The Angel and the Nut

She was a woman in her 40’s who had been admitted for vague abdominal pain. A number of tests had been completed and no cause of the pain had been found. When I had been assigned to care for her she was no longer complaining of pain in her abdomen. The pain had moved to her neck. Little did I know that she would be giving me a similar pain over the next three nights.

She is what we refer to as a “brittle diabetic”. This basically means that her blood sugars are extremely labile and difficult to manage. On top of this, she was crazy. She was forgetful, paranoid and irrational. The first two nights I cared for her were busy but uneventful. She called frequently for snacks and with questions about when her next dose of pain medicine was due, but we got along just fine. She called me her “angel” and told me that I was the “kindest, most compassionate nurse”.

The third night didn’t go as smoothly. The previous day she had been refusing all of her medications and meals. She had vomited on herself and refused assistance cleaning up, so she was lying in bed covered in dry vomit. When I went in to see her, I offered to get her some clean pajamas and a bedtime snack. To my surprise, she agreed and allowed me to help her get cleaned up.

Slowly the rest of the night began to deteriorate. She questioned me repeatedly about her medications. She became more dependent on me to do things that she could previously do for herself. She couldn’t walk without holding my arm. She wasn’t able to open her sugar free jello. She couldn’t undo her pajama bottoms in order to use the toilet. I encouraged her to be independent, but that didn’t work. She quickly became angry with me.

“I don’t feel good!” she yelled.

“You were able to walk without any help yesterday. You need to be independent,” I rationalized with her.

“You don’t fucking care about me!”

I could feel myself getting irritated and I was afraid that she could also sense my annoyance. I grabbed another nurse and asked her to cover for me so that I could leave the room. I needed to get away from this woman. She was getting to me and I felt like a horrible nurse for allowing it to happen. Why was I permitting this woman to upset me? Why was I letting her take control?

After I had cooled off, I approached her. She was crying, which wasn’t really unusual. She cried easily and I wondered if it was an attention seeking behavior.

“I’m sorry for taking up so much of your time,” she said.

“It’s alright. I’m here to help you but I need you to do things for yourself,” I told her.

She looked at me with tears in her eyes, her upper lip quivering. I couldn’t help but think she looked like a six-year old I once cared for during my pediatric rotation in nursing school. Emotionally, I think the six year old was probably more mature.

“You’re my angel,” she whimpered.

High praise from a nut like her. High praise, indeed.