The Slug

Have you ever cared for that patient referred to as a "slug"?  I first heard that reference in coronary care.  It referred to a post open heart patient that you had to pry out of bed, they didn't want to do anything to get better, they didn't want to eat, didn't want to walk, didn't want a shower.  They exist in all areas of health care.  Nursing homes, hospitals, clinics.  People get tired, get depressed, get demoralized, and give up.  They don't believe they can get better anymore.  They stop making any effort.

Sometimes the slug needs Nurse Ratchett.  The mean nurse that says "It's time to get up".  "No, you're not going back to bed, we're going to the shower."  "Do you want to sit in the chair or go for a walk?"  This is the patient that you need to come to a shared understanding with.  "Choosing to lay in bed is choosing to die.  Today, there is no reason you can't get up to a chair for every meal.  And after every meal we are going to walk one lap around the unit."

I had to be the mean nurse.  It wasn't fun.  The patient hated me.  And there were moments that I felt bad.  But I knew I was doing the right thing.

She wanted a bedpan when I had just seen her walk around the unit earlier that day.  Why in the world would you need a bedpan if you can walk?  "The commode is uncomfortable!" she exclaimed.  "Let's go into the bathroom then"  I insisted.  We went.  She did fine.  But she wouldn't look me in the eye.  She scowled the whole time, and rolled her eyes like a teenager.  It's not that she was incapable.  She got out of bed slowly but without any help from me.  She didn't need help.  I just stood by.  Just in case.  But she was strong enough and there was no reason for a bedpan.

I was with her for three days total.  Day one, I was nice nurse.  Day two and three I had figured her out and I had to become Nurse Ratchett.  She hated me.  She scowled at me.  Made statements like "There's no use arguing with you."  "This is some kind of power struggle."  "I have no say in what happens."

I gave her choices.  She had a pressure ulcer developing on her back.  I asked her to stay off of it.  She was independent with her bed mobility.  But even though I would get her on her side when in bed I would find her on her back a little while later.  On my second day with her, after making her take a shower, I asked her what she was going to do about the pressure ulcer on her back.  I made her own it.  After that, she stayed on her sides when in bed.  The next day, the pressure ulcer was starting to look better.  I let her decide left side or right, walk before the meal or after.

By day three she was up to a chair for every meal and she walked the unit before going back to bed each time.  At the end of my shift I told her I expected her to continue this plan while I was gone for the next four days.  Hopefully, her nurses won't be fooled, and will insist that she do what she is capable of.

The student I had with me put it well.  He said, "Our job isn't to make you happy, it's to make you well".  I was so proud.  This was actually a big lesson for him.  A young man who comes to nursing from a service industry job.  While, as nurses, we do need to be mindful of our "customer" and give them as good an experience as we can.  The goal is to get better.  Our job is to help them get better.  Even when they don't want to help themselves.