Wednesday, June 24, 2009

A tale of two patients

Two of the three patients that assaulted me have died, and I am sad but glad that they are gone.

One had Alzheimer's. She had started on a gradual descent into dementia that increased into a much steeper slope when she arrived at our facility. She was lucid most of the time at first, but as the days went by she started to become more and more confused...and with that confusion came violence. She wanted to leave, she said that she was tired of staying at "this cheap hotel" and that she wanted to go home. We couldn't let that happen, and that's when we would get hit. She would be wheeling herself towards the doors, and when we'd try to turn her around away from the doors she would grab onto the handrails in the hallway and hold on for dear life. She would hit us and claw at our arms when we tried to get her back into the facility - she clocked me in the face with a roundhouse swing once. I have to say that I was impressed with her strength, she rocked me a little bit with that punch. She truly thought that we were kidnapping her or trying to accost her, and she fought us like her life depended on it.

When we would get her back to her room we'd take turns in sitting with her until she fell asleep. She'd lay in her bed and cry, confused and not knowing why we were keeping her there. She'd threaten to sic her son on us, saying "you wait until my boy hears about this. You'll all be in BIG trouble then". It was heartbreaking to see and hear her in that state, because when she was lucid she was an incredibly sweet, generous and gentle woman. If it was my turn to sit with her, I'd try to talk to her about her family and her husband and how she lived when she was younger. Sometimes it would work and she'd settle easily. Sometimes it wouldn't, and she would cry herself to sleep.

When I read about her death I was glad and sad at the same time. Sad because the world is a little dimmer without her presence, but glad because she's escaped the dementia that held her prisoner.

The other patient, however, is a different story. He was not demented, so the aggression and violence he focused on us was not the result of a confused mind, it was because he wanted to.

He was, to be blunt, a miserable fuck. I can nearly always find some redeeming qualities in people, but I couldn't find any in him - and I tried really hard. He fought us at every turn. Everything was a battle. EVERYTHING. Taking medications, bathing, emptying his uro-bag, changing dressings and pads, dressing, undressing, eating, sleeping....every single thing was a fight. He cussed at us, swung at us, grabbed us, hit us and kicked at us. One of the more assertive nurses told him once that if he swung at us again she'd be calling the police and pressing charges against him. That stopped the physical assaults for a day, but he more than compensated for that with his words. He was petulant and obstinate and I really think he enjoyed being a pain in our arses.

I thought about him often, wondering *why* he was the way he was. He had led a full and active life and was fiercely independent. He lived with some conditions and injuries that would have made other people take to their beds and stay there, but he never let it stop him. I can't decide if it was courage or sheer bloody-mindedness that kept him going, but I think it was probably the latter rather than the former. I think that was a huge part of his unhappiness at being in a long term care facility and that displeasure manifested itself in aggression and general nastiness towards anyone who came into contact with him. People that reside in places like that aren't there because they can take care of themselves, they're there because it's no longer safe or prudent for them to live independently. It's a very managed and structured way of life with not a whole lot of room for deviation; there's a schedule for everything. You eat when you're told to, you shower or bathe when you're told to, you go to therapy when you're told to, you can't get up out of your chair or bed without someone being there to help you, you can't go outside unless someone is there to watch you and unless you're lucky enough to have a private room, you have to share your living space with someone you don't know and may not's not an environment a previously independent person would find easy to live in, and I think that was a huge factor in this guy's behaviour.

When I read about his death, I had an immediate sense of schadenfreude and said aloud "good, I'm glad he's gone". I'm slightly ashamed of that reaction, but I cannot deny that I'm glad he's dead - not because I hated him (I didn't like him much, but I never hated him) but because he is now free from the misery that engulfed him in his final years.

Two very different patients with two very different reasons for their aggression. I'm feeling their loss - but for very different reasons.

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