Time, Place, Person

George as a puppy with Meg

Please no comments telling me I'm a lovely man
This is an observation not a request for praise

The buzzer went off around 4 am

It was room 12
I suspect the lady who slept in room 12 wanted to get up as she thought it was morning
I was wrong.
The lady wanted to go home and was incredibly fuddled
I sat on the side of her bed and fielded questions the best I could
No it was only 4 am in the morning
No she couldn't go home to her daughter right then
She had poor poorly at home for a while so needed to be here
yes her daughter visited very regularly
My name was John and I was one of the nurses
Yes I knew that her daughter lived in the same village
No it was 4 am and it was not possible that she could go home

In nursing , reality orientation is centred around the reinforcement of time, place and person
but like any concept it only works well in the classroom and not in a side room of a nursing home where the ceiling light casts hash shadows on the wood chip.

The patient was becoming more and more distressed, not with the reality of her situation but with her own inability to understand what was going on.
She screwed up her fists like a child.
I thought of what next to do
divert, divert, divert

I gave her a drink. I straightened her duvet and I told her a story.
I told her about how I needed to  take George to the vets later that morning and how he shakes so as he is sat in the waiting room.
I told her about how he came to the cottage in the back of the old white polo
Covered in vomit after his first long car ride.
I told her how he used to wait all day for the moment just he and he alone would be allowed to bed upstairs on his own
and I told her about how for nearly thirteen years he had never caused one minute of fuss or demanded one minute of attention
At first, during the monologue, when I left a gap or a space in the narrative she butted in with an
I want to go home
but as I droned on, she quietened down somewhat
I told her about how George totters along the railway walkway at such a pedestrian pace its maddening and I  told her the story how he and William fought for the first and very last time as teenage dogs and how I had to separate them by hitting them with the contents of the washing up bowl and a bin bag full of sooty scrapings from the hearth and by the time I had finished she was quiet but still awake.
I tucked in her duvet and told her it was time to rest
diversion or boredom?
She closed her eyes
You use any tool that comes to hand

…..at 4 am in the morning


90 comments:

  1. Suzanne4:38 pm

    I have 2 cats and I find that their feline antics are fantastic subjects to talk about when a neutral subject is needed. Somehow whether or not they have pets, most folks react well to pet stories.

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    1. Having said all this , I can also bore for Wales.
      There's nothing worse talking about your pets when someone isn't interested

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  2. I think it takes a great amount of empathy though, to work in the ‘caring professions’. It also takes a great deal of dedication. I would not be able to do it. I would be burned out in no time.
    That photo is utterly adorable.When I see puppies I have the same feeling I get when I see young children: I think it should be super cool to have one. Then I remember they grow up very quickly and decide that I’ll live vicariously that experience through others.

    XoXo

    P.S. It’s cute how you post disclaimers when you know we’re still gonna think it 😄😆😉

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  3. Shame we can't clone you and put several of you in every hospital.

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  4. The advice to "divert" is welcome to me at this time. My mother is losing her cognitive abilities and it is most evident when she isn't well and has to be under medical care. She gets easily aggrieved and I have not known how to intervene without making things worse for both her and myself. Next time I will try this. I'm glad you posted about it.

    Meg looks for all the world like she is smiling in that photo.

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    1. She wasn't a smiling dog , but was only really happy when with me

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  5. Okay, I won't praise you. I came here for the puppy pix! My best friend of close to forty years used to call me up from New York. It was late back there and I wondered why she was up. After talking for at least an hour, she would slow down, say she needed to sleep (at two a.m.) and hang up. It became a joke that she used my voice to make her sleepy. I prefer to think of my dark brown *cough* voice as soothing, rather than boring. After hearing your voice once or twice, I'd say go with soothing also.

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    1. Listen I'll take any reader where I can get em

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  6. Anonymous5:09 pm

    Thanks for this helpful post. I will remember it when I visit my elderly neighbour who is ,sadly, in a similar state to your patient.It sounds like just exactly what you would do for a child who had woken after a bad dream so I can see just why it would help.
    Hugs. Susan

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  7. Interesting post today, I understand why the story is just something you started talking about to calm her down. but your talking to a Scotty person here. I understand the ways of Scotties are the way of the Jedi. Secure little gud dugs.

    cheers, parsnip

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  8. George and your gift of the gab saved the day. What a cute puppy photo of he and Meg!

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    1. That's the last time he was truly playful

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  9. Anonymous5:22 pm

    Knowing individual patients and their sweet spot is the key!. An old chap frequently woke up at 4am in a panic needing to get a train to Edinburgh thinking he was in England. He was in Edinburgh. I found at home an old sony walkman and scottish tapes , That worked for a week or so. Last night i was on didnt work, he had packed all his belongings in to a dressing gown and tied it it in knots as he had to get to Edinburgh. I wittered on about being hungry and as we were in Edinburgh i was having haggis tatties n neeps. His face lit up!. So i shared my supper his face lit up and said i,m really home arent i. Sure i could have been hung for giving paients my microwaved food but was a calculated risk that worked. Benefit of being an old unscared nurse.x jac

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    1. lol I may draw the line at sharing a scotch egg with ANYONE

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    2. Anonymous8:56 pm

      To see the old lad relax saying he was home was worth every bite!..He slept soundly after that. Jac x

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  10. It was like a soothing bedtime story. Although never read to as a child, I was once read to as an adult and I immediately relaxed. I would like to get a bedtime story routine incorporated in to our dementia unit. I have also used stories to calm and distract children when doing long treatments.

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    1. I was never read bed side stories as a child

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  11. Really interesting post. I did not realize time, Place and person is a mantra.
    Traveller

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    1. Yes TIME PLACE AND PERSON
      The mantra of reality orientation

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  12. At 4am the only tool usually at hand is my.......

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    1. And like every good straight guy sidekick I set you up

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  13. Anonymous5:53 pm

    What a great story - made me laugh out loud when you said:"diversion or boredom..."
    KJ

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  14. Are you sure you haven't got children? You can see how tiring living with that day and night is. At least as nurses we can walk away.

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  15. This is precisely why you are SO good at what you do, John.

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  16. So much more effective than administering a sedative don't you think?

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  17. Replies
    1. I didn't have anything to write about today

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  18. This post moved me. My Dad suffered from vascular dementia in the months before he died and he was in a nursing home. I wonder if he ever woke in a confused and distressed state like that. If he did, I hope he received attention from a nurse like you.

    On a lighter note, divert divert divert works with a 2-year-old granddaughter’s tantrums too, if one can think fast enough!

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    1. Same interaction different patient

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    2. Barbara Anne7:54 pm

      My sweet MIL was direction of a child care center that had kids from 6 weeks to 5 years in age. She said one good technique when dealing with a small person's tantrum is to whisper. The child is so curious the tantrum will usually stop so he/she can hear you! That worked on our sons. :)

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    3. I'll remember that one

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  19. A story containing valuable (practical) information for some future day. Thank you. -Kate

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  20. I've been there. I used to do two, consecutive twelve hour night's when my children were small. One sweet lady used to wake around four and two weetabix with hot milk and a few soothing words as I spooned it into her mouth usually did the trick. They were loooooong nights.

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  21. There are times John when i could do with you here at 4am - but don't bring the contents of the washing up bowl!

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    1. I could often do with Russel Crowe at 4 am

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  22. Anonymous7:23 pm

    Virginia here....

    It must be very distressing when those landmarks disappear.

    A friend of mine’s mother became forgetful and distressed during the final stage of her cancer. Beside her bed, Jane had a picture for the two of them together and a whiteboard that said something like “I came today at 4pm, and I’ll come and visit you tomorrow at 3/whatever/“ . Once the nurses had read that to her, she’d read it again and again and they said it helped . But I’m thinking that she was still a little more anchored than your patients are.

    Another thought provoking blog. Thanks John.

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    1. Songs have the same effect so I've read

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  23. Nice to hear you still have tools coming to hand.

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  24. Barbara Anne7:46 pm

    Brilliant interaction with the confused little dear.

    I am reminded of the night (only 11pm) when I was sure my sweet mother had Alzheimer's. I was visiting her home as I knew something was amiss and as I was headed for bed, I met Mom coming up the hall, dressed for the day, purse and CAR KEYs in hand. Gulp! She wouldn't believe me that a black sky meant night or that the clock showing 11 meant night. She actually said "I don't believe you!" and it was an effort to get the car keys. I finally got Mom to go back to bed but she slept in her clothes and kept her shoes on. Some battles aren't worth fighting. The next day we had a comic/tragic conversation about "me" and "you" with pointing back and forth to illustrate our meaning. It did not compute with Mom but we did have a good laugh and hug. Sometimes you just have to laugh.

    Hugs!

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    1. Humour helps certainly
      As does breathing through your mouth

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  25. You have more patience than I do. When my dad was in the nursing home with vascular dementia begging to be taken home I really didn't know what to do. He was so deaf I couldn't have a conversation with him so I just switched on the TV, with subtitles, and watched mindless dross with him.

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    1. I have patience because The you are not my relatives and I only see them for a few hours a week

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  26. reading and telling stories to people relaxes them. like putting a child to bed at night.

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    1. I never experienced the phenomenon ever of the bedside story

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  27. Totally different scenario but my daughter and I saw a toddler fall today who didn't cry until his mother reacted. My daughter thinks she is not maternal but we both said how a slight distraction could have avoided the tears.
    It just takes a bit of extra effort but the outcome is usually worth it x

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    1. There is a video doing the rounds about a doctor giving a baby an injection...he spends a good few minutes playing with a blunt needle on the baby's skin then wham injection given and baby hadn't a clue

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  28. Yesterday one of my brothers passed away. Two phone calls( each an hour and half long) later I'm simply drained of energy...not from grief, from the efforts of dealing with two other siblings' detachments from reality. Doing your job well must be exhausting, John, I hope your taking pride in your ability to bring a bit of ease into a troubled person's world is reward enough to keep you willing to go the extra mile with them.-Mary

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  29. It's no wonder you are drained after a night shift. Having patience at 4am is the hardest thing, ask any Mum with a baby who doesn't sleep through and they'll tell you the 4am feed is the killer.

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  30. Old age is frightening.

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    1. Ain't that the truth
      I'm never going to be old

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  31. My Dad suffered from vascular dementia. When he would go off the rails completely, and be in such a panic and he would say, over and over, "I need to get out of here!" and it was SO hard to help him. What helped one day, was to ask him to tell me a story about his college days, about football. He could so easily go back to those memories, which he cherished. That would usually work. Not always, though. He would get into such a state, that we had to give him crushed-up Xanax in pudding. That seemed to help, too. I can see why elders in nursing homes can end up medicated - it is sometimes the only way to get them comfortable. What was hard for us children is that we always second-guessed ourselves about whatever we tried to do to help him. Did we do it for us? Or did we do it for him? Was it both? Sigh. Sending LOADS of white light, love, and patience.

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  32. You would have made a good father. You have the power of soothing.

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  33. You are very patient and very kind.

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    1. No more than many nurses I have known

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  34. My most memorable distraction moment was with a client (and friend) who suffered from chronic pain that would get out of hand on a regular basis. We had many modalities etc but that time she remembered she had bought a 'do it yourself' ear piercing kit. After considerable persuasion on her part I agreed to pierce her ear! The horrible part was the dang thing broke while halfway through... I had the willies so bad and didn't know what to do next. She was laughing and told me to just push it through. A horrible sensation, but in the end it worked and she still has that extra and very memorable hole in her left earlobe.

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  35. Damn, I have my heart on my sleeve today. I cried and cried. Poor old dear. You did well.

    How do you keep from crying?

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    1. I have witnessed these scenes since I was 20

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  36. I work in a community alarm call centre and many of the night time calls are from dementia sufferers, some of them are heart breaking. We have no relationship with these people, we're just a disjointed voice coming from a box that they might not even remember is there. It can be incredibly difficult to know what to say.

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    1. I'm sure you say things with warmth ....warmth is what can be picked up on

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  37. In a better world, there would be a dog to make her feel at home, she can’t go home someone needs to walk the dog.

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  38. Hmmm, I probably shouldn't have read this but I wish there were a few nurses like you where mom went.

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    1. I was thinking about you today my friend

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  39. My grandma spent her last years in a nursing home, but in the in-between time and she was on her own, I would get her and include her in the day's activity.But sometimes she get frustrated with the noise of the children or laughter of adults. I would ask her, if she remember a time when she and her brother or sister played, and get her to tell me a story. Adult as I was, it was like magic for me to listen, and perfect for her to tell. After awhile the ploy of Tell me about Childhood didn't work, but while it did it was good for both of us.

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    1. There is always a key to unlock something that helps

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  40. An emotionally disturbed student was placed on my case load. I came upon him, curled up on the floor and rocking. I sat down with him and started talking. I can't even recall what I babbled about but he stopped rocking and I got him to walk with me to my office. He spent several hours working quietly in the office with me. Yes, sometimes you have to meet them at their level in time.

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  41. It's odd to me that we all seem to forget the power of story, even when we know how important story-telling was to the preservation of our culture and our past, before print. So many factors are involved--humans speaking directly to each other (which seems to become more and more rare in our electronic culture), the sound of a voice, the shared experience as the teller responds to the listener.
    I'm happiest interacting with other humans when we start to tell stories to each other, of our childhood, our mistakes, our escapades...and yes, it usually takes a little alcoholic lubrication to get there, but it also takes the right people sharing with you.
    When my granddaughter was a wee tit-wren, my daughter Laura and I looked after her 3 days a week. Laura's best trick to induce sleep was to prop Lily against her knees on the bed, so they could see each other, and make up stories about their shared experiences...the dog they saw on a walk in Lily's pram--do you think he was happy to see us?, what do you think those birds are talking about in the tree outside? and so on. A little gentle jiggling didn't hurt either.
    Sort of random response, but thank you for reminding me of the joy of hearing another human. (Yeah, I've had a glass of wine or two, but that's okay.) Take good care of yourself, love Kate

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  42. You ARE a lovely person though. My Mum is very poorly in hospital (dementia/stroke) and it has given me hope that she will receive that sort of loving care too. Thank you. xxx

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  43. I am sure you helped the old girl sleep and get some rest. Well done.

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  44. I guess nursing is as much a question of ingenuity, sensitivity and common sense as it is of medical skills.

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  45. Anonymous10:07 am

    I would hope you were just doing your job as others do, but I know some don't. It must have been an awful experience for her, even though she probably did not remember it. Yep, you are a pretty wonderful care person. The care people who have looked after my mother while in hospital are white Australian and recent immigrants. It was a recent immigrant Muslim woman who my mother liked the best. "What Mother? One of those foreign types from one of those countries?"

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  46. You are a treasure!
    Debbie

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  47. This really is a great lesson for anyone! ... And i would never say you’re a lovely man. It’s not an expression I use. But you ARE a sweetheart.

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  48. I also worked with dementia and one day we had an admission who was a lady from Russia. She had taught at university level and her command of languages was unbelievable. She used to say often "I have lost my head" which was disturbing to hear. One day we were all playing Bingo, and the caller said "4 and 7, 47" This patient suddenly quipped " Oh it was always 11 when I was young". Clever, clever lady, we all loved her but sadly she was ambulant and escaping was her thing, after all she escaped from Russia. She had to be moved where they were allowed locked doors and better staffing. I often think of her and it would do us all good to listen and talk together quietly. Love Andie xxx

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  49. We were woken at 1.30 am by an old dear who rang our doorbell looking for her son. She had driven around since 3 the previous afternoon and had no idea where she was or how to get home. My husband asked her address (3 miles away) and got her to follow our car as we delivered her back home safely. I wonder if she remembered the next day. We went to the place she said her son lived the following day but it was an empty house.

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