big mouth, fat face
i never thought i’d say it, but last night, i did.
as always, i’m sort of beating myself up for saying it, but what can i do, i can’t take my words back.
one of my patients was having DT, and by far, he has exceeded every encounter i had with expletives. he has called me every unacceptable name in the book, including fat face and pig face. he started, ended, and elaborated his every sentence with the F word, i just got tired of cringing.
at 2000, his repeat potassium was still low, so the doctor ordered two doses of potassium tablets. if you have taken or seen those things, they are humongous! i cut two in halves and offered it to him after convincing him that he badly needed it. he did take the tablets in between cursing and yelling for me to get the f#*k out of there. he started chewing the tablets, and i imagined how bitter it was, so i offered him apple juice, which, to my surprise, he sipped without argument.
when he started gargling the juice, i should have taken the hint, but sometimes, to my disadvantage, i have too much trust in humanity, even for people like him who was logically out of logic. he looked away, i breathed a sigh of relief, expecting he was swallowing. it was too late when i realized that he was aiming his lips directly at my face. with all the strength he could muster, he spit the chewed KCl and apple juice mixture. most of it went to my scrub, but my face wasn’t spared. he then belted out a devilish laugh and said ” i told you to get the f#*k out of here, didn’t i?” then he started kicking, missing the doctor’s chest by an inch, because she pulled away by instinct.
giving in to the frustration that had been building up in the past hours, i wiped the goo off my face, stopped myself from crying out of frustration, and said “i am not paid enough to do this job!”
words, that in a million years, i have never imagined i will ever ever say for real. you know, like i really mean it. and last night, i really meant it.
i did, and though i hate to admit that i am one of those stereotypical guilt ridden christians, i would be lying if i say i do not regret saying it.
anyway, it’s past now, and there is no way i can take it back. it made me wonder if this sudden change in behavior is a sign that i am not cut for the bedside nursing challenges anymore. if my patience quotient has reached it limits and i am now devoid of compassion that i should seriously consider other nursing options, those that do not involve dealing with confused patients.
i’m just reflecting, just wondering outloud.


I wish I could take away your regret for your normal human response. I hope you decide this was just a lapse, a momentary understandable and unintended reaction, because I believe that nursing - and your future patients - need you.
Comment by Kelly — August 25, 2008 @ 5:25 pm
Are you kidding? Because somebody spit you in the face you uttered a few words, so what. A lot of people would not reacted this mild. Don’t start doubting that you are not cut out for bedside nursing. We are nurses, not saints!
Comment by annemiek — August 25, 2008 @ 5:39 pm
You are human…….
I would have responded in a very different way and in language he couldn’t have misunderstood…but then I know that I’m un-PC and don’t suffer fools or patients with the DTs at all well.
Don’t beat yourself up…
we all get to the point where we doubt why we still do this job….
And after a day or two and a sweet patient who appreciates all you do you get your groove back and remember why you chose nursing in the first place.
Hang in there.
Comment by Kj — August 25, 2008 @ 5:54 pm
Nobody is paid enough to take that kind of shit. Being a nurse is, as far as I know, not about letting your dignity and feelings at the door — sure you have to expect that it is a setting in which it is unavoidable that a few people give you a really hard time, but that does not mean that you have to like it.
Comment by Citronella — August 25, 2008 @ 8:12 pm
I second the above.
Comment by Karin, RN — August 25, 2008 @ 11:02 pm
I agree, you ARE human. We are human.
Comment by Rygel — August 26, 2008 @ 7:13 am
I think I’m going to go out on a limb here and say that you are not paid enough to do this job.
What other profession in the world considers it acceptable to be cursed at and spit upon, and then hold your tongue about it?
I have oodles and oodles of respect and admiration for you, May, and I love the way you write. But I really don’t think that nurses should take this kind of crap.
Comment by Beth — August 26, 2008 @ 8:08 am
I wouldn’t take it as a sign of anything other than you’re not a statue. I bet anyone who’s ever worked in a hospital has had something like that happen. I agree with Beth that we shouldn’t take this, and I’m not sure why we’re expected to.
Comment by Not Nurse Ratched — August 26, 2008 @ 8:40 am
Your response was more restrained than many might have made. Imagine someone spitting in the face of a police officer or someone working at the local government offices. I don’t think that the response would have been as measured.
Simply voicing frustration about your treatment by that patient helps to relieve some of the anger, frustration, and powerlessness that this profession can heap on, and is therefore healthy.
Just so you know you are not alone, I once had a drunk teen spit in my face. He had been brought in for a blood alcohol draw after refusing the roadside sobriety tests. The cop grabbed the kid by the neck and flipped him onto his face roughly, and then told me that I could hit him if I wanted (and being a 240lb former Marine, I really sorta did). I was like “ah, NO. I don’t think that would be productive.” Instead, I placed a surgical mask on the kids face which prevented any further spitting (he was handcuffed so he could not remove the mask). In this case, the next day he was so upset when he heard what he did that he wrote me a letter of apology and thanks for my care.
At any rate, most states hold patients legally liable for their behavior, despite their health status. Often, reminding them of this will help mitigate bad behavior. If their status is such that they are not rational, then the behavioral restraint policy comes into play.
Comment by Ken — August 26, 2008 @ 12:14 pm
Takes more than irrationality for behavioral restraint to be employed here,
So, yeah, we have a lot of crap to deal with.
This is a universtiy town and drunk students are a big problem,
90% of the ed population on any give weekend is drunk students who don’t have a clue where they are or what they are doing…
But some do appologise…
One guy was really upset..
Said usually he treated nurses in the fashion he would treat his gran,
we got chocolates and flowers as a suck up appology…
It worked.
Comment by Kj — August 26, 2008 @ 3:01 pm
YOU GO GIRL.
We are nurses and we are HUMAN in fact. We sometimes forget that part. We have feelings just like the rest of John Q public, and we can only take soooo much before the bubble bursts.
I’m impressed that’s all you said. I might have said more.. or something worse.
I feel you pain, to a smaller degree. I admire and respect the work you do on the med-surg tele floor. I myself could not do the work or handle the amount of stress you deal with on a daily basis.
KUDOS to you.
Comment by Strong One — August 26, 2008 @ 5:38 pm
KJ - I’m not suggesting restraints for irrationality alone (if that were the case, we’d all be tied up
but when coupled with threatening or physically violent behavior, they may be appropriate.
Of course, each case is unique, but in the critical care units where I have worked, I’ve seen nurses punched, kicked, threatened with knives, spat on, urinated on, and one nurse was struck with a phone handset knocking her unconscious.
Employers have an obligation to ensure that their employees can practice in a safe environment. They must balance the need to provide good customer service with the requirement of providing a safe practice environment. I know from my own experiences that this is a tough line to walk, but it’s the nature of the job.
Comment by Ken — August 26, 2008 @ 7:26 pm
Wow. I am so glad i found this blog. perfect for an inside perspective before i’m actually out there practicing.
Comment by Nursejen — August 27, 2008 @ 9:02 am
Just because you are a nurse doesn’t mean you have “Spit and shit all over me” written on your forehead! Limit setting and requiring respect are not bad things. We should all expect respect. And if we don’t receive it, or disrespect is literally spit at us, it is completely ok to say “enough” or just walk out. We are professional caregivers not doormats!
Please do not feel guilty!
Comment by Jenny — August 27, 2008 @ 2:44 pm
Ken…. Not suggesting that irrationality alone IS a reason for restraint…
Or, your right, I’d be in them 24/7….
I am a nurse,
Does that not show, especially in this case that I have to be a little crazy….
What I was trying to say is that in the country I practice in (ie NOT the States) there is a STUPIDLY long protocol involved in getting restraints instated and that our system needs improving…
(Read: our system sucks!!)
Psych has to be consulted before we can restrain, and the threat to staff and patient has to be of a certain level that endangers all….
So we have a LOT of patients who SHOULD be restrained that our system says can’t be….
I reiterate: our system sucks!!!
But at least the amazing security staff actually get paid for work done…
No sitting around waiting for something to happen in our ED in the weekend…
they deserve to be paid more, with danger money…
Hell, we all deserve to be paid more…
WITH DANGER MONEY!!!!
Rant over..
Cheers
Comment by Kj — August 27, 2008 @ 3:31 pm
It was an assault. And it was witnessed. I also assume that you documented his behavior.
It’s a police matter.
Comment by shrimplate — August 27, 2008 @ 8:24 pm
It was an assault. And it was witnessed. I also assume that you documented his behavior.
It’s a police matter.
Comment by shrimplate — August 27, 2008 @ 8:25 pm
Oops!
Comment by shrimplate — August 27, 2008 @ 8:25 pm
may, you’re a saint. if that happened to me, i would have annihilated him on the spot!
Comment by Laura — August 28, 2008 @ 10:59 am
May - I agree with everyone… That was a very mild reaction AND you are HUMAN!!!
As nurses, we are exposed to patients who act horribly towards us… On top of that, you can also add patients’ family members, certain doctors, residents, fellow nurses. You can’t expect yourself to take it all in stride every day… It’s just not possible!!!
At the end of the day, remind yourself who you are. You are more than what people see… It takes a lot of heart, courage, and strength to do what you do.
Hang in there!!!
M.
Comment by unsinkablemb — August 28, 2008 @ 6:52 pm
next time may, (because i am sure there will be a next time sadly) don’t offer the apple juice.
you are cut out for this job, and no you are not paid enough for all the abuse you take…but you are good at what you do and there’s a place for nurses like you…
Comment by kimmyk — August 30, 2008 @ 10:45 am
I don’t think it has to be measured in total. I think it can be a day to day allowance. You asked if patience quotient had been reached. I think for that day, yes. I think it is a day to day thing. I don’t think in total they have. If it were something that accrues, it wouldn’t have bothered you enough to write about.
Horrific thing that guy did. Whatever understanding any generous soul wants to offer, that was a horrific thing, and others that have been in his situation have managed not to behave like that.
I’m sorry you had to deal with that. Truly, not fair.
Comment by Veronica — August 30, 2008 @ 10:47 pm
I completely understand your response, as nurses we are abused we are only human, under monents of distress any nurse would have lashed out. Nurses are to be super human never to make a mistake, have our feelings hurt or to counter an attack. I have had blood spit on me and lets just say I was not not nearly as nice as you. Since I worked in the ER everything that I said was herd by all, at the time I ment every word but it did not make a difference to him, he had no idea what was going on. It only made me look bad so I too have had to deal with regret, and I shame. I hope you have forgiven yourself. Kim
Comment by Kim — September 2, 2008 @ 8:57 pm