What Your Nurse Hates About You

Let me be honest, a lot of this post is going to be me bitching about things that are specific to nurses, doctors, or healthcare professionals at any level. I am not going to write things about how I hate patients that have a certain disease. A lot of those things cannot be changed like some of the behaviors I’ll describe.

Mostly, I want you, the non-healthcare people, to know exactly what you do that pisses us off. I don’t expect you to change because change is something people don’t want to do anymore; but now, however, we will both know what you’re doing is pissing us off.

You Don’t Know What You’re Taking or Why You’re Taking it

Okay, I get it. You might take a lot of medications. Blue pills, red pills, water pills, blood thinners. You might take these medications faithfully at the same time every day like you’re supposed to, but most you don’t know the names of the medications you take or what you take them for.

As an experiment, I have started asking people why they take a “water pill.” I know what the water pill is and why they’re taking it. The best answer I get is along the lines of “I take it to pee for my blood pressure.” I guess that’s correct, but not really. These pills help your kidneys get rid of extra water and salt and they do that by peeing.

Even knowing about a third of what the medication is for is not knowing enough. I have had a panoply of patients with diabetes say that they eat whatever they want and just use more insulin to cover the extra sugars. Here’s an exchange I had about that at work:

Patient: I just take extra insulin when I want a second or third piece of cake.

Me: That’s not what the insulin is for.

Patient: Well, it’s my body.

Me: That’s fair.  You ever hear of Death by a Thousand Cuts? Because that’s what you’re doing to your body.

Patient: That’s rich coming from a fat boy.

Me: Yeah, but I’m not diabetic and have lost 130lbs. And this is what I went to school for. But it’s your body.

We nurses and your doctors went through a lot of schooling to become experts on what medications do to and for your body. We will teach them to you as best we can, but the burden to understand it fully is on you. We want to help you. We have the data you need. You have your opinions and feelings, which leads me to…

Disagreeing with our “Opinions”

You can disagree with us on social issues and that’s fine. Those are the societal issues that welcome debate. But we come to you medically with facts and treatments that have been honed over years of evidence, research, and testing.

I can hear you contrarians already: “You’re just humans and you don’t know everything because my homeopath blah blah blah blah.” Yes, we are humans. We are not infallible. We make mistakes. I acknowledge that.

Our mistakes acknowledged and put aside, we do know what the best ways are to treat your illnesses. Let’s pick one that’s causing a lot of controversy right now: cyclic vomiting caused by the heavy use of marijuana. We dorks of medicine call it Cannabinoid Hyperemesis.

A lot of these patients come in with vague abdominal pain complaints, lots of vomiting, and “just feeling sick.” We do a lot of tests to rule out diseases that cause these symptoms. You get blood work, ultrasounds, CT scans, urine tests, and you get your nurse and doctor to push all over your abdomen. We spend a lot of time and resources to rule out dangerous disease processes and we decide that your pain and vomiting is happening because you’re chronically on The Chronic.

I had a patient who had all of these and had even been worked up by a gastroenterologist. A whole team of medical professionals had applied their expertise to this person’s body and found that the patient was in pain and puking because they smoked too much pot too often.

I entered the patient’s life on one such exacerbation. So, naturally, we had a Nurse Tyler Snark Talk:

Patient: Me and my doctor had a differing of opinions about why this happens.

Me: Kind of. Your doctor told you why this is happening, and you chose not to believe the truth.

Patient: You know what?  Fuck you. I’m in a lot of pain here.

Me: I understand that. But you’re so unwilling to stop smoking pot to see if that helps. Hell, you’re addicted to it.

Patient: Pot is not addictive.

Me: Then why can’t you stop for one month to see if your life improves?

Patient: (Keanu Reeves face) Woah

I doubt that I got through to that patient, but I told them the truth about their body and about their opinion. It’s often that your opinions are based on feelings about having to do really hard work, so you look for an easy answer or you don’t do anything because it doesn’t fit your narrative. Kinda like vaccines (guess what: they fucking work and don’t give your kids autism).

This stubbornness and unwillingness to listen is one of my biggest pet peeves. There’s even a type of patient that does it the most…

Your Toxic Masculinity Makes You Look Like a Huge Coward

I’m looking at you, older white men. Yeah, you, the biggest purveyors of saying, “I’m fine” or “I don’t want you to do that” or “I don’t take my meds because I don’t need them” or “Why can’t I just go home?”

Here’s the patient I hate the most: This patient is an older person who is brought into the hospital in an ambulance and refuses all treatment when offered or recommended by their treatment team. They come into my emergency department and immediately want to leave. They could be having a heart attack. They could be a breath away from respiratory arrest. Guess what, shitbag, you called the ambulance. They didn’t barge into your house, tread on your rights, kidnap you, and take you to the hospital to be held against your will.

You insist that you’re fine. You just want to go have a smoke. I get it. You’ve lost all your power. It’s a terrible feeling, but your imagined toughness hurts you more. Every time you delay emergency treatment (or any treatment), you are hurting yourself. You are so afraid of showing weakness, illness, or vulnerability that you’re hurting yourself.

I’ve argued with countless patients and heard every excuse. That’s all they are—excuses. A recent one was a patient who was in diabetic ketoacidosis (for non-medical people: simply put, this is when your cells release ketones into your blood, turning it acidic. A common thing that happens after that is a build up of potassium in the blood stream, which can cause some life-threatening heart arrhythmias at high [or low] levels.). This patient pled with me that they had a sick spouse to care for. I had researched this patient’s history and knew that the spouse was in a care facility and having their medical needs tended to. The patient expressed a desire to be with the spouse. I get that desire; there’s not much better than being near the one you love, and it must be maddening to have a loved one that’s ill.

Me, being me, had to challenge their bullshit:

Me: So what are you going to do when your heart stops?

Patient: I guess I’ll die then.

Me: (picturing a meme of an old man saying, “guess I’ll die”): hahahah that’s so stupid. You can’t do anything for your wife if you fall over dead next to them.

Patient: Aw fuck you.

Me: Sorry, sir. You’re not my type. You’re too old for me and have too much penis for my taste.

Patient: (a moment of silence and then some begrudging chuckles) Yeah okay. You’re right about that hahahahaha!

All things considered, you can refuse whatever healthcare you want. And if you collapse and lose consciousness?  Then it’s easier for your healthcare team to get things quickly done. That being said…

No, I Don’t Know How Long It’s Going to Take and, No, I Can’t Give You an Estimate

Healthcare is not fast food. Healthcare is not a car wash. Healthcare, for the most part, is not in and out. Get in and out of the hospital takes time. Also, some people never get out of the hospital.

A lot of people come up to me in the lobby of the emergency department and want to know long the wait is. It could be 30 minutes and it could be 10 hours. There are a lot of factors in these numbers. Is the department short on nurses?  Is there more than one doctor on duty? Is the department holding admit patients when they should be going upstairs?  Was there just a massive trauma and the departmental resources are focused there?

Another non-department factor to consider is you. How “sick” are you?  Departments have systems and algorithms in place to determine your place in line. An ED is not first come, first served. It basically works on a spectrum to almost completely dead (cardiac arrest, traumas, heart attacks, etc.) to not even close to dead (foot pain for years, dental pain, vomited once this week).

A doctor that I respect has a nice line for people when they complain about how long they’ve had to wait (shout out to Becca P!): “You don’t want what it takes to be first in line to be seen.” She’s right. That’s wishing death on yourself. That’s why I’ve stolen her line and use it when people bug me about wait times.

And, once you’re waiting, there’s nothing you or I can do to make it go faster. So, stop standing in the doorway and watching me chart. Yes, I know it looks like I’m just sitting there doing nothing, but I’m not. I am painting a picture of your health for your records. I am documenting your vital signs, signs of illness, and behavior. And, if you say some mean shit to me, I am directly quoting you.

We are charting these things to look for trends. Are you getting better or worse? Having your loved ones hover at the door and scowl at us does nothing to help you or me. If anything, it sours us on you. We’re feeling judged and inadequate for providing care.

When you (or them) wag your finger at us or threaten us or yell at us for things we cannot control—and yes, this happens every single day to every single nurse in emergency departments—you are showing us that you don’t know how the system works, that you have poor coping skills, and you treat your common man like garbage servants. And we are not your servants. We are not your waiters. I don’t work for tips; that’s why I say whatever I want to people. Your feelings are not my priority. They are important, and I don’t ever want to completely dismiss them, but they do not come first. Your life and treatment come first.

The endless bureaucracies of healthcare get to us too. We are on your side. My job as a nurse is to advocate for you in all ways. But we cannot make anything move faster.

This inability to affect change is why we won’t give you an estimate on how long it will take. We can kind of guess on how long labs take—30 minutes for some, an hour (or more) for others—but we can’t know when a machine that runs labs goes down or the blood tube clots or if the specimen is lost. Giving you a time estimate is giving you a reason to be mad at us later. Things take longer than we estimate.

I hate seeing you retch and vomit and would love to give you medications, but your doctor hasn’t ordered it. I can’t pull it from the machines without their order—sometimes I can, but most of the time I have done that already for you—and they are nowhere to be found. I wait outside of rooms for your doctor to get you the things that you need to be comfortable.

So, no, I don’t know how long it will take. I do know that I will be here with you through all of it. I will work quickly and efficiently no matter what, but I will like you a lot more if you’re nice to me.

A Bunch of Little Things I hate

Yes, I know the blood pressure cuff is squeezing your arm. Yes, I know that’s uncomfortable. But you need to stop moving that arm. It squeezes harder when you move. It’s a like a boa constrictor. If the blood pressure cuff hurts you more than your arm pain, then, honey, you have a new chief complaint.

Also, don’t tell me you’re a hard stick when it comes to starting an IV. Chances are that you’re not. It’s more likely that you’re just jumpy and weak when it comes to a little bit of pain because that’s all it is.

I will tell you when I am going to poke you with a needle. Please do not jump in surprise and knock the needle out of you. Then we both must start over. You get poked again. And again. Until you stop jumping and dislodging things.

Let me ask you this: how come you didn’t eat anything today?  A lot of my patients come to the ED in the evening and say something like, “I’m very hungry, I haven’t eaten or drank anything at all today?” or “I didn’t take any of my meds today so I’ll need those now.” What is it about being in the ED that makes you suddenly so hungry and thirsty?

Guess what?  If you’re having pain anywhere in your abdomen or chest, we don’t want you to eat or drink until we rule out your need for surgery. Do most people need surgery?  No. But the ones who do, shouldn’t wait for it because they bought out the entire vending machines supply of snacks and had a huge meal in the lobby.

Don’t tell me you’re having a seizure while you’re “having a seizure.” That’s now how it works.

No, there is not a vending machine for your medications. They come from our pharmacy. No, that pharmacy won’t fill your prescriptions.

I’m not sure how much the surgery will cost, but I know you’ll die without it, so maybe worry about that right now.

If needles freak you out, how did you get all your tattoos?

No, I don’t need to see the picture of your poop that you took / I don’t need you to open the container you have full of your poop that you brought from home / I don’t know if that snake that bit you is poisonous but kudos to you for killing it, putting it in a plastic bag, and putting it on the counter in the lobby.

Your child has a fever?  Did you give them any Tylenol or ibuprofen?  Why not? Please unroll them from that blanket. It’s making the fever worse.

Yes, I hate myself more than anything you can do.