Severance
I mentioned post-operative psychosis a while back, knowing that it was bound to strike one of my patients at some point in the future, and that it would provide for a good subject matter.
The past several days, I've been dealing with Patient T, who has developed a full blown case of it. For reasons not fully explained, some patients tend to get a little loopy after an operation. It usually starts 1 to 2 days after an operation, and they develop various reactions to varying degrees: audio and visual hallucinations, agitation, aggression, unintelligible speech, and short term memory loss are the more common manifestations.
Post operative psychosis tends to occur mainly in the elderly, and is probably associated with disturbance of sleep/wake cycles, surgical stress, anesthetics, narcotics, over stimulation, and disorientation of not being in a familiar environment. 99% of patients will recover on their own after a few days and will never recall going through it. Nobody really knows what exactly causes post-operative psychosis, and the best treatment is supportive treatment until they come out of it.
Now my patient has remained in this psychotic state for the past 5 days, and although her initial ramblings and nonsensical accusations of nurses defecating in the corner of her room were amusing, they have now become quite tiresome. Each time I come to the beside, Patient T's nurse looks at me pitifully, begging for a sedative. If not for the patient, then for themselves.
Most patients also develop some degree of paranoia, convinced that they've been abducted by the government for experiments. They also accuse their families of selling them to the government for money. I had a patient once that went on a derivation of this hallucination and was convinced that he was on an alien spacecraft. I walked up to the main nurses station and overheard this coming out of the patient call monitor:
"Cosmonaut X to base. Come in base."
Brief pause.
"Cosmonaut X to base. Come in base."
I looked at the unit secretary, who looked up at me, roller her eyes, and went on back to work. When questioned as to what that was coming over the monitor, she mumbled something about "crazy" and pointed me in the direction of the patient's room. Upon entering the patient's room, I was amused to find him standing stark naked on top of his bed, wearing his bedpan on his head (as a helmet) holding his wired TV control/Nurse Call Button, repeatedly calling for his home base.
The past several days, I've been dealing with Patient T, who has developed a full blown case of it. For reasons not fully explained, some patients tend to get a little loopy after an operation. It usually starts 1 to 2 days after an operation, and they develop various reactions to varying degrees: audio and visual hallucinations, agitation, aggression, unintelligible speech, and short term memory loss are the more common manifestations.
Post operative psychosis tends to occur mainly in the elderly, and is probably associated with disturbance of sleep/wake cycles, surgical stress, anesthetics, narcotics, over stimulation, and disorientation of not being in a familiar environment. 99% of patients will recover on their own after a few days and will never recall going through it. Nobody really knows what exactly causes post-operative psychosis, and the best treatment is supportive treatment until they come out of it.
Now my patient has remained in this psychotic state for the past 5 days, and although her initial ramblings and nonsensical accusations of nurses defecating in the corner of her room were amusing, they have now become quite tiresome. Each time I come to the beside, Patient T's nurse looks at me pitifully, begging for a sedative. If not for the patient, then for themselves.
Most patients also develop some degree of paranoia, convinced that they've been abducted by the government for experiments. They also accuse their families of selling them to the government for money. I had a patient once that went on a derivation of this hallucination and was convinced that he was on an alien spacecraft. I walked up to the main nurses station and overheard this coming out of the patient call monitor:
"Cosmonaut X to base. Come in base."
Brief pause.
"Cosmonaut X to base. Come in base."
I looked at the unit secretary, who looked up at me, roller her eyes, and went on back to work. When questioned as to what that was coming over the monitor, she mumbled something about "crazy" and pointed me in the direction of the patient's room. Upon entering the patient's room, I was amused to find him standing stark naked on top of his bed, wearing his bedpan on his head (as a helmet) holding his wired TV control/Nurse Call Button, repeatedly calling for his home base.
posted by THW at 8:26 PM
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