It's been an exciting couple of days in community health nursing. My
co-worker, the other triage nurse, and I have decided we'll write a
book some day detailing the more interesting contacts we have with
patients whether it's via walk-in or over the phone. The more recent
of the two events fresh on my mind occurred yesterday and it isn't
really an event at all. More a patient's interesting use of the
English language to refer to their genitals.
I see walk-in patients all the time, many of them never having visited
the clinic before. Some of these folks would otherwise have gone to to
the ER at St Vincent's Hospital but with its closing, they have little
options elsewhere if they're uninsured, underinsured or undocumented.
This particular patient filled out the 'request to see a nurse' form
which I got to after dispatching several people waiting ahead of her.
Under 'Problem you're experiencing:' she had written: "I have itching
and discomfort in my virginia." Because I have the maturity of a
4-year old, I nearly fell out of my chair laughing hysterically. I
shared it with the other triage nurse as we're prone to do frequently
during our day at which point he replied (after composing himself) "My
virginia's not so hot right now but my Ohio is raring to go!" More
tears and laughter from me. Yes I know. I should grow up. Fine. But
how is it that we have so many euphemisms for these areas of our body?
Is it the innate shame that's instilled into us about our bodies and
sex? Poor educational system in this country and elsewhere? "virginia"
is not the worst I've been told in my short time in community health.
"Junk" and "down there" rank right up there.
The night before last was the more exciting of the last two days'
noted notables. I got a call about 10 minutes before I was supposed to
leave and the clinic was supposed to close, that there was a disturbed
patient on another floor. They had been trying to get the patient to
come to "screening" (that's me) for the last hour, as the floor
personnel who care made up of LPNs and MAs, do whenever someone's out
of their comfort zone or scope of practice. I run downstairs to find
this individual standing near an LPN, holding their arms very stiffly
and occasionally moving them as if they're treading water. The person
is sort of wobbling back and forth, looking like they're going to fall
and sustain a subdural hematoma, the paperwork for which would be
horrendous on my part. They don't really answer any of my questions.
They're hyperventilating and I can see their pupils are so dilated and
fixed they've either already sustained a head injury or they're riding
the crystal pony. Tina aka Meth aka Glass aka Crystal aka Dirt aka
Juice. Ok I'll stop. Or possibly crack, but that's lesser used among
our population of patients.
I repeatedly tell the individual, after declining several of my
requests to sit down, to concentrate only on their own breathing. The
rise and fall of their chest and stomach. Block everything else out.
Their behaviour isn't escalating. They've never once shouted at anyone
or made a threatening gesture but they continue to back up towards the
nearest wall as I walk toward them. Several minutes more, they ask for
a glass of water and agree to at least let me feel their wrist so I
can get a quick heart rate. 15 seconds. 40 beats. 160 beats a minute.
Ridiculously fast for what appears to be an otherwise healthy
individual who clearly works out. The hyperventilation continues but I
can understand their speech and they're no longer speaking in clipped
one-word gasps. They agree to steady themselves on a wall nearby that
comes to waist height. 2nd glass of water. More concentration on their
own breathing. Their respiratory rate slows to about 30 and I'm
finally able to get them agree to accompany me to my office where they
can sit and I can monitor the rest of their vitals.
Their BP on arriving in my office is 180/110, heart rate 120. Pupils
still big as ink blots. More water. They speak in full sentences now.
They say they've done crystal in the past and smoked only a joint
today before coming to their appointment for routing bloodwork. It is
clear however, that there is fresh amphetamine in their system, not
"in the past". BP now 160/90. HR: 110. We continue to discuss what
happened to precipitate today's episode. The patient reports hearing
audible hallucinations while walking to the clinic and upon arriving
in our lobby, extreme paranoia overtook them. They've stopped and
started crystal use in the past with no significant length of time in
recovery. There are other health issues they're dealing with putting a
great deal of stress on them apparently. They gradually became more
lucid and were able to recall most all of the events of the evening.
They expressed a good deal of shame and were aware of what just
transpired. I am torn between sympathy for their health problems and
loathing of their continued self-sabotage. Was able to find their case
manager and a social worker who were still in the building, to see
them and eventually left them in their care after vitals returned to
normal. I finally left the building about an hour after I was supposed
to. Some days my salary seems meager. ;)
