how am i gonna be an optimist about this?

today i had my ass handed to me.  twice.  

the first time was by this pregnant patient with a bowel obstruction who refused to see reason and systematically tortured me all shift.  halfway through receiving an MRI to determine what exactly is going on in her belly, she decided she had enough and demanded to go home.  and she remained dead set on this terrible idea even though her entire family and all of the hospital staff told her it was a horrible idea.  after literal hours of trying to bargain and reason and threaten the very real possibilities of sepsis and death, i just couldn't handle it anymore.  she made her decision, i pulled out all of her lines and drains, and she left AMA.  

and it really sucked, because i didn't agree with her decision, yet i was the one that had to take out the PICC line giving her the nutrition that is keeping her baby alive.  and i had to get rid of the NG that is keeping her distended bowel from exploding.  and i had to pull the foley that was showing us her terrible urine output and let us know just how sick she was.  she made me do things that would ultimately harm her and her unborn child, and it made me feel kind of terrible.  

so after this emotional abuse, i was treated to 10 rounds of fighting with an overprotective daughter who refused to let me put a catheter in her elderly father.  the guy is super old with a bowel obstruction, and i couldn't tell how his urine output was because he's incontinent.  i explained to the daughter that we need accurate I&Os to tell us how his fluid balance is, and that we don't want to give too much fluid because of his bad heart, but also that we need to perfuse the kidneys.  i explained that catheters don't stay in as long as they used to, and how there are initiatives to DC foleys asap to avoid UTIs.  and then she basically told me that if we put a foley in him we would never get it out again and "i'm not taking care of a 91 year old with a catheter".   

and she went on and on about how we need to give him a bunch more fluid and she can tell when he needs it and he won't go into heart failure because she can tell and she knows and she watches him because the nurses are too busy, especially the last time he was in the hospital and did i tell you about 12 years ago one time after he had surgery and we had to stay for a few extra hours because he wouldn't pee and i had to have a catheter last year and i would never wish that on anyone because it was so painful and terrible and blah blah BLAH.

and i know she wanted me to agree with her, BUT I DON'T.  and even after i told her like 12 times that i would have her discuss her concerns with the doctor, she JUST KEPT TALKING.  

and then it was shift change, i was way behind with report, and guess who's getting readmitted?????

yes.  so it turns out that when you have a bowel obstruction you will go home and vomit and then go directly to the nearest ED, who will do nothing but place an IV and send you back from whence you came a short 5 hours ago because YOU NEVER SHOULD HAVE LEFT IN THE FIRST DAMN PLACE AND YOU HAVE NOW WASTED ALL MY TIME AND EMOTIONAL ENERGY AND I AM SO FRUSTRATED.

and in sitting here trying to find some sort of moral to this story, i'm coming up empty.  

may tomorrow be better.  goodnight.