Over the course of your intern year, you really learn how to work with nurses.  Some nurse you know will call with the most stupid things.  It just seems they can't think for themselves.  Others, however, only call when it is important.  And when they call in the middle of the night, you better get your butt out of bed.

I got one of those calls 1 am Tuesday morning.

It was from a nurse on one of the surgical floors who has been doing this for years.  He is fantastic.  He knows how to take care of his patients, and he knows what constitutes an on call page.  So when I get a page from him, I am already paying attention.  But this one was a doozie.

There is a patient down on his floor who had a kidney transplant in the past.  But the guy just isn't taking care of it or himself.  He has some psychiatric problems as well, and so was recently admitted because he let himself get dehydrated and is basically killing off his new kidney.  You already can tell, this is a class act we are working with.

The phone conversation goes something like this:

"Peter, I am taking care of Mr. SoandSO.  I just went into his room to find that he had urinated all over the floor and that he had a large amount of firm, well formed stool in his pants.  These didn't just sneak out, he had to push to get these suckers out.  When I told him that pissing on the floor and crapping his pants wasn't really a great idea, and that if he needed help he should just push his call light, he proceeded to take a swing at me.  He then pulled out his IV and started bleeding all over the room.  Oh, by the way, he has Hepatitis C.  I've called security, oh, here they are, and I think you need to come talk to him."

Brilliant.  Freaking brilliant.

So, I hop out of bed (doesn't matter, I wasn't really sleeping yet, other stupid pages had been coming in all night), throw on my white coat and head down to the patient's room.  There is security (3 guards all putting on isolation gowns), there I am (doing the same), and we walk in.  He is in his street clothes, wandering around the room (he is blind).  I start talking to him, and you know, at 1 am I don't hold back.

"What are you thinking?!?  Man, you cannot just crap your pants and take a piss on the floor.  Not cool."  He then goes into some lame excuse about not being able to make it to the bathroom with his IV pole.  "Don't give me that bull.  You have been walking on the floor with that, you know you can move it into the bathroom.  Now look.  Here is what is going to happen.  I am going to give you these two Zyprexa (an anti-psychotic), you're going to swallow them.  Then you're going to get in bed or your chair, whichever is more comfortable, and you are going to quietly stay there the rest of the night.  You're not going to bleed on anyone.  You're not going to try to hit anyone.  If you do, it is going to get ugly.  Trust me.  Do we understand each other?"

He looks in my direction for a second, takes the pills, swallows them, and sits down.  "Excellent.  I appreciate your cooperation.  We will all have a much better night if we can get along.  I'll tell the nurse he doesn't need to come in and check your vital signs tonight, you can just get some rest until your primary team comes in the morning."

Turns out, he slept the rest of the night.  Of course, the next morning he was transferred to the psychiatry service.  Sweet.

I tell you, you can't make this stuff up.