Nursing Voices

Monday, June 23, 2008

Word Games

Do you remember President Clinton’s infamous quote during his 1998 grand jury testimony on the Monica Lewinsky affair? When asked about his relationship with Lewinsky, Clinton started out his response by saying, "It depends on what the meaning of the word 'is' is.” His response is a classic, and that type of deceptive response is alive and well within the world of healthcare.

I spoke to a psychiatric social worker this weekend that would have made Bill Clinton proud. She had a psych patient in her emergency room that she wanted to unload—I mean place—at our hospital, and she called me to see if I had an empty bed on my unit. The conversation went something like this:

Social worker: Hi Mother Jones, I have a delightful 45 year old gentleman that I'd like to place at your hospital. He tried overdosing on pills and alcohol, but he’s medically stable now.

Me: What do you mean by stable? Does he have an IV? What about his medical history?

Social worker: Well….um, about that IV, his nail beds are still a little dusky, but we can take the IV out before we send him to your hospital. And his medical history…..he’s diabetic, but surely his COPD and pacemaker wouldn’t disqualify him from getting a bed on your unit would it? And then, there is that other thing….you know, besides this long history of drug and alcohol abuse.

Me: What other THING?

Social worker: He’s on oxygen therapy, and he's on a liver transplant list. He’s kind of a funny color, but he’s medically stable.

Me: Nice try. Have a nice day.

This screening was too easy, and it was obvious that the social worker was a rookie. It usually takes me a few more questions before I can figure out who is trying to send me a dump. She’ll learn how to be more deceptive, and I’ll be waiting for her. I have a very long memory.

What’s your definition of medically stable?


Blogger distracted by shiny objects said...

pulseless and apneic.

9:16 PM  
Blogger Amrita said...

Nice try social worker, you must be joking

12:23 AM  
Blogger Nurse K said...


If he's always like that, though, he's STABLE. You can have lots of chronic medical conditions and still be stable. You can look like s-h-i-t and still be stable. You can live in a nursing home and be stable. You can have terminal cancer and be stable.

"What's the ammonia level?" is a good question and "is that markedly different than his baseline?"

"What is his APAP level?"

The social worker should NEVER be giving any medical report to you. She doesn't know what's left or right with regards to liver disease or COPD. "Funny color?" WTF? It's either "he has XYZ but has been eval'd by Dr. blahblah and is medically cleared" or she makes no phone call.

1:30 AM  
Blogger Mother Jones RN said...

Nurse K:

You made me giggle. When I first saw "pet peeve alert" in your post, I thought the world had just turned upside down, and that you were going to give me hell for poking fun at Bill Clinton.

The hospital that I was dealing with has dumped on us before, and we have to be on guard when taking their patients. The last patient they sent us had to be transfered to ICU. The patients on our unit must be walkie-talkies, and the hospital that I was dealing with has some odd ideas about the term medically stable.

8:50 AM  
Blogger Jean-Luc Picard said...

medically stable...a horse hospital

2:59 PM  
Blogger Braden said...

This comment has been removed by the author.

4:24 PM  
Blogger kiddiepsych said...

Medically stable - nothing has changed in the past 10 minutes, transfer him out before the **** hits the fan. Not cured, but no longer improving ???

Sounds like a residential client I recently turned down. He was "stable" as in no longer making progress, but still biting, kicking, hallucinating and scaring his siblings.

5:22 PM  
Blogger Nurse K said...

Pretty much in this country if you're depressed/suicidal due to a chronic/debilitating illness (or depressed/suicidal and happen to have said illness) and/or you're elderly, you can't get inpatient psych care and that pisses me off. "He needs one assist to transfer? He can't come here. He's incontinent? Can't come here. He has hyperglycemia? He's 80 years old and had an MI in 1996? Can't come. Can't come here..." The list goes on and on. Obviously, it's different if the patient is GI bleeding from said liver disorder, but if they make do at home with these illnesses, they should be able to make do in a hospital.

If some soc worker tells you a bunch of medical "stuff", you need to ask to talk to the nurse if you think it's not a slam-dunk admission. Social workers DON'T KNOW MEDICAL STUFF.

5:33 PM  
Blogger Mother Jones RN said...

Nurse K, you are right about the need for more medical/psych beds. Sick people get depressed, too, and they deserve help. Unfortunately, our unit is not set up to take care of medically ill patients. We don’t even have wall suction or O2 on our unit.

6:29 PM  
Anonymous Anonymous said...

Medically stable? Three drips, two chests tubes, just survived a code and on a vent with Propofol. Oral airway in, wrist restraints on, foley inserted, Lasix and Solu-mderol on board. Nurse drinking coffee and charting.

That, my friends, is medically stable.

*I also agree with Jean Luc, of course.


11:57 PM  
Blogger RehabNurse said...

Medically stable...hmm...

Here are a few of the characters I've worked with on rehab, who were considered "medically stable".

1. My personal favorite: lady with a fenestrated trach, G-tube, blue fingers, labile BP, and O2 sats regularly hovering around 80...up and down, up and down. She was so much fun in therapy. She was there 5 minutes and would have to leave, even with her O2 on and everything kosher. Finally got bounced back to her admitting hospital after three tries.

2. Patient with active GI bleed. Yes, they've dumped them on us, too. "Oh, it was just a smear of blood in the stool when they left." Sure, it was.

3. Kid with major DKA who came to us with his PRN vent. He turned out really well, but a PRN vent....what?

For some rehab sites, just breathing counts as medically stable.

11:36 AM  

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