Neuro was not one of my favorite courses in nursing school, but one lesson stayed with me throughout my approach to unresponsive patients and that was to talk with them. It didn't matter if they were comatose, obtunded, catatonic, or my favorite term, hypovigilant. If the auditory cortex found within the temporal lobe was intact patients could at least hear to some degree. Even if they could not understand the speech, a nurse's rhythm and timbre could still be detected and communicate caring and concern.
There were quite a few nonresponsive patients I encountered while working at Downey V.A. hospital, a long-ago shuttered facility devoted to the long-term care or in more pejorative vernacular, warehousing of schizophrenics. Crude treatments of the day including lobotomies, insulin shock, and massive doses of major tranquilizers were enough to silence just about anyone including a gentle old soul named Ireno who rarely spoke.
Ireno was a massive bull of a man who had been confined to the forlorn pastures of Downey VA hospital for decades. Standing in line for medications he towered over the other patients, despite his threatening size a HumpteyDumpteyish aura surrounded him. He was mute and acted as if the slightest action could break him apart.
Ireno had been on massive doses of Thorazine which works by blocking dopamine receptors in the brain and as a result more dopamine is released systemically in the synaptic clefts. There is more dopamine around the peripheral nerves and more receptors to respond to it resulting in uncontrolled tremors and movement disorders.
One evening I noticed Ireno reclined on the floor of the day room which was his usual habitat before the dorms were opened. I frequently opened the dorms early, but had to wait until the nursing coordinator made her rounds. The VA had many rigid rules and one dictum stated the dorms were to be locked until 10PM.
I noticed Ireno busy at work with a pencil and paper while wearing heavy winter gloves to attenuate his shaking hands. He also was applying counter traction to his tremoring arm by attaching a sleeve of an old tee shirt to a valve on the radiator with the other sleeve wrapped around his elbow. Whatever endeavor he was up to required great effort and concentration When I walked over to him, he quickly covered his paper, but looked up at me with kindness in his eyes. I told him the dorms would soon be open so he could hit the sack and rest in comfort.
About an hour later, Ireno shuffled up to me and proudly presented me with this portrait he had laboriously sketched out for me. I was stunned by his effort and thanked him profusely and was rewarded with an extremely rare vocalization. "You're welcome" Ireno clearly stated.
A nurse who genuinely cares can make such a massive difference to a patient in a mental health facility. I obviously cannot speak for other people, but it was always obvious to me at least, whether a nurse genuinely cared or was just going through the motions and giving lip-service. Thank you for being someone your patients could trust.
ReplyDeleteThanks,so much. You made my day!
DeleteSo you're still posting your wonderful stories OFRN - I haven't seen you for so long and I was worried about you!
DeleteI've put a couple of Australian nursing students onto your blog - they can't comprehend how different things were in the 1070s here - I do truly feel prehistoric now mate.
Good to see you again! Sue
Hi Sue,
DeleteI received an email from a very nice lady explaining how much my posts about my time at Downey Veteran's Hospital meant to her in helping her to understand her brother who was a patient there. I searched through my nursing archives (also known as my basement junk pile) and came across this drawing a patient made for me in the early 1970s. Fond memories of the patient, Ireno, who made the sketch inspired me to finally post. I'm still vertical and am enjoying improved mobility after having bilateral knee replacements. I was deeply impressed by the quality of nursing care provided by the so very youthful whippersnapperns! I was so impressed by them and felt so inadequate that I hid my nurse identity from them by telling them I worked in a produce warehouse which was partly true. I really enjoyed hearing from you and wish you all the best!
Hi OFRN from Sue in Australia, how are you keeping these days? I tried to post earlier today but I don't know if it went through.🦘
ReplyDelete