Tuesday, June 12, 2007

I thought you quit smoking!

We have a patient, who shall be called Flo, that we all hate. Actually, hate is too strong of a word. We all dislike her. She is very exasperating. To the point that Pillow Therapy has been requested of the Docs as a Standing Order.

Flo exists in just about every ER in the country. She's the COPD-er that comes in three times a week for SOB, will not quit smoking, will not take care of herself, and ends up being admitted every 5 or 6 trips because she's either got pneumonia again (or still), or else her sats are just too low to justify d/c-ing her home.

One of the medics does a dead-on impersonation of Flo. Dead-on to the point that we look around for her if we hear him. She has a very memorable redneck-smoker-hillbilly-with-a-basement-IQ voice.

One of our RNs came in with a bad gallbladder on a night that she happened to be arrested in the ER for an outstanding warrant. (Hell, if I'd known she had outstanding warrants, I'd've called PD to come get her 3 visits ago!) He said that the sight of Flo leaving the ER in handcuffs made the cholecystectomy worth it. I'm not sure I disagree.

The last time Flo was admitted (last week), she didn't do her usual set-down-the-neb-treatment-and-go-out-and-smoke routine. We figured that she must be really sick if she didn't disrupt her nebs to go smoke. She always goes out at least 2-3 times, usually after each neb. It's like a shot of Albuterol with a Nicotine chaser. We try to catch her, but it's just too busy, and stupidity alone doesn't qualify you for a patient sitter. (Thank God. If it did, we'd have to have 100 patient sitters.)

I mentioned this peculiarity to the nurse who had triaged her, and she said, "Oh, Flo said that she quit smoking."

After I picked myself up of the floor, I thought to myself, "Self, keep an eye on her. She's figured out how to tell us what we want to hear. That means she's evolving. Evolution has previously passed her by. This could be dangerous." (Self didn't reply. I'm weird, not schizophrenic.)

Sure enough, 3 hours later, she still hadn't gone outside. And she was being admitted. Creepy.

We took her upstairs (I say we, but I really mean somebody else that I suckered into doing it for me) and the night went on as usual.

Until 2 hours later when I walked by a previously empty room and Flo was sitting on the bed with a breathing treatment. What the.........?

My frantic rush into the nurses' station scared the Hell outta everyone, that, and the fact that I was babbling words like "Flo" and "twin" and "clone" and "aaaaaaaaahhhhhh".

Turns out that Flo had been out of cigarettes. Her brother brought her some, so she signed out AMA to go smoke. She hadn't had one for almost 5 hours, after all. And since she was actually pretty sick this time, she had to come back in for a breathing treatment. Go figure.

Her response to the "I thought you said you quit smoking!" comment she was hit with by the triage nurse? "I lied, sweetie. I'm sorry."

She really is a nice person. I just hate her. Oh well. At least I got to meet her brother. He looks just like her, only his beard is a little fuller than hers is. Sounds just like her, too. The last thing he said as he walked out the door was, "You better pay me back for those cigarettes as soon as you get out."

Ah. Redneck hillbillies. Gotta love 'em.


Loving Annie said...

Good Tuesday morning Monkeygirl,

You get to see it ALL...

It never ceases to amaze me how people like Flo can look in the mirror and not do something about their lives.

Smoking is just a small part of the issue.

The other issues include entitlement, deceit, manipulation, lack of consideration and being self-destructive.

Normally I just roll my eyes and keep going. It's entertaining, in a sick way. And I've got a twisted sense of humor, so...

Anonymous said...

Haha. My mom's a poorer and prouder (that is -- phobic of doctors) version of your Flo, god bless her. If we had the money for home oxygen, you damn well bet that she'd be smoking on it.

People always give me shit for laughing it off. But what the hell am I going to do? She's been -literally- smoking two packs a day for the last fifty years. Jesus coming down from above in crotchless panties isn't going to stop her.

Judy said...

Addiction. Isn't it wonderful? Folks like Flo make me glad my drug of choice is chocolate. That will get me eventually, but it's not nearly as obvious ad Flo's addiction.

codeblog said...

"Jesus coming down from above in crotchless panties isn't going to stop her."

That was pretty damn funny.

Nurse K, Generic ER Nurse said...

The "Flo"s in our ER all want to smoke, of course, and they receive their AMA papers right there in the ER if they insist on going out. We offer the gum, the inhalers, and/or the patches, and if they still want to leave, they leave AMA. It's a hospital policy. Our ER can't be holding beds for people that think they can come and go as they wish.

MonkeyGirl said...

Could you have your people talk to my people?

Nurse K, Generic ER Nurse said...

You think I have "people"? Heh.

You can always ask your committee-type people to make it a policy since (1) If they're outside smoking, you're still signed in as their care provider and are responsible for their care outside of the hospital and this is a liability issue unless your hospital is so overstaffed taht they have 1-to-1 escorts for patients available to go outside and smoke (2) Smoking is detrimental to health obviously is never "indicated" for any health condition being treated in a hospital (3) Going outside to smoke causes delay in treatments/MD/nurse visits and assessments, so that's also a convenience/liability issue (4) Guests to the hospital are disrupted by patients asking to "bum a smoke" and this is an image problem and makes guests uncomfortable

MonkeyGirl said...

Oh wait. You're using common sense. Sorry, that won't fly in my neck of the woods. We abhore common sense here.

I get in trouble because I skip over people for triage or to go to the back if they're out smoking. Everyone (and I mean EVERYONE) else goes out and gets them.

And my committee-type people are always in a meeting and not returning phone calls, or e-mails, or notes....

Anonymous said...

^We are technically a no-smoking campus. All the hospitals in the state are.

It just means that if you piss off your nurses/doctors enough by going out to smoke, they'll discharge you AMA.

And then you move to the next hospital (aka - us) and throw a shitfit even though I told you before you checked in that you couldn't smoke on campus.

Nurse K, Generic ER Nurse said...

We have a hospital-wide standing order to d/c any patient AMA who insists on smoking outside despite being offered no smoking stuff. You don't even have to call the MD to ask if you can d/c the patient AMA [as long as they're competent] or if you have to stick security on him. You wanna smoke, you're discharged!

Corey said...

I like some of those nonsmoking policies! Our hospital is about to go smoke free, and I CAN'T WAIT. I can only argue so many times with the COPD/chest pain/etc pt that smoking is what's killing them, but the "it's hospital policy" line will be so much easier.

Kaylene said...

Oh good grief, this sounds like my mother-in-law. She hasn't been diagnosed with COPD, emphysema or lung cancer, yet, but it will only be a matter of time. She's been a 2 ppd smoker for 40 years.

Her dearest and best friend(her words) who recently died of cancer had quit smoking for awhile after her diagnosis. I figured that would wake MIL up and might actually get her to quit. Wrong! Her "dearest and best friend" had gone back to smoking, and was hiding it from her family. Well, come to find out my MIL was giving her cigarettes, and MIL is not sorry. After all, this woman was her "dearest and best friend in the whole world", and DBF loved her smokes. Nevermind that she went downhill very quickly after that, and ended up dying within a matter of weeks. Oh yeah, that's loyalty and friendship. Give the woman with cancer who is getting chemo and about to start radiation cigarettes. Help her hide it from her family. That's a real friend, MIL. *yes, you do detect a hint of sarcasm there*

Kaylene said...

MonkeyGirl and Nurse K, the hospitals in the area I live in have made their whole campuses smoke free. No need to worry about patients going outside to smoke. They aren't allowed to. :-) I hope more hospitals take this route.

911DOC said...

no one outside of the emergency medicine community will believe that you are not exagerrating in this tale.