Friday, June 12, 2009

Dealings with the mentally ill. . . .

A patient gets transfered from an outlying hosptial at her request. In report I learn that she is refusing to eat, take medication, answer any questions or even be touched. She will not allow that hospital to treat her at all. She has been inpaitent there for at least a week.

She arrives to her assigned room, I go to greet her with a smiling face hoping she is more happy now that she is in our hospital. After all this is what she wanted. She has a very badly infected surgical wound that I was sure was going to require and I&D. I go through the whole admission process and as I am walking out of the room to go check orders and call our docs to let them know she is here, she informs me that someone has stollen her wallet. She was sure she had it with her when she got here. It only contained her insurance card, pacemaker card and driver's license. So I search her belongings looking for it. It is not there. I called the other hospital, they don't have it, I call the ambulance company and of course since it is after midnight I have to leave a message.

Later, she calls me into her room to let me know that there are two men in a black car that keep circling the parking lot looking into room. I assured her there was no one outside her window. She didn't believe me, she becomes hysterical. I continued to tell her this was not possible as we are on the 6th floor and there is no way possible a car could be driving by her window. I close the curtains and this satisfies her for the time being. The docs have not seen her yet, so I have no orders and no meds to give her to help calm her down.

Later, I am trying to start an IV and her arms are all bruised up. She has terrible veins and after 2 attempts I am unable to get the IV. I apologized and told her that with all the bruising it looked as if they had already used up all the good IV places. She looked at me with angry eyes and said, "If you had been held down by 5 people why they were trying to kill you, you would look like this too. I just knew if I didn't get out of there tonight I would have been dead by morning." I told her I was sorry, she had had such a rough time and we would see what we could do to get her IV started and get her medications going. Another nurse tried and again, no success.

Later, another nurse comes into her room to answer her call light. She proceeds to tell that nurse that her wallet was laying on the table. She said, "that nurse (referring to me) took it and put it there trying to hide it from her." What she was actually seeing was an eraser for the dry erase boards in the rooms. The nurse tried to tell her that wasn't her wallet but she didn't believe her. She actually showed her the eraser and she still didn't believe her. So at this point in the night I became a theif and took her wallet.

I was so upset that my co-workers found out about my secret wish. I had always wanted someone elses pacemaker card. I didn't want anyone to know that I was collecting them and wallpapering my guest room with them. (Please read the sarcasm in this) Really? Why would I want her wallet???

As I was leaving my shift, she was standing in the hallway with her walker. I asked her if she needed something, since she really shouldn't be up walking in her condition. She looked at me and said, "I want to go home!" I told her that she was going to be seeing the doctor today and they were going to take care of her infection. She then looked at me with very angry eyes and said, "How could you treat your mother this way? I have always been good to you and you have no respect for me!" Another nurse was approaching slowly to help me when I told this lady, "I am not your daughter, I am (my name) and I have been your nurse all night. You are at (hospital name) with an infection and are scheduled for surgery today to fix it. Let's go back into your room and we can talk about this." She then said to me, "You and your mother are trying to kill me and are going to put me in the furnace. I heard you talking about it and I am not going to let that happen!" I then looked at the nurse that came to help and told her I thought it would be easier without me. The other nurse was able to get her into her room. I just thought since she was thinking I was someone who was going to hurt her it was probably making her worse for me to even be there.

I went to tell the nurse I had reported off to about this incident, and immediately she said, "I don't have time for this today! If she wants to leave then fine! She can go AMA!" She then called the charge nurse and told her she had a patient that wanted to go AMA and wanted us to call a taxi for her.

I was so not believing my ears!!! That patient NEVER said all of that. And besides she was OBVIOUSLY mentally ill. She had a horrible infection, had not had any medications because she was NPO for surgery and had been having hallucinations through the night. Was she seriously telling the charge nurse to just let this person go???

What are our responsibilities as nurses for taking care of people? She was not really ok at that moment. She needed medication! She needed that infection taken care of before it went systemic! And this nurse was just going to blow her off because she didn't want to deal with her?

Sounds like someone needs a vacation! So I come home and worry about this patient all day. Did she end up leaving or did she go to surgery. Did someone get a psych eval? Did she finally get some medication that would bring her back to reality?
Will I ever know if she was ok or not?

This is the part of nursing I hate. I take care of you one night and then I may never know what happens to you after that.

God, please bring peace to this ladies mind. Please help the staff be patient and tolerant. Please give the doctors the compassion to treat her as a whole person and pull in the extra disciplines needed to treat ALL of her! And. . . . keep her save as she recovers.



  1. Oh that leaves my heart hurting for her. Was she not one of those demented people that you could have just taken the "journey" with?
    You know, on her "stories"?

    And about that nurse. . . sounds like she needs more than a vacation! Maybe she should work in a computer lab so she doesn't have to have a heart to take care of old confused people. . . that really makes me sad!

  2. She was not demented. She was probably barely in her 60's. I am sure she had a psych diagnosis, just not sure which one. She didn't have a line, and was NPO, we couldn't give her any meds. What she needed was a doctor that would order an IM or something to calm her down some and let her rest. She had been awake for more than 24 hours.
    Yes, that nurse really made me angry! She was lacking in the compassion department.

  3. Wow, again excellent nursing on your part...reorienting her and having patience with her. Sounds like her new nurse was more confused than the patient about her role and how to be a good nurse...It is hard not to worry about them when we leave especially if their new nurse is less than kind...

  4. My heart hurts for her, too. AND, ummm, when I am a RN, I can already tell you that I am sure I will be praying the serenity prayer 20 times/day so that I don't lose my kewl on cold nurses like the one who didn't want to be bothered with this patient.