catfight in the ER

There are very few patients who push my buttons. In fact, I'm the one that the nurses come to when they have a patient they don't want to deal with. So when one of my favorite nurses (she refers to me and herself as "the alpha bitches," which from her is a compliment) snagged my arm at the nurses' station and started telling me about the patient she'd just brought back, I kinda rolled my eyes.

"firefighter girl, she's 17, diabetic, states she's had high sugars for a week and a half and is now convinced she's DKA. She refuses to put on a gown, has a leopard print blanket and a red heart teddy bear, and claims she's a hard stick. p.s., the woman with her is her mother, but don't expect her to say a damn word."

Alpha Bitch leans close and grips my arms hard enough to leave bruises. "good luck."

Piece of cake.

I grab the IV tray, and if I coulda set it twirling on top of my index finger, I would have- my game was that good, baby. I love patients who are "tough sticks." Especially the ones who think they know my job better than I do.

I walked in to see the princess sitting criss-cross applesauce (we used to call it Indian style) on her gynie bed throne in a private room. Mom stood anxiously at the foot of the bed. Amazingly, as soon as I entered the room, the princess started Kussmauling. I leaned in a little closer and sniffed for that sweetish ketone scent a true DKAer would have, but all I could smell was the pungent odor of bullshit. I looked at her, sat down on my rolling stool, and started preparing the IV goods.

"Just so you know, I'm a tough stick. You're only going to get me from here up, and even then you'll have a hard time," she says, gesturing to her antecubitals. "It always takes them four or five times to get me. At least." She glared at me triumphantly, then resumed her Kussmauling.

I recommended that she calm her breathing down before her hands got all numb and tingly and stuff. Her eyes narrowed. I started asking my standard questions, things that I ask every diabetic patient: how high have your sugars been, for how long, what are they normally, have you been sick, do you take your insulin regularly, etc etc etc, blah blah blah. Princess stops her hyperventilating long enough to take a deep breath in order to deliver a speech she's hoping will scorch my eyebrows off.

"I. Am. A. Brittle. Diabetic. When I am sick or stressed my sugars go way up. We'd all do a lot better if you'd just shut up and quit judging me and start paying attention to what I'm saying. Understand?"

It makes me blink a little. I try to cover up my guffaw with a cough. I explain to her that these are questions I ask every diabetic, I've never met her before, I haven't read her chart, I'm here to start an IV and draw some blood. I am being very, very nice and oh-so-polite. And as patient as god, I might add; my mother would be so proud. She sighs and flips her hair. I ask for her arm, and wrap the tourniquet. I dutifully check her ACs- nothing doing- and then, lo and behold. . .

a beautiful vein goes POP in her right hand. And another one springs to attention in her wrist. And so I reach for the swab. . .and she yanks her hand away.

"Excuse me. We just went over this. You're not getting any vein down there; they roll. And while you screw around with that and miss, you're wasting precious time that you could be using to start an IV where I tell you so I can get the medication I need."

I'm afraid I may have started losing my patience. I give her the standard "I will take your suggestions into consideration, but I do this all the time and I will start an IV in the place I feel is best. Please allow me to do my job" speech. I reach for her hand, swab at that gorgeous, bouncy blue vein, and she yanks her hand away again.

"If you aren't going to listen to me, you aren't going to start my IV. Go get somebody else."

I unwrapped the tourniquet and said, "fine, honey. I'll go see if I can find somebody to help you. We're awfully busy, though, so it may be awhile." and I smiled at her, left the room, and went into the store room to kick some boxes. It was that, or pull her hair and scratch her face with my nonexistent fingernails.

I decided to ask the one male nurse on shift if he could fit in the IV. I had a feeling the princess would prefer a guy, anyway. And I told my young, buff medic student to hang around and soften her up a bit, too. Male nurse said his rooms were all full, but he'd get to the princess when he could. I thanked him, asked if there was anything I could help him with, offered to wipe his patients' butts because that would be far preferable to dealing with the brat. . .er, princess. . .again. He laughed. I warned him I would be getting the better end of things. Pun intended.

As I walked by the room, I noticed the brat's mom hovering outside her door. I mentioned that I had someone coming in, but it would be a while before he could get there. She said, "you know, she's such a hard stick, it would probably be best to get the IV team in here to do it."

I smiled at her. "Ma'am? I am the IV team."

Medic pay in the ER? not much to write home about
The incredibly self-satisfied feeling I got, watching her jaw drop and her mouth open and close like a fishy while she attempted to stammer an apology for her spoiled rotten daughter? priceless.

fyi: if my daughter ever, ever treats anyone like that, she will be flogged and bound and forced to watch reruns of . . . of. . . Barney until she gets control of her lip. I cannot imagine treating anyone as poorly as that 17 year old girl treated every single person entering her room with the sole intention of helping her. And I wasn't the only one kicking boxes in the stock room last night.