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The Story of Mr. Smith: Part I

Nursing is a profession where you encounter people from all walks of life. Our patients are usually assigned to us; we don't get to choose who we care for. Most patients come to the hospital not because they want to, but because they need to be treated and cared for. Because of their condition, patients are likely to be easily annoyed and short-tempered and often put little or no effort into participating in their plan of care. So, this is where my story begins...

difficult patient

I was assigned to care for Mr. Smith, a 65-year-old male diagnosed with liver cirrhosis. He was a bit withdrawn but always had the tendency to shout at his caretakers - even his nurses. He was your typical uncooperative, snobby patient.

How many times did he pull out his much-needed NGT? Probably more than the number of times he refused to have it reinserted. The stubborn Mr. Smith didn't even want his vital signs taken; he would just sleep as much as possible to try and avoid nurses coming and attending to his medical needs. And so, it was very difficult for me and my colleagues to provide proper nursing care when we were assigned to him.

I am the kind of nurse who is very cheerful and loves to exchange stories with my patients. My colleagues know that when I’m missing during breaks, they’ll find me in my patients’ rooms chitchatting or saying long goodbyes. With that personality embedded in my character, I get to know my patients well and establish a good rapport not only with the patients but also with their families. However, with Mr. Smith, it was different—very different.

How could I possibly give the best quality nursing care if Mr. Smith was being hard on me and on himself? What could I possibly do to help him? And how could I approach him to have even a small conversation? That was my dilemma. I decided I would have to try a unique approach to get him to cooperate.

I managed to keep my cool with Mr. Smith many times as I tried to understand him better. Sometimes, I would wait for him to reach out his arm and offer to have his blood pressure taken, but then he would deliberately hold his arm firmly at his side.

One time, my patience with him was tested beyond my limits. On a bright, sunny, and wonderful day, a perfect day to work, Mr. Smith needed to empty his bowels. As his nurse, I needed to help him since he couldn't ambulate to the toilet without assistance and didn't tolerate standing up for long. He felt that needing someone to help him was bothersome and shouted at me. I apologized for “troubling” him but explained that I was his nurse, and my job was to care for him. Whenever I went into his room, I would ask him how he was doing and encourage him to feel better. Most times, I was met with only a straight face and no acknowledgment whatsoever. Most of my colleagues were giving up on him but giving up was the last thing I would do with any of my patients. Even if Mr. Smith were giving up on himself, I would not give up on him.

When the doctors ordered a clear liquid diet to prepare him for NGT removal, I spent an hour feeding him. With a gallon of patience and a bucket of perseverance, I was able to establish a rapport with him. It took a long time but, finally, I was able to have small conversations with him. When I asked about his life and his work when he was young, he raised his brow and gave me an unkind look. Right there, I knew I had overstepped my boundaries. After a moment of eerie silence, he took a deep breath and looked at me again with a defeated demeanor.

He smirked, and with an irritated look on his face, he said, “You’re annoyingly persistent, aren’t you?” I was ready to give my most elaborate apology when he started the conversation and said, "This is my second life, you know?”

Thank you to Matt P. RN for this story ... to be continued.

For more stories like this one, pick up a copy of Off the Chart A Nurse's Journey

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