As an adult nursing student I worked with a lot of patients who were confused and had problems with their memories.
There are any number of causes: dementia, Alzheimer’s disease, head injury, cancer, brain tumor, blood poisoning, fever, infection or mental health issues. There are also varying degrees of severity with some patients only being mildly confused and others having no lucid periods whatsoever. It’s also common, especially in the more advanced stages for the patients to stop eating and drinking and to refuse to sleep long after they should have dropped from exhaustion.
The most severely affected patients sometimes require ‘specialing’ which involves the patient having one nurse assigned to supervise them 24 hours per day to ensure that they don’t hurt themselves. As students we were quite often allocated to special patients as it meant that the more experienced staff away from the rest of the ward.
On one occasion I was asked to special one lady who had very advanced dementia and had barely slept since her admission 24 hours previously. She was very mobile and so was constantly pacing up and down and trying to get off the ward.
In her confused state she was also prone to violence as I discovered when she slapped me around the face and attempted to strangle me with my own ID lanyard.
Apparently I’d been sleeping with her husband.
That day I learned why lanyards have quick release safety clips on them.
The day after she was admitted I came onto the ward to start an early shift and saw that she was up and about already, even though I could see the deep purple shadows under her eyes and the bruise on her forehead where she’d tripped because she was so tired but refused to sit down.
I did my round of washes and bed baths but two hours later when all my other patients were clean, fed and settled she had not stopped pacing.
Up and down, up and down
Walking towards the door and turning round
Walking between the two rows of beds up to the nurses station and then back towards the door.
Up and down, up and down
For hours and hours
I asked her if she minded if I walked with her for a bit, saying that I’d done all my jobs for the moment and most of my patients were asleep. She told me that it wasn’t her fault I had nothing to and I should sort myself out but she didn’t attempt to brain me, which I considered progress.
As we wandered up and down I noticed that she kept looking at the clock and out of the door so I asked her if she was expecting anyone. She told me that she did have someone coming, although she wouldn’t tell me who and if she didn’t keep watch she might miss them and then they’d go away.
I knew that this lady didn’t have any family or friends coming to visit but what good would it have done me or her to try and convince her otherwise?
Instead I asked her if she’d like a bit of company while she waited?
My acceptance of her claim that she did have a visitor coming seemed to take her by surprise and I wondered if any of the other staff had been trying to reason with her. Some patients have a sufficient grasp of reality that you can explain to them that their partner will be coming during afternoon visiting hours or that they can’t possibly expect anyone to visit in the middle of the night.
This lady was not one of those patients.
The whole time she was on the ward she didn’t seem to have any periods or even moments when she really knew where she was, who was with her or how old she was. She didn’t even seem to have a full grasp of day and night time, even though we kept the curtains open during the day and switched off all the lights at night.
Now that she realised that I wasn’t going to argue with her she relaxed slightly and seemed a bit less irritable with me so I gently pointed out that she could see the door from her chair so would she maybe like to rest her legs a bit and then she’d be fresh for when her visitor arrived.
She looked at me a bit suspiciously but wandered over to her chair before abruptly turning round and asking where I was going to sit. I said that I could go and find another chair or maybe she might like to sit on her bed and I could sit on the chair.
I thought she’d refuse and would go back to pacing but she perched on the edge of the bed, satisfied that she could see the door, that she wouldn’t miss anyone entering or leaving the ward and that I didn’t seem to be trying to trick her in anyway.
I would say that we chatted but what mostly happened was that she alternated between telling me I was too young to work, that she didn’t like my (subtle) lipstick and had I not found myself a husband yet. As mildly insulting as the ‘conversation’ was I could see that she was starting to get comfortable on the bed, sitting further and further back and suggested that she maybe take the weight off her feet.
After all, there was no point in her waiting in discomfort .
She swung her legs up and lay back on the pillows while I sat in her chair and made sure that I wasn’t obstructing her view of the door. The past 24 hours of almost constant wakefulness seemed to catch up with her; she started to mumble and her eyes started to droop.
I sat beside her and softly suggested that she maybe closed her eyes, just for a few minutes. I promised her that I wouldn’t go anywhere; that I would sit beside her, watching for her visitor and that I would wake her as soon as they arrived.
I promised her that I would wait with her.
I stroked her hair and soothed her, this lady who was old enough to be my great-grandmother and who had had children and grand children of her own. Yet here I was, 19 years old in my first year of training, talking to her as I would to Squidge when he’s fretful and overtired, even though this was many years before he was born.
Slowly but surely she drifted off as I continued to smooth her hair and murmur to her, hoping that I could help her into the deep, healing sleep that she so desperately needed.
I watched the lines of tension and anxiety on her face relax.
Some etched by a long life that had been far from easy.
Many from living in a world that she no longer understood or made sense to her; where she spent most of her time afraid, not knowing who to trust and having people disagree with most things she believed to be true.
The ward sister had been watching my progress over the last hour and as soon as it looked like the patient might have settled she shot round the ward closing all the curtains and putting some soothing music on the mini CD player we kept under the nurses station.
I sat beside her long after I was sure she was asleep.
Hoping that she trusted me enough to wake her when her visitor came.
Even though I knew they weren’t coming.
This was one of the reasons why I didn’t apply for any adult nursing jobs when I qualified; I just couldn’t cope with wards and wards full of men and women waiting for husbands and wives, sons and daughters, grandchildren, parents and friends that were dead, estranged, lived too far away or who just didn’t visit for reasons best know to them.
Every week I look after babies who are so very ill and some who die before they’ve even really lived but it is vanishingly rare that they don’t have anyone to love them.