So last night at work was an interesting one. I think I got to see a couple of the unique challenges of working with this population firsthand. They often have underlying mental issues that keep them from adhering to care, their health isn't exactly a priority, and they are frequently intoxicated.
At the start of the night, I had two individuals come in for TB tests. One had started the two day series three weeks ago, but never came back for a reading. When he walked in last night for his reading, I assumed he had the test replanted at our downtown clinic on Monday. Turns out, he wanted us to read his test from three weeks before. I tried to explain that he needs to have the test planted and then read two days later. It took me a couple of tries, but I think he finally understood that he has to go to the other shelter to get the plant and then we can read it or vice versa. We came up with a plan, but I emailed his case manager just in case he forgets.
A few patients later, a gentleman came in who said he had "rings on his genitals." He said that I had given him an antifungal cream for it the week before, but I definitely don't remember that rather outlandish condition. I checked his record and the nurse hadn't made any notes on him either. I got him checked in to see the nurse, and when I did his vital signs his blood pressure was through the roof. I asked him if he had any dizziness, lightheadedness or headache. He said no, not really just a little lightheadedness. His insurance had been terminated by mistake two weeks earlier, and he had been off of his blood pressure medication ever since. That is a very dangerous thing to do. When he got to the nurse, she asked about chest pain, blurry vision, etc. and he said yes to almost all of the cardinal symptoms of a heart attack. She called an ambulance and the fire department from up the road came to help us in the meantime. I wish I would have asked him about those symptoms sooner, but I had no idea he was feeling that way until I took his blood pressure. I thought he came in for that weird cream request. Hopefully he can get it checked out while he is at the hospital too.
After we took a break for dinner, a man came into the clinic clearly intoxicated. I could smell the alcohol on his breath and I was at probably 5 feet away. He was in one of our overflow beds, which means they didn't have space for him downtown. He was asking me about getting duplicates of his medications so he could keep one set at our clinic and one at the location downtown. Every time I tried to give him an answer he would start talking about some other subject. Eventually, we were talking about his previous psych problems. One of his friends walked by the door of the clinic and punched him in the arm, saying something biting in jest. The patient in my office turned around and shouted something really lewd at his friend as a joke. The nurse heard him shouting from the next room and immediately kicked him out of the clinic for inappropriate behavior. He wouldn't leave at first, but he finally got the message. As we were closing the door, he that he was restraining himself and he wished she could hear what he was thinking about her. After I closed the door, he made this angry grunting/squealing sound (I think I would define it as a keen. Is that a word?). We called the case managers, but when they didn't come I reopened the door so the clinic could resume.
Not two minutes after I did so, he had come back to apologize for his actions. I tried to explain calmly that he needed to leave and how he could talk to a case manager, but he nurse heard that he had returned and told him to leave immediately. He was not allowed to come back at all. He got very sad and apologetic and insisted that he be able to apologize. I stood up, told him I needed to close the door and started to close it. He just stood there with his head poking in the door, saying he was sorry and didn't want to leave. The nurse and I kept telling him he had to. He put his boot into the door so I couldn't close the door, but eventually took it out. When I closed the door again, he said to the nurse, "I hope that falls back on you" (referring to the door, I think) and he left. The nurse called the case managers again and this time someone came to help. They set him up on a cot in the dining room and he promptly went to sleep.
I cancelled my smoking cessation group that evening so I wouldn't have to keep the door open and we made sure we were careful walking to the other shelter that night. A policeman walked me to my car. There really isn't a dull moment with these folks. Hopefully, my year out here will prepare me for anything.
Everything else is good! Had a great weekend hiking in the snow and watching the game with the roomies/landlords. The Super Bowl will be interesting since my roomie is a Giants fan and the landlords are Patriots fans. I think I'll go to a different friend's house so I can get out of the line of fire.
Love to everyone! And sorry this post is so long,
Lynne
