I C U P

Quick set up to for the following conversation I had yesterday at work. The 7 days before a person actually gets their bone marrow transplant, they receive a lot of chemotherapy and a lot of IV fluids. Because they are getting so much fluid, we have to weigh them every 8 hours to make sure their body is processing it all well and "eliminating" it instead of retaining the fluid. So we weigh them and if they have gained more than a liter (2 pounds) from their initial weight, we give them some lasix, which is a drug that essentially makes you pee. That way the excess fluid is not hanging out in their lung which could lead to possible pneumonia, pulmonary edema, or general difficulty breathing. It also keeps the extra fluid from building up in their ankles and legs making more work for the body. Anyone who has had too much Chinese food and felt their ankles swelling afterwards can probably relate to this sensation. Another reason we give so much fluid is to help flush the chemo out of their body so it is not doing extra damage to the healthy cells. Long story short, it is good for them.
Mr. F. was supposed to have been weighed at 1 p.m.. In the usual chaos of a busy day (pt circling the drain and finally transferred to the IMU, another patient being discharged, another patient being admitted, another patient needing to be walked and have a bunch of procedures) the weight was not done at 1 pm. Neither myself or my CCP (Clinical Care Partner) had gotten a chance. Apparently she had not been told by the night CCP that it was needed to be done, and I had forgotten to make sure it was done. So even though it was a CCP responsibility, ultimately I would be the one to get into trouble for things not done.
At 7, minutes before change of shift, I realize this, and thankfully my CCP did get his weight, which happened to be 2 kilograms over base weight. This morning he was only 1 kilo over, and did receive lasix that time too.
I entered the room with his lasix, and here is how the conversation unfolded.
"Hi Mr. F. Sorry to tell you this, but your weight is still up so I have to give you some more lasix."
"Well I don't want it right now. Can I have it in the morning after I wake up and have breakfast?"
"No, I need to give it to you now because we are going to weigh you again in 8 hours and so you will probably have to have it again at that time, and if I give it to you now, you might pee it off and not need any more again at 3 in the morning."
"What!?! Don't you know that stuff makes you piss! You should not give that to anyone at night! How are you supposed to get any sleep?"
"Well, yes, I do know it makes you pee, that's the point. And we have to do this if you are over your weight every 8 hours, and so that does fall during the night shift as well. And, you are right, it is very difficult to get any sleep when you have to wake up and pee all night. We are a lousy hotel, I know. We are in here all the time waking you up for vital signs or lab draws too. I am sorry about that."
"Why do I keep gaining weight that I have to have lasix?"
-Insert full explanation of IV hydration and flushing kidneys and so on...
"Then you're reasoning is all backward and you should give me less fluids! That way it is balanced! Stupid! If you give me less fluid then you don't have to give me lasix!"
I explain again preventing kidney toxicity and all that. End with "so even though it is very inconvenient for you to have to pee now, we really don't want you to have to end up in the ICU because your kidneys quit working and now you need dialysis for the rest of your life. Believe it or not, we are doing this for your best interest."
"Can't you just give it to me later then?"
"I can't, I am about to go home, but the nurse coming on could give it to you around 9 if you really want to wait."
"How long does it last?"
"About 4 hours. But that varies for each person. If I give it to you now, you should be done by about 11, or if you still want to wait till 9 you will probably be up peeing until around 1."
"4 hours?!?! Damn it! That stuff kicks in and you don't have enough time to get to the can! I piss all over myself trying to get into the bathroom!"
"I can give you a urinal so you don't have to actually go into the bathroom, you can pee at the side of the bed. I can also give you a hospital gown so your pants are not in the way slowing you down."
"No I don't want a hospital gown! I don't want a urinal! I am just going to piss all over the bed!"
"If you don't want an extra urinal, I see you have 2 in the bathroom, that is okay if you pee in the bed. We don't mind changing the sheets."
"I'm not going to piss in the bed! I will just piss all over the floor!"
"We would rather have you pee in the bed and change the sheets because if you pee on the floor you could slip on it, fall and crack your head open or something and then you would end up in the ICU."
"How many more times are you going to do this?"
"Tomorrow we will be decreasing your fluid rate so you will be getting less fluid and peeing less."
"Promise?"
"Yes. Today is Day 0, tomorrow we decrease your fluids."
"Okay fine! Give me the lasix now so I can get some sleep later."
"Thank you. And I will talk to the next nurse about waiting until later in the morning to get your weight again."
"Thank you. I appreciate it."

I love how patients threaten me with peeing all over the bed or the floor. Like I have never dealt with that before.

I love my job though. It's good to be me.