Ok, this is probably NOT going to happen to you. At least, probably not on day 10. But most people who work with the
elderly, specifically the population of elderly with severe dementia, will
probably experience a combative patient at some point in time.
This week I had my first experience with one of these patients. I was not touching her, but was
gently talking to her to try to get her to do a little bit of exercise with me.
My coworkers had warned me that she was having a bad day and had scratched the
nursing staff earlier, so I may want to watch my shins in case she decided to
kick me. I moved to her side and
engaged her in conversation.
Suddenly she yelled “I hate you, go away!” and karate chopped me hard in
the neck. It brought up so many
emotions in me. Shock. Anger.
Sadness. Frustration. The biggest
thing was an overwhelming sadness.
Sad that this woman was so far along in cognitive decline that she
couldn’t realize I was trying to help her. Sad that I couldn’t communicate better with her. Sad that all of these elderly people
are just waiting here, in this place, this limbo, until their time comes.
I knew that working with the elderly, especially in Skilled Nursing,
would be challenging. I knew
that at times it would be devastatingly sad. I knew that the patients might be difficult to work with. But it’s impossible to prepare yourself
for how much it honestly truly hurts to realize that you are useless. You cannot help everyone. No matter how much you want to. I think this is something that will be
a particular challenge as a new grad, because we are so excited to go out and
change the world. I don’t want us
(or myself) to lose that drive, that sense of purpose. So we have to find a way to keep our
positive attitude while at the same time accepting that not every patient will
respond to us and not every situation will turn out how we hope it will.
I’m fortunate that a great deal of the patients I see are Medicare A –
which means they are temporary stay with a goal to go home or return to living
with their family. These patients
are generally highly motivated and tend to be more advanced in their functional
abilities. I love my Med A
patients. They are basically, to
me, like the elderly you would see in an outpatient facility except I get to
see them every day. I’m not saying
that I don’t love my Med B patients (permanent residents). I love them in a heartbreaking
way. We can only do so much for
them, sometimes all we can do is try our best and hope that it benefits them in
some way. When someone has
dementia, they have good days and bad days, and it’s difficult to know how they
will react. They have no filter,
and will tell you exactly how they feel about you. They may verbally berate you and say they hate you, or tell
you that you are beautiful, or that you have too many freckles.
As I continue this journey I hope that it gets easier for me to manage
my emotions. Many people have told
me I need to build a wall to keep myself self. However, I think that not having a wall is one of my
strengths when it comes to patient relations. Only time will tell what method ends up working best for
me. For now, I will simply work on
accepting that even the very best therapist has bad days, as does the very best
patient.
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