So, there’s a joke in nursing, that’s come about in recent years…..that “RN” actually stands for refreshments and narcotics. That seems to be a lot of what we get asked for as nurses, and one can argue, rightfully so. I mean, if you’re stuck in the hospital after some kind of trauma, who doesn’t want pain medications? And I’m all for eating at any given time! Sign me up! So I get it, truly I do.

This joke was kind of brought to home the other night at work though, and then it wasn’t so funny. I work in critical care, where we usually only get two patients at a time. We get the sickest of the sick, and with hard work and some luck, help people get better from devastating situations. So I had my two patients the other night. One of the things that critical care nurses do best is prioritize. What HAS to be done to keep this patient alive and hopefully comfortable. What else can kind of take a backseat. We’re making these decisions all the time and adjusting our day to them.

Patient one is a younger patient just recently off of the ventilator after critical surgery, and still having significant pain, and wanting it “gone”. Keep in mind this patient’s pain hasn’t been completely “gone” in several years, so it’s unlikely that will change now. Patient two is the new admit, very critically ill and on life-sustaining blood pressure medication that needs to be monitored closely and titrated as needed to well, keep them alive. Prioritization.

Funny thing is, (not necessarily funny “ha ha”), the sickest patients are quiet and not calling frequently for every need. Guess what? It’s because they are TOO sick to gain your attention in that way. That was the scenario this night.

Patient number one, who would be leaving the ICU the following day because of doing so well and being less critical: On the call light every five to seven minutes. Yes, I was timing it at one point. ALL NIGHT LONG. Needing pain medication, which can not be given more frequently than every hour. And wanting it exactly on the hour, on the dot. Now, I can tell you that in critical care, rarely can that kind of pace be kept up where you can be “on the dot” with anything, if your other patient is crumping.

Patient number one also, wanting ice chips every three or five minutes. Again, I get this, I’m drinking fluids all day long and hate having a dry mouth. However, I’m also willing to drink or eat ice chips by myself, because I am, after all, a grownup. Not this patient, who was “too weak” to use a spoon, but certainly capable of using a call light all night as well as moving themself around in bed throughout the night. At one point, I am told “well, feeding me ice chips is your job”. Well, funny, I seem to recall that my job is to save your hiney if you start to die, and you’re still alive, so obviously I’ve been doing my job.

Patient number two, incapable of even moving themself in bed, and remaining on life-sustaining medication throughout the night. Did acknowledge pain once, given pain medication, dozed off to sleep on and off the remainder of the night. Unable to speak due to their condition, but able to make their appreciation known.

Patient number one, no “please”, no “thank you”, just “gimme gimme”. Demanding pain medication every 20 or so minutes. When told that they were getting the strongest pain medication we have available, said “well, get something better”. Alternating between two very strong narcotics, with patient expressing no relief at all. Calling doctor to get adjunct medication provided to patient, which also had no effect. Well, this sucks, I can’t sufficiently medicate my patient. Although they were able to sleep for brief periods, and per the non-verbal pain scale scored a 2-3 rather than the 10 that the patient always reported.

Patient number two, a social nightmare, with a lot of resources going to have to be used to ensure a safe discharge, and a total care patient who could not go to the bathroom appropriately and could not even move themself in bed to prevent skin breakdown. I spend some time in this patient’s room doing as much of the admission as I can with a nonverbal patient, and taking pictures of and treating various areas of breakdown on the body.

Call light for patient number one. Pain meds and ice chips, and where were you, I’ve been calling for half an hour (untrue, I’d only been in the other patient’s room 10 minutes at that point). I get it. When you’re sick and miserable in bed and waiting on something to give relief, that one minute wait is like 10 minutes. But I point out the clock and remind patient when I was last in the room and when the next pain medication is due.

I realize that any one of us could be either of these patients. How are we to know how we’ll act as a patient in the hospital until we’re in that role? Having been a hospital patient before, I wanted very much to do nothing but sleep and be left alone, but that’s me. I realize that both patients deserved an equal amount of attention, but with the prioritization of the situation, one patient definitely required more hands-on care and time in their room. And the other patient was thwarting those efforts.

It was a long and exhausting night, and sadly, it’s not that uncommon to have such patients with such diverse needs, both who deserve to have their needs met. It’s frustrating as a nurse to not be able to provide as much comfort as patients deserve. And maybe one day we’ll come up with stronger medications than Fentanyl and Dilaudid, although personal responsibility matters some as well, and unfortunately, lifestyle choices some folks make make it harder to sedate and medicate for pain as tolerance to medications is high.

I love being a nurse, I’ve been a nurse for a long time and can’t imagine doing anything else at this point. And I love being able to provide comfort and care to people during their times of need. But I have to say, my RN stands for registered nurse. Not refreshments and narcotics. Yep, that’s it. Joke’s over.