An Hour in the Life

or, Crazy Person #982

Written in a darkened patient room:

Again, I am a psych nurse here in stepdown ICU. It's not my favorite thing, but I can do it adequately. At least...better than the day RN, who had to go into the bathroom to cry a few times with this same patient. I'm pretty sure I can make it without crying about it.

Lemme tell you about my night. It has been from the buddhist 'animal' hell. This is the one where you go about your business with continual blinders on your head and see nothing else around you. I don't remember which level of Dante's hell it would be. Whichever level where Mephistopheles shows you the people who are hitting their heads over and over again with a frying pan. And ...you know...where there's random eyeballs lolling about on the floor, staring at you. Maybe some entrails. And it is humid and smells like toes.

(your mileage may vary.)

I'm in my elderly patient's room, sitting in the corner while he is tied down in four-point restraints plus mitts, plus vest. He's adorable, actually. Trouble is, he keeps trying to rid himself of things that annoy him like his foley catheter, his leads, his IVs. He doesn't realize considerable pain and some degree of blood loss will follow if he does these things. When he's calm, I will retry untying him...feet first.

0315 HR 122. Hold on.

0335 HR 124. D#mmit, I just gave him some IVP's which should theoretically fix him and clearly did not. Hate when that happens. Flipped him, washed his face, cooed softly, checked all six of his restraints, taking them off to massage his feet and hands and reapplied them as he went to rip out his foley. He will never know to thank me for tying him up so he doesn't cause himself to pee blood. Nor will his family. They are not here.

0337 HR 127, bp 156/78 when his norm sbp is 110's. Well, scheiss. Let's try something else. Excuse me.

0350 Cool. 180/70 and 122. (That was sarcastic 'cool'.) Just gave the Clonidine. Now we wait. Now we coo and coddle and get that systolic down. When he looks at me... when he looks me in the eye, his whole demeanor changes. He softens and smiles and I'm just this nice girl and he forgets for a moment that I'm the same one who tied him up and he was trying to bite a little while ago.

This is a luxury to be able to write, despite the fact that I'm sitting 2 feet from my patient's bed in the dark, listening to his respirs, having an eyeball on his telemetry monitor to notice the ST c PVCs and watching to see what he's pulling at. He moves constantly. He is worse than a toddler. Because your toddler isn't going to stroke out with a systolic blood pressure of 180. There is really not much risk of ventricular tachycardia in a toddler.

0400 Pardon me. Must recheck bp, and I have to go hold his arm down and talk in my best Taming A Rabid Wildebeast Voice through the entire thing.

0404 169/66. Neat. Improvement. He tells me that there are six pickles in the pickle jar if I want any. I tell him thank you, but I don't like pickles. I don't mention that there's no pickle jar in his room. When I told him there was no kitty in the room earlier, he flipped out.

I am a stepdown nurse, not a psych nurse, so I perhaps should feel guilt over allowing the delusion. I am sure I am supposed to continually reorient the patient to what is real and what is hallucination. Ask me right now if I feel guilt for letting him have his pickle jar.

0406 HR 109...schweet, respirs 21.

0410 It might be safe to restart his fluids now that he's tied down so tight he cannot rip it out again. Well, 'cannot' is optimism because when there is a will there really is typically a way.

0415 Okay, that went well. Maybe we'll try the feet again this hour. Adopting Taming Rabid Wildebeast Voice again....

Welcome to my night. Actually, it's been nothing like this for the past eight hours for the simple fact that I am writing frivolousness just to get this out of my head. Just to remove it. Because I gotta just dump it, get it out.

Psych disorders are horrible. The truly mad are exhausting. Trying to keep them from hurting themselves...I mean, you can't let a little old elderly gentlemen get so bent outta shape with his anxiety that his systolic bp skyrockets. You cannot constantly take his hands away from his various tubing because you cannot be glued to an out of control person for twelve solid hours. It is not physically possible to sit on somebody for 12 hours solid to stop them from hurting themselves.

Well. Maybe it is, but I don't weigh that much.

We manage to keep our toddlers from their wriggles and wanting to touch hot stoves and the pretty ends of sparklers and stick their hands into grocery carts. I'm not saying that's not exhausting, I know it is. (I'm glad I only did it part time.) Usually the toddlers grow up into small people who are able to hold conversations. And they often spell and can learn that baby bumblebee song with you for long drives.

But when our parents get older and nuttier and it's no longer cute, do we know how to do this? I am not seein how we do this well. There's no guarantee that they'll grow out of it. If it's underlying dementia, it only builds to a catatonia (if that's a word) that brings guilty release for everyone.

This man has been awake for 48 hours so far, most of it going from one anxiety-driven hypertensive crisis to the next. I do not know where his adult children are. Maybe this particular brand of psych disorder has a strong enough genetic component that they, too, are lying, shaking, in a puddle of their own crazy.

I don't know.

I'm here for the night. He can't be left alone, even in full restraints.

He pauses every few minutes or so to look at me and smile, and call me sweetheart. I don't know who he thinks I am. But there's pickles in the jar, and a nice kitty running about.

On occasion, I just gotta dump it out. You know?