The first little old lady I came across today was my lovely 96 year old patient. Long story short, she doesn’t function well. She is disoriented and demented and bedridden. And every day for the past week the worst part of my day is explaining to her husband of 70+ years that she is not going to get better.
The second little old lady I saw today was wandering the halls of the psych floor. She was teeny-tiny, had white/blue hair, and was wearing dark, movie star-like, cat eye sunglasses. Indoors. On the psych floor. I put my head down and avoided eye contact with the rogue patient, an efficient (and totally mature) maneuver when you are determined not to get side tracked.
Later in the afternoon I returned to the same psych floor to follow-up on another patient. This patient, mind you, hates me. Mostly because we decided to involuntarily commit him to the inpatient unit. He is large and he is aggressive and when I enter his room I position myself between him and the door. I go into his room alone as little as possible.
So this afternoon I entered his room and who do I see sitting there but the same little old crazy lady I saw lost in the hallways earlier. Um, what is going on here. She was relaxing in a chair across from him carrying on a pleasant, jovial conversation. Huh. This man is not nice, and this woman does not belong here. But before I had to do something awkward, like intervene, the emblem on her shirt caught my eye. She was wearing a hospital uniform shirt, a patient-monitor*-uniform shirt.
My little old lost crazy lady is not so lost after all. She is my patient’s one-to-one patient-monitor. And she has blue hair. And wears sunglasses. Indoors. On the psych floor.
*when a patient is considered a danger to himself or others we are obligated to assign a one-to-one monitor. This monitor sits in the room with the patient all day and all night. The monitor doesn’t usually speak to the patient unless the patient speaks to him/her. He/she becomes a fixture in the room and ensures that the patient isn’t pulling out his IVs or doing anything else alarming or stupid.
One of the last little old ladies I saw this evening was admitted for delerium/suicidal ideation.
Little old lady: Here is my list… of medications. Oh… and I should warn you… I have a lot… of trouble… hearing.
My resident: WHAT?
She didn’t get the joke.