Going to dinner with D's parents. Thankfully, got off early enough. A speedy day.
This mesmerized me. Below is a rant, don't feel you should read it. Just watch this.
Despite our last patient being a squirrelly drama queen nutjob. Not that often we have a young, healthy crazy patient. Older, ill crazy folks are fairly common. These are the people who think the Nothing By Mouth thing is a kind of joke, tell everyone their life story without invitation, take longer for the pre-op nurses to get ready than the elderly, half deaf, mobility impaired patients - who we expect to take a while. The ones who have no impulse to calm themselves, even with clear and calmly repeated prompts to take a deep breath, relax. The ones who go down fighting, but without a known, clinical anxiety diagnosis. Had one when I was in Boston, in recovery room, having a complete freak out about the nerve block for her arm, wanted us to make it go away. Well, that isn't possible, it takes hours to wear off, that's really the point. Admittedly, it is an odd sensation, but most people find it amusing or mildly annoying at worst, not to feel a limb, to sense that it is in a different place than it actually is. This woman was screaming, demanding, squirming off the gurney. Her boyfriend stood and watched, a kind of awakening horror on his face. As though he'd known she was eccentric, but had no idea she was earfuckingly insane, and realization was dawning. He was determined to stand by her, get her home and safe until she was stable. Then, he was going to run away as fast as humanly possible.
These inconsolable people never get just local anesthetic with a whiff of sedation, they cannot be trusted to be still through the case, to tolerate any amount discomfort, not to try to get up and leave. It's a full on general, for simple safety. That we have quiet after is just a plus. I've seen the lighter version tried, and seen it go bad, prolonging the surgery unnecessarily.
We once watched the show Mad About You - for a couple of seasons, until the one where the lead female has surgery. She behaves wholly inappropriately, demanding and ridiculous throughout. I could never see the character as believable after. I know the difference between the abnormal normal of such a stressful situation, and the freakish abnormal of someone broken completely decompensating. Especially for a minor, ten minute, hand procedure, that most people could easily manage with a local or a bier block.
Still, takes all kinds. I just prefer the ones who have some modicum of self control, or a good reason not to be able to.
4 comments:
You must see all kinds in your line of work and I admire your forbearance.
That animation is indeed mesmerizing! Reminds me of Brian Eno's 77 Million Paintings (I wrote about here should you be interested: http://www.marja-leena-rathje.info/archives/77_million_paintings.php)
Oh, wow! So cool, Z. Thank you for posting this. Notes on parade, battalions of notes marching off to musical battle.
My former s-i-l, a scrub nurse, was knocked out by a terrified patient whose hysteria pushed her into mindless violence. Patient pulled out IVs, contaminated the surgical field, bit the anesthesiologist. Bad scene, all around. Glad you escaped unscathed today.
Crow,
That has to be partly the fault of anesthesia. They have drugs to keep it from going that far. Your former SIL's story sounds quite out of the probable. Not that I haven't seen such situation start... but never to go that critical.
I've been nearly punched a few times, backhanded more often, but I worked in long term care, and I know how to duck. I have had to take care of an otherwise completely sane patient in recovery, who had post anesthesia psychosis, put in 4 point restraints by security, eventually came out of it. A very pleasant guy, no history, nothing.
I've been grabbed, or my clothes have, but they are usually pretty weak right after surgery. Had a Very Large Tongan woman have a come-apart coming out of anesthesia, but I listened to her. She desperately wanted to sit up, and as soon as we did that for her, she was fine.
A scrub sees things differently from a trained, and experienced nurse. They don't think so, but it's true.
"no impulse to calm themselves" is a very good point. i deal mostly with mild nervousness in my dental patients but that impulse to self-soothe can go a long way to an easier experience for everyone concerned. still, some people get off on the drama, and sadly, i find women 20-50 to be the worst at this. it's like they're cultivating something, anything interesting about themselves, even if it's just a swoony fear of the dentist.
over the years, i have learned to distinguish between the real fear which can be terrible to the patient that i try to soothe as best as i can, and that egomaniacal drama that i have no patience for.
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