Miss Ollie had just returned home after spending a week in a psychiatric unit for treatment of dementia, uncontrolled anxiety and hallucinations. She was confined to bed or wheelchair because the part of her brain that commanded her body to move just refused to obey, which is often the case in the very elderly. As a result, she was being referred to home health care for follow-up.
After completing the massive amount of paperwork required for a home health care admission, I asked Cynthia, our psychiatric nurse, for a mental health evaluation of Miss Ollie. She advised us that the best way to handle the hallucinations was with reassurance and redirection a program we felt we could easily manage. As her antipsychotics kicked in her mental condition was expected to improve.
Miss Ollies niece was a full time schoolteacher. She was thrilled to have any help she could get. She was bleary-eyed from being awakened throughout the night. "Look! There it is," Miss Ollie would shriek. "Help! Help!" Some invisible creature of unknown description would appear out of nowhere to torment her. It would zoom past her ear, fly across the foot of the bed and then disappear under her bed. It was especially frightening because she could not get up and run from it. Each time the vision came, it took hours to calm her down again.
Rudine, who was assigned as Miss Ollies aide, saw how the "creatures" antics affected her elderly patient nearly every time she visited. Rudine would reassure her that there was nothing there and try to redirect her attention, just like the care plan said to do. Miss Ollie was not buying it, though, and could not be comforted. She refused to eat and would not sleep unless she was medicated.
When Rudine took a week off, Betty was assigned to bathe Miss Ollie. That week was so much calmer that the niece called the Home Health office to remark on it. Cynthia assumed that the medication was finally working and that we could expect better days ahead.
When Rudine returned, so did the creature! It was as wild as ever, seemingly with a renewed sense of energy; and Miss Ollie was more disturbed than ever. Cynthia had no explanation for the regression, but I had an idea that Betty did. I took her aside to ask her about it.
Betty is one of those well-grounded people, full of wisdom and common sense. When she came in to the office to do her charting at the end of the day, I liked to sit with her and get her talking about things that most people avoid talking about like politics and religion. Shes the only person I know who actually enjoyed having Jehovahs Witnesses ring her doorbell so she could get out her Bible to compare notes. Although she was not a book learning sort of person, she had a unique worldview that was hard to argue with. I would characterize her as a bona fide self-actualized person at the peak of Maslow's scale.
I cornered Betty to find out what she had said or done to calm Miss Ollie. Yes, the change was her doing, all right I could tell by the twinkle in her eye when she looked away. She was a bit reluctant to tell, because she had actually ignored the care plan. Still at the same time she was bursting to tell her story:
Betty had only been at Miss Ollies house a few minutes on her first visit when the creatured reared its ugly head. Recognizing the situation, Betty was prepared for action. "Oh, no, there it is again", Miss Ollie screamed. "Where, where?" Betty hollered back. She threw a small wastebasket on its side, grabbing the lid and a broom. The creature was on the bed zoom, zoom, zoom! Betty took off after it, trash can lid in one hand, broom in the other. "Its over there!" hollered Miss Ollie. "I see it!" said Betty, breathlessly racing in circles as she was directed. Finally into the trash can it went Betty closed the lid triumphantly. Miss Ollie was beside herself with joy, clapping her hands. Now what to do with it? "Take it outside and let it go!" So Betty took the container out the front door, jiggling the lid, struggling mightily with it for effect, and released the miserable critter. Betty made sure Miss Ollie could see her from the bedroom window as she chased it across the yard, wildly waving the broom after it. She was able to bathe Miss Ollie who then settled in for a peaceful nap.
The creature apparently had babies, Betty explained, because she had to repeat the performance many times! Eventually the medication did begin to help, but at the time we were happy for a simple plan that provided at least temporary relief. We told Miss Ollie's niece and the rest of the staff about our new intervention. We debated about it, and in the end decided not to tell Cynthia some things are better left off the care plan!
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