Thursday, September 30, 2010

Staff quote of the week

“I don’t know if it is an ethical conflict to go to a patient’s funeral. To be honest, all I really remember from the ethics manual is “don’t have sex with patients”—not like you’d want to with our patient population!”

Wednesday, September 29, 2010

Vacation woes

Dr. Warmnfuzzy went on vacation recently. As is our policy when a doc is on vacation, all requests for medication refills on her patients were referred to Dr. Analytic. And as is his policy, he filled the prescriptions with only enough pills to get the person through until their next visit with Dr. Warmnfuzzy.

Which meant that I got to field the following phone call:

Mrs. Worried: "Hi, I'm a patient of Dr. Warmnfuzzy and I picked up my prescription of Xanax and realized that it was only filled for ten days and I wondered what's going on. I mean, I've never had my medications get eaten by the dog or blown away in a hurricane or something weird happen to them for early refills--does this mean Dr. Warmnfuzzy doesn't trust me anymore?!"

After the myriad daily phone calls from assorted drug seekers, it was very nice to have a call from someone who was less concerned about the quantity of Xanax they'd been prescribed than why they'd been prescribed that amount of Xanax.

Monday, September 27, 2010

A drug is a drug is a drug?

Mr. Methhead is one of our long-term patients. He's been with RCMH for ages. While our chart numbering system is currently at six digits and growing, his medical ID number only has four! Due to his bad decisions on how to finance his drug habit, he takes a break from us regularly to spend quality time with the nice folks at the Random County jail, but he always comes back.

He's out again, and that means he's on my list of clients who come in for regularly scheduled injections of long-acting antipsychotic medication. As I gave him his injection last week, he said "Wow, I got such a rush from that!"
At a loss for words, I just stared at him before finally stammering out "You know, Mr. Methhead, that may be the nicest thing anyone's ever had to say about Prolixin!"

Monday, September 20, 2010

Probably not in my job description

Even though I work as a psychiatric nurse, I do a lot of other things in the course of the average day at work.
Like passing out condoms.
I'm a firm believer in preventative medicine. It's a lot easier to prevent contagious diseases than it is to deal with the consequences once they've taken root in a population. Since most of my patients aren't in the most stable of circumstances to begin with, the last thing they need is a serious infection or an unexpected family member.
As part of this philosophy, I pass out lots of condoms to the therapists, crisis team, caseworkers, etc. I'm much more tactful about this now than I was when I first embarked on this project.
"Sheryl, would you like some condoms to give your patients who may not be making the best lifestyle choices?" is a much better way to initiate the safer sex conversation with a co-worker than:
"Hey Sheryl, want some condoms?"

Friday, September 17, 2010

Overheard at staff meeting

Therapist: "I think Patient Steve is getting a lot better: He was telling me about his kids' mother 'and she told me, 'Steve, which do you love more--the booze or me?' and I told her it was her, but it seems I was wrong.' "

Monday, September 13, 2010

Staff quote of the week

From a buxom female co-worker: “I don’t know what it is that makes men so obsessed with boobs. It’s not like they do anything--they're just there. I even tried to ask a lesbian friend what was so important about them and she just looked at me and said 'I’m not talking about this with you.' ”

Thursday, September 9, 2010

Overheard at staff meeting

Crisis worker: "How old are you--I'm pretty sure I've been sober longer than you've been alive!"

Tuesday, September 7, 2010

Not a FDA-approved appetite suppressant

"Can I check my weight?" He stepped on the scale in my office.
"Mr. Methhead, that's ten pounds less than you were last week!"
He grinned sheepishly. "I just got back from a four day meth binge, so I'm not surprised."
I didn't know what to say, so I settled for "Then I'm glad you're here and on time for your appointment."
A worried look came into his eyes. "Say, I've been having bad anxiety attacks lately. Do you think Dr. Analytic would give me something for that?"
"I'll certainly ask him, but I'd bet good money that he'll say your anxiety attacks are because you're coming down from meth binges."
"@#%! I figured it was worth a try."

Wednesday, September 1, 2010

Don't hit on the nursing staff

I've been a nurse for almost five years now. And in the course of doing my job, I've been kicked, punched, sworn at, spit on, vomited on, and hit on more times than I can count. The last one is particularly difficult to deal with. I realize that one of the hazards of being a woman is that some men make rude remarks.
Nursing seems to amplify this tendency. There's something about the intensely personal nature of the work a nurse does (asking intrusive questions, feeding people, administering medication, wiping backsides, educating people, etc.) that leads some men to over-estimate their own attractiveness (Now that you've told me all about your genital warts, what makes you think I'd like to date you?) and under-estimate my proffessionalism. (Dr. Grumpy tells a hillarious story about this here.)
I used to work for the VA, which has an overwhelmingly male patient population. And the patients who hit on me there fell into three distinct categories: (1) elderly men with dementia, (2)middle-aged to elderly men who thought they were being flattering, (3) and thirtysomething alcoholics going through withdrawl.
And I soon found that three different responses were required for these groups of people: (1) "Dave, I can't go to the movies with you, but do you want to watch sports right now?" (2) "It's nice to see you too, Dave." and (3) "Here's your pills, Dave."
Most of my current patients are very appropriate. However, there's always those few... Throw in a history of mild mental retardation and some organic brain damage caused by years of drug abuse on top of their usual mental health sypmtoms, and I often find myself grasping for an appropriate response.
The first thing "Dave" said to me when he saw me last week was "You've got a real nice shape--I like you!"
What do you say to that? I know he's trying to be nice (even by the most liberal of interpretations, Dave has never been playing with a full deck) and I don't want to hurt his feelings, but I do want to set reasonable limits for his behavior. So I settled for "I like you too! I'm so glad you showed up for your appointment today."