Drama Signs
Patients who display any of these signs probably do not have an emergency medical condition, and they will be SHOCKED to learn that all of their tests are normal.
1) They keep their eyes shut during the entire interview. Sometimes life is just too difficult to face with open eyes.
2) They flutter their eyelashes rapidly as they explain how sick they are.
3) They speak in a mousy whisper of a voice. If they tried to speak normally, the pain would be unbearable.
4) When I ask them what is the matter, they give me an exasperated look and a sigh, then they ask their spouse to tell me their story. Telling me themselves would just be too much to handle.
5) They come to the ER in a nightgown, especially if it's satin or silk.
You can bet that if any of the above patients require an IV or a blood draw, they are going to say they are a "really hard stick" requiring a "butterfly" or the "IV team," and during the procedure they are going to histrionically complain how painful it is, possibly even yelling and jerking away.
1) They keep their eyes shut during the entire interview. Sometimes life is just too difficult to face with open eyes.
2) They flutter their eyelashes rapidly as they explain how sick they are.
3) They speak in a mousy whisper of a voice. If they tried to speak normally, the pain would be unbearable.
4) When I ask them what is the matter, they give me an exasperated look and a sigh, then they ask their spouse to tell me their story. Telling me themselves would just be too much to handle.
5) They come to the ER in a nightgown, especially if it's satin or silk.
You can bet that if any of the above patients require an IV or a blood draw, they are going to say they are a "really hard stick" requiring a "butterfly" or the "IV team," and during the procedure they are going to histrionically complain how painful it is, possibly even yelling and jerking away.
Labels: ER, pain, patients, perception, tips
posted by scalpel at 7:41 AM
41 Comments:
And in my experience with this type of patient, they are usually female, fifty-ish, fat, and freakin annoying.
Christ. I completely agree on the whisper voice thing. PUUULEASE!!!!
The 50-ish/fat/annoying tag is soooo accurate. In addition, I would submit that frequent flyer miles apply.
As for pulling away from an IV or a draw stick, don't'cha know that's also true? Not to mention dangerous...
Is mousy whisper the same as asthma breathless or are the asthmatics excused for being a little Marilyn Monroe-ish?
I fear I could score high on your drama meter with 1, 3, and being a hard stick unless you gave me a fair chance. With 4, I've been thinking about having my husband advocate for me and do my history because when I am having an attack I am not functioning nearly as well as it seems. Besides, talking gets in the way of breathing.
On the sticks...I'm a hard stick, very hard stick but I am not wimpy about it at all (and I know this is true as doctors have flat out told me I'm not the typical hard stick personality).
I usually just try to warn people so they are prepared because the time record for an IV is 1.5 hours (non-emergency) and stick record is 17 sticks (emergency). I've had 3 doctors give up--including, most recently, my labor anesthesiologist.
By give up, I don't mean someone else came and tried, I mean they gave up entirely on getting a blood draw (although I have to say I think the labor anesthesiologist I had was kind of lame). Things should get interesting if I'm ever seriously sick.
Anyway, I don't want to ruin a good vent, but don't forget there's always an exception!
M
I don't wanna put words in Sacalpel's mouth, but I suspect we all know there's a difference between the mousy whisper and the polyphonic wheeze of asthma... and is it that hard to open your eyes? Hypothetically, If one's asthma has one so exhausted that eye opening is too much, one may have left it a little late...
I used to hate #4...aargh!
Nurses usually give my mother an exasperated look when she tells them she's a "hard stick" but then they end up agreeing when they see her arms. She has eosinophilic fasciitis aka Shulman's syndrome, so her skin is like shoe leather with serious banding.
Hopefully someday her health care providers wise up and spare her (and the poor nurses that end up trying to start her IV's/draw blood) a LOT of trouble and just give her a PICC line.
I used to be a hard stick, even the nurses agreed. I used to always end up with getting stuck in the hand and getting told I had crappy veins. I lost 200 pounds and now I am the easiest stick in the world and get praised on my wonderful veins and how easy it is to stick me. Go figure!
All of the above coupled with a stuffed animal in an adult patient is nearly diagnostic for borderline personality...
Awesome post! I have only one thing to add as an OB/GYN, when you tell them they aren't pregnant by blood or urine test they tell you, "Oh, I've never had positive pregnancy tests with any of my children."
I am a hard stick. If I'm in your ER telling you that, it's because I'm trying to avoid yet another blown vein. In Virginia, they had only one corpsman who could get it in the first jab, and when I gave birth to the third kid in Hawaii, the first nurse went and got another nurse after blowing the first vein; the second nurse took one look and went and got a third.
Funny thing is, I apparently don't look like a hard stick. The nurse soliloquy goes something like "Oh, you'll be fine. That's a great vein right there." Thump, thump. Stab. "Damn. Let me try again. Clench your fist." Stab. "Uh, you know, I think I need to call someone else in."
Promise I don't go into histrionics about it, though.
whitecap nurse says:
also, in triage, anyone that drapes themselves attractively over my desk, usually with one hand at the forehead. Sitting up is just too, too difficult. Curiously, BP is always normal. Also, people that lie down on the waiting room floor.
OH My yes, the drama alert.
I've been told repeatedly that I need to warn anybody who's trying to draw my blood that I'm a hard stick and that I tend to pass out. On the other hand, i don't yell, scream, or try to pull away. (Yelling and screaming don't help, pulling away only makes things worse.) So should I not say anything?
If you are an adult, or even a teenager, I want to hear your history from YOU. I've heard histories second-hand MANY times and gotten totally different stories than from the patient him or herself. Please tell me yourself unless you're unconscious or demented or really CAN'T breath (yes, we can tell the difference).
FYI anon--Healthcare workers don't withhold PICC lines from patients just to be mean. We hate poking people a gazillion times, too. We've all just seen too many infected lines, clotted lines, and DVTs related to lines. They are not without risks.
Whoa. Gotta stop reading this and go get a Powerball ticket...
I am a hard stick. But it's my fault. I'm 400 lbs and morbidly obese. I also don't goto the ED complaining of the symptoms I attribute to the fact that I'm overweight. For instance, lower back pain (once it was so bad after a trauma I do go but not because of disc issues due to being overweight), issues relating to what I presume is sugar/insulin related, or instances of frequent heart palpitations and/or prolonged chest pain. Thus far I haven't had any real complications after the presentation of any of these symptoms which reinforces my generalization that they're simply due to my obesity. I won't waste ED staff time with these problems when all I need to do is restrict my calories and move around more. I realize that I am causing my poor health, truly sick people should benefit from the ED and I have no right to take away from their care just because I don't want to deal with my obesity. Also, should I find myself in the ED or otherwise needing it and I know that I am a hard stick I don't say anything. I figure nursing staff can learn from their attempts at an IV/blood draw on an obese patient and benefit someone who is in fact truly sick.
If we need to get blood or obtain IV access, it doesn't matter if you're a "hard stick" or not....we still have to do our thing, and we don't do it any differently based on your self-report.
"You're a hard stick? OK, I'll try EXTRA hard to get your IV."
In oncology we get these all the time- especially the "tough stick" "veins roll" "special cart" and "you'll need me to use a baby needle on me."
Most of the time it's cause the stupid teenager at county missed on their 3rd day and they have to blame it on the pt. Which is why almost everyone thinks of themselves as a "tough one."
Eh, as an ER nurse, I don't mind people telling me, they're a hard stick as long as they're willing to be patient and work with me. Know where your good vein usually is? I don't mind you telling me, but don't expect me to restrict my looking to that one spot. Oh and none of this, "You get one try" bullshit. Oh man, nothing makes me angrier- and you don't want to make the person with the needle angry. Shit, they had to poke me 3 times for my glucose tolerance test and I'll let the new nurses practice on me, I know it doesn't hurt THAT bad.
I have a question, sort of related to this thread but not entirely: what is the point of a Lidocaine wheal injected into an IV site?
When I was in Paramedic school we started them on each other to learn how - been stuck lots of times... But 6 weeks ago I had an Achilles tendon repair and the Anesthesiologist was who started my IV's - he needed two attempts because he hit a valve on the first one. He prepped the sites with Lido, something I have never had done before. I really didn't like it; I would rather he did it without Lido but he insisted that this was his preference.
As far as I'm concerned, it doesn't matter whether or not this is done as putting Lido into the site has just as much of a sting as an IV start without it. At least it did for me.
Any takers on this?
If we need to get blood or obtain IV access, it doesn't matter if you're a "hard stick" or not....we still have to do our thing, and we don't do it any differently based on your self-report.
"You're a hard stick? OK, I'll try EXTRA hard to get your IV."
I'm cool with that! If I say I'm a hard stick, I'm just trying to be helpful b/c it does make things go faster if they pull in their best nurse/phlebotomist/doc and lidocaine worked really well one time.
Also if there is time to let me sit with my arm hanging, that really helps. I do that with lab draws with great success.
According to one nurse, my veins are small and crooked and she kept running into valves when she did get a stick.(I asked because I was trying to understand why this was a repetitive issue for me.)
I think that I'm just the one patient that looks like a big red flag of whacko, but proves not to be in the end. Thank goodness I rarely, rarely go to the ER and I have a great pulmonologist (who I am losing because our multi-billion dollar in sales employer "can't afford" good health care any more. :( )
M
if you hit a valve - (and have had a flash back) simply flush it in with normal saline, wait 10 mins, draw off 1 10cc syring of blood and discard, then take a second spec for your tests. simple.
EJ lines are nice too.
What if you really are a really hard stick? Not that I complain about it. It's not the nurse's fault, and it don't hurt anyway.
I usually just wish them luck!
I have to say if I felt I needed to be in the ER, say for broken bones or heart attack, the LAST thing on my mind is going to be changing out of my pajamas.
we still have to do our thing, and we don't do it any differently based on your self-report.
Actually, several times upon saying that--although not in the ER--the person with the big pointy thingie has gone to get someone who's a bit better at it.
Of course, there was the one nurse who stabbed me and then stood there digging around in my arm, causing even more pain than normal, just so she could brag she got me in a single stick.
I know it doesn't hurt THAT bad.
Actually, yes it DOES. For some people. I saw my uncle brought to tears in the hospital a time or two by needle sticks. And he wasn't by any means a malingerer--he was in fact a Type I diabetic who injected himself with insulin twice a day, and so was used to needles. Didn't make it an less excruciating to have a vein tapped, though.
I can understand people showing up to the ED in PJ's- it being an emergency and all that. Well, sorta understand.
But I work in FP and I don't get people showing up in their Tweety PJ's to an appointment at three in the afternoon...
And really, c'mon, a silky nightie? Outdoors? How long does it take to put on a pair of pants and a T-shirt? Not as long as it takes the ambulance guys to get there and do their assessments.
whitecap nurse says:
Dear Walt,
I agree with you about the lidocaine - it hurts worse than the IV start. I guess in theory it would keep the IV site from hurting over time. However, in my personal experience (on the receiving end), lido just spasms the veins making it harder to start the IV in the first place! Everytime I tried lidocaine, I ended up getting stuck more than once anyway.
I just want to mention, as a bragging point of course: I have awesome veins!
]"How long does it take to put on a pair of pants and a T-shirt? "
I checked in a Migraine patient this week who came in wearing a shorty robe (barely hung below her butt cheeks) and no underwear. Dramatically flailing away in "pain" showing her cooter to everyone passing by in the hallway.
Ha ha, you said cooter. This might get deleted, it probably should, but nevertheless I'll post the 3rd definition of 'cooter' from the Urban Dictionary:
Cooter: N the holiest of holies, the place all men aspire to be. Often paired with large, flappy labia known as "Beef Curtains."
The appearance of the Cooter is usually heralded by the distinct reek of low tide.
Lauren's cooter smelled like an octopus and resembled a bearded axe wound.
I'm not a hard stick at all. You could probably do me by braille. Which is why I can say for sure that there is a huge disparity in skills out there. Most times it's one shot but every once in a while I get someone apparenty trying to tenderize me.
Some docs and nurses (mostly docs) just don't have the knack or maybe they're just out of practice. Either way, I wouldn't expect a self-assessment of "hard stick" to be viewed as a negative. Rather sounds like a good indication that "pincushion Paul" might want to defer to the nurse for this one and save everybody some hassle.
Resident hubby (orthopaedics) enjoys patients who come into the clinic complaining of "severe left arm pain"......and then [nonchalantly] use their left arm to lift themselves off of their chair to introduce themselves to him and his attending... :o)
This comment has been removed by the author.
Your girlfriend Lauren sounds nasty.
You need to be a little bit pickier when choosing your next girlfriend.
Maybe one that freshens up now and again. :)
LOL
Sorry the above comment was for grandoldpartyer
I would have to add to that list, anyone who comes to the ER with their own bedding and is not in the end stages of a terminal illness automatically redlines my bullshit meter...
Janice - I was merely posting the definition from Urban Dictionary because I find the word rather humorous. My wife, on the other hand, thinks it's a terrible word, among many others for the va-jay-jay. There are actually some very hygienic individuals whose who-ha's aren't so positively aromatic beyond their control (I guess, I'm giving them the benefit of the doubt as they've appeared to be otherwise cleanly). I've been blessed to find my partner so tasty that I often can't get enough of that particular delight, but thank you for your concern.
GRANDOLDPARTYER, YOU SOUND LIKE A SWEET HEART, TAKE CARE OF YOURSELF. SEEK MEDICAL ATTENTION IF YOU NEED IT, DON'T WORRY ABOUT CONCERNS OF ED STAFF. YOUR LIFE IS IMPORTANT, AND WORTHY OF SEEKING ASSISTANCE. TAKE CARE.
Ooooh, I have another one. It's a bad sign when you walk into the room and the patient has the sheet or blanket pulled up over their head. I guess it's a variation on the eyes closed thing.
"I'm cool with that! If I say I'm a hard stick, I'm just trying to be helpful b/c it does make things go faster if they pull in their best nurse/phlebotomist/doc and lidocaine worked really well one time."
Do you really think I'm gonna say "oh gee you say youre a hard stick I had better not look or try let me go get the best nurse/phlebotomist/doc?" If you do you are sadly mistaken. Oh and BTW our docs don't start IV's they start central lines.
"if you hit a valve - (and have had a flash back) simply flush it in with normal saline, wait 10 mins, draw off 1 10cc syring of blood and discard, then take a second spec for your tests. simple."
Great advice minus the 10 minute wait. LOL who the hell has 10 minutes to spare in the ED and if I put in 5cc saline and draw out 10cc of waste it's not really a problem.
"Of course, there was the one nurse who stabbed me and then stood there digging around in my arm, causing even more pain than normal, just so she could brag she got me in a single stick."
Let me guess you are a "you only get one stick" person right. I dig on those people too if I need to. LOL after all might as well make the most of my one stick right.
"Actually, yes it DOES. For some people. I saw my uncle brought to tears in the hospital a time or two by needle sticks."
Sounds like he may be as much of a drama queen as you are.
Ahhhhh.... feels good to vent using stupidity of others.
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