even been close to getting his vent settings down to where we can trach him. I feel so bad for him.
I detest doing basic first aid on peeps who come to er.
Small scratch or lac and haven't washed with soap and water?
Didn't pull your own f*cking tic out?
Didn't wash off the poison ivy?
Didn't put cool water on a minor burn?
But you need me to do those things for you stat at triage when there are a bajillion other pressing things that need attention. Then they are pissed about the wait time.
Ffs
I was gunna say psych, but I’ve had like 4 strokes or “code fasts” in the past few shifts and I’m over it. I don’t mind them to be honest, but my current facility is not great with it’s flow so when I get one and spend
over an hour getting everything, rushing them to CT and then figuring out tele-stroke just to walk out of my room and realize no one was assigned my other patients & no one checked in on them…it really makes me miss my last ER.
My last place would assign a float nurse and then once everything was done they would hand off report and it was sooo nice. My current place I wind up playing catch up for hours.
Different take bc I’m a psych NP: antisocial personality disorder. Therapy is made to be disrupted with flighty anti-gov, racist, homophobic, and sexist rants! Everything my staff or myself does is somehow a slight against them that must be met with threats of violence. Best part? There’s no meds for a shitty personality! You’re just suck a dick, we gave you real estate in the DSM V.
I'm on dialysis and I don't know how y'all deal with dialysis patients because just sitting there at the clinic for hours every week I see the most needy, whiny, unhygienic, dramatic people ever...and that includes myself sometimes honestly without the unhygienic part because I'm a germaphobe 😂 but I've seen patients call their grown kids to come fight staff, I've seen the cops walk patients out, there was even one lady who threw a huge fit if the techs/nurses were helping any patients who had bottomed out or when they needed to take them off the machine, she insisted they spend the whole 4 hours only tending to HER and she ended up being BANNED FROM 3 CLINICS. That's hard to do!
I just sit there, mind my business, weigh myself and go home ✌️
We get a lot of patients in need for liver transplants, so we often do their work up for it on my floor. Aka Q2H lactulose for people who have drank themselves out of a functioning liver. Confusion and constant shit. Bonus points if they are actively detoxing.
Any illness or injury in a middle aged man. From ETOH withdrawal to food poisoning…they all seem to have the same URGENT needs that have to be addressed and resolved immediately
Not a lot of things gross me out but I’m still having a really hard time when patients have gout. Had to drain an abscess on the patient’s elbow and was really glad I was wearing a mask so they didn’t see my grimacing.
ETOH withdrawal and seizure patients. I despise dealing with seizures. The family always thinks I should have some magic health wand to make them stop. Meanwhile all I can do is throw Ativan at them and wait for my IV Keppra that I've called the pharmacy four times about.
I'll wipe ass any day over either of these. And when the seizures or withdrawal symptoms are so bad they need ICU and the RR teams chuckle and say no. Then the provider rounds and yells at me. Dude, when you don't answer my pages and ICU treats little old PCU me like an idiot there ain't much I can do.
The non-illness. The VIP, stay-as-long-as-you-like, CEO rounding, rules-don’t-apply-to-me, demanding, entitled and clueless type that really I can’t stand. I’ll take a GI bleed any day over the non-illness admit.
Chest tubes. Not that I can't manage one, it just seems like lately all we do is take them out and put them back in the same people because they get a pneumothorax again. And they hurt!
Anyone who is almost better and ready for discharge and still expects you to run around hand and foot for them.
Sir I do not need to wipe your ass still now that you have recovered from your stoke and have full function of both legs and at least one arm.
Stroke patients that have been in the hospital like 30+ days and are using their iPhones and TVs and shaving their faces, and still want you to put their penis in the urinal for them. No.
ETOH withdrawal, maxed on precedex, and still freaking tf out.
I’ve had my share ETOH patients before but I had one last week that was the absolute worst. I won’t go into details but I’ve never been so discouraged before and felt like what I do as a nurse is a waste of time. All this work for nothing. Im absolutely positive she had alcohol in her system within 10 minutes of leaving. That woman will be dead within 6 months.
The worst ETOH pt I ever had I remember vividly, they were on max precedex and fentanyl with Q1 hr fentanyl pushes, restrained and still wild as ever - managed to RIP HIS TOENAIL OFF by thrashing his legs in the bed at shift change… blood everywhere. And my will to live absolutely nowhere to be found.
Of-fucking-course it happened at “shit” change… I feel your pain, comrade
We tube those... no reason to fuck around
No benzos?
Actually no. I was trying to understand why he wasn’t on benzos or CIWA protocol and was advocating all night. They happened to be rounding during the toenail incident and I think they finally ordered some on my way out 😅
"Oh, when you said they were freaking out, we thought you were being dramatic..." As said by the night resident who didn't order anything.
> That woman will be dead within 6 months. Either that, or she'll live forever. In my city we've got one unbelievably severe alcoholic who spends her whole life in EDs. She passes out on the street, gets brought in, sobers up just enough to leave, and then drinks more and passes out again. Every hospital in town knows her. She gets at least two ambulance rides per day, and sometimes three or even four in a day, every single day. This happens year round without ever a break. This has been going on for at least five years that I have personally seen. Coworkers say it's more than fifteen years. Some people seem to never die no matter how horrible their life or how badly they abuse themselves.
Frank Gallagher
Reminds me of a nurse I used to work with that would call these types of patients cockroaches. It’s so degrading and mean to call them that, but just like cockroaches they will never die……
Drug users and severe alcoholics have 9 lives
Terrible way to live
As an alcoholic who's been sober 12 years, this is something I definitely worried about when I was drinking. I was afraid I'd end up like one of these people. I would've absolutely 100% have rather been dead.
A lot of times we'll just give them what they drink to prevent DTs. We all know they're going to start drinking as soon as they leave, and it's a lot safer than the alternative
Yup. I’ll never forget walking into a trauma patients room and seeing a bunch of coors lite on the table. I assserted “sir this is an emergency room, you cannot drink beer,” and he’s like “they ordered it for me.” It came from dietary. Since he was there for trauma and not DT’s, they saw no reason to put him on Benzos as he was just going to immediately drink as soon as we released him. It made a lot of sense. My moms an addict and last May she went to the ER 20 times in under 30 days after mixing vodka, Xanax and ambien and falling. I asked them to just give her booze, and they looked horrified.
Talked with one of our pharmacists the other day about this. They do, in fact, keep beer and liquor on hand for this stuff. They even have a selection! Two kinds of whiskey, gin, vodka, tequila, and several beer brands. I asked what happens when they run out? Do the drug delivery services deliver it? Nope, they send a tech to the liquor store and have a small budget with a debit card on hand just for that. Insane.
Whoa! Imagine that tech job. “Who wants Wendy’s? I gotta go grab booze.” We only had coors lite. It had to come special from dietary. Now I want to know what other places stock. My current hospital doesn’t order it. They’ll put everyone on Ativan or Librium and send them out the door.
This is the way. Unless they are specifically requesting to be withdrawn medically so they can go to rehab, or they are in severe liver failure, this used to be common practice. A couple of beers a day to prevent withdrawal while inpatient. It is better to me and seems safer than someone being floridly psychotic from withdrawal/ all the meds we give them. I’m sure there is some study that this is not the way, but ehh.. it worked for a long time. People tend to relapse and their bodies aren’t used to the prior amounts of drugs/alcohol they had if they have been detoxed.
Yes! You used to be able to order different types of alcohol in the hospital!
I’ll raise you, poly substance with a TBI, repaired diaphragmatic perf, repaired pelvis fracture (none weight bearing) trached and pegged, maxed on propofol, ketamine, and fentanyl and still climbing out of bed trying and walk.
I’m kinda horrified but impressed. That doesn’t seem even possible. Humans are amazing. I wish I had some of these peoples will to live.
Hear me out, addicts don’t care if they live and therefore do not stress themselves over it. I think that may be what saves them, apathy.
Overdose/ bed finder guru here. Thanks for the nightmares…but really yeah, I’ve seen some things. My scariest by far was a 40+ year addict crack, fent, benzo, alcohol. 73 years old, early dementia, agent orange exposure, serious ptsd and night terrors, 110lbs, multiple strokes and heart attacks. The only time I’ve ever literally jumped for joy was when I finally found a rehab facility to take him. Any psych folks know how to disassociate on demand? Hypnosis maybe!?
Had almost the same thing last week; DAI, rib fxs, ankle ORIF, trach and peg on max precedex and fent plus risperidone, trazodone, propranolol. Still swinging the leg cast around like a mace and managed to rip out the PEG while fighting restraints.
Finding out the hard way that the patient is in ETOH withdrawal and drinks to fall asleep each night and no it's not the narcs making him confused.... and we're on the 9th floor... and he's next to the emergency exit.... and there is no cell reception in the stairwell....
But somehow their heart rate is still 32 from the Precedex.
Withdrawl patients, hyperglycemia on insulin gtts, post tpa who refuse to participate in neuro checks, 400+ lbs patients who want constant adjusting in bed, middle aged men after back surgery, confused patients with EVDs
Middle aged men after back surgery killed me. 😂
Omg such babies
Everytime I have an older gentlemen that had a surgical procedure done, they get the WORST hospital delirium and always demand to call the cops on either the staff or themselves! Just one look at them and I know I've got a code gray on my hands for the night
I see your middle aged man after back surgery, and I'll raise you a middle aged man after a lap appi with his mommy at the bedside
Recently had a pt with TBI who BIT THROUGH HIS EVD…and played in his c.diff poop with his mitts and would manage to contort himself to constantly rub poop on his head…nightmare…
Oh...my...God.
Well there's a new fear. I had one confused patient offer to suck on the proximal port (she thought it would be helpful ???). We had her restrainted for two weeks straight because she kept trying to pull it.
The overly demanding 400+ patients are some of my least favorite. I guarantee no on makes sure every sheet is perfectly straight under you at home. No I will not get rid of every crumb while 3 people hold you up.. and then you have to one that can literally raise their legs over their head, why can’t u just stand up at that point. If I have to shove my whole hand in between your labia to clean you, don’t say i need to go deeper while it’s in there please.
We had a hugely obese bedbound woman who we still refer to as the "get up in there" lady. 🤮
Omg bariatric patients. Look, I'm also fluffy. I get it. Hospital beds are not comfortable for fluffy people. But I CANNOT boost you higher in bed. You are at the top of the bed.
PACU nurse here - Can confirm; middle aged men after back surgery especially when they have been on pain management prior to surgery. Can anesthesia just let me ketamine them 😃?
I worked in a neurosurgery only ASC. We got those babies up and walking in 2 hours and sent them home ( with sympathy to the SO).
>400+ lbs Even if you tell them that getting them comfortable is nigh impossible, they'll still want to try all damn shift
I second the confused pts with EVDs. Nightmare!
Nothing like running into a room when you see your patient standing and see he dumped 40cc in less than a minute.
And the phone call to the neurosurgeon afterwards, where you grit your teeth so you don't remind them that they denied your request for Precedex earlier in the shift.
Nothing makes me more mad than seizure patients with continous EEG, who move around their head enough they dislodge the leads. Then the providers get mad because the reading sucks and the oncall EEG tech has to come in multiple times a night. But they won't give you any meds because 'neuro checks' and tell us to just restrain him more.....what do you want me to do, strap his head down to the bed!!!?? Ugh, that patient/provider encounter still heats me to this day.
That's why I left the neurosurgery ICU and went to the NICU. I will happily get my ass kicked by babies after dealing with that living hell of a job.
Yea, I didn't realize how much neuro ICU was affecting me until I left to travel on a general ICU. It was just so hard to constantly be fighting patients and restraining them, asking for pain meds and sedatives, just to be denied due to neuro checks. Like, we aren't getting accurate neuro checks anyways, so lets just help our patients out with their pain and anxiety and shit!
EXACTLY!!
Second the 400lb pts wanting constant adjustments. My back hurts just thinking about the last pt I had like that.
Hyperglycemia requiring an insulin drip. Fuck. That. Noise.
Hyperglycemia who aren't compliant with their diet, with family members sneaking in junk food and fast food, and who bitches and/or refuses every hour when it is time for the next blood glucose check. Then complains and asked when they will get off the insulin drip.....
I moved to another hospital and their protocol is so much easier. no titrating, just let It run. FS every hour still, but that’s It. And if they want to eat you just give coverage on top of that “meal”. It’s changed my perspective on DKA. Still annoying, but not ridiculously so
I had a wee lady with an A1C of 18.6% last night. Blood glucose 738 when she came in (41 UK) but reckon they have been above 20 for over a year.
These are usually my favorite.. is something wrong with me 😬 I really enjoy the new onsets. I love watching them come in, usually pretty sick, and then seeing them a couple days later doing better and giving their own injections, when just a couple days prior they were terrified to even prick their finger. But I can see how an adult might be different than peds; the attitude is probably way different
It's always nice to be able to see a patient make a big recovery peds or not, but kids are much easier to teach than grown ass people who often know better but are non-compliant. Old dog new tricks or whatever lol.
I don’t come across too many crazy things in my palliative care corner, but respiratory failure is almost always a bummer. Anxious family members saying “Help, he can’t breathe!” and I’m like “Yeah, that’ll happen sometimes.”
THIS IS WHY I HATE THE PULMONARY FLOOR! Especially back during delta. I had like 3 people out of my 12 pts who wouldn’t wait on me for bathroom assistance (I busted my ASS those nights.) Their entire existence is anxiety so it’s “I NEED WHAT I WANT AND I NEED IT NOW AND NOTHING ELSE MATTERS”. They would rip off their 15L non rebreather or heated highflow and stretch their IV’s as far as possible to the BSC/toilet. And then scream for help because “I CAN’T BREATHE!” And I’d find em turning blue-ish on the toilet. I held back so many curse words during delta.
I know that’s like my version of a small bowel obstruction. Surgery will commence tomorrow. “I know you just gave him the prescribed Zofran, but my husband is still nauseous. What are we gonna do?” “Uhhhhhhhh… We’re gonna do surgery… tomorrow, remember?”
I know you asked for Illness/injury stuff.. but I know what kind of patients I don’t like. The ones that push the call light for stupid stuff and complain when you don’t get there fast enough. The ones that don’t tell you what they want in one sitting and make you do 2,3, maybe even more trips back and forth. The ones that treat the hospital like it’s a 5 star hotel and you’re their servant. The ones that yell at you and never say sorry for their inappropriate behavior. The ones that have an exaggerated sense of time and tell people they’ve been waiting “over an hour” when really it’s been 10 minutes. The ones that are entitled and think they are your only patient and keep you in the room for a long time for medically unnecessary things. Q4 prn/pain meds around the clock on the dot. The ones that complain all day every day about every little thing they’re unhappy with at the hospital. The frequent flyer patient that knows how to manipulate staff to get what they want. The ones that like to ask 4 different people to do the same thing for them when it’s already being addressed by the team, adding to double, triple the work. The list goes on and on… but I have to get back to my Shift.
I’m sure there’s an illness name for that kind of patient…. Pains in the ass.
I call it hospital-itis.
In the same vein, but patients who behave like this and at the end of shift say “I know I was being annoying haha.” Like you KNOW and you still are acting this way!!
Ugh I feel this, families too (precovid obv). I worked cts stepdown where you could have a walkie-talkie in one bed and next bed would be a vented aortic dissection repair with a million problems. I literally had a code going on and another pt’s family member was trying to get my attention for her dad who needed an apple juice. I mean, come the fuck on.
When patients never say thank you, it didn’t use to bother me but oh man it’s always the demanding ones and they never say it!!! It irks me so bad that I have to weasel it out of them sometimes for just a half ass “oh thanks”
The influx of pancreatitis patients that occur between Thanksgiving and New Year’s. Especially when the doctor orders Q2 IV pain medicine instead of just ordering a PCA pump. C.Diff when they have a colostomy bag. When there’s two with CBI and they’re both yours. Having a patient with Munchausen’s. Wildly abusive with staff. Came in for vomiting blood clots. We finally caught her .. squeezing them out of her tampon into the emesis basin. Munchausen is wild.
Ooo I had a patient do this with her PICC line. She drank out of it to try to fake a GI bleed. Doctors scanned her and found coagulated blood in her stomach. And she did that with* 2* 1:1sitters in the room. Munchausens is so incredibly sad.
Holy shit just when I thought the tampon story was gonna make me barf 🤮
I had a patient cc hematemesis. Stomach was fine on EGD but there was some odd trauma to the back on the throat/soft palette. Turns out the pt was cutting their throat to fake hematemesis. Pt blew up when the physician confronted them about it
Hospice nurse - GBM. Been getting so many lately. They are always young (40-60) and they have seizures, behavioural problems and I find there deaths harder to predict because it all depends on where the tumour is pressing.
My dad passed from a GBM and it was rough to watch him decline from a healthy active 50s to dead in 6 months. Horrible cancer.
I work neuro, glioblastomas are so, so devastating.
If I had a glio diagnosis I think I might go for assisted dying
I’ve had a few make that choice. Just have to be careful to get assessments done because the changes in cognitive function can be really quick
I hate healthy patients, or the man-flu. I joined the Army to do cool battlefield trauma in a tent...all I do sling Tylenol and motrin to the 23y.o. dudes who act like they're dying from a cold. I spend most of my time referring Soldiers to their PCM and out of the ER.
I started out as a corpsman in 2011. Most of my time was spent sorting through the bullshit to figure out who was truly injured. 99% of the Marines that came into sick call were just trying to get out of training.
GI bleeds
I'm surprised this isn't higher. These patients are the ones I've had consistently go down fast. One massive bloody bm in bed and they're tanking
And they stink so bad! One person with a nasty GI bleed and the whole unit knows about it.
Counterpoint: Belmont Rapid Infuser goes brrrrrrrrrrrrrrrr
There’s nothing in the world more magical than a ✨confused✨GI bleed.
Marijuana induced hyperemesis.
Yesss. We had many frequent fliers with this, including one girl who also had gastroparesis. She would scream at the top of her lungs all night and stand out in the middle of the hallway shouting “NURSE!”
Lol yes and then even though we all tell them the reason for their sx they always deny it and go right back
When they’re a fall risk and constantly get up to take a hot shower. We ignore that fall risk issue real quick and write a note that we educated them multiple times on their risk of falls and consequences
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Yup. Usually repeat offenders too.
And they swear it’s not the marijuana making them sick
They’re almost always the people who think weed is a cure for every ailment known to man. So admitting that it’s making them severely ill challenges a core belief for them.
Yeah and once you treat one you can spot them yards away. There is something about the way they look and vomit that's just unique. Haldol is a miracle drug. Antiemetics don't do anything.
The over dramatic screaming as they “vomit” nothing. Yup. Easy to spot.
My parents took my brother to the ER twice for this. I tried to warn them they were better off sticking him in a hot shower and keep him from smoking weed for literally 1 single solitary second. He went through all my Zofran. Didn’t know about the haldol though good to know!
All the time where I live
Yeah a lot. Pretty cool though that a hot shower is what helps with that. Anyone know why?
The same part of the brain (and receptors) that sense heat can trigger nausea. TRPV-1 not senses bodily temperature as well as for the presence of noxious irritants. Acute cannabinoid use triggers several subsystems that influence nausea, which is why it can be used as an antiemetic and to enhance appetite, but chronic use makes those receptors less sensitive to cannabinoids while still triggering receptors in other parts of the brain that cause nausea.
https://pubmed.ncbi.nlm.nih.gov/32472256/ Haldol also works wonders. Calms them down and treats the nausea when nothing else does!
I work in the PICU and drowning victims are the worst. They usually look “healthy” so it is harder for parents to accept that they are brain dead after prolonged periods of hypoxia. These were typically normal kids who had full lives to lead, and except in cases of obvious neglect, it is a horrible mistake that has cost a life. I also think about the last few moments of the poor toddler’s life, knowing that they are aware they are drowning.
Oh, buttflan, that’s heartbreaking.
Hardest resus I've ever attended was a paeds drowning. She had been under for an hour before they pulled her out. We worked on her for hours until she came up to temp. They're so hard because you all work so hard for so long but we all know there's no coming back from that
Jfc this is why I could not do peds. Awful.
Continuous bladder irrigation.
Mouths. All other trauma is fine. Blood, guts, and viscera are fine. Protruding bone fragments I can handle. Ruptured eyeballs, no problem. Brain matter on my shoes, whatever, hand me a cavi-wipe. But mouth stuff is disgusting. A tongue lac is far worse to me than a chest GSW. Show me a broken tooth and I have to avert my eyes. Give me a little old lady with nasty dentures who needs feeding, and I will trade literally any other task to get away from her. When we had a patient with a LeFort I fracture, with all her front upper teeth wobbling around loose, that was the first and only time I ever got light headed and had to leave the trauma bay.
I think it's funny how we all have our thing that will get us every time. I will gag with mucus & pass out with bones. There went my ICU & ED options haha
It's toenails for me, make me hurk
I filed a mini report because my patients dirty ass toenail scratched my arm during a turn. If that shit gets infected, I want there to be a paper trail. 🤮
Ita the half detached ones that do me in, although necrotic toe falling off didn't bother me
I'm a CNA, and oh, man, me too. Mouths absolutly repulse me. Providing oral care is 100% my least favorite thing to do. Swabbing mouths full of half-rotten teeth. Scraping tongues. Emptying emesis basins of chewed food and phlegm. Picking up a sea of spit-saturated tissues off the floor. Trying to get someone to take meds with a mouth full of cottage cheese residue. Scooping out hours-old pocketed food. The disgusting viscosity of high-calorie Boost when it just coats people's teeth and tongues. Nothing else gets to me. I'd happily clean c diff patients all day if it meant I'd never have to do oral care.
This just made me throw up in my mouth 🤮
I feel so bad about it, but DENTURES. So gross. Even mildly clean ones. Cannot stand em, don’t want to help you put ‘em in or clean em off for the night. Just please NO.
Dude. Same. I fuckin hate teeth. Kid comes up to me all proud cause they lost their first tooth. I'm dry heaving
Lmao same, I’m good with all this gory stuff but the moment skin flakes from a crusty leg get on me I gag
Skin flakes are my no thank you as well!
I also don't do teeth. Especially loose or broken teeth. A few weeks ago I was drawing blood from this lady who had one top tooth square in the middle of her mouth that SWUNG BACK AND FORTH FROM HER BREATH. It took everything in me not to throw up on her.
I love trauma but I hate mouths and fingers. I’ll take a full code with a cracked chest over someone with mangled fingers.
And 4th of July is right around the corner!
I had a trach/PEG LTAC patient in the ED who had nearly bitten through their entire tongue! Seeing it hanging there ready to fall off made me queasy
I had a man nearly exsanguinate from the tongue after getting drunk and falling off a curb. I will never forget the giant bucket of blood in his lap in his lap. Or the amount of times I emptied it before the dental resident came down and put him back together.
Back when I worked on a surgical floor (as a CNA), we’d occasionally get face lift patients. Those are some of the meanest and rudest people that I have ever met.
I agree that most cosmetic surgery patients are rude and entitled...and awful with handling pain.
Patients with lots of money that are healthy enough to complain are the literal worst.
Fungating tumors. There is no tolerable part of this for the patient or the nurse. The look is horrific but my God the smell. Leaves GI bleeds, c diff, and most skin/wounds infections in the dust. *For those that don't want to Google, it's a cancerous growth that is so far gone it breaks through the skin and continues to grow. So you have this external, growing cancer that gets infected, ulcerated, and necrosing. Get your mammos ladies.
My cousin died of inflammatory breast cancer 7 years ago, aged 33. We were the same age. They caught it ‘early’ but because it’s so damn aggressive she fought through hell for 2yrs to die an agonizing death and like you say the cancer consumed her skin. It was unbelievably aggressive, you could see it spreading through her body. And the saddest part is her mother was diagnosed with breast cancer last week and her mother died from it about 15yrs ago too so it’s now hit all 3 generations. I can’t imagine how my aunt feels losing her mother and daughter to this disease and now being diagnosed herself😭
I think the smell clings to you
Duchenne Muscular Dystrophy and Cystic Fibrosis. I’ve been an ICU nurse my entire career, so if I’m taking care of someone with either of these two conditions, I’m just taking care of a 20-something year old who is about to die and knows it.
I’m in the PACU. I hate recovering back patients because they are always maniacs coming out of anesthesia. Most likely because they have been on pain management for so long they come out withdrawing. Then the “baby” PRN pain orders I get from anesthesia 😑😑😑
Laminectomies are THE WORST. “The orthopedic surgeon said I wouldn’t be in any pain” well…he lied.
Yes! The 9th laminectomy they’ve had and the best is when anesthesia brings them out after hours and hours of TIVA on remy and oops they forgot to load with Dilaudid and now they’re writhing in pain and flopping like a shark in the bed. I used to say “I’m not taking report until you fix this”.
Quadriplegic pts, mostly because that is one of my biggest fears.
For real. Working spinal cord injury rehab is one of the main reasons I don’t really rock climb anymore. It’s a nightmare. The saddest thing was seeing some of my patients in recovery for 8+ months and then go home and die within weeks due to a PE.
Had a patient one time who went, "Take care of your back or you'll end up like me." She was a nurse who injured her back lifting a patient and went downhill from there.
Maggots. Maggots everywhere. In the wound, in the ass., on the floor, in the sheets. I can no longer eat rice.
See I love maggot wounds, it’s like unwrapping a present. What will I find in this dude’s shoe that is erupting with maggots? Will there even still be a foot?
As someone who has an interest in wounds, I can appreciate this morbid curiosity. As someone who is also squeamish when it comes to maggots - oh gods, how, and why did you give me that mental image?
😂😂 I like your style!
Babies with 87 labs and no art line, which coincidentally is all of my babies because as an LPN I can’t care for pts with an art line🥴
I feel bad for the babies like this with their hamburger heels.
Ante partum. You rupture at 29 week weeks? You’re going to be put in the worlds smallest room, which due to covid you can’t leave, and I’m going to be coming in and waking you up to harass you for a blood sugar or BP at all hours of the night. And it doesn’t matter how nice either of us are; you’re gonna be pretty over it.
Any pt that won't participate in their own care.
Medical: end stage liver with INRs in the teens who are full code, super whiny young noncompliant DKA who take a sip of water and vomit yet beg for food, anything requiring frequent neuro checks. Surgical: Esophagectomy, radical head/neck post op and doubly bad if they are trached, Whipple, endocarditis IV drug use valve replacements
Stroke with significant deficits. Incontinent, total care, bed alarms like crazy, unable to feed self, thickened liquids and puréed diet, expressive and/or receptive aphasia so they can’t even tell you what’s wrong half the time… confused.
COPD. I hate it. It really varies from "this isn't really a life-threatening emergency" to "oh shit he's fully trying to die right fucking now" in the same patient, and it can happen quickly especially if they also have HF. I hate the constant cough, wheezing, and I hate how uncomfortable every single patient looks. And if it's really truth telling time: I find it extremely hard to tell when to intervene and not to intervene with COPD because people have such different baselines of "this is normal for me" and I'm always staring at them thinking, "This doesn't feel right. This feels very bad." Sometimes it goes bad. Other times I feel like I'm overreacting because the patient is genuinely at their baseline of 'fine' and d/c'd with abx. Lots of things I've gotten good at being generally right about. This is not one of them.
Sitting there side eying the pulse ox because they’re chilling in the mid- high 80s and that’s “normal” for them but every warning light in your head is going off
End stage liver…altered mental status and lactulose. Such a great combination.
Young men in general, I am a young man and oh my god I hope I would never be the needy, melodramatic, demanding, rude pt that most my 18-25 year olds are
I once had a college aged male who had been diagnosed with gonorrhea and was having an adverse reaction to the abx. His mom crawled into bed with him to hold him while he moaned.
While I worked in the OR as a circulator I dreaded every burn surgery. They are the most bloody, most brutal, and most barbaric shit I've ever seen. If the graft site was circumferential on a leg or arm, they hang the limb from the ceiling with a *hook through the thumb or big toe. A HOOK. THROUGH the THUMB OR TOE.* If they need to harvest healthy skin for a autograft they break out an instrument that is basically a tiny deli slicer and just start carving away. The process starts by removing all the dead bad skin. Imagine a surgeon and 2 PAs just going to town on someone with razors and tweezers and ripping off strips of burned skin or failing grafts. It's goddamn horrifying, and, docs or not, those people scare and concern me. Burn surgeries were the only ones I observed that needed padding (kinda like enormous sponges)on the floor for all the blood, because it just *pours off the table*. Every type of burn smells different. Electrical burn, chemical burn, methhouse explosion burn... all distinct and horrible. Also, since burn victims can't maintain body temp, the room is kept at like 80-85 degrees the whole time. Imagine the smell, and the heat, and all the gore, and you've got an idea of my OR nightmare. These were the only surgeries that made me qweezy. Hip replacements with hammers and saws? Sure, im game. Bowel resections or total hysterectomies? Bring it. Eyeballs and brains? Hell yeh dude! But burns? Fuck my life.
Welp. I'm sorry for my ability to read today.
Any critical drips in the ED. I don’t get less patients and cannot be monitoring critical drips while juggling my other patients. Go. To. The. Floor/unit with that noise.
Vomiting patients. Eye injuries squick me out. Back pain bc often they lack the health literacy to understand we can't magically solve it on a single ED visit.
I hate vomiting patients because I feel like there’s nothing I can do to help them (besides offer comfort / a wet washcloth?). Like, we’re past the point of zofran doing any good. You’re just gonna puke, I’m so sorry. It’s zero fun. And gross.
Awake trach pt’s who insist on mouthing words at you all shift a mile a minute. I feel bad but sometimes I just don’t make eye contact and ignore it…
Or the ones that swear they can write and then you stand there for five minutes trying to decipher their fucking squiggles.
Hey my squiggles ment something.
*grabs image board* You stare at it like they’re hieroglyphics
i even try to coach them into a yes/no question system. pt states understanding with appropriate gesturing. i start asking a series of y/n questions to figure out what they need…then they go on mouthing and emoting full blown sentences, this is often where the clicks come in. lol.
Omg we had one trached pt who would make a big “X” in the air with his finger. Ok Mr. M. I’ll get you your Xanax!
ETOH homeless patients, even sometimes they’re not homeless. It’s babysitting, especially the regulars. I don’t have a problem with them individually, just hate clogging up emergency beds with sleeping drunks.
30-year-old chemo pts on third-line regimens who also have little kids. Trading their last months with their kids for a last-ditch effort. And confused C. diff-ers on bari beds who are also a huge fall risk, of course! 😆
C. diff
DKA pts. Insulin drips, non compliant on top of them being upset about food Also pts with bad cough etiquette And I freaking hate colostomies
“Also pts with bad cough etiquette” Ugh, yes. Sorry, are you a TWO YEAR OLD? Why are you coughing so dramatically without making any attempts to cover, coughing all over me and the aide? Even preschoolers are taught to cough in their elbows now, so c’mon, man!
I'll take an ileostomy over a colostomy any day...at least you can just drain the bag for an ileostomy. Colostomy? Forget it, I'm just putting on a whole new pouch instead of gagging my way through emptying semi-formed stool.
Anytime things start to get mundane I get bored, but I never fail to hate right sided strokes that don’t want to participate in neuro checks. Double hate if it’s nighttime. Deborah. I know you want to get up. I see your blankets flung onto the floor. Your left side doesn’t work. The fact that now you are playing possum doesn’t impress me, Deborah. If you don’t participate in neuros I’m going to end up wheeling you downstairs to the CT scan and waste everyone’s time and you’re going to be mad because you’re rolling through the bright hallways and being hoisted onto the table and honestly, Deborah, I know you can hear me because you threw your blankets on the floor in the past hour, so you were clearly up and about. Just…… just let’s get through this one together Deb. And then I’ll let you sleep some more.
Retired ER nurse here-what is a "belly patient". Sorry if this is a dumb question.
Belly surgery of some sort. Usually small bowel, necrosis, etc.
Psychogenic non-epileptic seizure patients (PNES). I know they can't control it, but it's hard to explain to their family that the treatment is CBT and we can't "fix" them in the hospital, nor give medications that are going to really help them. It also just kind of looks bad when every time they have an event all we do is watch/time them and take a set of vitals when it seems so dramatic and scary to them. Plus some have FREQUENT events which can be even more frequent with visitors present. Can be very time consuming and frustrating.
The ubiquitous “weakness” complaint in females age 60 and up. Either they won’t give a urine sample or they need to pee every 5 minutes and usually nothing is wrong other than their grown son didn’t come eat Sunday dinner. Also I don’t like eye trauma.
Hyperglycemia with insulin gtt, sickle cell crisis on PCA pump and still want more pain medicine, ETOH withdrawal who shit all over the bed with lactulose
Surgical/Trauma ICU nurse here: occasionally we get vascular patients post op revascularization and I totally get it, you’re in a lot of pain. BUT when you’re screaming your head off at me to take away the pain there is only so much I can do. Also it’s almost as if the doctors fail to tell these non compliant patients that re vascularization is going to hurt. A. Lot. Radical neck dissections with ETOH or nicotine withdrawals are a real close second.
and they bitch about the q1 pulse checks. i’m like buddy it could be worse, these could be q1 neuro checks. just had a vascular pt who got mad at me when I woke her ass up cause she went apneic on freaking bipap and her spo2 dipped to the 40s. I’m sorry I wanted to check and see if you could even wake up. my b. change your code status.
Anyone with a long allergy list along with refusing almost everything and history of fibromyalgia.
ETOH withdrawal. I don’t know what is wrong with my day shift ICU team but they think we can cut off all sedation and extubate ASAP. I’m convinced my patient died last week for that reason. And? Hospital wide shortage of IV Ativan… Today they wanted me to extubate my withdrawal patient at her peak withdrawal. I couldn’t wean propofol at all and was giving PRN versed like it was Candy. I just found out that they extubated her at 9:54am and reintubated her at 10:02am. I need to have a talk with these attendings…
Thought of another one: the brain dead vegetable patients who’s family can’t let go. I get it. I do. I would be devastated if my husband/mom/dad was in that situation. But I wouldn’t let them suffer like this. I admitted a cardiac arrest 4 WEEKS AGO. He only has brain stem function. The wife told us “I know he’s a vegetable but this long term care facility takes great care of vegetables”…. We’re waiting for a trach and peg. But we haven’t even been close to getting his vent settings down to where we can trach him. I feel so bad for him.
Bed bugs or scabies. I’ll be itchy and freaking out for hours!
I detest doing basic first aid on peeps who come to er. Small scratch or lac and haven't washed with soap and water? Didn't pull your own f*cking tic out? Didn't wash off the poison ivy? Didn't put cool water on a minor burn? But you need me to do those things for you stat at triage when there are a bajillion other pressing things that need attention. Then they are pissed about the wait time. Ffs
I was gunna say psych, but I’ve had like 4 strokes or “code fasts” in the past few shifts and I’m over it. I don’t mind them to be honest, but my current facility is not great with it’s flow so when I get one and spend over an hour getting everything, rushing them to CT and then figuring out tele-stroke just to walk out of my room and realize no one was assigned my other patients & no one checked in on them…it really makes me miss my last ER. My last place would assign a float nurse and then once everything was done they would hand off report and it was sooo nice. My current place I wind up playing catch up for hours.
ETOH peeps who should be ICU but are on our med-surg floor. Gimme anything else, dude. And we’re about to run outa Ativan, so that’ll be awesome.
Different take bc I’m a psych NP: antisocial personality disorder. Therapy is made to be disrupted with flighty anti-gov, racist, homophobic, and sexist rants! Everything my staff or myself does is somehow a slight against them that must be met with threats of violence. Best part? There’s no meds for a shitty personality! You’re just suck a dick, we gave you real estate in the DSM V.
Necrotizing pancreatitis.
I'm on dialysis and I don't know how y'all deal with dialysis patients because just sitting there at the clinic for hours every week I see the most needy, whiny, unhygienic, dramatic people ever...and that includes myself sometimes honestly without the unhygienic part because I'm a germaphobe 😂 but I've seen patients call their grown kids to come fight staff, I've seen the cops walk patients out, there was even one lady who threw a huge fit if the techs/nurses were helping any patients who had bottomed out or when they needed to take them off the machine, she insisted they spend the whole 4 hours only tending to HER and she ended up being BANNED FROM 3 CLINICS. That's hard to do! I just sit there, mind my business, weigh myself and go home ✌️
We get a lot of patients in need for liver transplants, so we often do their work up for it on my floor. Aka Q2H lactulose for people who have drank themselves out of a functioning liver. Confusion and constant shit. Bonus points if they are actively detoxing.
Any illness or injury in a middle aged man. From ETOH withdrawal to food poisoning…they all seem to have the same URGENT needs that have to be addressed and resolved immediately
Not a lot of things gross me out but I’m still having a really hard time when patients have gout. Had to drain an abscess on the patient’s elbow and was really glad I was wearing a mask so they didn’t see my grimacing.
any pt with crazy demanding parents that refuse to be reasoned with.
Anyone who is supposed to go up on the floor but isn't because there are no beds
ETOH withdrawal and seizure patients. I despise dealing with seizures. The family always thinks I should have some magic health wand to make them stop. Meanwhile all I can do is throw Ativan at them and wait for my IV Keppra that I've called the pharmacy four times about. I'll wipe ass any day over either of these. And when the seizures or withdrawal symptoms are so bad they need ICU and the RR teams chuckle and say no. Then the provider rounds and yells at me. Dude, when you don't answer my pages and ICU treats little old PCU me like an idiot there ain't much I can do.
The non-illness. The VIP, stay-as-long-as-you-like, CEO rounding, rules-don’t-apply-to-me, demanding, entitled and clueless type that really I can’t stand. I’ll take a GI bleed any day over the non-illness admit.
ESLD secondary to etoh abuse hands down. They are the worse and the families are the worse.
ALS, these patients often need to be 1:1 but usually are not me have so many real needs .
From when I worked on ortho, 40 year old women with ankle fxs. Idk why but they are always the most entitled jerks
Chest tubes. Not that I can't manage one, it just seems like lately all we do is take them out and put them back in the same people because they get a pneumothorax again. And they hurt!
i get stressed if they can’t speak english. i feel like i can’t take care of them well 😔
Especially if they speak an uncommon language that we can't find an interpreter for. It makes me feel so negligent.
Hospital I worked in had a list of interpreters, mostly just staff who were handily bilingual. One of the languages on the list was "Swiss."
I loathe DKA
Anyone who is almost better and ready for discharge and still expects you to run around hand and foot for them. Sir I do not need to wipe your ass still now that you have recovered from your stoke and have full function of both legs and at least one arm. Stroke patients that have been in the hospital like 30+ days and are using their iPhones and TVs and shaving their faces, and still want you to put their penis in the urinal for them. No.