Yesterday I was getting a patient from the ED whose admitting diagnosis was “altered mental status due to hepatic encephalopathy”. They had stopped taking their lactulose, so their mind was fuzzier than usual. Patients who struggle with alcoholism that result in altered mental status can be a difficult population to keep patience with. They are also more difficult to keep safe. Unaware of their surroundings or physical limitations makes them a high fall risk and frequently has nurses and aids running to their rooms at the sound of their bed alarms. For this reason, I’ll admit, I was less than thrilled about the potential challenge I was getting into.
As ED rolls the patient up to the room, they’re resting in the cart with their hands behind their head as if poolside in a lounge chair. We greeted each other and I helped them settle into bed. As my aid took vitals and noted belongings, neither of us noticed anything altered. My aid went to other patient’s rooms while I went to grab a computer to get started on admission questions and sure enough, the bed alarm sounds.
“Hey there, what can I help ya with? Where ya going?”
“Dinner. Can I have lasagna?”
“Sure, let’s get you settled back into bed and I’ll put your order in.”
“Okay, thank you!”
Very polite, easily redirected and reoriented. The patient acknowledged that they weren’t quite their usual self and said they’d try to remember to call before getting out of bed. As we were going through admission question there was some trouble with word finding. I listened with patience at their tangential stories. After all was said and done & the patient was settled in, I asked if there was anything else I could do for them. They thought and then said,
“Kate I have to tell you. You specifically, but also everyone here, you sure are sharp. And with that, you’re so kind. It’s amazing to me that in a place this big, people still show kindness. So thank you. You’re a good one.”
This caught me off guard. One, because they used my name. Most of the time I’m getting called “nurse”. And second, because it regrounded me. It was the personal connection I needed to remind myself this patient was more than their admitting diagnosis, and still needed to be treated as such. In a state of increased confusion, they had clarity in recognizing kindness.
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