Friday, March 04, 2011

Visibilium Omnium et Invisibilium

When I first saw her she was tied to the bed. Wrist restraints and a posey vest. We can do that here in Arizona. In New York, "double restraints" are illegal. Even closing the patient's door is considered to be a restraint. When I lived and worked there, the doors to patient's room were always open unless a clean procedure was underway, such as peritoneal dialysis, and you didn't want someone to enter and waft germs through the air.

At one time she was a respectable cardiologist but her mind had been eaten away by Alzheimer's disease. She apparently had been pulling at her Foley catheter, and the bag of urine dangling from the frame of her hospital bed was wine-dark red. Not all that an unusual occurrence. Confused patients pull their catheters all the time. They also pull out intravenous lines, nasogastric tubes, and whatever else they can get their hands on. It's only natural. But it can make treatment impossible, so god said "Let their be restraints! Tie unto them their wrists of fury! Hedge their catapulting torsos with vests of strong fibers!" and his merciful angels did apply them abundantly.

She had devoted family members. I always undo restraints when family members are at the bedside. They can come tell me if the patient is pulling out something.

I had a day off and when I returned to work the patient was still there, but I was not assigned to her. Her room was just across the hall from the medication room, and yesterday morning when I was going to fetch some nasty poisonous very expensive drug to administer to some poor sick bastard who probably wouldn't live without it and who couldn't afford it if he had to pay for it himself (he was an engineer,) I saw one of the Alzheimer's woman's daughters go into her room.

"You've got to cut that shit out," I heard her say to her mother. "You can't pull on that anymore. That shit's over."


I was going to speak to her nurse about it. But I was busy as all hell and I never had time to do so. I hit the floor running at 6:30 a.m. yesterday, took a 15-minute lunch at 3 p.m., and finished up my charting at 9:30 last night. I got my ass kicked.

Besides, the woman *did* stop pulling her lines. The physical therapists had her up in a chair and later walking in the halls. She was smiling that unknowing but happy Alzheimer's smile; you know, the "Reagan smile." Clueless and empty-headed, but genuinely happy about the way things were happening for them.

She went home before the shift ended. Content in her own bed, unrestrained except by her own plaque-ridden brain, home. While I was still typing up notes trying to remember all that I did for my own patients that day.

I was so busy I had forgotten to hang an IV mini-bag of Magnesium on one of my patients, and I apologized profusely to the oncoming nurse. She told me to relax and that she'd take care of it, and she called Pharmacy for the dose.

As I was waiting at the elevator to finally leave, she came up to me and said "Shrimp, you *did* give that Mag. You signed it off at 1 o'clock. I don't have to give it."

I didn't remember doing it. Not a clue. Just an empty spot.

Finally I got home at 10 p.m. You know what I did?



WinnyNinny PooPoo said...

My grandmother who had Alzheimers didn't recognize her husband of 60 some years when he died. She was 16, so who was that old man? She knew she was attached emotionally but she didn't know why. She could still sing all the verses to Amazing Grace long past all the time when the squirrels became dogs and she forgot how to use a fork. It is a very sad disease.

Anonymous said...

Somehow the spiritual essence of the person survives even when the mind is eaten away. I watched the disease progress in a relative and, even when the dementia was so advanced that she was unable to speak, it was the same person.

I sometimes wonder whether dementia is, in part, a decision. People who live long often have reason to forget. The people they knew the best are gone. They may suffer pain. Most people's lives are not easy, and there are many bad memories.

So, me, I try to remember it all. I have started to compile a list of the names of every person I can recall. And I try to remember it all, even the really bad stuff.

Don't work too hard, shrimpie.

Anonymous said...

The above is Charles of the Phoenixwoman blog, just to be clear.

Anonymous said...


Where are the owls?