And yet another dateless entry...

Long day today with a questionable look into the mirror. 50 year old, male RN working 60 hour weeks. 2 kids, aged 18 and 15. 18 year old was going to college, 15 y.o. in a private high school. Wife is a stay-at-home mom. Patient himself gave up drinking 6 months prior to presentation but seems to have a problem with both Perocets and oxycodone. Dude was manic when he got here, in my face, pointing hif finger at me - jabbing it actually, cursing, refusing procedure even after we'd made it to Bay 41. To complicate matters, the patient's brother was the mayor of a nearby town / city and apparently good friends with someone at the top / upper echelons of administration here at the hospital. Of course. Doesn't it always work that way?

It's pressure, of course. It makes things a bit more difficult. Add to that the side stepping of protocol by the docwho took charge of the case and suddenly, I have a labile, volatile manic man who doesn't want to be on the unit who is allowed to circumvent procedure because of his place in life coupled with his volatility and he gets to do this in spite of the edicts I started to lay down related to his stay in APS. It's already been decided he will stay - already decided he will be amitted - already decided he will be secured and locked in while simultaneously allowed to circumvent policy regarding the changing of his clothes all because he was loud and cursing and his brother was a mayor. And at that point, enough was enough.

Security was in speaking with him about behavior and I decided to end the difficulty. I went into the room and told him straight out that nurse-to-nurse, he came onto the unit where I worked and pissed all over it with serious disrespect to both me and our profession in general. We had a few words about doing our jobs and the fact that when patients came through and acted like ass holes, it made the rest of the job that much harder. He listened and he agreed, reluctantly. Then he changed and handed over his clothing.

Sure enough, he told me later that he had Percocets in his pants pocket and he wanted to know if they were still there after security put his belongings in the lock area. 1.) Opiate dependance, even in a well-functioning individual, trumps all other concerns. Initially, he'd told me he was prescribed Percocets but didn't take them. However, when the blood was drawn, he began to sing about both the fact of oxy / opiates in his system and later, that he had the Percs in his pants...

So, well functioning RN, husband, father - at least by his report. Wife and brother both telling me he was not at baseline. About 4 hours of sleep per night, loss of 32 pounds since January, huge spending on a new car for wife and 18 yo daughter, college at 52 G per year with 20G in scholarships. The sound of torture in his presentation, working to keep the family afloat, anger toward wife when he wanted to spend money and she wouldn't allow it. I really had a hard time separating some of the pathology from the overall story - probably because it so closely resembled my own life.

So, how is any of this important? Why does any of this matter? Two good questions and I have to wonder whether or not I have a viable answer or if I'm going to spit out a ridiculously overblown / over-thought / somewhat pompously and attemptedly introspective answer. Hmmm...

I guess it's important because it's a facet of humanity. It's important because his life story mimicked so much of my own. Busting ass to keep a family together is a truly difficult arena of life.

There's a fight in the bar right now and I'm distracted, so...

edit: Two women started grappling while I was writing, punching and yelling and what have you. The husband of one of the girls suddenly jumped up from the bar and grabbed the girl who wasn't his wife and that's when I jumped up and went after him. He saw me coming and let go, put his hands up and started saying, "It's cool! It's cool! She's ok, man. We cool? We cool?"

Stupid shit.

I told him to leave them alone to work it out or i'd fuck him up and he left while the two girls continued to yell at each other - without any punching. The girl he grabbed came over to me after to thank me (I was talking to someone else at that point who invited me back to her place and of course I couldn't go because I'm married) and then she bought me a drink. Whatever. I left soon after that anyway so I could head home. Chances are I had to work the next day...