The Thin Man

It's rare after so many years of doing the same thing to stumble upon something new....well, not new, but a new version.
What do you do with a 50 something year old man, who is quite tall, maybe 6'3".....and weighs........128 lbs????  Not kiddin you! And that was with his clothes on...so maybe closer to the 124 mark.  He does not have anorexia, which is usually the only time you see someone this cachectic in psych. As a matter of fact, in moments of "awakening" he is a delightful man, funny, warm, brilliant.....and starving to death.  How it got this far is almost beyond me. But not quite, you see his wife will not come visit him, nor will she call the staff to see how he's doing. She's apparently afraid we'll keep her, obviously unaware of our "one family member at a time" policy. 
During his moments of lucid thought (he had one entire day over the weekend) he has tried to eat whatever is not nailed down. I had to stop him. Re-feeding a starving body has its own unique set of complications.

We do get calls from his siblings around the globe telling us what to do and not to do. I didn't have the heart, even after the 25th phone call to tell sis, 1). We are not new at this. 2). Have you SEEN your brother lately?  He wouldn't let me take a picture, but let me tell you, some of the survivors of Dachau looked healthier! I think the "standing by and watching someone die" was already covered by his wife, so we've crossed that treatment approach off our to do list.

I have twice had the pleasure of  bathing the Thin Man, so I've seen his body up close and personal. 2 amazing things. 1). His skin is (so far) intact. Kinda odd considering his nutritional status in not "up to par", and his bones stick out way farther than any other tissue. 2).  You could easily teach an anatomy class with this guy as a living example/skeleton. You can count each bone all 206 of them.

So exactly what is the matter with this man, you may ask? Here's my 25 cent diagnosis: he has a major depression, with psychotic features.  He has delusions (here we go again) vs. hallucinations. He chose not to (or could not) get help or have his depression treated, so typical of men! It progressed along it's merry way and invited some psychotic thinking to join in.  Fortunately his last healthy neuropathway was lonely and picked up the phone to schedule a check up with his internist (who, btw has called 3 times a week to see how he's doing), who booted his butt (gently, hence the still intact skin) into an ambulance and off to the hospital.

I like this guy. I wish I could tell you more about him....he has had a fascinating life so far.....but seriously, all that HIPPA stuff is real, and was around YEARS before the stupid HIPPA laws, which really have nothing to do with privacy BTW.  That's another soapbox story.

Dementia is a THRIFTY state of being!

So my significant other came home last night. I had arranged a trip to Colorado for him to help out our 24 year old son.  Tiling, spackling...a brake job. I stayed home to care for HIS Mom. I was way too pissed off to hear/see him.  Red wine does that to me. I am Holy Hell on wheels if I've had red wine.  He had NOT done the 2-3 things I had implored him to do, with repercussions.
So here is my current threat.  I will find an apartment in the spring and move out.  I can hardly kick the 92 year old MIL to the curb.  His siblings are 1000% worthless!  They want financial information.  Shit, we didn't get that when she was 1 day from being totally un-cared for. Guess I could have called Dept of Elderly Services and reported her abandoned.  I just thought that would be... like....unethical!  HELLO!!?? Do you leave a 92 year old alone just to get some cha-ching?  Gag me!

The good news is that she will read the same magazine 4-5 times in a single day.  So dementia is a thrifty state of being.  There is NO such thing as leftovers, it's totally new every night!!

People are treacherous creatures!

One of my patients is back.  Not unusual at all. I don't know why, but I get along pretty well with this fellow. Most of my coworkers see him as cold and bitter, but for some reason he cracks me up.  He worked as a psych tech in his previous healthy life, so he's been in "the business" so to speak.  Well the last time he was in I asked him to make some sort of a list...maybe the pro's and con's of having a disabling illness (yes kids, there are pro's, but that's another post entirely), maybe his strengths and weakness's....neither of us could remember.   What I do remember was that the 1st thing on the list was his view of humankind, "people are treacherous creatures".  That was the moment we connected as 2 people vs nurse/patient.  Don't get me wrong, I don't agree with him, and I don't normally laugh "at" my patients, but this slammed my funny bone!  I laughed so hard I had tears streaming down my face, and I couldn't stop. So why was that a "moment"? Because he started laughing with me. It took him a bit, but we all know what it's like to be sitting with someone who is busting a gut laughing!  You either storm out of the room (looking back I'm surprised he didn't) or you join in...and he joined me.  So he has joined the ranks of "my favorite patients", and it's not a very long list.
This stay?? We have something new to add to our list of secret laughs. He was telling me why he couldn't return to his current residence. Gangs, cops and his internist.  They are all in it together. I LOVE THIS!!! So he's going through this long convoluted story and I say to him "geez, you have a fixed delusional system"!  It was an "ah ha" moment for me.  He didn't like the idea (can't say as I would either). In fact he got a little defensive...duh! The next morning when I brought him his meds, as I was leaving the room he said, "and I do NOT have fixed delusions". I said "oh yes you do" and dashed out of the room before he tried to explain why he didn't. I didn't have time.  See that's the thing about fixed delusions. They are FIXED!!! There is no convincing him otherwise.  The good news is that the ECT he was having did not effect his short term memory.  What would I do if it did?? He would forget that "people are treacherous creatures" and that his world is a fixed delusion. And then what would we laugh about?

This is TOO much work

So, I'm reading my nieces' blog "Like Doogie Howser" and I try to leave a simple comment.  OH, hell no they say!! Must have a Google account.  Well, I have about 3, none of which I can recall the password.  Several trys later I give up, and post "anonymously".  Then I have to try to decipher those wacky words they now enjoy torturing the Baby Boomers with.  Then they text me a "validation code" which apparently must be used in under 15 seconds, or they send you another. Are these people kidding?? I have to at least FIND my cell.  Then find my glasses, then "accept cookies" (I'm sorry, do I look like I don't accept cookies??)
So, THIS TIME I really am gonna try to keep this blog going. I'm not gonna tell ya where I live or where I work.  Too much really funny shit happens at work, and it's all HIPPA protected.
I will tell you this much:

I make Mildred Ratched look soft.

I've been a psychiatric nurse for 32 years.  I could NOT make this shit up if they paid me.