clinic pt. 4

It seems we have a thief in our midst. We have a medicine cabinet on our unit that is well stocked and also well locked to prevent drug seekers and common crooks from perusing our sedative resources. Unfortunately, management brought a locksmith to that area this morning to discuss how somebody managed to jimmy open the lock over the weekend and snag some fentanyl, an opoid with many times more the potency of morphine. The locks they have on the unit are deemed to be "unpick-able" by our resident locksmith, which begs the question that perhaps the thief is either extremely smart, somebody left a key lying around, or someone on our unit has a secret drug habit.

In other news, it always fascinates me how human patients are. Of course I know they're humans, but it's so easy to just treat them as a case number or as another procedure passing through. Here they are being wheeled down the hall hand-in-hand with their best friend, who waits faithfully in the stretcher bay beside the empty bed filled with stuffed animals, as her counterpart gets a catheter stuck in their kidney. As I was taking some dirty linens to the supply room to drop off for laundry services, a patient lying in the stretcher bay called my attention. He told me that he had been waiting for over an hour for somebody to come pick him up and take him back to his room, and that he was getting both impatient and uncomfortable. I don't usually get much client interaction (most of the patients are sedated and just lie there when I'm called around), so I actually, for once, felt useful. All I was doing was simply addressing this man's needs - a man's needs, not a patient's. I relayed info that yes, he had been sitting there for a long time and we know he's been there, but porters are backed up and as soon as they're ready we'll have him on his way. I just think it's the human side of us worrying about people neglecting and abandoning us, especially in a novel and rather scary environment like the hospital bay. I think just being able to relate to that made this encounter very personal, even though it was fairly trivial. All he wanted to know was that we hadn't forgotten about him.

While it's obviously important to realize that patients are humans too, we had a rather bizarre case today that makes you wonder how human the patient actually is. Let me elaborate. A client with a meningioma (a tumour in the meninges, the layers covering the brain) came in for a cerebral angiogram, and seemed to be quite comfortable with the proceedings of the pre-op.


(Note the white coloured meningioma on the left frontotemporal side. The large mass causes displacement of the surrounding tissue, most obviously noted by the squishing of the ventricles, the black moon shapes in the middle indicated by the central red arrow. The right one is more normal.)

We transferred the patient over to the table and readied for the procedure. When everything seemed like it was going swimmingly, all of a sudden the patient sits up quickly, head banging into our Siemens angiography system, exclaiming that today didn't seem like a good day for the procedure.

Now at this point, I began to wonder what was the contributing factor to this sudden outburst. Was this purely fear? Did the patient suddenly feel overwhelmed with claustrophobia or trypanophobia or the abrupt realization that they just couldn't stand doing it? It's only a natural reaction for humans to bolt in a moment where they feel cornered, threatened - it's both instinctual and evolutionary.

At the same time, I began to wonder what portion of this behaviour was purely pathology. The patient came to the room almost half an hour late, managing to wander off in search of a bathroom and ending up halfway across the hospital. This was the second time in the last few days this was accomplished, so I began to ponder whether compression from the tumour was resulting in deficiencies in orientation and possibly even judgment. Could this have contributed to the refusal of the procedure? Another indication the patient wasn't all quite there was that the patient kept saying that they were ready for their hysterectomy, and insisted quite heavily that this procedure was what the patient was in Neurovascular for.

Sometimes it's hard to determine whether to call a neurologist or a relative over, whether to cite pathology or jitters. Either way, at the end of the day, no means no. We didn't follow through with the procedure, and the patient went back to their room to await another day.