Wednesday, June 20, 2012

Honesty - The Easy Way Out


If you find yourself in the hospital and the admitting nurse asks how frequently you use alcohol – tell the truth. If the same nurse asks you if you take anything for anxiety – like benzodiazepines – and you take more than your allotted daily dose, fess up. The nurse or doc isn’t there to judge you. They want to keep you safe while you are in the hospital. They have probably seen and heard it all. But, be honest because if you end up being admitted to the hospital and you normally drink or take more medication than you said to make yourself look better, this may happen to you:

You may have a fairly uneventful first day and even second day – a series of tests, lab work, standard stuff…and then your night nurse arrives. You seem a little anxious but are pleasant. Then your family leaves and you start getting more restless. You tell your nurse you are feeling short of breath and finding it hard to get enough oxygen. You start to get a little agitated. The nurse thinks your lungs sound pretty good but puts some oxygen on you and calls a respiratory therapist to come see you. The respiratory therapist concludes that your lungs sound good and you just appear to be very anxious. The night progresses. 

You beg your night nurse to help you because, although everything appears ok – vital signs stable, labs decent – you are sure you are dying. This concerns the nurse and she starts looking through all the notes a bit more carefully. There is a vague mention of the possibility that you use more anxiety medication than you have been prescribed. There is another fuzzy mention that you might experience withdrawal while in the hospital. The possibility seems a bit remote so the doc doesn’t put any ativan (common for anxiety) on your medication list so you can taper off. Withdrawal isn’t pretty or always safe so, typically, it is a slow weaning process. Not in this case. There is nothing to taper so the nurse tries to reassure you that you are okay and maybe you could take some deep breaths and get a little sleep? No such luck because you used the ativan to sleep and now you don’t have any. Pretty soon you are constantly on your call light. You want the nurse to sit with you and are appalled that she has four other patients who want some attention. 

Pretty soon you are calling 911 and asking to get admitted to the ER. What you don’t realize is that when 911 gets calls from patients already in the hospital, they alert the hospital. So, the nurse is made aware that you are calling 911. She goes in to ask you what you are hoping for from 911 and you tell her you want to go to the ER and she should take you – right now. You insist. You don’t care when she tries to explain that you are already in the hospital. You are getting help and being followed by the doctors in your current location. You are no longer rational. You strip off your clothes and run into the hallway naked. Why not? Then you realize you can’t leave the hospital naked so you put on your nylons and heels…quite a fashion statement with the hospital gown. You insist you are leaving. The nurse tells you it isn’t safe to walk out on the streets at 3 in the morning with no family here to take you home.

 The nurse realizes that you are delirious and the doctor needs to be notified. The possibility that you are withdrawing now seems to be very real. The doc is roused and the situation explained. An order for ativan is secured as well as some labs. The problem seems temporarily solved EXCEPT you are too agitated to agree to take the ativan. Much to your nurse’s dismay, you refuse. You insist that you must talk to your family and you are sure they want to hear from you at 3 a.m. So, you call. Your family, bless them, calms you down and reassures you that the nurse is there to help you, not harm you. You decide to take the ativan. You settle down and get a few hours of sleep. Meanwhile, you have given the night nurse gray hair that she did not need. Now, wouldn’t this have been much easier if, in admitting, you had just disclosed to the use of a little extra medication to help with anxiety?

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