"Don't mess with me, I have needles..."

So I figured it was about time I wrote this blog since I am never going to live this story down at work, I thought I'd share. A few months ago I was working one night and my patient (we'll call her YS) was someone I had had the week before when she was on the ventilator. Now she was extubated and using a BiPap machine to breathe. Long time smoker, very large (I'm being nice here), multiple problems, etc., etc. On the ventilator she had been an ok patient. However, during report this night the day nurse said that the patient occasionally would get confused and let's say difficult (combative). She had done great all day though and I did not expect anything different. So, I go in to do my assessment and I am talking to her and WHAM out of nowhere, she punches me in the nose. She did it about 3 more times before I could grab her wrist and stop her. Ok, that hurt and now I'm peeved. So I try to figure out what is wrong, but the patient won't let me touch her and I am unable to understand her because of the face mask. I can't take the mask off because her oxygen saturation plummets to the 80% in seconds without it. So another nurse comes in and tries to talk to YS. She beckons the nurse to come closer and then starts laughing. The darn lady is enjoying this. She wants to abuse us. She got a stern talking to and I finished my assessment while staying out of the reach of one wrist and holding the other. Not very effective. So now my charge nurse (head nurse for the floor for the shift) comes in to try to give her a pill (anti-anxiety, she needs it badly to help calm her down). We mix it in applesauce and quickly take off the mask to give the pill. As soon as that mouthful was in there though, she spits it all over the charge nurse (needless to say, she was not amused). I was on the other side of the bed and missed the spray, thankfully. So I am still really really trying to be patient and figure out what this lady needs/wants but she is seriously stretching my patience thin. So I get a piece of paper to see if she can write what she needs. First she scratches out the word "suck." So I am trying to be empathic and say "oh this sucks, being here in the hospital. I know." She shakes her head vigorously "no." Then she rewrites and I discern out two words that decided her fate for the rest of the night: "YOU SUCK." She starts laughing. Ok, I'm done. Now, I am pissed and my patience is gone. Not "this sucks," "you suck." Directly aimed at me. It takes quite a bit to break my patience like that, but once it's gone, it's gone. Of course I had to take the note to show all the other nurses, which they thought was incredibly funny (I do too now, but at the time I was a little less amused). This story has now spread and more people know from my unit. I may be forever known as the nurse who got told that "you suck" by a patient. Awesome. Back to YS: We told her that she really should be nice to her nurses, we are just trying to help her. After the note I then told her that she really should be nice to me, I'm the one with the needles...I proceeded to get some Geodon (anti-psychotic which also makes people sleepy, yay) which is an IM shot, long needle that goes into the thigh. Unfortunately, with all of her subcutaneous tissue (fat) I'm not sure it even got to the muscle (I'm not being mean, I'm serious), but I got a little satisfaction from sticking her just the same. Later, I also got to give her her Insulin shot, she didn't like that at all, at which I told her "yeah I told you not to mess with me, I have needles." Normally, I don't like sticking my patients, but this night was an exception. Apparently, after an interesting discussion with her MD, we theorized that as her CO2 levels in her body rose, she got crazier. One thing I have learned is that you CANNOT reason with a crazy person, it doesn't work. The longer she wore the mask the better her CO2 levels would come down and her mind/actions would return to normal. So when I walked in the room at 4AM to do her blood draw and bathe her she was a COMPLETELY different person. She was nice, helpful, friendly, talkative, etc. She even helped us bathe her. I don't think she even remembered what had happened 8 hours ago. Ugghhhh...I guess I can't hate her too much, she wasn't in her right mind. People do things they would normally never do otherwise when they are sick and their mind isn't all there. Most would probably be horrified to find out some of the things they do (I've seen them be dumbfounded when they hear what they did and apologize profusely for their actions). This is exactly why I never take anything personally at work, even a note that says "You suck."