He asked me, again, to meet him in his room because he needed "to talk." Bipolar, mixed phase sliding toward the more depressive side, with notable paranoia. The other nurses and I had animated conversations about his constant, attention-seeking paranoid delusions as being just that - attention seeking and thus, behavioral in nature. I on the other hand, having taken care of him for several days throughout the week, noted the genuine fear in the paranoid delusions. "When I was in the ER, they gave me IV fluids and I think they poisoned me....When I was sleeping at the hospital before I came to this one, I think I got raped. My butt hurts....I got raped, I know it. I think I have HIV. I want an HIV test.....I have a headache, I think I have a brain tumor. I want a CT scan. Call the doctor NOW-I need an Xray of my head!" And on and on the delusions went. I patiently attempted to address each one and, if need be, contact the doctor to see if further testing might be warranted, or a possible medication change, or a complete set of vitals, or....Oh, I'm exhausted just remembering this patient!
"I want to see your notes."
"You can't see my notes. They are mine. Why do you want to see them?"
"I just want to see them. I want to see my medical records and the doctor's notes. I want to see what people are saying about me."
"You can't see my notes or the doctor's notes. You can see some of your medical record on your iPad app the hospital provides, but it is limited in the information. It won't have the notes."
"Well, then, I want to see your notes."
"Why do you want to see my notes?"
"Because I want to see what you're saying about me. I don't think you like me."
"Why do you think I don't like you?"
"I don't know - it's just a vibe I get."
"Have I done something to indicate that I don't like you? I have made a lot of effort these past few days to answer your questions, spend time talking to you and helping you in any way I can."
"Well, I just don't think you like me."
"What I don't like is being told that I don't like you when I have done nothing to indicate that I don't like you and many things to indicate that I care about you and want to help you have a good day and get better."
"Well, I guess I'm just treating you like I treat my mom."
"Ok. I can understand that. Do you want to know what my notes say? They say that you are having paranoid delusions, disorganized thought processes and that you are easily overwhelmed and slow to process information."
"Oh, yeah, I guess that's accurate."
END of conversation. Reality orientation can be SO effective.
Phew!
*All descriptions of any identifiable data of each patient have been drastically altered to comply with HIPAA laws. If you think I'm referring to you or someone you know, you would be completely wrong.
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