One of us is crazy

I had a patient for two consecutive days. The first day, he seemed pretty normal. The second day, though, I was in another patient's room when my nursing assistant came up to me and said I was needed in his (the person of interest) room. When I  went into the hallway, I could hear him yelling for his wife, cussing out the doctor, and complaining of abuse. I apprehensively entered his room, and asked what he would like help with. He started complaining about how his wife was controlling his life, and not letting him finish breakfast, and withholding his phone. When I talked to the wife, this list of complaints focused into a clearer story: his daughter was going to drive him home in her car, and he wanted to smoke, but she didn't want her car to smell like smoke.  He promised that he would smoke 50ft away, but I pointed out that HE would still smell like smoke. He told me that he was old enough to make his own decisions. This amused me, because while he was pointing fingers at other people for the blame, and yelling about the unfairness of life, and wearing a diaper and needing help eating and missing teeth...he reminded me of a toddler. He refused nicotine patches, and I don't think he was thrilled with our suggestion of electronic cigarettes either. AHHHHHHHHH. He went home, and I hope all goes well.

I've had confused patients before, but now I've discovered it's worse when they aren't confused and are hallucinating. They are so much more resistant to nursing care. My 80 year old patient knew her name, knew where she was, knew when it was, but was POSITIVE that I was trying to kill her. She was sure every time I went in her room to do something (give medicine, take vital signs, clean her neck wound) that I was going to stick something up her butt. As "butt" never came into the conversation, I'm not sure where she got this idea. When I had to give her a heparin shot, I carefully called it a "poke", and distracted her while I stuck the needle in her stomach. I hid her pills in pudding. That didn't work so well, since she spat them out, but her sisters managed to convince her to swallow them. I think that traumatized her, because she refused to eat or drink anything else for the rest of the day because she was convinced we were poisoning her. She became convinced that her sisters were not her real sisters, possibly because everyone who went into her room had to wear yellow isolation gowns because of her wound infection. Whenever I entered the room, she told me to "GET OUT" in quite a firm schoolteacher manner. I took to peaking around the door, and she still didn't like that. So I took to watching her feet, and telling myself that if they moved, I would run in there and see what she was doing. That never happened. She never moved, even when her favorite doctor tried to get her to a chair. It was strange. We'd explain what we were doing, and why we were doing it, and mostly she'd agree. But then when we started doing what we told her we would do, she became paralyzed and resistant. I believe she was mostly scared. She was legally blind, and hard of hearing, and in an unfamiliar setting. But mostly I was thinking how difficult it was to do my job if she wasn't letting me do any of it. My favorite part of the day was when she started recruiting God to her side. I was trying to give her a blood pressure pill, since her blood pressure was quite high. I told her that she could take it by mouth, or I could give it to her IV, but either way, she was getting this medicine. I think that was a wrong move; I think it backed her into a corner, because she closed her eyes and said "Please, God, take her away." Or when we (by which I mean 3 nurses, because it took that many, and we could have used more) tried to insert a Foley catheter, and she started pushing back at one of the nurses. The nurse said that she was not allowed to hit, she did not have that right. The lady responded, "No, but God does." I reminded her that she wasn't God.