I was a 24 year old RN working on a cardiac floor back in 1999. I arrived for my normal night shift at 6:45 pm. We were all young. The charge nurse had the most nursing experience and she was only 42. It was one of those floors that burned nurses out. Every room was always full, the patients were very sick and as soon as you discharged one patient, the ER would call with a new one who was patiently waiting on a stretcher in the hallway. We routinely made our patient assignment the moment we walked in the door and then quickly received a daily report from the day shift. It was my third 12 hour shift in 3 days. I knew all the patients and I knew Mr. Anderson. I had him last night. It was someone else’s turn tonight. My friend Kristi got him. She rolled her eyes because she knew that it would be a long night. I put my arm around her and reassured her that I would help her out. Nurses do that. We help each other out. Except for that one asshole nurse that everybody dreads working with but that’s a story for another day.
Mr. Anderson was a sweet guy in his 80’s. He was on our floor for a cardiac arrhythmia (irregular heart beat). Other than his heart, he was basically healthy. He stayed in the bed most of the time because his arrhythmia made him feel dizzy and he was afraid to fall. During the day he was a very kind, sometimes forgetful elderly man. He was what most nurses would call an easy patient. It was during the night that he got a bit more difficult to care for. He had “Sundowner’s”. For those not familiar, it’s a form of Alzheimer’s disease. Something happens and as the sun goes down and it gets dark. These patients change. They become moody and they seem to get disoriented. Nurses are trained to reorient these confused patients to person,place and time. It must be a scary feeling for them. They probably feel the way I do in Chuck-E-Cheese. Confused, disoriented, and moody. Mr. Anderson was no exception.
It was 2 am and I heard my friend Kristi struggling in room 348. I listened in on their conversation outside the door Kristi: [She is a very straight-laced nurse. I have never seen her bend the rules, ever. It’s kind of morally refreshing but at the same time, annoying as hell.]
She reorients the patient. “No Sir. You are at the hospital. It’s Tuesday night. My name is Kristi and I will be your nurse tonight, OK?”
Mr. Anderson was aggravated and retaliated. “What the hell are you talking about? This isn’t the hospital. I’ve been here the whole time. I’m not getting off the plane.”
Kristi: “No sir. You aren’t on a plane. You are at Memorial hospital. I need to change your bed linens. They are soiled.”
That’s when I decided to knock on the door and let myself in. [knock knock] “Hey Kristi it’s Ronda. Do you need some help?”
Kristi answers. “Sure. If you don’t mind, that would be great.”
I walk in the room and Mr. Anderson recognizes me but he can’t remember my name. “Hey there Mr. Anderson. It’s me, Ronda. I was here last night. How are you?”
Then I look at Kristi “So? What’s going on? How can I help?”
She takes a slow breath. “Well…Mr. Anderson does not want to get off the “plane” and I would love to change his sheets for him.”
“I totally understand.” I smile at Kristi because I have walked in her shoes. “I think I know how I can help everybody out. May I?” Kristi allows my help with no argument. Then I talk with Mr. Anderson.
Me: “Hello there pilot Anderson.”
Mr. Anderson: [calming down] “Hello.”
Me: “When are we taking off?”
Mr. Anderson: “Whenever you are ready?”
Me: “I’m ready. Let’s do this.” He smiles. I press the button on the outside of the bed and raise the bed to the highest position so I don’t kill my back. “Alright here we go. We have lift off.”
Me: “Alright. Looks like we are at cruising altitude.” I motion to Kristi to grab some clean linens out of the cabinet. She does so diligently and I organize my work area. I loosen all of the soiled linens on my side of the bed. When I am ready I motion to Kristi and ask Mr. Anderson if he is ready to turn.
Mr. Anderson: “As ready as I’ll ever be.” he answers with confidence.
Me: “OK. Turn left, left, left”
He rolls to the left. Kristi helps hold his body as I work diligently to push all of the soiled sheets underneath his body and place the fresh clean sheets around my side of the mattress. I have changed thousands of bed linens and I don’t mean to brag but this is one nursing skill I have mastered quite nicely. [loser alert] It only takes a few minutes and I nod to Kristi that I am ready for him to turn again.
Me: “OK Mr. Anderson. Turn right, right, right.”
He turns right with such precision. I assist him and hold him on his right side while Kristi pulls the soiled linens out from under him. She is shaking her head in disbelief with a smirk on her face. I shrug my shoulders and smile. We both know that we did not learn this in nursing school but it works. I don’t mind playing airplane. What the heck? Why am I going to keep orienting a patient who will never be oriented? Sometimes I “embrace the crazy” for the sanity of everyone involved. Mr. Anderson seems to be enjoying it as well. He must have been one hell of a pilot back in his day. It’s funny how much you can learn about someone’s past when they are disoriented. They seem to revert back to moments in their life that they are particularly proud or ashamed of. Thank goodness this seemed to be a good memory for him. He must have enjoyed turning in the air because he rolled with a content smile like it was therapeutic. Krisiti reached underneath his shoulder and grabbed the final corner of the clean linens and finished pulling the fitted sheet tight over the mattress. We were almost done.
Me: “Ok! Excellent turn. We can straighten out now. We will be landing shortly. Quick ride today.”
Mr. Anderson rolled onto his back with a smile. “Well? Sometimes those are the best.”
Me: “Absolutely.” We finished up changing his linens and I began lowering the bed.
Me: “OK, it looks like we are ready to land.”
Mr. Anderson : “Good. I’m tired.”
I lowered the bed all the way to the lowest position, lifted the two upper side rails and locked the bed into place so it would not roll.
Me: “Are you warm enough?” [Hey? I’m not ass kissing. It’s the right thing to do. It’s important to make sure people are comfortable. Fact: comfortable patients are happier which makes my job easier.]
Mr. Anderson: “I am. Thank you.”
Me: “You are very welcome.” I handed him the call light and reminded him “Remember? If you need anything, please don’t hesitate to call the control tower. We will be glad to help you.”
Mr. Anderson:[With a smile and sleepy eyes] “Sounds good. Good night.”
I turned on the bathroom light to provide some light in the room. Light will help orient him if he wakes in the middle of the night. I gave Mr. Anderson one last glance and a military salute over my eye brow just before I exited the room. He raised his eye brow and saluted back. Mission accomplished. I looked at Kristi and we giggled.
Kristi: “You are crazier than I originally thought but I love it! Thank you! I’m so stealing that airplane thing the next time I have to change his linens. Sooooo much easier!”
I laughed and put my arm on her shoulder. “Yeah? I felt your pain. I had to help my girl out. I couldn’t watch you orient him all night. He will orient when the sun comes up, not tonight. Sometimes you gotta embrace the crazy Kristi.”
Kristi: [She is not sure she heard that quite right] “Embrace the what?”
Me: “The crazy?” [Yeah..OK. I get it. I guess the word “crazy” probably isn’t the most professional way to say it but damn? When I’m 80 something years old and I think I’m a pilot at 2 am, please feel free to call my ass a crazy lunatic. I promise you that I’ll be OK with that.]
Kristi: “Ronda! [she looks around nervously] “You can’t say that???”
Me: [giggling] “I’m saying it to you NOT him. It’s fine. Shh!”
Kristi never let me forget the night I played airplane at 2 am. In fact, we giggled about it for years. I know I did not follow the text book interventions for caring for a patient with dementia. What can I say? There are moments when you have to think outside the box to succeed. You can’t learn everything from a book. Sometimes the only thing a patient needs is a good copilot. I think Mr. Anderson would agree.
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