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.....

Adventures in Long Term Care

My first job out of nursing school was at a local LTC/rehab facility. Of 75 residents, roughly 60 residents carried a diagnosis of late stage Alzheimer/dementia, which made for an extremely interesting work environment, not to mention a learning experience of EPIC proportions.

Going to work was never boring, in fact, I learned more from my LTC residents than I ever did in school.

But on to the funny...

One gentleman in this particular establishment was well known in my very small town for being somewhat of a barfly before his admission to my facility, and he fit the reputation to a T.

He was about 5'6, maybe 100 lbs soaking wet, with nary a tooth in his head.

The lack of teeth probably contributed to his low weight, but he refused to wear dentures.

(Bear with me, the backstory is necessary.)

Due to his very toothless state and refusal of a mechanical soft diet, he gummed/smashed meals into submission. Because of this, by the time I arrived on the floor,this resident (we'll call him Jack), was in possession of an extremely hypertrophied and protruding tongue/lower lip.

Which got in the way whenever he would ask for anything, which resulted in the CNAs getting frustrated and refusing to deal with him. Thus Jack would become frustrated and no one was happy.

Enter me.

I happen to be in possession of some sort of internal translation device which allows me to understand nonexistent languages. (Unfortunately, my linguistic skillz do not extend to my attempts to become bilingual, but that's a story for another day.)

So, before long, Jack and the rest of the staff learn that I understand what he's trying to say, effectively making him my "person". He posts himself in front of my desk, demanding coffee/cigarettes and telling me various stories about his past exploits.

One day as I'm charting, Jack is sitting in his usual spot next to my desk. As horrible as it sounds, I've by this point learned to tune him out for the most part because he's so excited someone can understand him he TALKS non-stop.

He's engrossed in telling me some story, and I'm mumbling "Uh huh....oh yeah?" as he goes on about God only knows.

Somewhere in this exchange he apparently asked me a question, and realized I was only paying him the minimum of attention.

I'm absorbing in charting when I hear from across the desk, "AWWWWwwww......sPIT!"

I look up to see Jack glaring at me. "Bgurwl....byou ain't wispinin tboo a BAMN bword ah sbayin!"

I attempt to apologize, telling him that I was busy writing and didn't hear what he had asked.

Apparently, he wasn't placated, because the following exchange went down:

Me: "Jack, I'm sorry. I was really busy, I wasn't ignoring you."

Jack: "Awww sPIT!"

Me: "Ok, I understand that you're mad but you absolutely cannot sit up here at the desk cursing. If you want to talk like that, you'll have to go to your room to do it."

Jack: "BHELLL!"

Me: "Jack, I'm serious. Roll on. No more."

Jack: "PUCK BDAT!"

At which point I lose it, and crack up, thereby rendering my Nurse-Face totally ineffective.

This was the first of many "Jack stories", others which include the time he somehow hid a very large BM in his sock (while still on his foot); the time he wrapped a similar item in a napkin and delivered it to my desk in the middle of the night while bare-ass naked; and the time he offered "bgurl, bwehm ah bwgit outta here, ahmwa pake byou bto thwu BDepot" (the bar he used to frequent).

I miss me some Jack. :)

First Post

In hopes of finding a creative outlet for the frustrations/hilarity that is my career, I decided to jump on the blog-wagon. Names, identifying information, and some situations have been altered to protect privacy of the patients (and my job from the HIPAA overlords), but all of the scenarios are mostly true accounts (with only minor embellishment/hyperbole for the sake of humor) of my sometimes heartbreaking, frequently unbelievable, and always interesting adventures in nursing. Enjoy!