83 year old man admitted with change in mental status. Sweet as pie, but confused and forgetful. Makes multiple attempts throughout the night to get out of bed by himself, setting off the bed exit alarm and prompting me to rush into the room, settle him back in bed, speak softly to him and remind him that he needs to call for help if he wants to get out of bed. "Thank you for all the work you do, sweetheart", he says to me. "It's no trouble at all. Try to get some good rest tonight", I reply.
83 year old man admitted with change in mental status. Obnoxious, but confused and forgetful. Makes multiple attempts throughout the night to get ouf of bed by himself, setting off the bed exit alam and prompting me to rush into the room, settle him back in bed, speak softly to him and remind him that he needs to call for help if he wants to get out of bed. "You're a downright witch, what's that in your pocket, did your parents leave you out in the cold?" he demands loudly of me, reaching his unwashed hands into my scrub pocket to grope for the pens, saline flushes and scissors there. "Get your hands out of my pocket! That is very rude!", I reply.
Where did that sweet, though slightly confused old man go? DID YOU EAT HIM?!?
62 year old man admitted with pneumonia. Homeless, absolutely filthy even after multiple intense scrubbings by staff, positive urine drug screen for opiates, elevated blood alcohol level upon admission. The first night I cared for him as a new admission, I walked into the room to find feces all. over. everything. Walls, floor, commode, bed, bedrails, patient... everything. I patiently clean him up, he yells at me for bothering him, I firmly tell him that he has poop all over himself, and that part of being healthy is being clean and I simply cannot let him lie in that mess. He concedes. Refuses his meds. Goes to sleep.
The second night I have him, I receive in report that he was pleasant, calm, cooperative, agreeable to the treatment plan, taking all of his meds and resting comfortably. I breathe a sigh of relief, happy to hear that his attitude about his healthcare seems to have changed.
I enter the room and find that he is refusing all assessments, all care, vital signs, meds, EVERYTHING. He would not even permit me to take his temperature. Uses explitives to get his point across. Is completely disinterested in the fact that our nursing staff pooled money together and bought him new, clean clothes (to replace the ones saturated with urine and feces... including IN THE POCKETS... the smell of which made a seasoned nurse vomit when she handled them). Yells until I finally leave the room.
Sometimes, I can have seven patients, and it honestly feels like I'm caring for fourteen of them. Holy hell. I need some sleep.
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