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Alert and Oriented x 3

LollipopsA blast from the past …

A nursing home patient was brought by ambulance for a complaint that they woke her from sleep, er, um she was having mental status changes.

Her chart listed a slew of medical problems including dementia and the fact that she was “non-verbal.”

It was busy that day, so the nurses ordered the basic “dementia” workup while the patient was waiting in the room.

When it was finally her turn to be seen, I went into her room and began asking her questions. She didn’t say anything. It was a little frustrating – how exactly was her mental status different if she wasn’t talking? At least it made my job a little easier in documenting the history.

As I examined her, she just laid there. Heart and lungs sounded fine. She would slowly pull her hands away if I pinched her fingernails, but I couldn’t get a great neurologic exam on her because she wouldn’t do anything I asked. She just laid in the bed with a blank stare. I could tell there was some higher brain function left, though, because I walked out of the room for a few minutes and when I returned, she had rolled on her side and pulled the covers over her face.

I usually make small talk with the patients – even if they are demented. Actually, it’s probably a sign of my own impending dementia. So, kind of rhetorically, I stood in front of her and said “Mrs. Peel, you don’t seem happy today. What’s wrong?”

From beneath the covers a raspy voice blurted out “I’ve been waiting in this motherf@#king ER for three hours. That’s what’s wrong.”

With that statement, she proved to me that she was alert and that she was oriented times three – to person (herself), place (she knew she was in the ED) and time (she knew how long she had been waiting).

Once I rearticulated my jaw, I asked her what would make her happy. She didn’t answer me.

I had a lollipop in my pocket from a previous kid who “didn’t like butterscotch.” So I said “how about a lollipop?” Still she didn’t say anything. I lifted up the blanket covering her face and put the lollipop in front of her face. Her eyes were shut and she didn’t open them. Like a little clam, she pulled the covers back down over her face.

As the ambulance crew was wheeling her back to the rig for her all expense paid trip back to the nursing home, I looked up to say good bye and the covers were still pulled over her head.

Just like the Madagascar penguins, I “smiled and waved.”

I actually laughed out loud when the tech found the lollipop wrapper on the floor by the side of the patient’s bed. She was playing possum at the ol’ nursing home. And I busted her.

But it was our little secret.

And to see why I recently felt this way, you’ll have to read this post on my other blog.

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This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on DrWhitecoat.com, please e-mail me.

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