Wednesday, August 24, 2011

Sundown Talk-down

"Can you please help me?" A nurse looked frazzled, "I have an old lady sundown-ing in room 12. She's pulled her IV out."

"Sure," It was the end of my shift, but I still hurried into the room to see little Mrs. Hallucinating sitting with her legs hanging over the railings.

She had undressed herself, sitting on a half-undone diaper, and thrown all her bloody bedding on the ground. Staring at it, she was exclaiming, "look at all that blood!"

S: "That sure is a lot of blood, Ms. H. Let me take a look at your arm."
Mrs. H: "It's not MY blood- I was watching it appear all of a sudden from that wall over there. I'm sure glad it's not mine. It's an awful lot!" She tried to snatch her arm away.
S: "Oh look, you got it all over you. Let me clean some of it off!" She acquiesced to my cleaning motions. Meanwhile, I held pressure over the bleeding vein until it stopped.
Mrs. H: "Well I'm in no hurry- I'm waiting here for the vets to get back."
Nurse: "The vets? You mean veterans?"
S: (I cut in) "Where do you think you are, Mrs. H.?"
Mrs. H: "I'm at the vet's. I'm waiting for the dogs."
Nurse: "What dogs?"
Mrs. H looked very confused.
S: "Do you have dogs, Mrs. H?"
Mrs. H: "No, I don't have any dogs. But you do, right there." She pointed at the wall.
Nurse: "There are no dogs here..."
The nurse and I exchanged looks.
Mrs. H: "There are two!"
Nurse 2: "I don't have dogs, I'm a cat person."
S (under breath): "Though we have dogs in the center hallway right now..." Referring to the 8 rowdy drunks in the makeshift drunk tank.

Meanwhile, Mrs. H. is struggling against us as we are trying to clean her. The nurses were exasperated. It was time to distract her, as terrible that it is, so we could get her situated.
S: "Mrs. H., are you English?"
Mrs. H: "No. I married an Englishman, but I am German."
S: "Oh, that's nice."
Mrs. H: "Yes, it is, isn't it?"
S: "Absolutely, can I see your arm so I can wipe it with this wet towel?"
Mrs. H: "You don't have to bother."
S: "Oh, but wouldn't it be nice to be cleaned up?" She let me take her arm.
Mrs. H, accepting: "I suppose it would be." She looked into my face and as I smiled, she smiled back and I took the opportunity to slip her hands through the sleeves of a new hospital gown. At least now she was dressed.

We had similar struggles with trying to get her diaper off, trying to stuff her legs back through the bars, and to replace the sheet she had soiled. Each time, I would distract her, then as a group effort, we'd sweep the sheets/diapers/cleaning pads under her. At first, she resisted lying down, but then I convinced her she must be tired (it was past midnight), at which suggestion, she laid back comfortably and stopped trying to climb on the "staircase" she apparently saw protruding from our blank wall. Then she did not want me to tuck her in a blanket, so I talked her into allowing me to make her comfortable and snug.

I stuck around for a little while, trying to keep her calm, because she would speak normally, then warn me about the bedbugs crawling all over the sheets, at which point, she would spring up and try to pick at them with her fingers.

Because the present was confusing and distracting for her, I tried to keep her in the distant past, where she told me about her parents, siblings, and husband. Using the ring on her finger as a prop, I would ask her to tell me the story behind the ring, and she would be distracted long enough not to rip out the second IV she discovered on her forearm.

Twenty minutes after I was supposed to leave, I mentioned how late it was and asked whether she was tired.
Mrs. H: "You young girls are just so sweet. I think I will take a wink right now, if you don't mind."
S: "Not at all, Mrs. H. Sleep well!"
Mrs. H: "All right, I will turn in, then."

She pulled the covers up to her chin. I quickly changed out of my scrubs and passing the hallway on my way out the door, looked in to see Mrs. H. being chastised by another tech for trying to climb out of the bed. Oh Mrs. H... I hope they don't tie you to the bed upstairs.
Though she is active and confused, she is also quite manageable and sweet. I hope I can be half as spry when I'm in my 90's...

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