Stasis Ulcer + Severe Schizophrenia = Frustration/Hilarity

During one of my last jobs I worked at a long term/chronic psych facility. The residents there were basically the people who had been kicked out of every other LTC facility, and "Itty-Bitty Care" was their last resort before prison in some cases.

In addition to charging on evenings, I was also the unofficial wound care guru due to past experience/the fact that trying to keep dressings intact in that place was next to impossible. So being the "new kid", I got nominated.

Most of our patients were more or less ambulatory, so there wasn't much to do in the dressing department overall. In fact, I didn't know why no one wanted the responsibility, there didn't seem to be anything to do.....That is until I met "Pop".

Pop was a SEVERE schizophrenic, with several more pages of diagnoses, psych and otherwise. He was on enough Thorazine to drop an elephant, 300 mg BID last I knew, and enough other meds that it took 2 souffle cups to pass them. And on top of all of it?

Insulin dependent diabetic, with severe circulatory issues and a massive venous stasis ulcer on his shin. And this was now MY venous stasis ulcer...the one with the start date TWO YEARS PRIOR....That one. "How the hell does that happen??," I asked in all my fresh-from-clinical indignation. I was about to find out, but first some filler...

My first day at the facility, I was introduced to Pop, who immediately insisted that I was his "little daughter, Mary Ellen." From then on, that was my name. He had an elaborate backstory to go with it; claiming that I was in fact the DON's and his daughter, and he paid for me to go to nursing school. Every day the story would change a little bit, but I remained "Mary Ellen".

Every day at 3, he would be waiting at the nurses' station, ready to try and con my out of the Coke I brought every day. "I'll give you alllllllll this gold if you gimme your Pepsi.....", holding a "purse" that no one else could see, and giving me a goofy, snaggletoothed grin. He claimed he had gotten "some gold" but wouldn't say where or from whom. (I suck at reorienting, ps....lol)

When he got upset, he would squidge his face up, hold his breath, and shout "BOMB!!!!", flinging his hands at the offending person. We learned to ignore it after awhile, but it was funny to see anyone new walk in.

Back to the leg...I first saw the offending hole-o-nastiness when Pop came to my office demanding a new "mummy-wrap". It was my second day there, and after translation, I learned that he'd taken his bandage off and wanted a new one.

He pulled off his shoe and pulled up the legs of both pairs of pants (another fun behavior), and pointed at the gaping, oozing pit of ugh on his shin. Even without looking, it was easy to see linear marks across the wound bed. "Pop, have you been scratching this?" I asked. "I had to...." he said, "there was Marine Corp gold in there!!!!" Ok, I thought......"Well, Pop, how did it get there? You had your mummy-wrap on, they shouldn't have been able to get to it! Didn't you....???"

"I had to take it off", he explained, "I needed to wash my leg."

"But Pop....the girls help you wash. Did you do it on your own?"

Long pause....."I did it myself".....goofy grin.....

"How? Where? When?" I ask.

"I don't remember...."

"well," I say, "can you show me?" He stands and walks to the bathroom down the hall, goes in, and points to the toilet.

"Pop........THAT'S where you 'washed' your leg??????"

He nods. I nod.

Now I see why this is the venous stasis ulcer which has no end.

Epilogue:

Problem eventually solved with a combination of super-sticky Omnifix tape, knee high cowboy boots, and a Diet Pepsi for every intact dressing I found on change day....

I am not above buying patient compliance, lol.....