Clock Watchers

My patient and I have a good rapport. She is young and has many issues going on, one of which is renal failure. She is on a complicated medication regimen and she is in pain, nauseous, and itchy all the time. How miserable she must feel! In report I am told she is a "frequent flyer" and a "clock watcher". The reporter speaks judgmentally of her, but I try to keep an open mind. As I work with her I realize that she is used to clock watching because she is forced to in order to properly manage her disease. At home she takes the medications she knows that work for her at the intervals required to keep her pain and nausea at bay. Now here in the hospital she is uncomfortable because we have custody of her medications. We tell her what, how often, and how much she can have. If she complains or asks for more she is labled and judged.

She asked me to do something a different way and as I obliged she thanked me for not getting mad. "Why would I be mad?" I asked. She explained how she felt other nurses were upset with her if she contradicted them. "I feel like a kid who got caught with their hand in the cookie jar but I didn't do anything wrong." I told her she should never apologize for advocating for herself. I told her she knows her body and her treatment plan best and she should always speak up for herself. She seemed relieved and grateful. How sad it is that we get so jaded over time and label these patients. My thinking is even if they are a drug seeker it is often because they have developed a genuine physical need for more drugs. My job is not to judge how they got here, it is to address the issue they are having now. The alcoholic with pancreatitis still needs his pain addressed, the lifelong smoker with lung cancer deserves the same respect as my breast cancer patient. I hope that over time I don't get jaded and forget to treat the patient and not the circumstance that brought them to me.