Sunday, November 19, 2006

driving me crazy

Over the years I have had one kind of patient that will try me so badly I want to quit nursing right on the spot. The anxious, demented, paranoid elderly escape artist.
These patients begin the shift seemingly pleasant, rather normal, hell, boring people. I get fooled every time.
Then they ask a weird question like: "who is that guy standing there?". You look around and you are all alone. There is no guy standing there. You tell the patient and they laugh it off, blame it on the drugs and it all seems fine. Until they ask again. Then you know.
Once it begins you have to have a strategy. If you deny the presence of phantom man your patient will think you are lying to them and hiding some scary dude behind the curtain.
You can answer their query with "I don't know, would you like me to ask him"? But then you are lying and it's your job to re-orient the confused not give names to their imaginary friends.
I have tried ignoring the question but that only buys you a tiny fraction of time.
Usually I tell the patient a second time that "theguy" ain't there. I follow that up with a discussion about pain meds and how we can fix this unnerving side effect. This buys you just about the same amount of time as ignoring the question.
Inevitably the patient decides you are lying and the paranoia begins. You are doomed at this point.
If you are experienced this would be the moment you call the doc and get an order for Haldol and lots of it.
Haldol is not all that reliable. I have never seen it work as advertised. Eventually if you give enough your patient falls asleep. Asleep is better than screaming for the phone to call the police.
Patients calling police is a regular thing. Elderly demented patients love to call the cops. The police actually have to respond. Patients on the ward have private phones and half the time the staff have no idea the cops are on their way. It's a hilarious interrogation though. The cop asks what is wrong and the patient, wily and paranoid announces they are being held behind enemy lines by the insert racist comment here. Always it's some long held, well hidden streak of bitter hate about another ethnic group. The cops close their little notebooks and walk out. Then they tell us to unplug the guys phone.
In the ICU patients have no phone. This pisses them off. After you tell them you aren't calling the cops and no they can't have the phone the escape attempts begin. First it's a little toe testing the water. Then the foot follows. Soon the whole leg is searching for the floor. If you are preoccupied the other leg will slip across the bed to join it's wayward brother. Two legs reaching for the floor is a bad thing because the rest of the body cannot resist the impulse to join in.
Then you have a guy fresh from a big surgery standing at the side of his bed wrapped in tubes and lines with, no shit I kid you not his ET tube still in and still attached to the vent. Encouraging this guy to get back into the bed really wasn't all that hard. We would have freaked out but the patient had that covered so completely it would have been overkill.

Sometimes you can't get the demented back into the bed. Their incessant picking, pulling and plotting has weakened you. You have no patience left so you stick them in a chair. The chair is usually blue. These patients now become the blue chair people. You can tell how rough any night shift was by how many patients are lined up in the hallway in their blue chairs.
These chairs are ingenious , damn near escape proof. They have the advantage of having a built in tray table. I have given the demented piles of face cloths and instructed them to fold them. By morning you can have outrageous piles of carefully folded laundry every where.
I have no patience for the demented. I want to. I try very hard in the beginning but eventually their inability, their obstinate refusal to stop picking or pulling drives me past the point of empathy or sympathy. I chant in my head "they can't help it" but that mantra gets old. It offers no plan, no solution.
I absolutely hate to use restraints. Tying some poor, sad ,confused old lady to the bed creeps me out. Especially when they start begging you to untie them. I did not go into nursing to tie people up against their will. I do it though. Anytime you have scary tubes and IV lines the risk is just too damn high. If you pull out a chest tube you could die, better you get tied to the bed until you get yourself together.
A million years ago I was walking around the unit when I heard some alarms going off. The curtains were pulled and I thought the patient was getting a bath. I peeked my head in to offer an extra hand and was confronted with the patient, He was sitting at the end of the bed and he calmly handed me his chest tubes. I stood there transfixed. Like a zombie I took them and then asked him to stay very still. Then I yelled for help. He had some minor complications from his first attempt at chest tube removal but he did recover well. I never forgot it. His nurse thought he was asleep, he never gave a hint that he was confused. They get you every damn time.

I once had a patient throw herself out of bed right in front of her visiting husband. She was wildly confused and combative. The family had refused any restraints and didn't want her drugged anymore. They thought it was the medications that were making her bonkers and I couldn't disagree. The family agreed to stay in the room at all times and we agreed not to restrain her physically or chemically. Her husband brought a book. He was busy reading and ignoring his wife when she got up on her knees and according to him "threw herself out of the bed". So, first she got physically restrained and then she got chemically restrained. She also got a nice black eye and a CT of her head. I felt sick.

Little tiny things that look like the wind could blow them over are stronger than linebackers. Never doubt they could beat the crap out of you.
I don't ask families about restraints anymore. I know what they will say and I also know they will forget their end of the bargain when it is inconvenient. Reading that book meant more than keeping his wife safe.

I have seen a pregnant nurse get kicked in the stomach, nurses are bitten and spit on. All from elderly, demented patients. They end up making you as crazy as they are by the end of your shift. Worse you go home feeling like you did nothing to help them. Instead you tied them down and drugged them. With the horrifically over entitled baby boomers moving into the "old" category it's all going to get worse.

I saw a cool idea the other day. Someone actually wanting to help with time and knowledge. Her website is
I wish I could have done this when I was a teenager. I don't know if I would have the courage.
I gave a little money. Hell why not right? There can't be anything wrong with orphans getting taught English and it makes the teacher a better person too. Give her some money and you can tell your friends you are fighting AIDS in Africa..just like Bono..except you actually gave some money.


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