Saturday, January 13, 2007

The Family Fun Pass

I just love it when people get angry at me for telling them they can't circumvent the rules and that they must play fair. It makes going to school for all those years feel so worthwhile.

I had a whole family come in recently: two little destructive spawns of Satan, their unhygienic-looking parents, and the patient who was apparently the matriarch of the family. She had begun feeling poorly over the last two days. Small wonder; she had COPD, heart failure, renal insufficiency and diabetes.

The triage tech walked them all past the nursing desk in my section. I heard the two children roaring and bawling like a couple of sawed-off soccer hooligans all the way from Triage, and looked up from my charting in time to see the mom put her cell phone to her ear and start chattering.

"Ma'am, you can't use your cell phone in here. Turn it off, please." I said to her politely but firmly. She shot me a dirty look, rolled her eyes and kept talking as she passed by. Fortunately, our security guard saw the whole thing and blocked the woman's path. She snapped, "What?"

"You were asked politely to turn off your cell phone, Ma'am. Please do it now."

"What's the big deal?" snorted the woman.

I answered, "Other than the fact that it is posted plainly on the entrance to the ER, it interferes with our telemetry equipment. Please turn it off. Now."

"Just a minute." She turned away and continued to talk on the phone. The security guard faced her once again, deftly took the phone out of her hand, turned it off, and handed it to her. The woman, whose husband had now joined her, voiced her dismay in rather unladylike language. The husband asked me in a challenging tone, "What's the deal, man?"

The security guard (who was just shy of being as tall and solid as Mount McKinley) replied with a smile, "The deal is that if you do not obey the safety regulations of this hospital then you will have to leave... Man." The man (who had no business challenging a guy who could break him into kindling with his eyelids) took his wife by the elbow, shot the guard a sour look, and disappeared into one of my assigned rooms behind the wheelchair-bound, hunch-backed, hacking old woman and the two little hounds of hell snapping behind her.

Oh, this is just prime, I thought. The ER tech hurried out of the room a minute later, handed me the chart while guiltily averting her eyes, and flung the word "Sorry!" over her shoulder as she retreated toward Triage.

Under normal circumstances, I really don't mind having family in the same room as the patient; even a comparatively large family does not bother me if the room is large enough and if they are well-behaved. But I could already tell that this was not going to go well for me if these people continued as I suspected they would. And the closer I got to the entrance to the room, the more my suspicions were confirmed. Just before I knocked on the doorjamb, I heard the man say "Please don't touch that, Satchel. Please behave and come sit by Daddy."

Of course, Satchel ignored Daddy. He instead shouted "No!" and dumped what he was touching- the stainless steel Mayo stand- over with an almighty crash. The little girl screamed and Mommy scolded lil' Satch with a sarcastic "Do you feel better now?"

I decided that now was as good a time as any to make my appearance. Knocking on the jamb, I parted the curtain and introduced myself.

"Oh, it's you," the mom sneered.

"Yes. I am assigned to this section, and I am going to be the nurse for-"

"Where's the doctor?" the dad demanded, cutting me off.

"He's with another patient and will be in after I perform my assessment." As I turned to the patient, the mom said, "Since we are already here... our kids have been sick the last day or so and I'd appreciate it if you could check them out, too." These were the same kids, of course, who had been running and bellowing around the Triage area for an hour and making life miserable for everyone else in the room.

I turned to her and said "No, ma'am, I will not." The woman looked as if I had slapped her.

"Well, why not?!"

"If you want your children to be seen, you will have to take them out to triage and have them checked in, and wait for them to be seen."

"But we are already here!" She insisted. Why can't you just look at them?"

"Because, ma'am, that would be allowing them to go ahead of patients who are still waiting in the triage area to come back to a room. That's not fair. And except in an emergency, I won't see them before they are triaged."

"It's not my fault that they aren't back here. We're already in here, and so I don't understand why you can't just be nice about it and look at my sick kids. Just triage them here," she said, throwing her hands up in exasperation.

"I will not. You have to go through triage like everyone else. I can tell right now just by observing their, ah, activity, that they are actually doing quite well."

"You mean we have to go all the way back to triage and wait in line?"

"That is what I have been saying, ma'am, yes."

"You are such a selfish ass. If you're like this with your patients, God help them." the woman hissed. She stood up, grabbed her kids and dragged them out of the room. The dad stood, glared at me, and followed his wife.

I turned to the patient at last, and she looked up with tired eyes, her lids heavy, like tired water balloons, from fluid overload. She raised a hand to my cheek and patted me softly.

"Thank you."