our patient:
- doesn’t take his medication, we inform him about the risks and document. He says he’ll take them ‘later’, never does.
- refuses his insulin, we inform him about the risks and document as well as chart.
- refuses his blood thinners, we inform him about the risks and document.
- turns his phone obnoxiously loud, also talks loud.
- insults us several times every day, gets passive-aggressive.
this is not psychiatry, patient is a young, AOX4, fully competent adult.
Fine, you’re a free man and free to do with your life what you want. But why go to a hospital in the first place if you are going to behave like this?
Yesterday we found him unconscious on the floor, vitals were normal, didn’t hit his head. He is being released tomorrow. Doctor agrees.
I have the feeling we’re going to see him again very soon, but he is the biggest asshole I’ve met in my nursing career.
Why do people behave like this? we are literally trying to give him some quality of life and he attacks us each time we open the door. why?
If any of you is a nurse and has some insight, I’m all ears.
Do please notice that I’m not asking how to deal with people like this: we document, chart and move on, but to understand why in the fuck people are like this.
The pain inside him is unrelenting.
I have no idea where it might have come from. Maybe at a young age, someone very close to him gave him overbearing pain, insult, criticism, maybe injury or deprivation that he wasn’t even equipped to comprehend let alone to resist or properly cope with. Maybe something happened to someone he loved, or maybe he put his heart into something that didn’t work out and he had to give up on it, resign himself to the long road of a miserable life now unwanted, and he chose to focus on it and stoke the fire of unhappiness until he hated everyone and everything. Maybe nothing in particular happened; his mind just happened to come out wired with anger and bitterness and stress, releasing chemicals to cause sensations that he can’t process and that will not stop. It happens that way sometimes.
Cruelty or malice can sometimes come from greed, or a desire for something, but unrelenting asshole behavior that is so counterproductive to himself almost always comes from agony. It’s like screaming from physical pain, or yanking violently away from your hand in a fire: A involuntary reaction. He lashes out at people around him because to be pleasant in the face of the burning he feels inside him is simply impossible.
From the way you describe it it sounds like he’s fucked. His mental inabilities are manifesting into bad choices and physical disability, snowballing in a positive feedback loop of bitterness and self-hatred. It doesn’t have to be your problem. He’s an adult and win or lose he has his situation and his choices. Even if you made him a lifelong project you might not find a way to release whatever’s poisoned him, and honestly he’d probably hurt you in the process. You want to protect yourself against him as you would against a large, dangerous animal: Without blame or bitterness at its behavior, but with simple responsible attention to your safety.
But remember the most likely root is terrible, terrible pain. This may help you not to take it personally and to give him what sympathy you can while still giving attention to your own security when you’re near him.
It’s really important to remember some people were dealt a really awful hand in life - helping them remain healthy in body and making services available to help or ease their mind is sort of the best we can do. As I said in my other comment it’s very common for people who feel like life shit on them to shit on those around them.
We can also be excellent to each other. That’s something we can do to help those living in horror.