We’ll make a fortune …

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I’m bending down to retie the shoe of one of my residents after breakfast. As I do so, she starts stroking my hair.

“Nurse Dux, you have such beautiful hair!”

“Thanks, Ella, that’s nice of you to say so.”

“It’s so soft … it’s very shiny … Oh! … We could sell it!”

o.O

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Probed by aliens …

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I had arrived early for my day shift to cover the emergency exit of another RN. One of my assigned patients was Dotty, a late PM shift admit, a 93-yo who fell at her home in a retirement community and broke her hip. She was scheduled for the OR sometime that day, but even unfixed she wasn’t in too much discomfort. I had looked over her PMH and saw that she was a relatively healthy woman for her age, was somewhat HOH, and was only beginning to exhibit some very mild cognitive deficits.

I was in her room about 0545 quietly changing an IV bag before she awoke, when the door opened and three medical residents came in. One of them greeted her by her first name, asked how she was doing (“I’m FINE!”), and then proceeded to tell her that they would be sending her for an MRI and a bone scan, running a CBC, a Chem-10, and some other labs, and making a decision as to what surgery she would need before scheduling her for a possible THA or IM-nailing sometime during the day. They told her that she would be held NPO but that Nurse Dux would make sure she was comfortable while she waited.

The resident (a 5th year) asked her if she had any questions (“I’m FINE!”), then said he’d see her later after surgery and they all exited. All I could see of her as they left was a pair of enormous eyeballs peeking over the blanket. Since she was now wide awake, I asked her how she was feeling and told her I would be taking her vitals. I was completely startled by her next comment.

“Did you see them too?”

“The residents? Yes, Dotty, I was right here next to you.”

“No, the ALIENS! They were right here in this room! Did you see them?”

Needless to say, I was startled. Believing I might be witnessing hallucinations and the onset of delirium, I asked her, “Dotty, are you telling me you you’re seeing things?”

She looked right at me. “You must have seen them! There were three of them. They were really tall, really green, and they were speaking some space language I couldn’t understand. Will they be back? You won’t let them probe me, will you?”

Resisting the urge to laugh out loud, I just smiled, and sat down at Dotty’s bedside. I held her hand while I explained what had just happened. The “tall green aliens” were three of our Orthopedic residents on their morning rounds. All three are over six-feet tall, and they were dressed in green surgical scrubs and hats. When they came into the room they didn’t turn on the light because the hall light illuminated her just fine—but left them backlit at the doorway. Scott, the 5th year BMOC, didn’t introduce himself or the others, and peppered her with rapid doc-speak – which she couldn’t understand at all.

They got no usable information from her, conveyed no understandable information to her, and had no idea that they had just frightened the bejesus out of this sweet elderly lady. They could have done many things differently – turning on the lights, introducing themselves, sitting down, making sure she had her hearing aids in and her glasses on, making sure she was awake and not in pain, and so on. But that’s not what medical residents are taught to do by attendings, and it would be years before they learned it on their own (the odds of them ever asking for guidance from an RN? slim to none …).

Dotty did settle down as I talked with her, but I sure didn’t fault her for her interpretation of the morning’s events. The pictures of those residents on the unit bulletin board now sport antenna and space helmets courtesy of this RN. I’ve been told that one of them thinks it’s disrespectful. Warms my cockles, it does.

Get me the alligator gun …

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I’m in need of a bigger alligator gun. I am up to my ass in them, and they think they’re winning.

I’m providing nursing care for 42 residents in a two-building, 60-bed facility. They are all here because they failed placements at other facilities for behavioural reasons. Lots of LTC facilities have “memory units,” and take demented old Granny as long as she can pay. But as soon as she starts screaming at the wallpaper, eating off of everyone’s plate but hers, delivering poop presents to staff, peeing in the fireplace, and getting naked before arts and crafts, they send her packing.

That’s where a facility like this comes in. It’s set up to safely house and care for the soon-to-be-homeless schizo seniors, the demented dodderers, the hitters, the kickers, the spitters, and the screamers. The youngest residents are in their 40s, the oldest in their 90s. Some have as many as 12 failed placements before they end up in a facility like this.

I spent the day wheedling med orders out of distant docs. I was polite when I told one doc that her wound care order was [barbaric] and 50 years behind the times. I shoveled one resident into a cab three times, only to have her exit out the other side three times. I finally had to send for a cab with lockable doors. My staff is uneducated, and although some have potential, some need to find other jobs. I have conversations that involve invisible refrigerators (it was in her stomach), “purple sixteens,” the people in the television [off] who tell them to not take their pills, poisoned food (the “twelve-inch people” do it), and missing hair. One resident called the police on me today when I wouldn’t get her a pregnancy test (“Polly, you’re 81 and you yell ‘whoop! whoop!’ every time you poop. I’m not thinking the guys around here are lining up outside your door at night to do the granny-hop with you”).

My first week in the new job as DON – 60+ hours – I spent defending the facility against a Statement of Deficiency from the state that ran 76 pages (it arrived Monday afternoon, my first day). Six IJs (immediate jeopardy tags), and 21 other nursing citations – the state closed one of their  buildings to new admissions. I had no idea that on my first day as DON I would go from the frying pan into the fire. I had to write a policy manual for the facility from scratch, and provide the nursing care for 42 psychiatric and advanced dementia patients (four of whom I discovered had pressure ulcers; there would be more).

At the end of two weeks, I was fried. The weekend came, and I tried to crawl inside a scotch bottle and hide. It didn’t work, Monday still found me.

Get ’em up, move ’em out …

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As a Med-Surg nurse, you take the assignments they give you. Some days you win, other days you resign yourself to being amused. Today’s line-up of patients, one any med-surg nurse would envy –

  • “Toga Boy,” a 20-yo who refuses to wear clothes, whose current girlfriend sleeps in his bed and spoon feeds him, and who has spent the last three weeks wrapped in nothing but a sheet.
  • “The Dripper,” a 34-yo woman sporting an insulin drip, IV parenteral feeding drip, IV fluids drip, and patient-controlled narcotic drip.
  • “Mr. Demento,” a seriously demented 80-something who spent last night mooing at the staff. Today he’s arguing with me about the “tall wooden Indian ladies” in his room who are playing with shotgun shells and shotshell boxes and who are going to blow their fingers off unless I stop them.
  • “Hoss,” a 57-yo Hispanic guy who fell off either a horse or a house, we’re not sure, because all he says over and over is “Fell off hoss! Si!”

Drive by …

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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.

I do not believe in the full moon effect …

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… but I have had to initiate two emergency detentions in the last two days.

Things I have learned as a Director of Nursing in a locked psych facility –

  • Patients never schedule their psychiatric crises during daylight working hours.
  • People who have normal jobs aren’t on a first name basis with the county mental health crisis center workers.
  • The top places on your cellphone speed dial should be assigned to folks who wear badges and arrive with lights and sirens.
  • If you can get to the facility before the news media does your life will be infinitely easier.
  • The corporate owners really don’t want to know that everyone’s safe – they just want to know how fast you can get a cost estimate on any damage.
  • It’s not polite to roll your eyes at nurses who tell you their day was horrible because they had to give an enema.
  • Kids who know how to cook dinner for themselves – and keep a plate warm for you, too – are worth their weight in haldol.

Caught in a landslide …

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… no escape from reality.

Every day, in every way, my life just keeps getting better and better. Being on 24/7 call as a Director of Nursing in a locked psych facility has its moments.

[It’s 1820, I’ve been home for five minutes, and Queen’s Bohemian Rhapsody – “Is this the real life? Is this just fantasy?” – sounds from my cell phone. Duty calls.]

“Hi, it’s Dux. Does whatever you’re calling about involve smoke, open flames, blood, or dead animals?”

“uhm, no.”

“Good. What do you need?”

“Julius has barricaded hisself in his room again. He won’t come out for meals, and he’s mad – every time we knock on his door he opens it and throws a cup of piss out on us! What are we supposed to do?”

o.0

“Stop knocking on his door.”

Some problems are easier to solve than others.

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