I take the people who have nowhere else to go. My patients are those who exhibit what is known as BPSD – behavioral and psychological symptoms of dementia. They aren’t the “pleasantly confused” folks whom everyone loves. They’re the hitters, the spitters, the kickers, and the screamers. They’re the wanderers, the accusers, the punchers, and the shoppers. They throw food, smear excrement, and pee in the fireplace. They’re all mine – they literally have nowhere else to go. Some of my patients have failed a dozen or more placements at other facilities.

This week’s best intake – a 70-yo, hard-of-hearing, schizophrenic, alcoholic woman in stage 3 alcohol withdrawal. She was basically an after-hours drive-by-drop-off from the ER. The hospital’s Discharge Planner still hasn’t faxed me her orders. Her kids said they would be by the next morning to handle the paperwork.

“THOSE AREN’T BUGS, THEY’RE DEVIL BIRDS!”

“Berty, there aren’t any bugs or birds in your room.”

“I SAID THEY’RE ALL OVER MY WALLS! WHACK ‘EM! WHACK ‘EM!”

“Berty, there isn’t anything here that is going to hurt you. I’m here to keep you safe.”

“I’M NOT TALKING TO YOU! SHUT UP! I CAN’T HEAR THE NURSE WHEN YOU’RE YELLING LIKE THAT!”

She was having a very loud argument with the voices in her head about what was or wasn’t climbing the walls of her room. It was a lot like listening to Gilbert Gottfried on acid – for three. Fscking. Hours. Not a single one of my Resident Assistants would even come into her room until she exhausted herself (and until I had enough PRNs in her to quiet the voices).

It’s lonely at the top.

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