“WHAT’S YOUR NAME?”

i pulled my badge out and showed her my last name, after saying “May”. she was so mad, she was shaky. while i was holding out my badge, she wrote what i assumed was my name in her little piece of paper.

there is something about being asked your name loudly, and being told, nonverbally, that you are in big trouble. it made me giddy. sadly, not giddy enough to apologize. so i kept quiet. the whole night, i saw her, walk past through her, and all i have given her was silence.

i don’t know her name, but i’ll call her Snarly, she was the daughter of the patient in bed 1, who wasn’t my patient. P, my 26 year old mentally retarded patient was in bed 2. Snarly was allowed to stay at the bedside overnight because her mom didn’t speak a word of english. since i started my shift, she reeked of cigarette and had somebody with her whom she chatted with endlessly. once, i saw her waking up her mom in the mddle of a rather peaceful sleep, sounding like she was asking if she was okay. her mother, disturbed, would answer “si”, a signal for her to leave for her smoke break.

P wore a helmet, because it was her habit to hit her head either on the side rails, or with her hands, occasionally. no reason for the hitting, she will just do it for a few minutes, 5 minutes was the longest i noticed, and then stop. she will then sleep for two to three hours, and wake up to do the hitting again, coupled with those incomprehensible sounds that do sound like moaning.

Snarly complained to H (her mother’s nurse) at about 9 pm, saying that her mom can’t sleep because of the moaning, and asked “can’t her nurse give her anything?” i told the nurse what she already knew. my patient was not in pain, she was not agitated, i will not give her any kind of narcotic just to knock her out. there is no medicne i can give her to stop her from hitting her head. irritated, i added: “they should be grateful she is like that, because at least she doesn’t complain about them talking endlessly, and coming in and out smelling like a burning lobe of lung.”

at 0130, Snarly was not in her chair when i went to see my patient,  who was sleeping like a baby. at 0137, Snarly was at the door, both her arms accross her chest, looking rather…well, snarly. she started pacing in front of the door, an action that led H to save her face and call out my name, making sure Snarly heard her. making sure Snarly heard me, i responded rather…well, snarly: “what do you want me to do H?” then, i asked the charge nurse: “is there a way we can transfer my patient to another room?”

this is the part where Snarly snapped and walked right in front of me, shaking, asking my name. after putting the paper in her pocket, she asked “can’t you at least check on her because she has been doing that for a while maybe she is in pain maybe she needs something just go there at least.”

“i just checked her….” i looked at the clock and it was just 7 minutes ago, but i kept my mouth shut.

“when? she has been doing THAT for a LOOONNGG time!”

i walked past through Snarly without a word, and went straight to the room. i stood at the bedside, whispered “it’s okay P” a couple of times. P did not even see me, but as expected, she stopped hitting her head, and was quiet again.

after that, between Snarly and me, the silence was deafening. maybe i should have, but as i said, i did not apologize.

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it has been a week. what did she do with that piece of paper? i have not heard from the nurse manager. not heard anything from patient relations. not even anything from the charge nurse.

what has writing my name in a piece of paper accomplish?

intimidation? threat?

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it’s called reflective practice. to look back on a certain situation and analyze what you have done. play out the previous scenes in your head and find out why you did what you did. reflect and see if you could have done better. then, do better next time.

well, if i listened to my mean, bitchy self, i would say i have done better if i said…

 ”look Snarly, i don’t care if you want to die of lung cancer. i don’t even care if you dote on your mother to the point of literal suffocation. most importantly, i don’t care if you disrespect my patient’s right to have a peaceful night by yakking your night away with your brother or husband or friend. all i care about is that you should at least have a little understanding and patience towards my patient. it is not my patient’s fault that she is mentally retarded and does not know that there are other ways to express herself other than hitting her head. i know you are important, but that does not give you the right to get angry with my patient just because she is being herself. do you understand? do you?”

only, my bitchy self is supposed to be getting older now, and this is supposed to be the time when i’m expected to be more understanding and mellow. so, i know i could have done better if i said…

“Snarly, i deeply apologize for disturbing your mother. i understand you want the best for her and it must be very frustrating to see her awake when all you want is for her to have a good rest and get better. i will do everything within my power to calm my patient down. if needed, i will put her on restraint just so she will stop hitting her head, so you, your visitor, and your mother, can have a peaceful sleep. i assure you, i will not hesitate in giving her the maximum dose of ativan just so she will get zonked and you can rest. thank you for being so patient and i again, i apologize. i hope that a pack of cigarette from our unit will appease your anger, and will let you know how sincerely sorry i am.”

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somehow, something doesn’t sound right.
let me sleep on it. i might come up with a better “next time” scenario.

i love reflective practice. i do it all the time. i honestly think it is very useful. sometimes, after a decent amount of time reflecting, i come up with brilliant ideas. sometimes, i come up with nothing. i guess i’m just too tired to reflect sensibly at this time, because it’s pretty obvious i came up with nothing.

…but seriously, i do intend to be a better nurse. any suggestions on how i could have handled this situation better? i don’t want my name in a piece of paper next time. not like that anyway.