ain't life grand

my last day on this cursed rotation. for at least 11 months anyway.

all this talk about patient autonomy is BS. once you start working on the wards, it’s all about ativan and restraints. getting nervous? ativan. talking back? ativan. complaining too often about pain? ativan. want to pull out your NG tube? ativan. trying to pull the foley? ativan. it got to the point when even i was saying to people, “i don’t like how we treat patients here. we control them medically. i want to do things the old fashioned way and talk to them.” explain things so that they aren’t as nervous, instead of masking their nervousness with drugs.

i’m also finding that i resent patients who don’t do exactly what i tell them to do. i want to yell at them to stop using so much morphine because that’s preventing them from taking a dump and getting off my patient census. get out of bed, walk, and work with PT/OT because if you don’t, it’s me who gets yelled at during signout at 6pm. why is the patient still here? because he’s a typical lazy ass leech enjoying his stay at our $1000/night hotel with free food, cable, and phone service. somehow, i doubt that these guys who live in their pickup trucks have much motivation to leave their bed and free cable just to go back to sleeping in their car.

i’m finding i need to fight the tendency to become punitive with my idiotic patients. i know it’s not pleasant to have tubes in every orifice, but if it’s what we need to help you get better, stop being dumb and keep that shit in there! i have this dumbass who aspirates every time he eats anything, so i put in a dobhoff tube for tube feeding. this moron pulled the DHT probably more than 5 times during the time i was there. he’s constantly begging to eat something by mouth. hey listen dude, we already explained to you that if you eat anything through your mouth you WILL choke and die. if you keep pulling the DHT, we can’t feed you, and you will starve. it’s funny, when the choices are starve/choke/die vs keep a thin tube coming out of your nose, this jerk off chooses the former every chance he gets. i was pretty damn tempted to say screw it and let him starve for a day.

dumbass patients create exponentially more work for me. just think… if this asshole didn’t pull his tube 3 times, i wouldn’t have had to write 3 orders to put in a tube, 3 orders for a stat KUB, look at the xray 3 times to check the placement, or tell the nurses to pull back on the tube just a little bit… and get another KUB, look at more xrays, etc. all this fucking work to feed some loser. if i ruled the world, noncompliant patients like this would be kicked out of the hospital, and if they choked and died, that would be their damn fault, and it wouldn’t be my responsibility to baby this asshole like a little child. whatever happened to personal responsibility? he’s not crazy, he’s just stupid. he’s free to make foolish decisions. why should i prevent that? let’s face it, the vast majority of the world makes dumb decisions and we let them do it. he’s an adult. a dumb one, but i think that still counts.

and let me just say, that i think it’s bullshit that some idiot who shoots himself with a shotgun (i’m not entirely sure how he managed to do that), has to be coddled back to health while watching cable tv and sitting on his ass while nurses and doctors have to change his wound dressings several times everyday, wipe his ass, and record the amount of urine he makes every 8 hours. you think america doesn’t take care of the uninsured in this country? then how do you explain why this redneck asshole with no insurance is getting world class healthcare after trying to kill himself? how do you explain how someone with no insurance has been staying at my hospital for 90 days getting huge operations, skin grafts, tube feeds, TPN, cable tv, and all that shit? if we didn’t treat uninsured people, i wouldn’t have spent all those nights smelling all the rank ass shit coming out of someone’s bowel fistula, obsessing over how much potassium she has in her blood, how many calories she’s getting in her TPN, how much urine she’s made, how well she is working with physical therapy, what types of stepdown places will take her without insurance, or write a note on her (non)progress for 30 god damn days. hell, i wouldn’t have had to deal with over half of these uninsured dipshits who drink like 20 shots and play chicken with a tree on the side of the road. i would have had time to eat at least once a day, actually take a piss more frequently than every 12 hours, and had time to read and actually learn something other than the doses of morphine, dilaudid, and fentanyl.