Demented Curmudgeon

I first met Mr. Jones* several months ago when he was admitted to our unit from an Alzheimer's home with severe dehydration. His lytes were all over the place (along with accompanying dysrhythmias) and he was severely anemic. We patched him up and sent him up to the floor, but not before he earned a reputation here in the ICU.

There's pleasantly-confused dementia, and then there's the-world-is-out-to-get-me-and-I'm-taking-you-down-too dementia. Unfortunately, Mr. Jones fell into the latter group. Bad enough was his constant profanity-laced muttering under his breath. But he quickly earned a reputation for taking hostages by violently grabbing arms, hands, whatever was in reach, and not letting go. Sometimes his steely grip could be peeled back finger by finger, but more often it required getting on the call bell and pleading for reinforcements and rescue.

I remember being struck by the juxtaposition of his violent tendencies and the tender devotion of his wife. She was there every single day for morning, afternoon, and evening visiting hours. Knowing full well he must have been a good and decent man to deserve such loyalty, I remember thinking how unbearable it must be for her to sit by day after day and bear witness to the slow corruption of his mind and character. There were moments of crystal clear lucidity, and honestly I think they were worse than the dementia--because she had her husband back for one brief instant. She never knew for how long--sometimes long enough to reminisce. Sometimes only for the breadth of an "I love you."

After he was transferred upstairs, I'm not sure if he was ever discharged from our hospital or not. But I do know at some point he came down with pneumonia, ended up intubated, and right back in our unit. He's trached now, and vented. He can't talk, and his mentation has deteriorated to the point that he's mostly unresponsive, constantly agitated, and generally belligerant.

Today was a super busy day on the unit. We're full, and with sick, sick patients. From hepatic encephalopathy to CVVHD on a post-op CABG patient to a 232 kg woman bouncing between Mobitz type 2 and 3rd degree heart block.

As shift change approached, I was making my rounds helping reposition patients one last time. The last bed on my tour happened to be Mr. Jones, and as we got him turned he opened his eyes, looked me square in the face, and grabbed my arm. He's much weaker now and I had little trouble pulling free of his grip. When I did, I noticed he was more agitated after I let go. Putting my hand in his to hold onto seemed to calm him.

I sat down in the chair next to his bed and held his hand. He drifted off to sleep fairly quickly, much to our surprise. But each time I'd try to extricate my hand, he'd wake up and become agitated again.

And so I sat, holding his hand, letting him sleep. My shift was supposed to be done at 1915, but I stayed until 2000 when his wife returned for evening visiting hours.

It was just 45 minutes, but it was more than long enough for this indelible truth to reveal itself--that even in the midst of a completely demented hell, the human soul reaches out, grasping, searching, yearning to know. To know simply that we are not alone.

Thank you Mr. Jones for taking time out of your day to teach me this profound truth.

*Of course Mr. Jones isn't really named Mr. Jones.