A little push and some perspective

I had an older gentleman two nights in a row recently. He was recovering from a big abdominal surgery and had gotten transferred to my unit after complaints of chest pain. We ruled him out for a heart attack but he had some other problems such as acute renal failure and an early pneumonia so he would be staying with us for a little while.

My first night with him he was surrounded by family members. He had had a rough night the night before including the transfer, a bout of confusion, and not much sleep. When I asked him if he wanted to get cleaned up for the night he refused saying he just wanted to sleep. Fine with me. My preceptor had taught me long ago that in a critical care unit you don't die from a little stink!! Missing one bath isn't too big a deal when the patient is pretty clean anyway and just wants to rest/sleep. We did turn and reposition during the night though.

I come in the second night and he has no visitors. They have all gone home already. He is still feeling pretty icky and again requests to sleep. But he needs some good respiratory toileting and a good lifting of his spirits. So I inform him that sleep isn't an option right now and that he needs to get cleaned up and repositioned. I promise him a back rub and that it will all make him feel lots better. He whispers something that I cannot understand. I ask him to repeat it and when I finally understand it he has said "not worth the trouble". I tell him that YES he is worth the trouble and that, in fact, it is no trouble at all. He just nods.

I take the first washcloth of warm soapy water and rub his shoulder with it and his tense body immediately relaxes and he whispers "that feels good". I tell him that I'm glad. He's been having tons of anxiety the past few days and hyperventilates with any stimulation. We've been between a rock and a hard place on giving him any anti-anxiety meds though as we don't want to further compromise his respiratory status.

I get done with his trunk, arms & legs and get a new cloth for his privates. I tell him that I am going to do them and he immediately tenses again and freaks out while I do that area. As soon as I'm done I reassure him that I'm done with that area and that it was necessary to do it since he has a catheter in. He whispers "I hate you" though I can tell it isn't with much vigor! After a turn, back rub, sheet change and rectal temp I'm done.

A fellow nurse comes in to help pull him up in the bed and get him repositioned on his side. I ask if he is comfortable and notice that he is again relaxed and see that he nods "yes" to being comfortable. Then I ask if he is ready for me to be done torturing him. He whispers "I am so glad you did that for me", claps his hands and has a sparkle in his eyes. I actually almost cried!! Mostly because the night before he was so confused that all night long he was intermittently sitting up and yelling out "help me" and it wasn't easy to calm him down. He was just a confused old man. And the next night he was a sweet old man. Kind of puts it into prospective. Either way, he is an old man who is a human being. I think sometimes it is easy to forget that as we take care of these sick people each shift.

The second night he took a short nap after his bath and then awoke quite confused again similar to the way he was the night before. But tonite I have my perspective back and also my patience. Sometimes I lose that perspective and I'm sad when that happens. Not that it's a great excuse but that first night we had only 1 lucid patient on the entire floor. Makes us all crazy sometimes you know!