The Demented Patient

I have been treating this patient every day since the beginning of P3. She was living by herself independently before she fell and fractured the mid-shaft of her femur. She is now incontinent, confused and displays many of the signs of a person with dementia. Currently she will need high level care. It's like treating 2 different people depending on the time of day. If I manage to treat her in the mornings she is much better but if I don't get to the ward until the afternoon she will blatantly refuse to do anything (more oftent then not). There is no reasoning with her...she will cry and scream and yell and kick till eventually you have to leave her alone. This was quite confronting the first week I saw her because I didn't really know how to handle it. She is rude and crude and will not let you touch her.

The solution to this was quite simple. Treat her in the morning. Sometimes I have to come back several times in the one morning because I can now tell as soon as I walk in the room whether the session will be productive or not. The best part about treating this patient is sharing with her the times where she actually remembers. You can actually see the change in the person and you know she's not in some fantasy land. Prior to this I didn't realise how difficult it is (emotionally) to treat a patient like this. It's hard to sit and watch them, knowing that at some point long ago they were living their life as we are now. And I think what's harder to deal with is that we could be just like that in the future.