Monday, February 28, 2011

You're The Boss

Sunday, 10 pm on the floor.  A nurse reports that her patient is refusing his blood pressure medication for the second night in a row.

Me: Hello, Mr. Logical.  I understand you have a concern about your medication tonight?

Mr. Logical:  Yes, doc.  I'm allergic to it.

Me: Oh, really?  What sort of reaction are you having?

Mr. Logical: I don't like how I feel when I take it.

Me: Hmm.  That's not quite an allergy, but ok.  What do you mean, you don't like how it makes you feel?

Mr. Logical: It slows my heart down.

Me: Yes, that is an expected side effect.

Mr. Logical: Exactly, an allergy!

Me: No, an allergy would be something like a rash or your throat feeling tight.  This medication is supposed to lower both your heart rate and your blood pressure.  That's what the attending wanted for you.

Mr. Logical: But I don't like it!  It's the same damn problem I had with that other medicine, hydralazine.  He tried to get me to take that one too.  But I refused.  I'm allergic.  *smiles triumphantly*

Me: Sir, a lowered heart rate is not an allergy.  I understand that having a lower heart rate might be a strange sensation for you, but I'm looking at your vitals and your heart rate is quite high.  A lowered heart rate in your case would be better for you, not dangerous.  And your blood pressure most definitely could use some lowering, too.  Having a high blood pressure is very dangerous for your body.  Do you want to maybe think about trying this medication?  Otherwise, we can try a different one, like clonidine.

Mr. Logical: No!  I won't take that one either.  They tried to get me to take that before.

Me: So basically, you don't want to take any medications to lower your blood pressure.  You prefer the sensation of high blood pressure and pulse.

Mr. Logical: No, I'll take something.  I'm just allergic.  Make sure they put that on my wrist band.

Me: *sigh*

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