I was doing an ECG on this patient . . .
He was shackled to his bed, dressed in black pants and a black mesh tanktop. He was absolutely BULGING out of his tank top, abs rippling – a 12 pack, if that’s possible. I had to take his blood pressure and his bicep was about twice the size of the largest cuff we have available; a cuff I can usually use for morbidly obese patients. He had a definitive personality disorder/substance abuse problem from a mile away and he was rattling on about his past exploits; guns, gangs, drugs, and conquering women. I don’t know why he was under police custody, but it wasn’t hard to imagine.
So, I wander over with my rickety ECG machine and ask it it’s allright if I do my thing. He’s nice enough and continues to rattle on about his time on the street and all the drugs he did recently.
Then, he pauses.
“Hey, I forgot to tell my doctor. I have tuberculosis. I was taking some medicine . . . INH? And I took it for a week or two, but then I lost the bottle and I was on the street anyway . . . I had all this fluid in my lungs a few weeks ago. I guess I should have told them.”
He’s not coughing, and I’m in the middle of my ECG, so I quickly finish up.
Then he coughs, a small cough, yes, but I grab my machine and scurry away.
When I find his physician, I ask, “Remember Mr. X. The Riker’s guy?”
She briefly nods and sifts through the charts in her hand. “Yeah, I just admitted him for Ativan withdrawal – what’s up?”
That was funny to me. And the story can really end there. Admitted for Ativan withdrawal, not TB.
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I tell her about the TB, ask if I can stick him in an Isolation room, and casually wonder when I had my last PPD.
After some confusion as to whether or not I was the Ortho resident (clearly, I’m not), she tells me that she’ll take care of it and walks away. I get caught up with something else. Later, I pass by the same patient. He’s still in the same bed, still not on isolation. He’s wearing a N95 respirator, but he’s periodically taking it off and hanging it around his neck – they are legitimately really uncomfortable.
Maybe they know better than I do – it’s true he wasn’t really coughing. It’s frustrating to constantly be in the position of thinking, “Weeellll, this doesn’t look right to me, but everyone else has way more experience, so I’ll defer to them.” Had he been my patient, I would have isolated him, just in case, and felt silly later if it was a false alarm.
Ah well. Another shift as a student nurse done. Not too many more to go.
