What does it mean when a patient hisses at you?
Ridiculous? Maybe – but here is my story.
I remember caring for one particular non-English speaking patient when I worked in the ICU at the county hospital in 1987. I was a fresh new grad – had not even taken state boards. Yet, I was being groomed in the SICU. So fun!
They let me care for extremely critical cases with all kinds of monitors, drains, and devices! It was a teaching hospital, and every day was new and exciting.
We got the rare and hopeless cases that other hospitals could not afford to take – because of their need to keep their scores high. We were not in competition. We accepted everybody. Nothing was too hard for us!
But this one angry patient was probably my biggest challenge in those days. He was in his early 20’s, slim, dark skin, black straight hair, and buck-naked. He violently refused to wear gown or covers. So there he was, day after day, wearing only his foley strap.
He was handcuffed to the bed (not unusual for our hospital), but nobody could communicate with him. His police guard didn’t understand his language any more than we did. Staff of various ethnic backgrounds also tried to understand his speech – but to no avail.
Communication was nearly impossible for staff – except for facial expressions and hand gestures. But he would make deliberate, angry, piercing eye contact, wriggle like a snake in the bed, say words I didn’t understand, and hiss.
Oh, yeah – and he would spit at us too.
My most memorable day with this patient was when his serum potassium level rose high enough to treat with Kayexalate – but he was NPO. Uh Oh. Not good news for him, for me, or for all my helpers.
I’ll bet you can imagine how many milliseconds he retained that enema. And – no – my flying leap was not fast or far enough!
After that, I had a couple of days off. When I returned this patient was no longer on our unit. Nobody knew what happened to him, and I never saw him again.
Not much later, I was recruited into the US Army to serve in Honolulu. New nursing job. New life. But, for a long time, I could still sometimes see those angry eyes and hear that sound in my memory. And I always wondered why he wriggled like a snake and hissed at us.
What was your most unusual patient encounter?
Here is something that might tickle your funny bone: Snakebit: Confessions of a Herpetologist