there is a difference. one doesn’t have to be smart to know it. the difference is plain and simple, one doesn’t need a degree in nursing to identify it.

i’m talking about confused patients (CP) and patients who are difficult to please (PDP). when i say confused, i am referring to that mental state of not knowing that you are doing something, and why you are doing it. when i say difficult to please, i am referring to that mental state of actually knowing what you are doing and why, but not being satisfied (and being vocally rude about it) with everything you see, whether it is what you want, or not.

to better explain that explanation, let me illustrate:

CP: “i want to get out of here because the fire is getting closer and and the fu#*ing priests are coming.”

PDP: “i am going out for a smoke and nobody can stop me! i cannot just sit here all day and wait for the fu#*ing CNA to take me downstairs. just watch.”

CP: “i don’t know. i don’t know where that thing came from” (pointing to the blood oozing from the IV site after he/she pulled out IV thinking it was some sort of an insect)

PDP: “i don’t care about those antibiotics, they are making me sicker. all i want is to go home before i fu#*ing die in this stupid hospital. all the doctors here are stupid and all the nurses are lazy and do not listen!” (after nurse asked why he/she disconnected or turned off the IV)

CP: “take that thing away, there are guns inside that pitcher, they hid it there, i have to call the police!”

PDP: “do i have to tell everyone i want the pitcher filled with ice only instead of water? do i have to call patient relations for that very simple request? didn’t somebody write that in the chart yet?”

CP: “i can’t stay here, my car is in the street, i have to get out and make sure the firetrucks can park!” (when asked why he/she keeps trying to get up and out of bed)

PDP: “i don’t care if my blood pressure is low and i just had a fu#*ing load of sedatives, i want to go downstairs and get food, because you have no idea what to get me!” (when asked why he/she is putting his/her shoes on when he/she just had a procedure and his/her vitals are not yet stable after a few milligrams of versed and dialudid)

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i could go on and on and on, but you get the drift.

confused patients DO NOT know what they are doing and it is glaringly obvious with the things they do and the words they say. when i take care of them, i am primarily concerned with only one thing: their safety. once they are safe, i feel bad and sad for them and wish the episode won’t last long. you know why? because it is very difficult to watch a confused patient. very difficult.

there are all sorts of reasons/conditions/diseases that can cause confusion. i won’t say i have mastered them all, but what i do know for sure, is that nobody wants or plans to get confused. not even those who are hardcore alcoholics or drug addicts who are going through withdrawal.

this may scare some patients, but this is the truth: in the hospital, there are people who get snarly when they know that the reason for a patient’s confusion is withdrawal from some illegal substance or alcohol. they get snarly because they think these patients did it to themselves, and they deserve to suffer. although i do not agree with them, it would be a lie to say they do not exist.

it takes a great amount of self talk and reflection not to judge people. it is easy to point fingers and mentally pass out rationalized, mean generalizations. but when you have seen addiction and alcoholism so close that you have stared at it with tears, you’ll know how to be more accepting. that being said, it is with all honesty that i say that having a father, a brother, and an aunt who used to be slaves of alcoholism to the point of humiliation, i have a lot of sympathy towards the confused. even those who are withdrawing from a nasty habit.

confused patients are frustrating. frustrating because aside from sedating or eventually restraining them, you can’t really do anything to pull them back to reality. you sometimes feel useless despite everything you’ve done. you worry endlessly about their safety, and you have nowhere to go when you see their family’s look of questions and pain. however, that frustration with the situation doesn’t mean you have the right to treat them with judgment and indifference. it just means it makes you feel terrible and helpless, knowing there is no instant cure for whatever it is that caused their confusion.

patients that are difficult to please are also frustrating. frustrating in the sense that whatever it is you do will never be enough. nothing is good enough. not a thing. you sometimes end up not helping them, not because you don’t want to be helpful, but because you run out of ideas on how to help them. as the word difficult implies, for these patients, no amount of goodness is seen as goodness, but every caring action is considered inadequate and unintelligent. eventually, caring is simply reduced to flawless skill and professionalism, because real empathy is almost impossible to pull off.

that is the difference, and every nurse knows that. only the heartless will accuse or treat a real confused patient with disgust and hostility. and only those who are unprofessional will treat the difficult to please patients with rudeness and contempt. those who listen to their hearts treat the confused patients with respect and compassion. at the same time,  those who are difficult to please, they treat with skillful professionalism.

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you see bobby, i happen to know the difference, that’s why i suggest that you don’t worry too much. i’m sure your nurse will know. your nurse will know when to draw closer to your side, or when to withdraw. your nurse will understand your fears, because they are real and reasonable. your nurse will acknowledge that you are right to be concerned about uncaring, judgmental, and apathetic nurses or doctors. you have every reason to be concerned, but you cannot let your concern and fears eat your spirit up.

think about this little fact: the good and caring nurses always outnumber the crappy ones. this is not false assurance, it is just what i have seen. there are a lot of good nurses everywhere. your chance of being assigned to one is higher than your chance of ending up with the not so good ones.

to top it all, there are a lot of us who aspire to be one of the good ones.
a lot of us are really trying.
i have been trying.

we are the ones who will be there for you, to ensure your safety. we will be there when your ammonia level hits the roof and you start to question if you are dead or alive, or in between. we will cover you up and reorient you when you try to get up and out of bed, after you strip yourself naked. we will take you back to bed when you try to break through the window because you thought your mother is picking you up from outside the 7th floor. we will change your gown when you pee all over yourself because you didn’t realize you had to go to the restroom or use the urinal to do that. we will change your sheets and clean you up when you have an accident and lather poop all over your arms and body. we will remind you not to use foul language when you start cursing endlessly.

we will be there.
not only as employees getting paid for a task, but as human beings who care enough to do the little things,
to make a difference.