Monday, June 1, 2009

There Was An Old Lady. . .

There once was an old lady who swallowed a. . .

Oh wait that's the wrong story!

What I meant to say was. . .

There once was a semi-young lady who just wouldn't wake up.

Ok, so really. . .
There once was this 70'ish year old lady who had been fine all day long. I actually don't remember what she was initially admitted for but I do remember her vitals were fine, she was up walking around in her room all day and in good spirits. I had not needed to call any docs on her that shift. Nothing abnormal.

Nothing that is until after lunch. I went into her room and and she was taking a nap. At least I thought she was taking a nap. I needed to do an assessment and check her vitals so I tried to wake her. She wouldn't open her eyes and didn't move at all. She was still breathing but that was it. . no response to verbal stimuli, no response to gently shaking her arm, no response to me lifting her very limp arm and letting it fall to the bed, no response even to very hard nailbed pressure on her fingernails and toes. I proceeded to take her vitals as I called for another nurse for back up. Vitals were all normal.
I called the doc who just happen to be a few rooms down. He came and tried all the things I had already tried and still no response. He then called her by name and told her she needed to wake up or he was going to pinch her. Still nothing. He proceeded to pinch her right in that crease between your chest and your arm, right at the armpit area. Still nothing. He did a sternal rub and again. . . nothing!

He motioned for me to leave the room with him and go to the hall, which I did. That is when he told me he thought she was faking. He then told me what he was going to do. I tried to talk him out of it but he promised it would prove she was faking. He explained he was going to raise her arm above her face and then let go and let it drop. All I could say was, "Are you sure? What if it lands on her face and it breaks her nose? I don't have time for a bloody nose! How will you explain THAT to the family?" He assured me that would not happen, but IF it did, we would deal with it.
We go back into the room, all the while I am holding my breath. He talked to her, did another sternal rub, pinched her again, then proceeded to pick up her right arm and hold it over her face.
Then. . he let go. . . .

Sure enough it dropped and landed right on her CHEST!!!! He was my hero for the day. No bloody nose. She still did not open her eyes, or respond in any way.
I guess she had acted out quiet a bit the day before, which SOMEONE, forgot to tell me in report. They had already been trying to decide if she needed to be transported to med psych for evaluation. So he is on the phone at the nurses station trying to get a psych consult. I go into another room and do a few things to catch me up since this is starting to take a while. We meet back at the desk approx 5 minutes later. He tells me to just let her be and to turn the bed alarm on. Psych consult has been called and someone will see her that day. He is still charting in her chart while I go to turn on her bed alarm.

I get to her room and the door is closed. This struck me as odd, as I didn't remember closing her door. This is not common practice, especially with patients in her state. I slowly try to open the door but cannot. I then try to push the door a little harder but still it won't move. He sees what I am doing and comes to help. The door is definatley blocked by something. We both try to push the door, it moves a little and she screams. Immediately we both stop, not knowing what is on the other side of the door. Maybe she fell or something and opening the door this way could make it worse.

We called security because she is still screaming and they are going to help us get in the room safely. Security comes pretty quickly and they try to talk to her through the door. She screams back. They tell her to move away from the door. She doesn't. They push and slowly whatever is in front of the door is allowing them to get the door partially open. . . then all of the sudden the door moves much more easily. When we get into the room she is yelling and screaming at us to get away from her. He had put a very large chair in front of the door and was evidentially sitting in it. I knew this because there was large amounts of BM in the chair, and a trail from her bed to the door. It was terrible!!
Security tried to get her to stop screaming and just sit down so we could help her and get her cleaned up. I was so afraid she was going to fall, especially since she and the rest of us, had no other choice but to walk through the mess that was ALL OVER the floor. She picked up a smaller chair and threw it at the window. Thank God for multipane glass that just won't break. Especially since we were on the 6th floor! While security was trying to talk her down, another nurse and I changed the linen on her bed and tried to get the biggest part of the floor mess cleaned up.

Security eventually got her to the bed and this poor lady was placed in 4-way leather restraints, and given a nice dose of Haldol. It was definatly time for her to take a little nap while we decided what was causing this and how to get her moved as quickly as possible to med psych where she would be safer.

This was my first experience with a patient that was this combative. My first experience with security and my first experience with 4-way leathers! I HATED IT!!!

The Haldol lasted about 20 minutes. By the time I was pushing her (in her bed, still restrained) down the hall to the elevator to go to the 8th floor, she was again screaming at the top of her lungs!!

I hated this for this lady. Put me in 4-ways and I would scream too! I don't know what caused her to act out, nor do I know what ever happened to her after she got moved.

What I do know is that I learned I loved this doc that trusted his gut enough to know he wouldn't break her nose. I also know that I have not had to use 4-way leathers since that day and I am very thankful for that! I also know that at the end of my shift I cried because my heart broke for her. What could be tormenting her so bad? What could I have done differently? What did I miss? What ever happened to her?

What I also know is . . .

There once was a semi-young lady. . . .who faked being unresponsive. . .

Why did she fake being unresponsive?

I will never know!



  1. Hazards of the job. This is a tough situation, but we see it all the time, pseudoseizures and plenty of other stuff.

    Many times it's just attention and/or drug seeking. But some people have more serious issues.

    You handled this perfectly, and have a lot of compassion. You must be a very good nurse.

  2. WOW....she had some issues. . . and even after you knew she was faking. . . didn't become 'jaded' with her.
    You are so in the right place. . . not just your profession. . . it is truly your calling.
    Thanks for answering that call!