Monday, February 14, 2011

"where there were eyes, there's only space"

Patient was a tough guy and he prided himself on it, to a degree of boneheadedness. He was in a manly profession. He kept his woman in check, and she liked it. He drove the stepdown staff to drink with his tales of great vengeance and furious anger, along with his total inability to follow directions or stay put. In short, he was tiresome. 

He came to the CVU for a CABG, and he'd had a surprisingly rough course. He was intubated for several days (though this was not through a physiologic deficiency. The pulmonologist kept waffling about Patient's ability to breathe, leading me to loosen his restraints so he could "stretch a little"---right up to his own tube. I hope no one billed him for extubation). Once he regained the ability to speak, I found that he wasn't himself just yet.

I walked into Patient's room. He was hunched down in his bed and looking extra bitter. I put on my Customer Service Face and said, "Hey, Patient, I was thinking we'd go for a spin around the unit, but you're looking a bit down. Wanna talk about it?"

He started sobbing.

"Aw, come on"---I fucking hate it when people cry because I don't know what to do---"what's going on? Maybe I can help."

He muttered something unintelligible and continued to sob. What did he say?
He repeated it. "I doh-hnn't ha-a-ave ah fuhmmphmphph." Sniffle.

A frump? A phone? A frog? What the fuck was he saying? I thought for a minute. No one had been to see him but his wife. Friends? A-ha! I grabbed a greeting card signed by all of his co-workers. "No, look. You have all kinds of friends pulling for you. There have to be at least forty names on here. These people all care about you."


Oh. Oh, dear.

Propofol has a short half-life. It's effective within 30 seconds of initial administration; if only used for short periods of time, it wears off in roughly three minutes. However, if you sedate a pudgy guy for, say, a week, the drug starts collecting in the Pudgy Guy's adipose tissue. Effect: it makes Pudgy Guys koo-koo for Cocoa Puffs.

Patient was a Pudgy Guy that had gotten, oh, a week's worth of propofol.

I tried to convince Patient that his face was still on him. I grabbed a shaving mirror and started to hold it up. "No, dude, still have a face! It's the same one we admitted you with! See?"
He screamed. "DON'T DO THAT!" The sobs were hysterical now.
And unexpectedly, he sat up and clutched me in a a desperate bear hug.

Earlier, after he'd self-extubated but before the Crazy had made its way to the surface, I'd set his bed alarm as a precaution. I didn't trust him to not fall out of bed or walk out of the unit. When he sat up, his bed alarm sounded, loud and proud. Jimmy came running to my room.

There I was, patting Patient on the back while he cried his missing eyes out.

"Uh...are you okay?" Jimmy asked hesitantly.
"Yeah, we're okay. Really. Patient seems to have misplaced his face, but we're gonna find it again, aren't we, Patient? It's probably lost in the sheets, or in your cubby next to your shoes. Could you do me a favor and shut off the bed alarm, Jimmy? It's killing me."
Jimmy's face was scrunched up; he was making his "ew, hugging" face. "Er...sure. Whatever." He flipped up the edge of the bed's console and disarmed the alarm. The only sound left was that of Patient's crying, and it was easing up.

I decided to let Patient take a powder. He'd already yelled, done some deep breathing, and sat up in bed, thereby meeting my goals of pulmonary toilet and exercise. Done, done and done. I got him tucked back in, and turned down the lights so he could try and nap. As I started to slide his door shut, he asked: "You're really nice. If I weren't married...would you marry me?"
I smiled. "You seem like an okay guy, Patient. I'd think about it."
"Even though I don't have a face?"
"Even so."
I shut the door and stepped out into the light of the Unit.


  1. I don't know where else to respond to this so here goes. That guy was me. Did I ever tell you Pam had eyes of fire? (Actually made her look better.) The hallucinations are incredible. They are more real than the reality you eventually come back to. It wasn't til last summer that I forgave the hospital for losing the hard drive I had backed myself onto. I don't know how you can help this guy, but I bet the fear is there now.

  2. I love your quick thinking compassion in the face of his very real distress! It's so mean when people (family, friends, nurses) give a patient crap about the things they said and did while under the influence of the junk we push on them. *(Sarcasm)I'm sure s/he was really trying to piss you off with all the wiggling and sticking legs out through the rails. I'm positive it was all planned out for your amusement and frustration.* These poor folks get so messed up, just like patient in the story.

  3. This is great. I love that you offered to help find it and listed ideas about where it might be. I can tell you've had some experience with toddlers.