“I wanna get out of here.”
“I know, but not til you’re ready.”
Patient X, whom I sent to the ER first thing Monday morning, did indeed have an upper GI bleed (UGIB) but we just can’t elucidate where exactly that bleeding was happening. Notwithstanding, three units of blood and enormous amounts of IV fluids have stabilized him to a large extent. Sadly, despite his end-stage liver disease, obtaining a liver donation for transplantation in our sorry state is a challenge and a half, so we must simply deal with the liver at hand.
A note in the chart stated that the patient’s pain was being treated with intermittent Tylenol and Percocet. Even though I’m “just an outpatient nurse”, I left a note in the chart that perhaps straight oxycodone might be less risky in a patient with advanced liver disease since Tylenol is so harsh on the liver. Also, another note details the patient’s verbalized suicidality and desire to leave AMA early this morning. I leave another note that I can be called at any time to intervene in such psychosocial crises involving my patient. Unfortunately, I assume that very few members of the team actually read my notes.
“Did you really threaten to kill yourself and leave AMA, not necessarily in that order?”
“Yeah, I did.”
“Did you mean it?”
“At the time I did, but not now.”
“Well, cut it out.”
“I’ll bring you another newspaper tomorrow.”
“Thanks. Thanks again.”
Our lighthearted banter belies a deeper meaning, and I know my visit to the hospital means alot to him. We’ve come a long way, but we also recognize that his liver is shot to hell. What’s left unsaid is the issue of his mortality and prognosis, and this we leave for another day. Until then, I’ll bring the paper every day and keep Patient X in line.