by fearandfartleks

A few weeks ago there was an article in the paper about a gentleman (and I’m using that term very loosely here) from a town a colleague of mine has affectionately named “New Port Rickity.”  For those of you reading this who aren’t familiar with central Florida’s West Coast, this is a city located in a northern county which has gained a reputation over the years as being a sort of white trash paradise.  Yes, of course there are citizens who are law-abiding and gainfully employed living there – so, lest I offend half of the nursing staff at North Bay Hospital, I will refrain from giving the name of the county.  Let’s just say it begins with “P” and rhymes with “tabasco.”  At any rate, this area seems to be largely populated by people who, while they may consider themselves  “rednecks” or “country,” habitually participate in activities that only lower-class white people do, such as: cooking meth, chain smoking (without shame) while heavily pregnant (usually outside a medical facility), purchasing their weekly groceries at Walgreens, and declining to watch “Here Comes Honey Boo-Boo” because it too strongly resembles real life.  Well, it seems that this “gentleman” decided that he needed assistance from his local Emergency Medical Services staff.  At this point I can’t remember what the exact issue was, although I’m sure it was life-threatening and not something completely trivial like, oh, I don’t know – needing a Tylenol or wanting the police to arrest your neighbor for “borrowing” your meth-cooking bunsen burner without permission.  So EMS arrives at his door and he tells them to WAIT while he finds a babysitter.  And you know what?  Those sons-of-bitches paramedics had the unmitigated gall to tell him that they were unable to do so, which prompts Mr. White Trash to call 911.  Again.  While the ambulance is literally in his driveway (okay, perhaps I’m giving him too much credit.  While the ambulance is literally in the tire-track ridden section of his “yard.”)  Mr. White Trash is then loaded into the ambulance (for some reason the paramedics suspected that he might be intoxicated.  Profilers!) where he proceeds to, once again, use his cell phone to call for emergency assistance.  The most shocking part of all?  I read this article without the slightest degree of surprise or dismay.  It struck the same emotional chord with me as would reading the weather forecast or Sunday’s “Marmaduke” comic.  I just simply wasn’t impressed.  All I could think was, “That was your best, man?  I’ve had patients call 911 from the ER lobby.” (Just as an FYI, this is, even in dire circumstances, never a good idea.  You will annoy the medics, irritate the ER staff, and succeed only in being transported around to the ambulance bay, wheeled through the ER, and off-loaded in the very same waiting room that you just left.  Only now you will have to explain to your insurance company why, on God’s green earth, you left without seeking treatment.)

The article did make me think about something which I thought I understood prior to becoming a nurse, but which I now realize I had only a dim grasp of.  And that is entitlement.  Yes, I knew the basics – expecting something that you don’t deserve and feeling that you’ve been done a disservice when that something isn’t given.  To illustrate my point, I’d like to share with you a conversation I had the other day with a patient – a conversation that is all too typical, but makes you want to put a gun to your head nonetheless.  Then I’m going to finish up by listing my Top Five Greatest Examples of Entitlement in the ER.

Patient X came to the ER for belly pain.  This was their third visit in as many weeks, and they had been told that, in order for the belly pain to go away, a certain-organ-in-their- GI-tract-which-shall-remain-nameless-in-order-to-ensure-that-no-privacy-laws-are-broken would have to be removed.  The patient continued to allow the offending organ to remain in their abdominal cavity, continued to have pain, and thus continued to enter that great revolving door of medicine otherwise known as the Emergency Department.

Me:  Okay, Patient X, I have your discharge papers here.  It looks like the diagnosis has remained the same.  What did the doctor recommend?

Patient X:  Well, he said that I need to have organ x removed.

Me: Oh, okay (and here’s where my friend Mr. Cerebral Aneurysm starts to stir from his brief but deep slumber, and subtle throbs begin just above my right ear).

Patient X:  But no one will take it out.  I mean, no one will do it unless I pay them. (Subtle throb becomes persistent hammering sound).  I went to see a surgeon about it and I waited for a few hours – but when the office manager looked through my chart and saw that I don’t have insurance or medicaid, they told me they couldn’t help me.  Can you believe that?

Me: Well, surgeons have to get paid, I suppose.  They do go to school for a long time. (reflective pause, where I try to put on my best frank-but-compassionate voice).  Well, have you applied for Medicaid?

Patient X:  I keep getting denied.

Me:  Hmm.  Have you considered getting a job?

Patient X:  Oh, I can’t work.  I’m disabled.

Me:  Oh, so you’re on disability?

Patient X:  No. I don’t qualify (persistent hammering is now just a long, low, mournful wail above which his words are barely audible).

Me:  But I thought you said you were disabled?  I’m sorry.  I’m confused.

Patient X:  I AM disabled.  I have diabetes and glaucoma. There’s no way I can work.

Me:  Diabetes and glaucoma?  I guess I need to review your med list – I didn’t see any diabetes or glaucoma meds on there.  What do you take?

Patient X:  Oh, I don’t take anything for them.  My diabetes is borderline and I control it with my diet.  And my glaucoma isn’t actually diagnosed.  I’m pretty sure I have it, though.  My mom has it, and I have to wear glasses.

And it is at this point that I want to jump up on the stretcher, grab this middle-aged, seemingly healthy person by the shoulders and shout, “WHAT THE HELL IS WRONG WITH YOU?  Stop pretending you have disabling medical problems, put your big boy/girl pants on, go out into the community and find a job.  Oh, and maybe while you’re out there, pick up some self-respect, too.  You are NOT disabled.  You know what “disabled” is?  “Disabled” is having to speaking by typing.  With a straw.  It is peeing and pooping into bags.  It is having to go to dialysis every other day to have every drop of your blood removed, cleansed of toxins, and then put back into you.  “Disabled” is needing to have your chest beaten five to six times a day to break up the masses of mucus collected there.  It is any number of debilitating conditions which severely limit the ability of the sufferer to enjoy or even endure this life, but it is most-assuredly NOT your adipose-induced diabetes and your fake Lens Crafter’s-diagnosed glaucoma!!!”

But I didn’t say any of this.  Not one word.  For one thing, I value my job.  I mean, I do have five children to feed.  And, at the rate we’ve been going, I’m sure at least one of them will require some nameless and random bowel surgery in the not-too-distant future, and I figure I might as well start saving now.  But, more significantly, my statement wouldn’t have made any difference.  You see, for this person, Patient X, the diagnosis of “Entitlement Syndrome” came too late.  The mindset was too entrenched.  When Arrogance and Ignorance marry, they produce a greedy, chubby child called Entitlement.  And this selfish brat doesn’t like to be told “no.”

Well, onward and upward.  I’m sure my fellow nurses who read the following list have their own shining examples of unchecked entitlement, but here, in no particular order, is my own personal Top Five Greatest Examples of Entitlement in the ER:

  1. Any patient who, when given a script, looks at you and says, “You can’t just give me the pills?  Well, how much do they cost?  (I don’t know.  Does this look like a CVS shirt?) How am I going to pay for them?  This is bullshit.  I’m gonna go smoke.”
  2. The patient who claimed he had no money, no friends, no family, no way of getting home and (loudly and with generous amounts of profanity) demanded a bus pass.  Then, as he was putting on his jeans, accidentally dropped his roll of twenty dollar bills.  Oops.
  3. The mother of a pregnant teen who decided it would be a good idea to drag along her three toddlers for a 10 PM ER visit.  The mother stated that she and the children were hungry and “hadn’t eaten all day.”  Five turkey sandwiches, milk, crackers, and pudding were provided…but the mother became irrate, demanding vouchers for the hospital cafeteria where she could obtain “real food, like chicken nuggets or something.”
  4. Pretty much anybody who asks that their turkey sandwich be “heated up.”  Really? Last time I checked, this isn’t an Arby’s.  I feel like I should start offering Horsey Sauce.  Oh, and family members who stand outside their rooms, empty coffee cup held high, and sort of jiggle it around in that condescending nonverbal “I need a refill” way.  Sorry, sweetie – but we’re fresh out of Sanka.
  5. Finally, my personal favorite: the patient with abdominal pain in the waiting room who demands to know why another patient (who happens to be having crushing sub-sternal chest pain and a terrible sense of impending doom and an EKG that looks like shit) got to go in before her.  She has, after all, been waiting over an hour and her pain is 10/10.  You know what?  A bed was just cleaned.  We can take you back right now.  Hmm?  What’s that?  Oh. I see.  Sure, you can have a few minutes to finish your bag of Corn Nuts.

*It know it appears, based on my last few entries, that I may have developed some bitterness/cynicism/negativity towards my job and/or the people I take care of.  I am going to address this further in another post, but I wanted to say here that I love my job.  I truly do.  I can honestly say that every time I clock in I consider it the fulfillment of a life-long dream.  And I care deeply about my patients.  I think about them on my off days.  I dream about them.  I feel sorry for them.  This blog is just my attempt to blow off steam, to vent frustrations.  As such, it presents a skewed view of me, my patients, and the relationship between the two.  So, if you haven’t liked the last few posts, stay tuned and give me some time.  I’m bound to dig up some positivity somewhere.