If you can't beat 'em, join 'em

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I have had so many confused patients in the last few weeks that I think I should either audit a psychiatry course, or see a psychiatrist.
I love explaining things to patients to help them understand what is going on, but this skill kind-of peters out in usefulness if their reality is distorted in some way.
I had a patient claim he was in a Nazi death camp, and asked when he was going to die.
I had a patient tell me she was in prison and her daughter had been arrested, and then further complicated things by believing me to be her granddaughter.
I had a patient who claimed, when I couldn't understand the context of his comments, that I must have hit my head coming into his room.
I had a patient who had been talking for 30 hours straight on promoting a work safety environment, and couldn't be dissuaded from either changing topic or pausing just long enough for me to listen to his lungs.
I had a patient that called me into his room to ask me which button on the TV remote/nurse call light would charge him $75 each time he pushed it (none of them, by the way).

I explained that we didn't hand out death sentences.
I explained that we were in a hospital, and I was the nurse.
I explained that I did not have any head injuries.
I explained that everybody needs sleep at some point.
I explained that nurses don't charge by the number of call lights that go off.

The only time the explaining did anything productive was with the death camp guy, and that's because he wasn't actually confused, but rather really REALLY anxious.

So as I ended one of my shifts holding the hand of the lady 'in prison', reassuring her that I was still there, I gave up reminding her that I was her nurse, not her granddaughter. I just reassured her that I was really me, wondering if she would remember this experience, and wondering how to shift the feedback loop of constant caring from frustration to healing.

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