April 2, 2007, 11:47 am

Just This Side of Elderly

shoes

“Tender Tootsies”?

It sounds like Tootsie Rolls for the dentally impaired.

But no…

…someone thought it clever to market footwear to professional women (and men!) as “Tender Tootsies”!

Oh gee, aren’t they pwetty-wittle shoes?

Give me a freakin’ break.

I don’t care if she is wearing a cap, although just judging by that this has to be a mid-’70s ad.

Nurses don’t need tender tootsies, they need freakin’ hiking boots!

I’d go through that little flat thingy with the buckle (a buckle!) in two weeks.

Oh well.

I guess it beats “Masochistic Metatarsals”…

******************************

We have an emergency nurse practitioner in our department now! I’m not sure whether to be excited that we are using an advanced practice RN or to be sick because I’m probably old enough to be his mother.

******

She was just this side of elderly.

A strong, solid woman.

Demented, combative and in soft wrist restraints after trying to deck a paramedic.

Alzheimers had taken her mind. Other forces had taken her hearing and most of her sight. When left alone she would curl up in a fetal position in spite of the wrist restraints and moan softly.

The nursing home papers said she was calm and cooperative. Able to feed herself. Wheelchair mostly, but some use of a walker. Someone was making rounds at 0530 and the patient was slumped forward in the bed so 911 was called.

“Slumped forward in the bed” was the actual chief complaint given for calling 911. A follow up call came in from an administrator. When I repeated it to the medics, I had to help them lift their jaws off the counter.

The patient was always combative. Uncooperative. Barely ate. Bedridden. Nearly blind and totally deaf. The antithesis of what the medics had told us in report; the diametrical opposite of the report they had been given less than half an hour before.

Of course she was combative. She couldn’t understand what was happening, she couldn’t hear us and maybe, just maybe saw us as big blurry objects.

She was also febrile which meant a full septic workup. It wouldn’t be easy. She screamed every time the blood pressure cuff would cycle, a cascade of mild cursing, heavy thrashing and lashing out at anybody or anything – staff member or side rail, it didn’t matter.

How was I supposed to get through to someone who is so locked in, physically and mentally? How do you tell them, help them to calm down, to feel safe?

Something told me to just stroke her forehead. It took a few strokes before I saw any effect but she relaxed and her moaning lessened, the thrashing died down and she looked in my direction. I had a chance to do that twice, in between drawing labs and blood cultures before the change of shift, with the same result.

When I left, it was taking four staff members to hold the patient down for a straight cath. God only knows what was going on in her mind.

I hope someone remembered to stroke her forehead when it was over.

*****

He was just this side of elderly.

Huge man. Someone had dialed 911 and he was found in the wee hours of a weekend morning sleeping in a park bathroom during a torrential rainstorm.

Now who was hanging around a park bathroom in the wee hours of a weekend morning that would have found this guy and dialed 911? Never mind, I thought. You don’t want to know.

The medics brought him in because he wasn’t able to ambulate on scene.

The patient was disheveled. It looked like his life hadn’t been an easy one.

It wasn’t. He was an alcoholic whose blood alcohol level would have qualified as general anesthesia. He was also the nicest guy and the most polite man I had met in a while. Turns out his drug of choice was vodka and he dialed 911 himself for help.

Said he hadn’t eaten in awhile so we offered him our “gourmet” box lunch with a few extra juices per his request.

I was helping him set up his snack when I realized the pungent aroma in the room was that nausea-producing concoction of a body oozing ETOH from every pore combined with the layered odor of multiple urinations.

He wasn’t drenched from the rain. He was drenched head-to-toe in urine! We pulled off the wringing wet clothing and put him in a warm gown and a few dozen blankets. He ate and he slept. Soundly. We deemed it best that he sleep the rest of the shift in the ER.

How on earth were we going to send this man home? Nothing in our spare clothing “stash” would fit this giant of a man. We’re talking a guy who would make John Wayne look like Woody Allen.

I enlisted the help of the nurses in our psych unit. They had a washer and dryer. Usually they weren’t allowed to use them at night but yes, they would make an exception for our patient.

Our tech put gloves on her hands and went through every single pocket to make sure there was nothing that could be damaged in the washer. It’s a good thing she did. We found out our patient had a job, with insurance, a driver’s license with the address the patient was too intoxicated to remember. Keys, a cellphone, an address book and the odd bill with change.

We took the clothes to the mental health unit.

When the patient woke up about an hour later, I grabbed some vital signs and told him his clothes were being washed and would be ready by the end of the shift so that he would have dry clothes to go home in.

The nursing diagnosis? “Dignity, alteration in, secondary to substance abuse resulting in poor personal hygiene and incontinence”. (I made that one up, just in case you were wondering…)

The treatment: one meal, warm blankets, a non-judgmental group of smiling faces, a good night’s sleep and a set of clean clothes made possible by the collaboration of two nursing specialties.

It may need to be repeated, prn. It’s hard to say.

All I know is as he sobered up, my patient was just as nice and polite as when he was inebriated.

I just pray he gets a handle on his alcoholism before it’s too late.

It’s a tough road.

15 Comments

  • Cinder
    Cinder

    April 2, 2007 at 2:27 pm

    Impressive,humanistic care of these difficult pts.Love your nursing diagnosis and treatment.


  • may
    may

    April 2, 2007 at 7:59 pm

    losing your mind to something is sad…no matter what that something is. the sadder thing is, even if we see it everyday, it is not possible to get used to it 🙁


  • shadowfax
    shadowfax

    April 2, 2007 at 11:36 pm

    Man, our nurses will occasionally do that sort of hygiene service for the drunks. It’s absolutely incredible. I have respect for their ability to get in there and get dirty — truly the hardest job in the ER sometimes. Good for you.


  • Miriam Susong
    Miriam Susong

    April 3, 2007 at 7:47 am

    Greatly written. I only had a few as I was waiting for my daughter to pick me up. I am off of work for a month–the stress of too many patients and not enough nurses got to me–as a nurse for over twenty years. I could relate to your “stories” though…if only THEY were stories. Sincerely, Miriam


  • Funky Mango
    Funky Mango

    April 3, 2007 at 8:57 am

    One of the saddest things I’ve ever heard was in A&E (the name for the ER here in the UK) one time when I was in as a patient. In the next cubicle to mine an elderly, demented woman was being catheterised. She thought she was being raped. She screamed and sobbed for mercy.

    I wish someone like you had been there to stroke her forehead. Keep up the good work…


  • Mel
    Mel

    April 3, 2007 at 4:42 pm

    Actually, Kim, my mom had a pair of those Tender Tooties flats in the 70’s and she wore them 5 days a week for 5 years. The single most comfortable shoes she ever had for work, according to her. She got the flat ones because she was 5’11”, but those shoes had arch support that put my daughter’s $100 cross-country sneakers to shame.

    I love the way you care about and for your patients. Keep being you when you have that
    BSN.


  • Betsy
    Betsy

    April 3, 2007 at 6:31 pm

    The sad part is that sometimes even stroking their hair doesn’t help. That is the heartbreaking part. they have no idea what is going on, yet we are forced to torture them–as they see it anyway.


  • ditzydoctor
    ditzydoctor

    April 4, 2007 at 4:00 am

    oh wow that’s really really caring of you! many thanks for caring. it helps immensely to come online and read all these after enduring a long day in the hospital and wondering whether i’ve chosen the right profession after seeing so much callousness and arse-holery around. you make my day!


  • Lindsie
    Lindsie

    April 4, 2007 at 5:58 am

    Nice to see how despite the social differences there are still people who understand the humanistic commonality. Great stories! I really liked your nursing diagnosis–I’ve seen the same thing a couple of times myself.


  • Mom
    Mom

    April 5, 2007 at 10:32 pm

    good job Kim. Don Ryan knows more about you and your kids than I do. It seems he reads all your blogs even the old old ones. Love Mom


  • Onehealthpro
    Onehealthpro

    April 7, 2007 at 12:41 pm

    Thank you for you compassion. You never know how much kindness can mean to one who is hurting. I think too many people pass through our lives without ever being touched emotionally. If the heart is breaking, the rest of the human isn’t going to do well.
    Onehealthpro


  • Peggy
    Peggy

    April 8, 2007 at 3:13 pm

    I fell and broke my hip at age sixty-six. It was repaired, and after I got home I went online to discover why my bone broke; the surgeon said my bones are in great condition. While reading tens of medical abstracts on the subject I noticed frequent references to ‘the elderly’ (duh). But then, I noticed that people aged 60 and older, or 56 and older (!) were the ‘elderly’ being referred to! This came at a huge shock to me. For many years I’d considered that one becomes elderly only after the age of 75. Apparently not. Well, I’m now reconciled. Not much I can do about it if I weren’t. LOL


  • Peggy
    Peggy

    April 8, 2007 at 3:17 pm

    I would like to add that there is no greater comfort than the kindness of nurses as they go about their tremendous tasks and responsibilities. How they sustain such equability and gentleness day after day is a mystery to me, but I’m so grateful that they do.


  • Sue
    Sue

    April 8, 2007 at 7:38 pm

    That could have been my grandma you described, except that no one in either the ER or the floor to which she was admitted ever tried to communicate with her. Grandma was blind, but not deaf. Even when I was sitting next to her, nurses would come in silently and push and prod at her, turn her over (which frightened her considerably), all without a word. Shameful the way the elderly are treated.


  • beastarzmom
    beastarzmom

    April 10, 2007 at 2:22 pm

    I love it that your mom reads your blog – and comments! I always enjoy your posts, but I don’t think I know you as well as Don Ryan! Maybe it’s best that way :-)!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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