our patient:
- doesn’t take his medication, we inform him about the risks and document. He says he’ll take them ‘later’, never does.
- refuses his insulin, we inform him about the risks and document as well as chart.
- refuses his blood thinners, we inform him about the risks and document.
- turns his phone obnoxiously loud, also talks loud.
- insults us several times every day, gets passive-aggressive.
this is not psychiatry, patient is a young, AOX4, fully competent adult.
Fine, you’re a free man and free to do with your life what you want. But why go to a hospital in the first place if you are going to behave like this?
Yesterday we found him unconscious on the floor, vitals were normal, didn’t hit his head. He is being released tomorrow. Doctor agrees.
I have the feeling we’re going to see him again very soon, but he is the biggest asshole I’ve met in my nursing career.
Why do people behave like this? we are literally trying to give him some quality of life and he attacks us each time we open the door. why?
If any of you is a nurse and has some insight, I’m all ears.
Do please notice that I’m not asking how to deal with people like this: we document, chart and move on, but to understand why in the fuck people are like this.
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The pain inside him is unrelenting.
I have no idea where it might have come from. Maybe at a young age, someone very close to him gave him overbearing pain, insult, criticism, maybe injury or deprivation that he wasn’t even equipped to comprehend let alone to resist or properly cope with. Maybe something happened to someone he loved, or maybe he put his heart into something that didn’t work out and he had to give up on it, resign himself to the long road of a miserable life now unwanted, and he chose to focus on it and stoke the fire of unhappiness until he hated everyone and everything. Maybe nothing in particular happened; his mind just happened to come out wired with anger and bitterness and stress, releasing chemicals to cause sensations that he can’t process and that will not stop. It happens that way sometimes.
Cruelty or malice can sometimes come from greed, or a desire for something, but unrelenting asshole behavior that is so counterproductive to himself almost always comes from agony. It’s like screaming from physical pain, or yanking violently away from your hand in a fire: A involuntary reaction. He lashes out at people around him because to be pleasant in the face of the burning he feels inside him is simply impossible.
From the way you describe it it sounds like he’s fucked. His mental inabilities are manifesting into bad choices and physical disability, snowballing in a positive feedback loop of bitterness and self-hatred. It doesn’t have to be your problem. He’s an adult and win or lose he has his situation and his choices. Even if you made him a lifelong project you might not find a way to release whatever’s poisoned him, and honestly he’d probably hurt you in the process. You want to protect yourself against him as you would against a large, dangerous animal: Without blame or bitterness at its behavior, but with simple responsible attention to your safety.
But remember the most likely root is terrible, terrible pain. This may help you not to take it personally and to give him what sympathy you can while still giving attention to your own security when you’re near him.
It’s really important to remember some people were dealt a really awful hand in life - helping them remain healthy in body and making services available to help or ease their mind is sort of the best we can do. As I said in my other comment it’s very common for people who feel like life shit on them to shit on those around them.
We can also be excellent to each other. That’s something we can do to help those living in horror.
That’s a lot of medication for someone young.
I imagine he could feel very angry, sad and resentful about that. And the yet he can’t express it to the thing that’s being so unfair to him how do you tell your illness it’s being unfair?
So it’s just sat there until someone comes along and reminds him of how unfair it is and how angry he is by telling him to take his medication, and again he’s feeling powerless.
So he takes what little power he has back, he refuses his medication and attacks the nurses.
Extreme situation, given it’s potentially life and death stuff, regular human behaviour. Who hasn’t snapped at someone when we’re in a bad mood when they were trying to help?
Consider cross posting this to !medicine@mander.xyz
We could use more content from healthcare people
Attention seeking behavior in a healthcare environment including faking a medical condition, or intentionally worsening a real condition are pretty glaring symptoms of Munchausens.
So they are acting this way because they are sick, just not in the way you’re accustomed to.
The ethical thing to do here is to put them into contact with mental professionals.
And remember—you’re 200% more likely to be sued and lose in the setting of an AMA encounter
For the later half - some people are just assholes… ain’t shit you can do about obnoxious phone talking and being rude.
For the first three issues, especially since he’s young, he may be in denial about his condition. Everyone wants a fair shake at life and some people are cursed to have cancer and type 2 diabetes (even with a healthy lifestyle) in their twenties. It fucking sucks but some folks just die young for stupid reasons… if you feel like that’s you it’s fucking hard and you may refuse treatment that will help you have a longer life because it constantly reminds you how short your life may be. If you’re in a head space like this you’re also more likely to be an asshole for the simple reason that life was a dick to you so why not be a dick to everyone else.
Oh, lastly, as a person with ADHD, remembering to take medication is just fucking hard for some of us. Some areas (like BC) have free medication adherence programs that may come with in home dispensers, blister packaging or other strategies. It might be good to recommend a program like that.
At the end of the day, though, the person is still a human being who deserves as healthy a life that we can give them. Sorry, some people are assholes but thanks for looking after them.
Why do you say he’s competent? There’s never been a shortage of stupid.
I think they mean competent in the legal self determination sort of way: not needing a guardian.
Hopefully the next time he blacks out like that he isn’t behind the wheel of a car or something where he could be endangering the life of someone else. Something like this should allow medical staff to have his license temporarily suspended, just like people with a seizure condition until they can go a set amount of time on medication without a seizure.
I know that where I live, a doctor can do something that makes the driver’s license folks have to hold a hearing on the individual. As far as I know, it’s almost never done because the doctor is going to 1.) be sued, and 2.) be dragged through the mud by the dipshit and nearly every single person who knows the dipshit. For most, it’s just not worth it.
Surely that must already be possible. Someone has a fainting disease, it can affect their license can’t it?
Jeez, that’s terrible - I am sorry! I don’t have an answer as to why people are like that unfortunately, I suspect most people here won’t either - but that patient sounds insufferable.
Sounds like he’s unconsciously suicidal, and only feels real when others are responding to him. The hospital is a narrow environment where he doesn’t have to face the full complexity of life. When you are paying attention to him, it gives him a sense of being valuable.
He won’t protect his own life, because he knows himself and he knows life. But he’s afraid of death, and recruits you to protect his life for him. You don’t know the full him, so you don’t have the hatred that he does. He knows this, so he knows you’ll try.
You say it’s not psychiatry, but perhaps it should be. Guy sounds like he’s got zero motivation to fix any of his health problems, and that’s worth looking into more deeply.
Wish I had an answer. Had an older relative that was like this. Others say he was always like that and he died miserable. Never did figure out what drove him to be that way and many people tried and failed to befriend him and get to know him. No one succeeded including his neighbor who was the nicest person I ever met.
