Friday, July 29, 2011

There's a Little OCD in All of Us

"Um... Um, nurse... I think I'm going to try again."
Mr. Antsy Pantsy looked so forlorn, disheveled, with worry etched in every line of his face.

"S, are you busy? Can you walk this gentleman to the bathroom?" the nurse asked.
"Sure, why couldn't he go before, just so I know?" I asked, looking over at the twitchy man.

Mr. Pantsy: "Um, excuse me. Did you want me to go in the cup? Because I just... can't. I can't. I can't. It's hard. I think the bottom of the cup touched the sink... do you think that makes a difference? It got dirty! It's too small. I just can't. Just can't."
S.(to the nurse, a knowing look): "Well, sir, how about this urinal? Do you think it would work better?"
Mr. Pantsy: "Well, I don't know. I don't think I can go. It is too much pressure."
S: "No pressure at all, sir, if you'll just walk with me..."
Mr. Pantsy: "I can't. I can't. You know, I don't think I can do this..." Nurse gives me an exasperated look. I try again, by walking forward. Mr. Pantsy follows reluctantly.
Mr. Pantsy: "I feel dizzy."
"Do you want me to hold your hand?" I grasped his cold little hand. He was shaking. "Your fingers are cold!"
Mr. Pantsy: "They're always cold. I don't know if I want to go back to the home."
S: "Why not?"
Mr. Pantsy: "Last night, the temperature wasn't set right. It was too hot. I kept thinking about it all night. I couldn't sleep much. I mean I did, but it wasn't good. I want my temperature to be lower. Oh God, I can't do this."
S: "Ok, sir, this is the bathroom, the urinal is right here."
Mr. Pantsy: "Can you put that right there? No, just there. Ok. I really can't do this. This is so stressful. I can't, I just can't."
S: "Please try, Mr. Pantsy, it would be really great if we could get a sample for the lab."
Another tech walks by, shuts the door, yells through it, "Just do it!", then says to me "I've had him before. He's always like this. In a few minutes, you'll hear a knock on the door and he'll say he can't do it. He can't help it, and it's sad, but it's a pain in the neck to deal with."

After standing outside the door for about 15 minutes, I got worried and knocked on the door. Are you ok in there??
"Yes, almost done. Can you come in?"
Mr. Pantsy was standing by the sink, staring at it.
"Mr. Pantsy, what's wrong?"
"I don't like water that's too hot or cold. My hands are always cold."
I turned on the tap and felt the water. It was cool. "What do you think, Mr. Pantsy?"
"It's cold! I want it lukewarm."
I turned the tap a little warmer. "How's that?"
"A little colder."
Third time was the charm. He began washing his hands. Looking fretfully at the soap dispenser, he gingerly pushed the button and a small dollop of soap went into his hand. He examined it closely and held it up to me, "is this enough?"
"I think it's just right, Mr. Pantsy"
"No, it is too much! Too much!" He began scrubbing his hands over and over. "I can't get it off!"
(about four minutes later, still watching him scrub) "I think you've washed all of it off."
"No, no! I haven't. It's still on my hands!"
"Sometimes, when your hands are clean, they feel slippery in the water..."
Finally, he turned the tap off and stared at the paper towel dispenser. "I don't want to touch it."
I moved the lever so he could take a towel and he ripped it out in a very ritualized way. "Did I do it right?? I have OCD, you know. By the way, I need two more towels." I obliged and pulled the lever again, twice.
"You did it just fine, Mr. Pantsy. Let's go and I will send this sample out to the lab."
"Wait," he looked down at his pants where some water had splashed, "I got soap on my pants!! Oh noooo."
"I think that's just water, Mr. Pantsy."
"No, I think it's soap! What do I do now? Oh God, I need to take them off and scrub them."
"That's really just water, Mr. Pantsy, I watched you splash it there."
"How could it be water? It's soap! I need to wash it off!"
"Mr. Pantsy, really, it's going to be ok. The water will dry and you won't see it."
He considered this and walked toward me, beckoning him out of the bathroom.
"Wait. I don't think my hands are clean. I'm going to wash them again."
And he rushed back to the sink and we repeated the ritual. He tried to wash his hands a third time, but he very reluctantly let me talk him out of it. I would have indulged him, judging how upset he got, but I had other patients to see!

Mr. Pantsy managed to get a sandwich and a ginger ale during the course of the night. The sitter who was watching him needed to go on a dinner break, so I sat with Mr. Pantsy for almost an hour. During the course of eating, he rubbed the bottom of the can of ginger ale. "I have to check for spikes every time I drink it," he explained. When he set his ginger ale down, three drops sprayed on him. It was barely noticeable to us, but a horrifying experience for him.
"I need a towel right now."
"For those three drops, Mr. Pantsy?"
"I need a wet towel! I need to clean this off!"
"Mr. Pantsy, I'm sitting with 3 people, I can't leave this area."
Another tech walked by at this moment and wet a towel for him.
"It's warm!!!" wailed Mr. Pantsy, startling the other tech, who mumbled something about ungratefulness and did not come back. "Can you get me a towel with cold water?? I can't use this. Take it away from me."
"Sorry, Mr. Pantsy, I really can't leave this area..." I said. "Maybe if you waited a few minutes, the towel will get cold..."
Mr. Pantsy looked crestfallen. He placed the towel gingerly next to him and burst into loud sobs.
"Mr. Pantsy, don't cry... Look, the doctor is coming to talk to you."

Mr. Pantsy was becoming increasingly agitated and began to pace around the hospital floor, ignoring any entreaties to sit down unless it was a specific, barked order with a sharp tone. He was miserable- so much so that the doctor ordered a tranquilizer cocktail to calm him down. With his discharge papers in hand, Mr. Pantsy declared he couldn't do anything with the paper and wanted me to take it from him because he couldn't read it without his glasses. He didn't like the idea that he could carry it back with him or put it in his pocket. He kept trying to hand it to me, so I instructed him to put it down next to him (and the towel). He couldn't help himself, though, and kept picking it up to try to read, then hand off to a person walking by.

Disturbingly, I understood him. I felt terrible for him, because I feel like I have been in the same paralysis and looped thinking at times. An hour after he was discharged, I saw him in the ambulance bay again.
"You're joking," I said to the ambulance drivers.
"Nope," they replied. He's back.

Thankfully, it was the end of my shift.

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