The other night was my first night shift in a long time. After fighting the ball game traffic and arriving on the unit at exactly 3 minutes until 7PM, I headed to the report room. I heard someone yelling down the hall.

“Can I get a cigarette?”

“Yo, Babydoll. You got a cigarette?”

“Sorry, dude, no smoking in the ICU.”

“Aw man.”

Bed 22. Not quite sick enough to be in the ICU, but I guess there were no beds available to send him to.

Sure enough, he ended up being my patient.

Sometimes it’s nice to have a patient who’s not so sick. We talked. He told me about his “job” panhandling, and how much money he made. He was suffering from dementia and was in an out of orientation. He knew I was a nurse but he thought we were just hanging out together in the shelter.

“How come you a nurse and you live on the streets?”

“Guess I just really like nursing,” I told him.

He seemed pretty calm so I left him alone for awhile. He had some lower extremity paralysis and so he couldn’t get up and walk away. There was an order for restraints but I felt that if I made him wear the restraints it would make him more confused and agitated.

Except for one thing. He still had a central line in. And he pulled it out while I wasn’t in the room.

One of the aides came and got me to tell me he was bleeding. I got to the room and there really wasn’t too much blood after all. Praise the Lord because when I got him cleaned up and settled down, I remembered that he only had 13,000 platelets. (Normal is 150K-400K). Hmmm. Maybe platelets aren’t so great after all.

I guess the experience made me wonder if I should have restrained him simply because he had a combination of low platelets, dementia, and a central line. Restraints have a way of adding insult to injury, though, particularly with a disoriented IV drug user who lives on the streets.

He was a nice guy, though. He was starving and for some strange reason the docs had him on “clear liquids.” I got his nutrition status changed and tracked down a lunch box for him. He then thanked me by offering me half of his sandwich and a plum. Although later, when I was reprimanding him for cursing at the nurse’s aid, he was very quick to remind me of his previous generosity.

Ah, the MICU. So good to be back.