A Cast of Characters

No doubt you've noticed that patients are characters.  I have my favorites from over the years, like Hank,  an inpatient who went on to home care through an agency I worked for.  Patients are memorable for a variety of reasons, and are more likely to be remembered if they were somehow difficult to care for.  Hank was a head injury victim with altered mental status (AMS) and a persistent flat affect that made him very difficult to read.  Bunny, his devoted but high-strung wife, had depended on him for everything and tended to swoon every time it appeared he might not come home. 

In the months it took for Hank to recover from the head injury and subsequent surgeries, he progressed from being wildly confused through an episode of PE, to discharge home.  On the day we began to strongly suspect PE, Bunny demanded to know why Hank was having a new series of tests.  My simple but clinically correct answer sent her immediately over the edge.  The dismaying idea that Hank was suddenly sicker  burned like wildfire across her mind toward the thought Hank Might Not Make It Now!  She immediately got on the phone to his doctor with a thousand queries and demands, and Doc  pretty promptly got back to the floor wanting to know what idiot told her Hank's actual condition! 

Bunny was an over-imaginative hysteric, incapable of remembering the simplest directions.    Hank under optimal conditions was no prize.  After being reprimanded for informing the patient's family as I had been taught to do in nursing school, I came to dread caring for the both of them.  One night I brought Hank's hs meds and found him in bed watching tv.  As usual, he glanced at me with utter disinterest and said, "The w'm'n w'n."  Hmm?  "The woman won," he repeated.  (What woman?  What now?  Good heavens; was he experiencing dementia?  Elevated ICP?  This would just be frosting on the medical cake.)  Suddenly and to my great relief I saw that he had been watching Billie Jean King beat Bobby Riggs 3 out of 3.  Saved.

Despite all, Hank did go home.  I never cared for him at home, but the nurse who did reported great success in implementing Hank's post-hospital regimen.  She convinced Bunny that really effective home care begins with a martini before getting started.  Once the wife was calm, Hank made excellent progress.

AMS is a condition a person has to get a feel for.  I once cared for a petite, elderly lady with terminal cancer during her long, final, hospital stay.  Her one pleasure was smoking, and back in the day we allowed patients to smoke in their rooms as long as no O2 was going; the right to keep & use smoking materials was one of the last privileges to be withdrawn, and as I recall a doctor's order was necessary to do it.  One evening she asked me if I knew what "they" were planning to do with her, but when I questioned her she clammed up.  I was concerned, but later her disorientation seemed to have dissipated and I took no further action.

Her roommate was a pleasant, alert woman who had just come back from knee surgery and was bedbound  with a hemovac in place.  That night was to be my last on the unit--my transfer to another floor had come through--and when I heard screams from far down the hall after lights out I first thought it to be a farewell prank of the night staff.  Nevertheless, on approach I found eerie shadows of firelight flickering in the doorway of a patient room.  I rushed in to find the terrified knee surgery patient screaming for rescue and the elderly woman watching as if observing from a balcony while a blanket blazed nearby on her overbed table.   I called a Code Red, and floor staff appeared with looks of astonishment.  We unlocked bed wheels and pulled the nearly frantic knee patient quickly out into the hall, where she reported her roommate had intentionally lit the blanket with a cigarette lighter. 

The rest was a blur.  I recall pulling the old lady's bed away from the fire, leaving the blazing blanket for fire responders, who were pounding up the stairwell.  I checked her bedding for sparks and then pulled her bed out into the hall.  I burned my hand on the metal side rail, although it was 45 minutes before I actually felt the pain. 

Fortunately it was a small fire, despite the great mass of responders present from all over the hospital.  The hospital was run by Grey Nuns and one of the sisters who responded had psychiatric experience.  It was she who learned that the patient who started the blaze did so because she believed the hospital was to be auctioned off  tomorrow and her along with it.  The source of her AMS was found to be metastases to the brain.  I never took the things patients say quite so lightly after that...