Tuesday, March 8, 2016

Man Baby, a cautionary tale

My latest needy patient, the dreaded Man Baby, reminded me of one of Hood Nurse's epic posts from a few years ago.  It is both hilarious and sadly true.  I miss Hood Nurse's regular posts, she is a badass.  You should go and read this, right now.

So, my patient, fat and bald and a self-professed wimp.  A man baby of the first order.  Clearly he did not do much for himself even on those banner days in which he was fit as a fiddle.  This was a middle aged man who had arrived by ambulance after vomiting once with a "high fever" of 99.5.   Wow.
 "I don't feeeeeeeeel goooooood", he whined

FYI, whining tops  my list of "Things I Hate".

 Mommy-wife enabler accompanied him, soothing his brow, holding his vomit bag (for him to spit in, for Man Baby never vomited), asking for warm wet washcloths to moisten his lips, and requesting juice, (no), crackers (hell no), extra blankets, and of course "one more thing to ask the doctor".  Plus she was a helicoptering monitor-watcher.   "Why is that monitor alarm going off!?  Is his blood pressure ok??  What is that number?? What's wrong???"

Well.  Here is the short list:
Mancold, manflu, man-monia (unlikely).

 Or a rare fatal disease (also unlikely).

Absent anything being found really wrong, I'm liking the all encompassing manvirus as the culprit.


You will get better, or you will die.  Going way out on a limb here, being a stupid nurse and whatnot, but guessing today is not going to be the second date (the one to the right of the dash) on your gravestone.

He was given the panacea for all ills when it is not politically correct to kick patients to the curb within 10 minutes of arrival:  IV fluids and Zofran.  In a 12 hour shift I will personally execute these lifesaving orders about 10 times.  That is just one nurse.  There are lots of others who will be saving lives many times over this shift, one bag of normal saline and 4 mg Zofran at a time.

He was there for a couple of hours, moaning, watching TV, texting on his phone, sending the little woman scurrying for ginger ale and ice, and arranging his other chargeable electronics.  He was pretty busy.  Eventually he was given the good news that he did, in fact, have a virus.  Since he had not vomited, his vitals were completely normal and was drinking  ginger ale, there was nothing more to be done for him.  Also, once a patient who presents with vomiting has asked for a meal tray, his status automatically defaults to "discharge pending".

He was shocked.  "I don't think I can go home like this".

Trust me, read your instructions,  "you will get better.  Drink lots of fluids, rest, take tylenol for headache and fever, here is a script for some Zofran.   Now get out and man up "

Mommy-wife will take really good care of you, maybe order out some Chinese.


Old Fool said...

We used to always get a sputum C&S order for patients like this and then aggressively NT suction them until they were cyanotic. This was in the days before pulse/ox technology so you had to be very careful. I imagine today you could easily titrate suctioning while keeping an eye on saturation. Now that's what I call progress. I've also known nurses to use this technique with drug/alcohol cases but sometimes they are too obtunded to make the technique worth while.

Old Fool said...

I just thought of another diagnostic procedure you might want to consider for your URI man-baby patients. It's an oldie, but a goodie. It's a gastric analysis for (AFB) acid fast bacilli or TB. The first step in this study is to insert an NG tube. Just remember to select a size of NG consistent with the severity of man-baby syndrome. A 10Fr. tube will be appropriate to deter further ER visits with most of these characters.

Rebecca Hayes said...

I work in primary care, it's always the man-babies who pass out when their blood is drawn or they get an injection. Even had one cry. Manvirus is running rampant everywhere.