Mr. A took a swing at one of the nurses' aides just before I arrived for the day. He was usually pretty feisty but as a rule wasn't a violent guy. Unable to speak since his stroke several years ago, he was still able to communicate his needs through hand signals and comic facial expressions.
But today Mr. A had been creating quite a fuss. He'd been aggressive with the staff, a few visitors, and apparently the chaplain. Usually if an older person has a sudden change in behavior, it means that they have a urinary tract infection. It's a simple matter of getting the patient to pee in a cup (or emptying their catheter bag), dipping a stick in it, giving them some antibiotics, and—voilà!—instant behavior correction! It was one of my favorite bits of medical magic.
I gave an order for a urinalysis. This was complicated by Mr. A swinging his walker at the aide sent in with the specimen cup. When I got there in the afternoon, the nurses' station was abuzz with tales of Mr. A's “attitude problem.” I asked about the urine sample that was requested. Never got it. No one wanted to deal with a violent patient.
Mr. A was headed straight for a psych evaluation and sedation.
Suddenly, or at least as suddenly as a guy who's had a stroke and uses a walker can go, he was standing in front of the nurses' station for a moment before he pivoted and started cruising down the hall. I grabbed my specimen cup and followed him down. It was time to use my advanced clinical skills.
“Mr. A, how are you today?” I gave him my biggest smile. He smiled and babbled back.
“Do you remember me?” More smiling on both sides.
“Can you give me a urine sample?” Smiling, babbling, and walking toward the bathroom.
“I have a cup right here. Will you fill it up for me?” Smiling, nodding, and babbling.
He went into the bathroom, came back out, and handed me a cup. I capped it, thanked him sincerely, helped him tuck his shirt into his pants, and took my prize down the hall.
The charge nurse on duty saw me coming with the still-warm cup wrapped in a paper towel.
“Nope. Got some test strips?”
Two minutes later, we had a positive test strip for a bladder infection. Mr. A cruised down the hall and said hello with a big grin on his face. There were no walkers thrown, not even a cross word spoken. For a few months, anyway, Mr. A had a reprieve from the threat of being moved to the state behavioral health hospital—a frequent destination for those deemed too difficult to deal with at our rural long-term care facility.
A few months later, however, he was gone. While I was away on vacation, Mr. A punched an aide. The facility administrator and the director of nursing made the call to have him removed from the home. They had their staff and other residents to think about. His family removed his meager belongings from his shared room and that was the last I heard about him.
I didn't forget the lesson I learned from my time taking care of him, though. Meet them where they are, and treat them with love.