Life of a Nurse

One of my patients was a white man in his 40s, with hepatitis C. He had been admitted with pneumonia, and now had a chest tube to suction in each lung. He had IV fluid and antibiotics. He moves around a lot, and is confused and forgetful at times. Sometimes he gets out of bed, and starts walking to the bathroom, forgetting about the tubes and IV line. Both chest tubes have had to be replaced because he pulled them out by accident.

At the start of the shift, I had to put a fresh dressing on one chest tube and tape on the other. While I was doing that, the patient said he saw smoke in the room. He said he was afraid there would be an explosion because he had oxygen on. There was no smoke that I could see, but the suction machine for one of the chest tubes was turned up high and felt hot. We have wall suction (built in equipment, behind a wall, with access in the room) in the patients’ rooms, but it could only be used for one chest tube. The patient was in a private room, and it only had one suction connection. He needed suction on both sides, so an old portable machine was brought in. It had a warning label on it that stated there was a risk of explosion if used with an explosive gas. Oxygen is an explosive gas, and the patient’s oxygen was turned up high.

I thought that just to be safe, I should call the doctor and ask him if I could turn down the suction on the old machine. I told the doctor that it felt hot, and the patient said he was seeing smoke. But the doctor said to leave the settings where they were, because here was a risk of the patient’s lung collapsing if I turned it down. He said to give the patient some Ativan to help him relax.

The patient was begging me to do something and was almost crying. He said he would not take anything that would make him sleepy, because he was afraid he would get blown-up in his sleep. I distracted him and gave a dose of Ativan through the IV line. He saw me, and knew I was giving a medication. He was angry and said that I tricked him. He yelled “You shot me up, didn’t you?! What did you give me?!”

I told him that I gave him something ordered by the doctor. He kept asking me what I gave him, and I told him it was something to help him relax. He was upset, but I didn’t have any more time to spend with him; I had other patients to see. I told him that if he didn’t calm down and behave, I was going to tie him down. I had done it the week before, when he was acting crazy, and some of the other nurses had to do it too, so he knew I was serious.

He started crying, but he stayed in bed. He said not to talk to him anymore, and he was not talking to me. I left his door open and watched him from the nurses’ station as much as I could. He sat up in bed, pouted, and played solitaire.