I was getting report that morning from a well-seasoned nurse. Her humdrum speech always made me sleepy and calm. Loved every minute of it.
The report was on an older individual with an uncomplicated urinary tract infection (please understand how hard it was for me to not abbreviate that). My report seemed quite simple to be frank. My entire patient load actually seemed to be that way.
I was entirely wrong.
The morning was fairly routine for me. Checking the telemetry monitors, watching the colorful heart rhythms dance across the screen, checking my blood pressures and blood sugars, passing meds and giving everyone insulin. (You RNs all know how that goes, the BEETUS is EVERYWHERE)!
How to describe what happened next, I have no clue how to begin. The only phrase that I can muster, of which is all-encompassing, is Kicking off. I believe I actually used that in more than one sentence when begging doctors for Haldol on this incredible day. (If you don't know what this lovely drug is, google it NOW so you can appreciate the resolution to this twisted tale).
It began with a deafening ring. My phone and the call bell system simultaneously graced me with their presence. My next thought was here we go. (Oh Jacquie, my dear, you have NO IDEA)
I had forgotten about the mega-moon that was shining beautifully outside the past couple of nights. (If you are not superstitious, just ask ANY healthcare worker, fireman, police man/woman, or really anyone who deals with extreme situations and "answering the call"-- they will tell you)
The first room I entered had a confused patient, who was, luckily, laughing hysterically. I walked in with a smile, bringing out the big guns (so to speak)-- kill em' with kindness! My patient turned to me, almost oblivious to my presence, but they knew I was there. I am so clueless as to how to explain this. It's like... You are being looked at, without someone actually looking at you. Almost through you.
The first room I entered had a confused patient, who was, luckily, laughing hysterically. I walked in with a smile, bringing out the big guns (so to speak)-- kill em' with kindness! My patient turned to me, almost oblivious to my presence, but they knew I was there. I am so clueless as to how to explain this. It's like... You are being looked at, without someone actually looking at you. Almost through you.
My grin was met with a grin, and the patient asked me about where her coat and hat were and that it was time to go. My eyebrows shot up, "Honey, you can't leave, I actually need to take care of you because your heart is sick. The doctor called and said for you to take your medicine." I held my breath, this usually works. My patient nodded, their head floating in a place of snowflakes and rainbows (No, seriously, they actually asked why it was snowing from the ceiling). 'I think I can do that, yes, that won't be a problem.. Have you seen the snow?' My eyebrows remained reaching toward the ceiling, speechless. "I haven't seen the snow, but I have seen your pills, do you think you will take them?" 'Why yes, I guess I can do that... Have you seen my dog? I think there is a zoo. I'd rather put my coat on, but I think I will just wait. Thank you.'
I just grinned my grin and nodded. I then checked their mouth 987345978245987245982734509827345 times before I left the room to make sure those pills DID go DOWN. I set that bed alarm so hard the floor rumbled with the promise of ill will to anyone who removed it, and then hurried out to answer the next phone call request.
I walked into a dimly lit room with a very petite patient with hair all over town. I mean crazy curls and sleepy time head at its best. This individual was looking up at me with a smirk and facial expressions that changed every 0.000000827345 seconds. This little thing was a ticking time bomb and I could feel it. "Good morning to you!" I said as cheery as I could. This resulted in a massive smile from my patient who seemed to be pleased as pie that I had walked into the room. Whew!
Dear ones. Dear dear ones. Please. Don't be fooled.
Outward appearances can be entirely deceiving.
And this marks the last time that cordiality was maintained..
I tried my best to describe what the plan was for the day then give this patient their morning meds (entirely necessary if you must know--that blood pressure was pushing stroke probability)! After the pills had been swallowed down, I was beginning to feel comfortable. Whew, starting off on a good foot. WIN!
Mind you.
I had report that morning describing the confusion levels of this patient as well. Two patients, doors away from one another, that were living on planet Z where snow falls from the ceiling and people randomly appear (who are always up to no good).
There was an uncomfortably long pause and a very hard stare from my patient that made me pause for far longer than I was planning to. I actually waited for them to speak first.. Mistake numero UNO.
'It's okay dear, I can keep your secret.' The last word uttered with disgust and malice.
I turned to face my accuser, totally stunned. "What secret might that be? I don't remember sharing any secrets with you earlier. Well anything for that matter actually... We've only just met."
There was another uncomfortably long pause, as my patient thought about their next words. 'I.. I... I just can't talk about it right now, it's just too stressful, and awful. I will never speak of it! NEVER! You can trust me to keep your secret.' At that, they raised a finger to their lips, and shushed me softly.
I drew a blank. I've worked with many patients who've had hallucinations, vivid and not, delusions, and just flat out mental breakdowns-- but I've never had someone be downright determined to keep a dirty little secret of mine, that didn't actually exist, and be contingent upon keeping it hushed up and take it to the grave. It was terribly odd, and just unsettling (to be completely honest). The immature side of me really wanted to know that kind of secret that could be. (Fast forward a few hours, I found out what it was!) be prepared to have your mind blown.
Whatever time in the day it was, I can't remember exactly. All I know is that it was time for blood pressures-- which my unit did every four hours due to the critical nature of our patient load. Instead of a call bell (of which I was expecting) my phone rang... And then I heard screaming.
So I started running.
I found patient #2 (the one who was keeping the secret, not the one playing in snow), with a death grip on my CNA's wrists, shaking uncontrollably, horrifyingly screaming the most unsettling obscenities I've heard come from an 87 year old person's mouth. My CNA looked at me completely terrified, stunned and unable to release her wrists from the patient's hands.
**A quick aside, patients with dementia have the MOST INCREDIBLE GRIP! I have been punched, kicked, pinched, slapped, spat on, grabbed, bruised and almost bitten by numerous individuals with this debilitating disease. It's horrible because you want to protect yourself and get mad at a blow that catches you in the jaw-- but then, this person has NO CLUE what they are doing. It's a terrible and awkward predicament.
I was at a loss of words, between the sounds of screaming, accusations, depictions of scenes I had no exposure to-- I was LOST.
I tried to talk my patient down, "please let go of my friend. They are here trying to help you, can you please release her hands, you are hurting her." Bruises were actually beginning to form on her wrists. My chest got tight as I started to panic (just a little). My patient looked at me with a slow turn of their head and a dark glare. 'You helped her didn't you? You are an accomplice! She listens to your orders doesn't she?! HOW DARE YOU! MY HUSBAND IS DEAD AND YOU ALL KILLED HIM!' With that she put her head into her hands, thus releasing my CNA.
Without a word I excused my poor friend as she was rubbing her wrists. If there was a moment where someone had their tail between their legs, she most certainly did.
I stood on that cold, hard, tile floor and stared at my demented patient (no pun intended here, just referring to their illness). They were entirely broken, in complete despair and I knew that whatever I wanted to do to help -- I couldn't. I just couldn't.
Out of luck doesn't even touch the hem of these circumstances. The entire interlude really, entirely, plainly, just downright SUCKED.
The room fell still, the crying stopped, and my patient looked up at me as they eerily sneered. The hair on my neck stood up and my arms became riddled with goose bumps. 'You killed him!'
My jaw fell open. Here is the secret you big dummy. Mistake numero.. I've lost count.
I took a step toward my patient.
Big.
MASSIVE.
Mistake.
This sent my patient into a frenzy of which I've never seen the like before. They wanted to stand up, sit down, punch at me, kick at me, and they began screaming a piercing blood curdling scream.
I would have been increasingly worried that they were going to upset the other patients on this 32-bed unit.. But unfortunately, they ENTIRE unit was suffering from people who were being encouraged by the full moon and the far reaches of their dementia. I have never heard so much screaming on a unit at any one time. Ever.
Overstimulation you may think? You have NO IDEA.
As this individual of extremely high fall risk began to hurriedly and shakily stand, I rushed to their side to assist them back to bed.
I got kicked square in the shin AND they began to scream even more loudly. How that was possible, it eludes me to this day.
But, one thing did go right. The bed alarm rang, and rang loudly. An almost frenzy. It was as if God reached down and said 'Sister, I see you need a hand, let me get you 6!'
Sure enough, my charge nurse, a CNA and another nurse ran in. I am sure it was mostly the 'HELP! HELP! SHE IS GOING TO KILL ME! FOR THE LOVE OF GOD! SHE IS GOING TO MURDER ME IN COLD BLOOD!' screaming that was emanating from the door (that send everyone feeling in). Regardless of what brought my comrades in, I am forever grateful.
When my team arrived I was being kicked, punched, bitten at and taking a serious verbal beating (of which I refuse to recount for anyone, no matter how close of friends and non-judgmental you are). The words that were chosen to slander me were striking, it actually made me warm and a bit nauseated.
My wrists were in the death grip that hold true for most dementia patients that are having an episode. Thumb marks began to show up across my forearms, wrists and hands. My charge nurse held her hands out in front of her in disbelief: What is going on?! She asked with a flabbergasted exhalation. (I can only think that she just ran from another room in the same predicament as my own).
As I opened my mouth to explain the situation, my patient quieted down to throw me to the wolves. Imaginary wolves that is.
'This b!%$@ killed my husband in cold blood. This spawn of SATAN shot him point blank in the head. I watched the blood collect under him. I watched my husband BLEED to DEATH because of this horrible woman! She works for the mafia you see. I wanted to keep her secret, oh but she wouldn't allow it. NOW SHE IS GOING TO KILL ME!'
I turned to my charge nurse, exhausted, spent and clueless as to what was the next move. How this confusing turn of events transpired in this person's brain, I will never understand (unless one day I end up in the same boat, I'm sure). But in all truth, this individual was convinced that I was the one who had instigated every ounce of horrible occurrences the World over. How I portrayed the person from her nightmares, I don't know, but I was struck speechless, saddened and a bit peeved at the four-letter words I didn't think this person could know.
Somehow (I believe I may have blocked out how I left that room)-- I ended up at the nurse's station with my hospital phone in hand and STAT dialed the physician. My doc answered in a flippant tone, protesting to bringing Haldol on board for this person's immediate crisis treatment. As I do, and often find myself doing, I didn't give the physician a choice and got the order for the medication, ASAP.
It took the ultimate distraction of three other people in the room for me to be able to give this medication IV. But, WE DID IT!!!
My patient was asleep in minutes. They slept the rest of the shift as a matter of fact. Stunning, I know.
I hoped and I prayed that the psychosis would pass and night shift would make it through unscathed.
As I walked away from the room, wiping sweat from my brow, I headed into the "room of snow." My patient was sitting up in their bed smiling. Just grinning the World's biggest grin from ear to ear. "Why hello my darling, where have you been? It's so noisy here." She said with a chuckle.
I smiled. "I'm sorry, I've been a little busy with a situation. But everything is okay now. How are you? Is there anything I can get for you?"
My patient looked at me with eyes agleam, "Oh my dear, just sit here with me and watch the snow. It's just beautiful."
...And so I did. I sat there for a few minutes and imagined what that perfect, fluffy snow would look like. How it would crunch under foot. How it would taste when caught on my tongue.
We sat there in silence, she in her world of snow, me in my World of imagination-- as the unit outside her door churned in utter chaos.
I did go back into the fray with my team.
So I started running.
I found patient #2 (the one who was keeping the secret, not the one playing in snow), with a death grip on my CNA's wrists, shaking uncontrollably, horrifyingly screaming the most unsettling obscenities I've heard come from an 87 year old person's mouth. My CNA looked at me completely terrified, stunned and unable to release her wrists from the patient's hands.
**A quick aside, patients with dementia have the MOST INCREDIBLE GRIP! I have been punched, kicked, pinched, slapped, spat on, grabbed, bruised and almost bitten by numerous individuals with this debilitating disease. It's horrible because you want to protect yourself and get mad at a blow that catches you in the jaw-- but then, this person has NO CLUE what they are doing. It's a terrible and awkward predicament.
I was at a loss of words, between the sounds of screaming, accusations, depictions of scenes I had no exposure to-- I was LOST.
I tried to talk my patient down, "please let go of my friend. They are here trying to help you, can you please release her hands, you are hurting her." Bruises were actually beginning to form on her wrists. My chest got tight as I started to panic (just a little). My patient looked at me with a slow turn of their head and a dark glare. 'You helped her didn't you? You are an accomplice! She listens to your orders doesn't she?! HOW DARE YOU! MY HUSBAND IS DEAD AND YOU ALL KILLED HIM!' With that she put her head into her hands, thus releasing my CNA.
Without a word I excused my poor friend as she was rubbing her wrists. If there was a moment where someone had their tail between their legs, she most certainly did.
I stood on that cold, hard, tile floor and stared at my demented patient (no pun intended here, just referring to their illness). They were entirely broken, in complete despair and I knew that whatever I wanted to do to help -- I couldn't. I just couldn't.
Out of luck doesn't even touch the hem of these circumstances. The entire interlude really, entirely, plainly, just downright SUCKED.
The room fell still, the crying stopped, and my patient looked up at me as they eerily sneered. The hair on my neck stood up and my arms became riddled with goose bumps. 'You killed him!'
My jaw fell open. Here is the secret you big dummy. Mistake numero.. I've lost count.
I took a step toward my patient.
Big.
MASSIVE.
Mistake.
This sent my patient into a frenzy of which I've never seen the like before. They wanted to stand up, sit down, punch at me, kick at me, and they began screaming a piercing blood curdling scream.
I would have been increasingly worried that they were going to upset the other patients on this 32-bed unit.. But unfortunately, they ENTIRE unit was suffering from people who were being encouraged by the full moon and the far reaches of their dementia. I have never heard so much screaming on a unit at any one time. Ever.
Overstimulation you may think? You have NO IDEA.
As this individual of extremely high fall risk began to hurriedly and shakily stand, I rushed to their side to assist them back to bed.
Another big mistake.
But, one thing did go right. The bed alarm rang, and rang loudly. An almost frenzy. It was as if God reached down and said 'Sister, I see you need a hand, let me get you 6!'
Sure enough, my charge nurse, a CNA and another nurse ran in. I am sure it was mostly the 'HELP! HELP! SHE IS GOING TO KILL ME! FOR THE LOVE OF GOD! SHE IS GOING TO MURDER ME IN COLD BLOOD!' screaming that was emanating from the door (that send everyone feeling in). Regardless of what brought my comrades in, I am forever grateful.
When my team arrived I was being kicked, punched, bitten at and taking a serious verbal beating (of which I refuse to recount for anyone, no matter how close of friends and non-judgmental you are). The words that were chosen to slander me were striking, it actually made me warm and a bit nauseated.
My wrists were in the death grip that hold true for most dementia patients that are having an episode. Thumb marks began to show up across my forearms, wrists and hands. My charge nurse held her hands out in front of her in disbelief: What is going on?! She asked with a flabbergasted exhalation. (I can only think that she just ran from another room in the same predicament as my own).
As I opened my mouth to explain the situation, my patient quieted down to throw me to the wolves. Imaginary wolves that is.
'This b!%$@ killed my husband in cold blood. This spawn of SATAN shot him point blank in the head. I watched the blood collect under him. I watched my husband BLEED to DEATH because of this horrible woman! She works for the mafia you see. I wanted to keep her secret, oh but she wouldn't allow it. NOW SHE IS GOING TO KILL ME!'
I turned to my charge nurse, exhausted, spent and clueless as to what was the next move. How this confusing turn of events transpired in this person's brain, I will never understand (unless one day I end up in the same boat, I'm sure). But in all truth, this individual was convinced that I was the one who had instigated every ounce of horrible occurrences the World over. How I portrayed the person from her nightmares, I don't know, but I was struck speechless, saddened and a bit peeved at the four-letter words I didn't think this person could know.
Somehow (I believe I may have blocked out how I left that room)-- I ended up at the nurse's station with my hospital phone in hand and STAT dialed the physician. My doc answered in a flippant tone, protesting to bringing Haldol on board for this person's immediate crisis treatment. As I do, and often find myself doing, I didn't give the physician a choice and got the order for the medication, ASAP.
It took the ultimate distraction of three other people in the room for me to be able to give this medication IV. But, WE DID IT!!!
My patient was asleep in minutes. They slept the rest of the shift as a matter of fact. Stunning, I know.
I hoped and I prayed that the psychosis would pass and night shift would make it through unscathed.
As I walked away from the room, wiping sweat from my brow, I headed into the "room of snow." My patient was sitting up in their bed smiling. Just grinning the World's biggest grin from ear to ear. "Why hello my darling, where have you been? It's so noisy here." She said with a chuckle.
I smiled. "I'm sorry, I've been a little busy with a situation. But everything is okay now. How are you? Is there anything I can get for you?"
My patient looked at me with eyes agleam, "Oh my dear, just sit here with me and watch the snow. It's just beautiful."
...And so I did. I sat there for a few minutes and imagined what that perfect, fluffy snow would look like. How it would crunch under foot. How it would taste when caught on my tongue.
We sat there in silence, she in her world of snow, me in my World of imagination-- as the unit outside her door churned in utter chaos.
I did go back into the fray with my team.
I just needed five minutes of bliss,
snow,
and uninterrupted,
uncorrupted
happiness..
Even if it all was pretend.
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