Old Fashioned

I was eating my spaghetti during a lunch break when I heard a code called on the floor above. I always went to the codes there, as that part of the hospital was a small hike from the main building and it usually takes the code team a little longer to arrive. Also there were lots of new nurses in that building.

I found the room easily and mosied inside. There was a little old man in the bed, Respirations looked shallow, but he still had his gown on. I jumped in to help and got the gown off. No respirations. The femoral pulse (the one at the groin) was fading. I saw he had an implanted pacer or defibrillator in his left upper chest. Two started to bag him as more hooked him up to the monitor. I placed an 18 gauge in his left upper arm, telling him what I was doing in case he could hear me. He did not flinch.

The code team had filed in by then and we had some atropine ready just in case. I drew some labs as everyone buzzed around him. To this day I have no idea why he was in the hospital. As the MDs were having discussions, the man came to. He wanted to explain that he felt something pulling his chest to the right. He seemed barely disoriented at first and kept saying the same thing over and over again. The staff kept moving around his bed. I stayed by his head to tell him what everyone was doing.

Now that I have seen a few codes, I always try to remember to talk to the patient. He kept his eyes on me as I told him step by step what was going on at the time. One of the MDs gave his hands to the patient and asked him to squeeze. The patient did so with great strength. The patient says once again that something was pulling him and that is why he pressed the call light. He asked me if they knew. I repeated it to the MDs at the bedside and tell the man they heard him.

Then that same MD asked him to lift each leg, one at a time. He lifts the left leg, then looks down as he lifts his right leg. He gasps so loud and looks at me with total embarrassment all over his face. He says, "HEY! Wait just a minute now!" and tries to fumble for the covers that were on the floor long ago. I grab the closest thing to me to cover him up. A washcloth was as good as I could do. I toss it over his penis and he grabs a hold of it, turning his knees in. He looks at me again with that surprised face and says, "Hey hey hey! There are ladies in the room! My momma taught me better than THIS."

As someone gives me a sheet to cover him up, I explain that we are terribly sorry, but we were very concerned about what just happened to him and had to take his gown of to work on him.

"Well show a man some decency here".

"Yes sir", I say.

I stay with him another couple of minutes and tell him what the MDs are saying since none of them are acknowledging him. They were busy looking at the monitor and strips from when he was out of it, and talking amongst themselves. I left as they were rolling him out to ICU. I couldn't help but chuckle as I went down the stairs back to my floor. We thought the man was in the process of kicking the bucket and he "wakes up" more concerned that he is nude. Bless his old fashioned heart. His Momma taught him better than to be naked in a room full of strangers.....

Nauseated

I once worked in a fairly small hospital somewhere in the South. Most of the employees and patients alike were either white or black. But there was one RN who was Filipino with a thick accent. She was a very good nurse and pretty quiet. She never complained and always helped out the other RNs, LPNs or CNAs without even being asked.
One night she had a patient who was nauseated and had vomited several times. When she ran out of anti-emetics, she put a call in to the MD to see about getting something else to help this poor patient who had been feeling awful all night. She told the MD what he needed to know expecting him to order another antiemetic. She hung up the phone with a confused look on her face. He had ordered a bisocodyl suppository. (The kind that helps you have a BM.)
Another RN had said maybe he was still sleeping when she talked to him and she offered to call him back. So she did and they got an order for a different medicine to help stave off the nausea for this patient.
The next morning, the sweet Filipino RN was called in to the office with the Vice President of nursing in regards to the conversation she had with the MD the night before. Apparently the MD was mad that she called at 03:00 just because a patient hadn't had a bowel movement that shift. He also said he didn't appreciate how she told him. When the VP asked the MD what she had said his reply was that she had told him the patient "no shitted" all night long.
If you know anything about some Filipino accents, you will understand how this southern talking MD thought she was saying "no shitted" instead of "nauseated".

When the word got out, everyone had a laugh including the RN and the MD. He actually came up to her once he found out and hugged her and apologized. She thought it was especially funny and told that story many times.

Dialysis

I sometimes got to have nights where I actually feel like a nurse instead of a rushed robot at this one hospital I worked at. You know, the nights where you actually get to chat a little bit with your patients. I had this one gentleman who was in for......actually I forget why he was in the hospital. But I do remember he had received a kidney transplant and his body ended up rejecting it about a month prior. He was back to getting dialysis 3 times a week.
As a nurse, I take care of dialysis patients all the time. But only until this night did I truly realise how much it sucks to be on dialysis. I had taken care of this man, I'll call him Fred, the night before. His wife and some family were there and the wife stayed the night. They seemed to want to spend some time together so I kept my visits in the room fairly short.
The next night he seemed a little bummed. I went about my assessment and asked where his wife was. He told me she was on vacation with his and her family in the Caribbean.
I said, "Without you?"
He sort of half smiled and he told me about how they had saved up and planned for this vacation for a year and a half. Every one in their family was going. He and his wife had been ecstatic and had been counting down the days the whole time. He had not been on a vacation in many years due to the restraints of dialysis. The plans were made long before his kidney failed and though they checked in to it, they could not afford to have him dialised during the vacation. Insurance wouldn't pay and the cost was astounding. I believe he told me it was well on in to the thousands each dialysis.
His wife protested about going without him, but he "made her go" and told her to enjoy herself. I told him I was so sorry he was missing the trip. He just gave me that half smile again and said, "Yes but I am alive."
The rest of the night, he was awake every time I went into the room to check on him. He was in a somber mood, but still so polite. I really got to thinking about how awful it must be to have to go through hours of dialysis almost every other day. How time consuming and I would just feel trapped or something. I would also be a royal bitch, even though I don't really want to admit it.
But just imagine all the planning and the excitement. He said he'd always wanted to go there. Only to have it diminish the moment you find out you have to go back on dialysis.
No, I don't know if I could take it so well. I hope Fred gets another kidney and gets to take lots of vacations. Hey-maybe he already has! I can only hope so.

Freaky spooky

About A Nurse reminded me of an experience I had while working in an old hospital. It was in a state where taking a nap was normal during the night shift. I didn't participate in this until I started working a lot of overtime. Plus everyone else did it, saying you can do anything you want on your break. There was an ICU on the same floor. There was also a separate ICU for overflow that was hardly used. Word on the unit was that is was haunted. Actually they really thought the whole floor was haunted.

I remember the first time I saw for myself the strange things they spoke about. I had been there about 3 weeks.There was a room on the floor that was a four bed room. It had no patients in it all night. About 0500 that morning someone noticed water coming out of the room. They grabbed some blankets and threw them on the floor and yelled down the hall matter of fact "the ghost is back, call plant ops".

I heard it and thought "HUH?".

The charge nurse promptly gets on the phone and I hear her saying "Yes, the ghost is back, there is water coming out of room 707 this time".

I was thinking these people were a little off kilter because I didn't really know them. So I go down the hall and tip toe through the water. The guy who found the water on the floor said the sink was on and overflowing on the floor. I asked if he turned it off because I could hear the water running. He wouldn't go in to the room.

I sighed and laughed and tip toed through the water on the floor to the sink. Nothing appeared to be stopping it up, but the sink was indeed full of water and overflowing onto the floor. I turned the water off and stepped carefully out of the room. I wanted to know why he wouldn't go in, but he went somewhere else and more staff was bringing extra towels and blankets to sop the water up. I took one and went back into the room and noticed the sink was no longer full of water. I thought it was perhaps a slow draining sink or something. To prove myself right, I turned the water back on and to my surprise, the water went directly down the drain. I didn't get a spooky feeling or anything. I just thought it was strange and sort of excited that things didn't add up and maybe there was a ghost or SOMETHING.

The guy from plant ops came up and investigated and found nothing wrong. OK so that was strange, but I didn't dwell on it. I got a kick out of it. So, on to my actual story.

This was about 2 weeks before my second assignment ended there. I had been going to the unused ICU to take my naps for a while. Some staff would not go in there to sleep, but I am not easily scared of such "stories" and I never had a problem- until this certain night.

I walked in to the room I always slept in and closed the glass door and made myself comfortable. I don't know how long I was in there before I felt a tingling sensation start at the top of my head on the right side and it went down to my toes on the right side. I thought I was dreaming but clearly woke up and looked around. I did not see anything strange. I was half asleep, so I closed my eyes. I felt it again along with the sensation of being pulled to the right side of the bed. It felt good, like it was relaxing me. I thought I was dreaming again, like when you are having a dream and wondering if you are dreaming and you are. --if that makes sense.

When the charge nurse came to wake me up I was all the way on the right side of the bed, still on my back as I was when I laid down. She even made a comment that it looked like I was going to fall off the bed. I turned the light on and looked around feeling very strange. I don't know if I was visited or not, but something weird happened. So sure, I think places can be haunted, but don't believe until I experience something!

Good Enough

Don't you hate it when you walk on the floor and hear someone being obnoxious only to find out it is going to be your patient for the next 12.5 hours? Being that for the last 8 years, I have been either a traveler, or a floater, I can just about count on it being my patient. That being said, I thought I would type about one that sticks out in my mind that I took care of several years ago.

The unit I worked on was notorious for giving me the worst patients. By "worst" I mean they could have one or more of the following: hypervigilant family members--the kind that go looking for you in the halls instead of using the call light-even intruding in to another patient's room to track you down. Or someone with multiple "needs" as in wanting you to come in the room so they can either boss you around doing things they can do for themselves--the kind who thinks the hospital is the Hilton, or all of a sudden can't use their hands or legs even though they are there for something like pre-op. (they are there the night before a surgery and nothing is really wrong with them yet--for example elective mammoplasty). Or the one who is going through DTs and no family in sight. Or someone who is demanding or degrading to the staff. Or......well really I could go on and on with the examples, but let me get to my little story.

I walked on to the unit to put my lunch in the fridge and I hear someone yelling and moaning. "Call 911! Oh Lord Jesus, won't somebody help me? OOOOOOOOHH HOOO " (dramatic fake sounding crying). I look down the hall both ways and see no one seems concerned which tells me this is not and unusual sound coming from this room.

"Please don't let that one be mine, please don't let that one be mine" I say in my head to myself.

I peek in the room as I pass when it is silent. He is lying on his side, perfectly quiet until he sees my reflection in the mirror. Then suddenly boo-hoos more along with a loud curdling scream. I go to the front desk to face my assignment, and you got it, he is mine. Plus 2 empty beds when everyone else only has one except for one staff member who has no empty beds. Not sure how that is fair, but I had been there long enough to know fairness does not extend to non staff members such as myself.

I take a deep breath and pray for the patience of a saint and decide to not make early assumptions even through the report I got from the day nurse, worn haggard from this one patient. He was in for an eye infection, abdominal pain-which they had figured out he had peritonitis and was being treated accordingly. He and had been on peritoneal dialysis for 10 years.

I entered Drama's room with a genuine smile on my face to introduce myself. He doesn't even look at me. Instead I get "You've got to get me something for this pain! You're trying to kill me I just know it!"

I find out his stomach is hurting, he has had a substantial bowel movement today and also had a platter of pain medicines. I do a quick assessment and say it is not time for pain medicines, but I am on my way to call the doctor. I also encourage slow deep breaths and to try to calm down and I would let him know what the doctor says as soon as I hear anything as I pat his large back.

"What? Calm down? Bitch I AM calm -don't you tell me I'm not hurting-you're trying to kill me to-OH LORD JESUS!" (screaming).

I quietly and as kindly as I can muster say, "I never said you weren't hurting. Did you hear me say I was going to call the doctor? Just hang in there, OK?"

"SOMEBODY CALL THE AMBULANCE, I GOT TO .....GET.....OUT .......OF HEEEERREEE!"

So then I wonder about the mental status. In report I did not get there was a history of anything, only that the day nurse tried to get his service to order a psych consult, which they did not do. So I ask the patient if he knows where he is.

"Of course I know where I am. I'm in hell and I'm hurting. Go on out of here and get me some damn pain medicine!"

"OK I am going to call the doctor now" I say and leave the room. I figure now is not the time to address the cussing, which I hate to be cussed at by patients. I call the on call MD and he says he will come see the patient. I go to the room and tell Drama the MD is on the way. More screaming. I ask if I can do anything for him in the mean time. He looks at me like I am crazy and squeals, "NOOOOO!"

So I go to the other patients and try to get them fixed and tucked in early as I know my hands are going to be full with Drama. Twenty minutes later I see orders for a stool softener and simethicone for Drama even though I told the MD about the bowel movement he had earlier. I take them to the room along with the night meds-which include a sleeping pill 2 hours early. Drama is sitting on the side of the bed. I name the medicines I have brought and notice he is grunting like he is bearing down for a bowel movement. I ask what he is doing and he yells at me to "fetch the toilet" as he continues to grunt, holding his breath. I hurry to the side of the bed and scoot the bedside commode one more inch to his leg as it is already in a place he can easily get to. (he can walk just fine) He is yelling at me to hurry after the commode is inched closer and then yells "oh no, it's too late! I boo-booed on myself and it is all your fault."

I see that his face has returned to its normal color instead of red and realise he just sat up in bed and took a dump in it. I press the call light for the CNA as I already have 3 pages for nursing needs and ask Drama is he'd like to take his meds now, or wait until the CNA can clean him up. He tells me "No, YOU are going to clean me up right now" I tell him that I am not, that I have 3 other patients who have been waiting on me and the CNA then walks in to the room, rolling her eyes behind his back, She is well versed in his antics. He then tells me the doctor never came and I am a liar.

I leave the room and call the MD back. I told him the patient said he never came to the room and I wasn't sure whether to believe him or not. The MD is just around the corner on the same floor and is astounded. "I just walked out of there 10 minutes ago....I'll be right there and I want you to come in the room with me"

So we have a mini-intervention--me, the CNA, the charge RN and the MD. Drama was confronted with his antics and lies and tried like hell to twist words around and argue. When he realised he was fighting a losing battle, he threw himself into the bed, face down and continued to yell, "Call 911! I need up out of here!"

I had the AMA papers ready and was disappointed when the MD wasn't keen to my idea. So that is how my night went in between the other patients and the 2 admissions, I had to deal with Drama's bullshit. I tried all kinds of approaches, but nothing was accomplished other than him absolutely getting under my skin and putting me in a foul mood. I searched his chart and the tests that had been run. Everything was negative so far other than nthe peritonitis and plans were in place to have him out of there soon. I refused to be his nurse the next night, and then was off for the next week.

When I returned I found out he had been transferred to the unit and DIED! "What in the world happened?" I asked.

It turns out, he was not getting over his peritonitis. They decided there was something else to it after the psych evaluation and somehow he went for an exploratory lap. They found he had perfed his small intestines and also found carcinoid tumors. They left his large abdomen open and sent him back to the unit. He went septic, had to go on hemodialysis, developed a raunchy case of calciphylaxis on top of everything and died 4 days later.

I must say I was in disbelief. And for some odd reason, my heart seemed to drop way down into my stomach. Could I have done something different? Not in the sense of figuring out what was physically wrong, but couldn't I have been more empathetic? I questioned myself out loud to the CNA who worked with me that night I had him. She very sweetly placed her hand on my shoulder and said there was no way we could have known something this bad was going to happen
to him. "You handled him better than most up here. We were all sick of him."

Somehow that did not make me feel any better.

Maybe he knew somehow and he was scared and acted out because he didn't know what else to do. The MDs were saying he was fine, they couldn't find anything that wrong with him. They, and the tests were never pointing to what ultimately happened.

I guess sometimes it is difficult to differentiate between someone being mean, acting out, and someone who somehow knows something is very bad wrong with them and must feel helpless. I promised myself to do better next time, no matter how difficult the circumstances. But at the time, I did the best I could, which maybe wasn't good enough.

Blue eyes

He was 89 years old. A little hard of hearing, but if you spoke loudly and slowly into his right hearing aide, he could hear just fine. He had a touch of Alzheimer's, but that only consisted of asking a few questions twice. When I answered them the second time, he would remember and finish the answer with me and smile. You could tell he used to be one handsome fellow. Most everything was now a little sagging, wrinkles here and there, but he had the bluest eyes. They absolutely lit up and turned a bright crystal hue of blue when he spoke about his grandchildren. His whole face smiled, wrinkles and all. And when he spoke of his wife who had passed away 2 days prior to our meeting, those same eyes paled into a dusty grey and his whole face showed the most sadness I have ever personally viewed.

I walked in to introduce myself a little too chipper for the mood of the room. He had 2 visitors, who shared with me the fact that his wife had recently passed away and that he was hard of hearing. I had not gotten that in report and instantly toned myself down to be empathetic to this wonderful man. The visitors were very kind to fill me in. I first merely introduced myself and asked if he needed anything. I must have been speaking too fast and he reached out to hold my hand, leaned towards me and asked if I could kindly repeat myself. I did and we were on a roll, as I had gotten it right this time.

"Pleased to meet you", he says, still holding my hand. My large hand felt tiny surrounded by his gigantic one. I was surprised by how booming his baritone voice was, but he was so gentle in comparison. I instantly liked being in his presence in a grandfatherly way. He denied any needs at that time and I thanked his company for the information and went about my way to see my other patients.

Throughout the night, and through our talks, I became very fond of Blue Eyes within the 12 short hours where I had the privilege of spending time with him here and there.

The third time I was in his room, he asked again,"what's your name?"
And I said, "Nocturnal RN from.." and he chimed in with the name of my hometown and patted my face with a big gentle hand and smiled.

I saw a picture of two little girls and showed him to ask who they were. This is when his whole face lit up. "Why, those are my grand kids. They were here today just a crawlin' all over me. They call me Grandpa Blue". His children were worried the grand kids would hurt Blue Eyes, but he'd told them it was OK. To please let them climb in the bed with him. Each time one said something to him, they knew to crawl up towards that right ear and he would cock his head down to take in their words. He said it had been a great day.

Towards midnight I walked in his room to check on him. It seemed he had been staring at the door, awaiting my arrival. He motioned hurriedly with both hands for me to come on in. He wanted something to help him sleep. I asked why he hadn't called me. His personal sitter said she wanted to press the light for him, but he wouldn't let her, saying he knew he was not my only patient and that he would wait for me to come in. I playfully scolded him, and told him not to hesitate the next time he needed anything.

I returned with the sleeping pill and squatted down next to his good ear as he took the pill. He stared out into space, those blue eyes misting up and began to talk. "I was thinking yesterday......that I am old. ......I do not have many years left to live......and I've lived a good life.........but I just hope......" tears began streaming down his face and the sitter quickly tried to change the subject. I knew she had mentioned needing to move her car, so I politely told her I had a while, if she would like to go move it now.

When she left the room, I asked him if he wanted to finish. He had wiped some tears away. "I just hope......I have a few more years left........to enjoy it. To enjoy this life some more.........even though it will be without......." His face scrunched up and he shook a few times as more tears rolled down his long face.

"Without your wife?" I finished. He just nodded his head and I laid one arm over his chest and let him cry. I couldn't help but get a bit teary-eyed myself. Here was this fine man; wealthy, humble, had an accomplished life- and he was heart broken. And I couldn't fix it.

I stayed with him in silence until the sitter returned, his hand holding onto mine. I tucked him in and told him good night. He held that hand to the side of my face again and said "What did you say, baby?"

"I said good night. And you call if you need anything."

"Oh I will this time".

I went back to my work station and sat there deep in thought for a while. I wondered what it felt like to love so strongly. (and so long!--60+ years) I wondered if I would ever have that capacity, or furthermore if anyone will ever have that for me. And how strange it must be to put into perspective; to realise you only have several years or so to live. What must that feel like?

After report was given I returned to his room one last time to say good bye. He asked where I was going. I said it was time for me to go home and he would have another nurse in shortly.

"Oh no, I was just getting to know you. "

"You will like your nurse today"

"Is she as sweet as you are?"

I said I thought so and he said he would miss me and he patted my face one more time.

But I knew I would miss him more.

Yes...................

This is why I am a nurse.

Ugliness and the longest night

There once was an incredibly ugly person, both inside and out. He was about 49 or 50 years old. He was homeless. He was mean. There were no breaking any of his walls of despicable rudeness. Actually the more I think about it, these were not walls he put up. He was just a nasty man. There was no getting to the human (or humane) side of him. I don't think it existed. My opinion of course. I am sure he was once a child before as we all were. But I can't help but think after my encounter with him, that it is quite the possibility that even as a child he was EVIL.

No one warned me about this particular frequent flyer I learned from the day RN many of the things he had done or said to her that day. I decided not to let it get me frustrated before I entered his room. Hey- I WAS in a good mood that evening.

I first went around to introduce myself as I always do after report. His room just happened to be last in the sequence of room numbers on my list. He is lying in bed with the foul colostomy bag odor reeking. I ask if he would like for me to change his bag for him, even though I know he is capable of doing so himself.

"No bitch. Fetch me my pain medicine STAT"

"It would make this long shift a bit more pleasant if you would not speak to me that way. I will be more than happy to see if it is time for pain meds."

"NOW" he roared.

Looking at him, he was actually physically very ugly. He had darkened dirty eyes--the whites of them were dusty colored, his nose was huge and a bit crooked and looked strangely like putty stuck to the middle of his face, most teeth were missing, his face was long and his chin seemed too short, his hair looked like he had cut it himself and was greasy, and his ears were huge. He was uncovered in bed and I see that his double amputation of his legs actually start from the bottom of his butt. He has a urostomy bag, and a colostomy bag. The colostomy bag was in the floor. I picked it up and threw it away, placing a towel over his stomach to catch any further leaking. As I was walking out of his room he yells,"I need 4 orange sherbets and some graham crackers!" Well isn't this going to be a lovely night.

He was in a room with 4 beds, only one of them across the room was occupied by a Japanese man who did not talk much and seemed to keep a watchful eye on Mr. Ugliness.

I brought the ice cream in his room. We were out of orange sherbet, but had brought chocolate, vanilla, and strawberry for him to choose from. I explained it was all we had in the freezer and that he just received his pain medicine 20 minutes ago and informed him of when it was due next. He picked each ice cream up and read the label, throwing them across the room each time. None hit the Japanese guy. I wanted to have Ugly march over and pick them up himself, but he had no legs and I was still trying. So I just picked them up, laid his new colostomy bag on his bed and silently left the room.

I pretty much ignored his every 5 minute call light, periodically sneaking a peek in his room to be sure he was not in any real physical emergency until I had finished up with my other patients and tucked them in. When it was time for his pain meds, I promptly delivered them on time and he cussed me. I just asked, "Do you want me to give them to you, or do you want to continue cussing at me, because I have work to do, so perhaps you can ring me when you get rid of the foul language."

He was quiet until he took the meds and then said"get out of here bitch" as I was exiting the room to get the supplies to change his dressings. He was paraplegic from his waist down to the bottom of his butt where his body ended and had some nasty pressure ulcers-open and draining.

I went back to the room-already decided I would ignore his commentary. He was compliant with turning himself over to let me change the awful smelling dressings.

He was quiet so I asked him a few questions just to try to make friendly conversation and hopefully establish a decent rephor. Somehow he twisted the conversation into all the lawsuits he had pending. I later found out from one of the regular nurses that his hobby was seeing how many cars, trucks, bikes, and buses in that big, busy city he could wheel out in front of with the hopes of getting bumped so he could sue. So far he hadn't won anything. I guess there are too many witnesses in a city as busy as that one is.

When he decided to share with me that he couldn't find the "bitch that sucks my cock regularly" and gave me her name so I could look her up to see if she was anywhere in the hospital because she owed him "a few sucks", the dressing change was complete and I left the room ignoring his request.

He was on the call light, I kid you not, every 5 to 10 minutes for various things. I tried to give him the nice talk about how it would be great to ask for everything he thinks he might need at once, and how he was not my only patient and I was just one person, etc. This did not work. So from then on, we would answer the call light and merely make a list and prioritize his "needs", or tell him why he couldn't have whatever ridiculous things he asked for. Every time I went into his room, he would have the front of his diaper open with his shriveled penis exposed. And I repeatedly told him matter of factly that I,nor did anyone else on the staff, OR his roommate had any desire to see his business and to please keep it covered. I usually got a "fuck you" so I just quit addressing it.

I tried to get the poor, sweet, Japanese man transferred to another room, but there were no more male beds open. I just kept the curtain closed around him. Mr. Ugly was beyond on my nerves. He refused to have his blood sugar checked, vital signs, refused all meds except for narcs and refused a bath even though he reeked of urine, body odor, and colostomy juice. He eventually caught on that I would not come running every time he pressed the call light for ridiculous things (request examples: 20 dollars, a DVD player, socks for his feet (? what feet? I guess he thought we would think he was someone else like we didn't see what room number was calling), more orange sherbet that he already knew we didn't have, a scrabble game, someone to "suck his dick", OH the list goes on.) At times I guess it could have been comical, but he had already gotten to me. Every time I heard the light go off, I cared less and less.

When Carl, one of the regulars went in his room to have a talk with him, he got squirted with the urine from Ugly's half full gravity bag. I think everyone on the staff chipped in and tried different approaches to no avail. I searched his chart for some sort of psych history, but there was none and he'd had evaluations in the past. I wondered how that could be true, but there it was in black and white.

When the shift came to a close, I gave report and then went from room to room to tell my patients good bye, as I usually do. I didn't want to step foot in his room, but I was taking care of the sweet Japanese man, so in I went. The stench had gotten worse and almost knocked me down. Mr. Ugly was across the room perched in a chair with shit running down his stomach. His urostomy bag was also MIA. I looked at the surroundings. Apparently he had thrown the colostomy bag against the wall right beside his bed, a large greenish brown splatter toward the top of the wall with more of the lovely liquid shit running down. There were drips and splatters all on his bed, on the floor in between his bed and the clean bed right beside him. I asked how he got over to the chair and like a gymnast he bounded onto the (used to be) clean bed using his arms and butt nub. To be honest I was impressed for a split second he could move so quickly.

"Change my bag, bitch and fix me some breakfast".

I calmly went over to Sweet Japanese man and apologized for his sleepless night. I told him they would be transferring him to a more quiet room as soon as there were discharges. The whole time I was behind the curtain trying to speak to my patient, Ugly was throwing whatever he could at the curtain and cussing me, demanding I "get on it" and change his colostomy bag "right now". Also he was complaining of being sick and tired of "smelling his own shit".

Right before I was coming out from behind the curtain, I could hear Ugly shuffling our way. When I pulled the curtain back a bit, Ugly was right there in from of me, juice still leaking from his stomach.

I told him in my most professional voice," I'm sorry Mr. Ugly, but it is shift change and I have already reported off. You will have to wait to get a new bag as it will have to be ordered. Maybe next time you should think about that before you sling it across the room. "

He threatened to hit Sweet Japan, so I said (again in my most professional voice,"touch him and I will not hesitate to beat you over the head with this chair".

I then picked up the phone a called a security code overhead, then pressed the call light from Sweet Japanese man's side and asked whoever answered the lights to bring the restraints. Ugly was fuming by now, trying to clamber back to his bed and I just held my post between him and sweet Japanese man until the security guards and various other staff members came running. Then I calmly walked out and clocked out, glad to be off for the nest 4 or 5 days. I knew they would be rid of Mr. Ugly by then. ...................Fucker.