Monday, March 09, 2009

You just can't believe me

Awhile back at work, I had transferred one patient of mine to a different unit and picked up another at 11 PM, a frequent occurrence. My new patient was originally some distance away (it's a big care unit) so I had to move her to be side-by-side with my first patient. I introduced myself and explained why we were moving. She was pleasant and rather sleepy. While the patient care assistant and I rolled her bed down the hall, she nodded off. By report from the previous nurse, she hadn't been sleeping well so this was good for her. She didn't have any medications due and so after a quick physical assessment, I let her be to get her rest.

When I came back from lunch around 1:30 AM another nurse in my section was walking down the hallway to get me. My lady had woken up, shouted loudly for help, and then promptly dismissed two different nurses from her bedside.

"She's a little crazy," the nurse told me.

I went to her bedside and asked what was wrong. She requested that she be rolled out into the hallway and left alone. I replied that I couldn't do that, there would be no one to look after her. She retorted that she didn't need anyone and besides, we'd been ignoring her all night. Oh, and that there was "no way you people graduated from nursing school." OK, so we have confusion with an obstreperous streak mixed in.

I calmly explained that I was her nurse,

"See my badge here says RN and that we haven't been ignoring you. You've been asleep."

She snorted, "I have not been asleep. Now take me back downstairs."

Now I was confused, "M'am, you are downstairs."

"No I'm not. A doctor stood right there at the foot of my bed and said I was being moved upstairs."

"M'am that was me, not a doctor, and I said we were moving you to a different part of the unit. You'll leave the ICU and go upstairs to a regular room tomorrow."

She just wasn't buying that. I realized I'd already been doing it, but I cast my mind back to my psychiatric hospital days and broke out my mental health skills. Was she feeling anxious? "Don't try that with me." A different tack then, a distraction with an offer of a drink. "No, you'll put something in it." OK. Could I change the dressing over her surgical incision? "You're not touching me mister." Thinking it might be cause I'm a man, I offered to get a female nurse. "If they really are a nurse."

We went round and round, me trying to reassure and reorient her, she denying anything I said. After she refused to let me draw blood for ordered lab work (painless for her thanks to a catheter already inserted in an artery), I ended up calling her daughter and son. They said they'd come up and talk to her. When I went back to her bed, she was sound asleep again. The kids showed up a little later and talked her through all the nursing care we needed to do. We went outside for a little conference.

Nothing was explicitly said, but I got the feeling that their mom had always been strong-willed. They'd picked up the knowledge somewhere that morphine could cause confusion, especially in older folks. That's true, but she hadn't received any for a whole day. Could be lingering medication effects, could be not enough quality sleep, could be after effects of being on a heart bypass machine during surgery which can cause memory loss and confusion. They thanked me for my patience and headed off to a very early breakfast. I went back in to find her asleep again. Excellent.

About a hour later, after finishing up my other patient's bath and dressing change he said, "Thanks Doc."

As I always do, I corrected him, "Oh I'm not a doctor."

"Well," he said with a mischievous grin, "You're not really a nurse so..."

Funny guy. It was nice to break out the psych skills again, and thank goodness she didn't really get riled up and try to get out of bed or something. So it worked out all right.

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