talk to me

I always thought I could talk to anybody about anything. When I was little I even imagined I could talk my way out of a bad guy kidnapping me. (Never tried to test this one out). And especially the hard stuff, the personal stuff, the down and dirty, & wild and crazy. But not today. Today the patient that I've building a trusting relationship with for the past 3 months, told me he couldn't talk to me, "It's personal."

There's obviously more to the story and this patient's story is one of the tougher ones. 53 year old male with history of schizoaffective disorder (schizophrenia + bipolar) fell at his group home and developed shortness of breath and bilateral extremity weakness after a few days. He presented to the ER was intubated and sent for a CAT scan, which revealed a C4-5 fracture. Basically- he broke his neck during the fall and its amazing he's not paralyzed from the neck down. Doctors stabilized his head and neck with a halo and he transferred to our hospital for further medical management and rehab. During his 16 weeks in the halo, we were able to build a solid relationship- a true achievement for someone with his history of mental illness. I introduced him to the internet, we baked pies for the nurses, and exercised him back into shape. He told me stories of what it was like living with his disease- surviving 14 years of institutionalization. His parents came to visit him everyday through every hospitalization.

Symptoms of his schizoaffective disorder presented initially as emotional lability and difficulty with appropriate social engagement. Later on he developed episodes of mania- "I'm gonna sell my coin collection and go back to college, get my degree in writing!" and negative thoughts, talking and crying a lot over war and killing. At times he was difficult to redirect, often going off on tangents with thoughts that didn't really connect. Generally he was pretty easy to treat given his boundaries and I really felt like we were getting somewhere.

But once the halo came off, anxiety began to rise regarding his discharge plan. During those 16 weeks he was receiving nutrition via a feeding tube since he was unable to swallow with his neck immobilized. Once that was removed he had a swallow test performed by speech therapists to determine if he would be able to eat or drink anything. And here's when his behavior really began to fall apart... he failed the swallow test. No eating or drinking allowed, probably for the rest of his life. Worse, he won't be able to return to his group home because they won't take him with a g-tube. Stuck. And stuck with schizoaffective disorder. Who's to say how a person without this mental illness would behave? Hi, um yeah, you can't ever eat or drink again and you can't go back home.

Well needless to say, he may be leaving the hospital tonight via Section 12. He's been screaming profanities at the nurses, flooded the toilet, rummaged through his roommates belongings, and hiding scissors, drinks, and food. His affect looks entirely different- drawn, lost, and empty. "I can't talk about it Amanda, it's personal." Come on buddy, talk to me!

CODE D

It's not too often you hear this code in a hospital, but Friday, December 12th we entered disaster mode. After 2 days of serious rain and ice, three telephone poles came down in the middle of the entrance to the hospital. There's only one way in and out, and that road was blocked. No main power and no one in, no one out. The generators kicked in right away, so no one had to ambu the vent patients all day. Thank god. The road was cleared by 2:45pm, so luckily the 3-11 shift could come on. My day was pretty much business as usual, a lot quieter though with having to talk to my patients over the roommates blaring TV or interrupting families visiting. Unforgettable- CODE D, hopefully the first and last. I called my OT buddy Mike to tell him the story and he told me his "fire story." Basically a patient was about to be discharged to a long term psych facility, so he lit his hospital room a blaze. Mike ended up evacuating 123 patients out into the parking lot. Now that is crazy! See anything can happen on any given day. Gotta stay focused.