So the other day I had a nice gentleman in new onset Afib with a rate of around 140. He had a pretty extensive cardiac and pulmonary history, so was kinda nervous about everything we did. I explained to him all about Diltiazem and why we were giving it, and he was still a bit nervous but let me give him the med. His rate came down below 100, and later I got the order to ambulate him. He failed the road test pretty spectacularly, with a HR now up to 160. I bolused another dose of Diltiazem, which didn't do much, and the doc came in to talk over his options.
The doc mentioned that she had talked to the cardiologist, who wanted to cardiovert the patient. The patient was really anxious about it, and so even though we talked through all the pros and cons he still wanted some time to conference with his wife.
The doc, myself, and the scribe were hanging out in the nursing station to give the guy some time, when the scribe looks over at me. "Hey," he says, "did you know that you have a major contraindication to cardioversion?"
I replied, with a somewhat confused look, that I didn't know of anything. [This is where I interject that this scribe and I are good friends whose friendship is 90% based off of the most creative insults we can think of for each other.]
"It's contraindicated because you have no heart!" he cackled.
The doc almost fell off her chair laughing, and immediately rushed to go tell the other staff that I had been one-upped in good insults for the night.
I, however, had the last laugh. Later on in the shift, when the patient was about to go upstairs, he graciously thanked me for taking care of him and making him and his wife feel so informed and relaxed. His exact words to me, which he said in the presence of the scribe and doctor, and I'm not even bullshitting you, were these: Thank you for being so caring. It's so nice to have a nurse with such a good heart.
Bam! Who's one-upped now, Scribe?!