Today was a really difficult day for me. In fact, I can say it was my hardest day of nursing school so far. All along I have been dreading a patient death, thinking that would be the worst outcome possible. I certainly don't want to discount death, and since I haven't experienced a patient death I can't say it wouldn't be the worst thing to happen, but today was pretty bad. Privacy and confidentiality prevent me from sharing detailed patient information, which is why I don't talk about stuff like that on my blog, so I will do my best here to share my story. My patient today had dementia, which always makes patient care dicey - I never know what to believe. Unfortunately patients with even the mildest baseline dementia get very confused when hospitalized and their mental status tends to deteriorate quickly. Today my patient had developed hospital induced psychosis which means that the dementia was exacerbated to the absolute extreme. It was a very sad thing to see, but what has affected me so much is there were many signs of pointing to abuse and, in addition to nursing home resident status, this was a huge red flag waving in my face. I spoke to my professor who supported my intuition initially, but once the hospital induced psychosis diagnosis had been mentioned everything changed. How can you evaluate a psychotic patient for abuse? My professor said that even patients with severe dementia still have a sense of self preservation. I guess self preservation is a sort of an innate thing that cannot be destroyed. I thought this might work to my advantage but the psychosis snuffed out any chance of me even validating the level if safety for this patient. She was unable to validate if feelings of security in the nursing home because of severely altered cognition. So at the end of the day I walked away from a patient who may be in a potentially life threatening situation having done absolutely nothing to help it. I cried the whole way home.
I find it frustrating that medical personnel just "poo poo" patients with dementia because they don't want to deal with it. Obtunded, demented patients are often left to just doze and drool because they aren't mentally "with it". The nurses do their daily care and meds, and don't get me wrong, I am not saying that the nurses don't care -- because they do, but it seems like they just can't be bothered dealing with a patient with dementia. We are student nurses, learning by example. What kind of example is it to say "oh that patient has dementia, don't worry about this or that." That's not who I am. I don't want to conform to that rationale. I want to help people and I don't care if it means I don't get lunch or I don't pee for 10 hours. I want to make a difference. I want to be ME.
I'm still haunted by the events of today. Of course, today of all days, my professor decides to cut out post conference and let us go early (YAY!) which resulted in me not getting to talk about what happened today (BOO!). I will pray about it and know that it is in God's hands. I will trust that He is The Protector and He will make things right. I also pray for His guidance and for the ability to be ME, to stand up for what I believe is right, no matter what others say. I hope that He provides comfort to my patient and that He provides me with peace knowing that I did what I could, in the time that I had with the tools I was given.
I want to make a difference by being ME.