A Scratched Buttocks, Col. Sanders And A Ship

The patient was missing a little piece of skin from her buttocks and we were trying to decide what happened. One nurse thought it might be a pressure ulcer. I thought that it was just a scratch. The patient indignantly replied, "I did not scratch my butt." Gently, it was explained that it could have happened many ways, such as from the bedpan or from a nurse's nails helping her with the bedpan. Most likely, though, she scratched herself on the butt. A large number of our patients have scratches there.

One of my patients had elective surgery and suffered a major stroke afterwards. She now has severe dementia. She spent the evening chanting, "Come here, Colonel Sanders. Come here." Before the surgery she was fine except for a worn out knee. Now, she's going to be chanting nonsense for the rest of her life. (If that ever happens to me, please kill me.)

We had another patient who kept asking, "When is the ship coming?" A lot of confused patients ask questions like that. Sometimes they're waiting for a bus or a plane, but they often think that some form of transportation is going to come for them. I once stopped a patient who was walking down the hallway carrying his suitcase. He was stark naked. I asked him where he was going and he answered, the airport. I told him that his flight was delayed and put him back to bed to wait for his plane.

The saddest patient of all tonight was a relatively young man with hepatitis C who most likely has liver cancer. He does not know yet. He has a large family for whom he is the sole support. The doctor's notes said that his prognosis is grim and that he's not a candidate for a liver transplant. My stomach is in knots. I wish that he had been put on a different floor because it's just too depressing to take care of young sick people who are only going to get sicker. I prefer my crazy, old orthopedic patients.