Confusion Pt. II

The up side of some confused patient is that sometimes they are pleasantly confused. Last night I had a patient who was adorable, but very confused. Let's call her Mary. Every time I walked into Mary's room she would smile and say, "Oh, hi honey". She is a petite woman and I instantly think she is cute enough and perhaps small enough to carry in my pocket. I check in on her and see how she is doing upon arriving on shift and she instantly starts telling me about her cat, baby. She thinks baby is in bed with her and she doesn't want me to squish him. She has dementia so I don't acknowledge or disagree that there is a cat in the bed; That is kind of a losing battle. After her story about how she found baby, she tells me that she doesn't want to keep me from my work. So I try to make her comfortable and turn off the lights for her to rest.

4am comes and Betty is awake crying. She is crying because she doesn't know when she is going to have her surgery on her knee. It's Friday and her surgery was this past Tuesday. I kneel down next to her and explain to her that she had surgery, it went very well and she just needs to rest so she can heal. She continues to cry and talk about all her family and that maybe they didn't know she had surgery. I let her know her family is well aware of her condition and recovery. I orient her to the time and explain that she may be forgetful due to anesthesia and pain medication. This is not a complete lie. Her confusion is the dementia, but I felt that if I told her the other mentioned reasons for not remembering her surgery, that it may calm her some. I let her know that after the surgery she was very sleepy and may not remember some things. I reassure her again and let her know her knee is doing very well and that we are there to make sure she gets better. Mary puts her hands on top of her head as she sobs and tells me how she hates her brain and hates how it doesn't work anymore. For that moment I knew she knew she was confused ... Looking into her eyes I almost lost it and had to fight my tears. I am not sure why this hit me. Maybe I understood her frustration or maybe because I had seen her so happy and content and here she was having a breakdown. There is nothing in school or this job that teaches you how to deal with these situations or know the right thing to say. I grab her hand and explain everything to her over again, let her know she is doing well and that I am there to help. The sound of her crying breaks my heart. An hour or so goes by and she gently falls back into sleep. I wonder how her family must feel to see her come and go out of confusion. I wonder if she knows who anyone is or what her perception of reality looks like. I imagine her moments of clarity and her frustration with the confusion. It's almost like ALS, or Lou Gehrig's disease... Your body fails you, but you are alert and oriented enough to realize it...And you can't do anything about it...