Incompetently Competent

One thing that frustrates many of my elderly patients is the idea that a time will come when they are deemed incompetent and unable to make their own medical decisions. 

This week I had one such patient but her situation had one major difference - she was perfectly competent. In nursing school, you learn the definitions of orientation in your patients - a perfectly lucid patient should know at least his or her name, date and time. In my facility, we ask if the patients understand their situation as well.

She was 93 and spent most of her life taking whatever various vitamins she took and for most of her life, she was very healthy and what she was doing worked out for her. But now, at age 93, she is sitting in a hospital bed and has been for several days. After refusing most of the recommended and prescribed medical treatment, the doctor covering her ordered a psychiatric consult.

In the three days I was her nurse, I spoke to her son several times. Our first conversation was where he told me she had been labeled incompetent and the decisions were now up to him, as he was her power of attorney. I had not gotten this piece of news in report from the night nurse but the patient was perfectly willing to tell me all about it. Repeatedly. Loudly.

Curious, I took a look at this note. What led the psychiatrist to this conclusion was firstly, that she was refusing all of her medications and treatment. Secondly, when he or she asked the patient about what the doctor said, all she would say was what she wanted and how everything she had been doing had been working her whole life and that nothing needed to change now. 

This woman wanted to go to rehab. Everyone in her family even remotely involved wanted her to go to rehab. Unfortunately, her blood pressure, even done manually, often registered in the 200's. All of the physical and occupational therapists on my unit take blood pressures before working with patients and they always call me when patients have blood pressures like that. Until the blood pressure is controlled, they won't work with them because they don't want to take the risk of causing a stroke. A rehab doctor deciding whether or not to admit her to a facility will have similar guidelines.

Over and over, we all heard about how her blood pressure has always been this high and that there is nothing that can be done about it. Furthermore, she was focused on getting a psychiatric re-evaluation to prove she was competent. But for her, the psychiatric consult was only relevant to her pride. The ultimate decision was rehab. The patient wanted rehab. The doctors recommended rehab. Her family wanted her to go to rehab. The exact decision she wanted would be made no matter who was officially making it. Honestly, it had already been made: the only thing holding her back was her refusal of medical treatment.

Some of her friends came in and wanted to provide the hospital with information about labile blood pressure that was supposedly supported by the American Heart Association (which may have been true and I would have been more than happy to read such studies) and to sue the hospital for deeming her incompetent.

I haven't had a very long career. I haven't seen everything. I like to think I've seen a lot of things but this is the first time I've seen a patient who is both competent and incompetent.

Last week, you demanded I find your NPO husband a shrimp sandwich.

This week, you have requested he be on the kosher diet.

Don't think I didn't notice the empty McDonald's containers ALL OVER THE ROOM! 

Wife of patient: You're Jewish and 27, why aren't you married? You should really try Saw You at Sinai. I know people who have gotten married, it's all rebbetzins who set you up. My friend Sharon has a son. Is 38 too old? He has a kid, how do you feel about that? I bet if he fell in love with you, he'd keep kosher!

...Oy vey.

I recently saw one of my patients at the eye doctor.

She smiled and winked at me.

I'm going to say she thought I did something right at some point.

This morning, my patient asked me which direction was east so that he could pray.

I love requests like that. It's hard to give a person everything that he or she wants when that person is a patient in your medical facility. Really hard.

So when something comes along that may seem like a small thing to me, I like to step back and realize it may not be such a small thing to that person. 

And after taking 30 seconds to think that, I took out my iPhone and opened up the compass.

10 ways to show love to someone with depression

Not everyone can be a nurse to everyone all the time but there are certainly times in our lives where we find ourselves with people we love who just need a little extra love and care thrown their way.

Here is a short piece with some small things you can do to make a big difference to someone struggling with depression.

We all need a little nursing every now and then.

"Are you married?"
"No, but one day, I hope."
"Do you have a boyfriend?"
"Yes, I do."
"I give you until July 4th to get married."
"I'm not sure he'll be ready by then."
"Have you ever heard of Sadie Hawkins?"
"Yes, why?"
"You should get a shotgun. He'll be ready if you have a shotgun."

I'm not that guy...

I work the night shift. Unfortunately, just because quiet hours are between 2200 and 0600, that does not mean that all of my patients are sleeping and completely stable.

That said, if and when problems arise, I have to call someone, namely the PA, NP or physician.

But sometimes the orders in the program are confusing. Sometimes the assignments have changed so many times that I don't immediately see the latest order.

Last night I accidentally paged the wrong person three times. I do genuinely feel bad when I do that, but it's an honest mistake. Being that I am a medical professional, that is clearly not the worst error I can make.

But if that's the case, at least have the decency to TELL ME I'M PAGING THE WRONG PERSON. I don't want to bother you if you're not covering but we also have the mutual responsibility to look out for our patients and if I spend a few hours paging the wrong person and you don't response, you're annoyed, I'm annoyed and the patient is sitting there wondering why nobody seems to care.

A Tangled Ball of Yarn

This morning I was knitting and one of the skeins of yarn I'm using is unraveling terribly. It's constantly getting into knots and of course the yarn is made up entirely of dark colors, making it difficult and time consuming to untangle. I said to myself, "This yarn is literally THE most annoying thing in my life right now."

But guess what? I'll give you a hint - it's not the most annoying thing in my life right now. Not even close. But what if it was? How cool would that be? Imagine if I just changed my outlook a little bit, an unruly skein of yarn really could be THE most annoying thing in my life.

So let's all take a step back and really look at everything that's going on around us. With a slight attitude adjustment, whatever your equivalent of an unruly skein of yarn is could really be the biggest problem you have. And if that's the case, that's an awesome problem to have!

Snow

I'm off until Sunday, having already worked three days in a row earlier this week.

I can't remember the last time I was able to just sit and watch the snow fall with nothing to worry about.

Here in Baltimore, the snow is collecting but it isn't nearly what my friends and family back in New Jersey and New York are expecting. I'm already seeing pictures of my friends and makeshift sleeping arrangements in their respective hospitals tonight.

To anyone out there who isn't able to make it home, thank you for doing what you do.