I talk to Carol, and she takes an interest. She responds. The second day we share a room, she stops closing the door and the blinds every time I walk out. She lets me and the light in. This woman probably could be reached with good nursing and not need ECT. It is a simple matter: her staff person for the shift could come in every two or three hours and bring tasty liquids for herself and Carol. When Carol refused the liquids, the staff person could say, “Is it okay if I sit here while I drink my [coffee]?” The staff person sits, makes an occasional comment about some casual topic, and encourages Carol to take a few sips of liquid. Keep this up for a day or two and Carol will begin (a) to rehydrate and (b) to connect with the staff. On the second or third day, you find her dentures, offer her food, and encourage her to come for a little walk.
Alternatively, you can do it the 3-6 way: leave the patient laying in the dark without food or water, then have the doctor do ECT. Occasionally send in a child-staffer who lives at home with her parents and has never tried to get a sick child or grandparent to take a sip of juice.
On Tuesday, around 6:30 a.m., Sue, the night staff person, comes to prepare Carol for ECT. Carol appears not to have been given any nursing information about the procedure, and knows nothing about the need for a hospital gown, removal of jewelry, and having an IV started. In the early dawn hours, it comes as a shock to her; she’s never had IV anesthesia before.
When she returns from ECT around 9:00 a.m., she is put to bed with her side rails up. This is standard procedure after anesthesia and the side rails probably should be left in place for a couple of hours until Carol has slept off the anesthesia and is fully awake. Staff members tell her that she needs to drink a lot of liquids, then they put them on the windowsill where she cannot reach them.
Staff closes the blinds. In the middle of the afternoon, after half a day of darkness, I become persistent in wanting them open. A staff member asks Carol if she wants them open. When she says no, the blinds are left closed. Carol neither asks for breakfast or lunch, nor is it offered to her. During the afternoon, a nurse checks her blood sugar and finds it to be in the sixties. The nurse tells her she must drink juice or she will go into a coma or have to have an IV started, then the nurse leaves the room. Her effort to get Carol to drink is threatening and frightening, not encouraging and supportive. The liquids are still on the windowsill; the side rails are still up: she can’t reach them. Carol has no history of any medical complaint that would warrant side rails; the staff simply put them up after anesthesia and never put them back down.
I get up every ten minutes or so and bring juice to Carol’s bed. When she says she doesn’t want it, I tell her I understand but that she needs to take a few sips anyway. By the time the nurse comes back for another finger stick, I’ve gotten Carol’s blood sugar above a hundred. I continue to talk to her off and on.
About 7:00 p.m.—ten hours after Carol’s side rails were put up—I look at Carol and think, “What’s wrong with this picture?”
“Carol,” I ask, “What would you do if you had to go to the bathroom?”
She says, “I climbed over the side rails.” Under further questioning, she reveals that no staff person told her that there was a call bell on the wall whereby she could request help, nor could she see or reach the bell.
As afternoon turns into evening, Carol brightens up. I chat about a colorful picture a friend’s little girl has sent me, knowing Carol can’t make it out. When she says she can’t see it, I get her glasses from the windowsill where they are out of reach. If you want to get someone oriented to reality, one of the things you do is make sure all appliances—glasses, hearing aides, dentures, and walkers—are operational and in use. (To be continued)
For the antidote to inpatient psychiatry, see Dr. Nasri Ghaly at http://annecwoodlen.wordpress.com/2010/12/29/dr-nasri-ghaly-psychiatrist-part-i/