The night I was Shelley

Over the last 6 years, I had never had a "funny" rapid response until this one patient several weeks ago. Larry was a COPD (lung disease) patient presenting with acute respiratory failure, and he was definitely one of the kindest patients I've ever had. He was in the hospital for several weeks, so I ended up having him as my patient at least 5 times. He was fully alert and oriented and always remembered me, greeting me with a delighted smile when I'd reappear at his door. He was elderly, in his 70s, but unlike many of our respiratory failure patients, he never showed any signs of confusion or paranoia in the slightest. He was anxious about his condition, but that's to be expected. The last respiratory failure patient I had was a paranoid mess who spent a lot of energy trying to deceive staff and turn us on each other. That's another story for another post.

Larry never had episodes of "sundowning" or "sunrising", the acute phenomena often seen in elderly patients where they suddenly go from oriented to confused and delirious around the time the sun goes down or rises. They are very real, very common phenomena that happen all the time and are usually not concerning unless it's a new development. New altered mental status always needs to be assessed in case of some other acute cause like hypoxia (low oxygen in the blood) or stroke. So, when Larry suddenly became aggressive, boisterous, and confused, it raised red flags.

Sometime around 4 AM, I went in to check on him because his oxygen was dropping on the monitor. He had his CPAP mask on and was asleep. I woke him up to give him some medication, but noted he was extremely drowsy and difficult to arouse. I couldn't make him awake enough to take his medication, so I abandoned that task. Suddenly, he started trying to jump out of bed. He became agitated, screaming at the top of his lungs and ripping his oxygen off. I held him in place and yelled for help while he struggled to jump out of bed. Luckily, my charge nurse was nearby and came in to help me.

"Call a rapid, this is not normal," I said as he continued to fight me. His oxygen on the monitor dropped very low because he kept pulling his oxygen off. When we explained that he needed it, he would simply scream, "NO!" The rapid response team arrived and began doing their assessments and trying to calm the patient. The respiratory therapist (RT) tried to put the oxygen back on him. Suddenly, something shifted in Larry that perplexed us. He suddenly became calm and stopped fighting us, and then he spoke.

"Where is Shelley?" Larry asked.

"Who is Shelley?" I replied.

"My girlfriend!" I heard the RT utter "Uh oh" and my jaw dropped. We knew Larry was married to a woman named Kathy, not Shelley.

"No Larry, you're married to Kathy. Remember we talked to her on the phone earlier?"

"Nooooo, I used to be married to Kathy. Now, where is Shelley?" he demanded. Suddenly, he made eye contact with me, and a devious grin spread across his face. "There you are Shelley!" I blinked.

"No, Larry. I'm your nurse, Bella. I've been caring for you all night, remember?"

"Nah don't worry, Shelley. You don't have to hide it." At this point, the others in the rapid team started giggling while they continued working on him, taking blood and vitals.

"Larry, you need to stop talking about Shelley before your wife comes today," I said with a nervous chuckle.

"Oh come on Shelley, what is it? Am I too old for you?" Now people just straight up started laughing. I heard people laughing in the hall behind me as well.

"You can't talk to her like that, she's young!" said the rapid nurse.

"Yeah, and you're old," Larry replied mockingly. Even the very serious doctor now cracked a smile. Larry continued.

"No, come on Shelley. You don't have to hide it from them. Want me to tell you what we do in bed?" I gasped.

"No Larry, I'm good thanks."

"Well, I need someone to help me, I'm at Giant right now." Relieved that he changed the subject, I corrected him that he was in the hospital.

"No, I'm at Giant, and I need someone to peel my cucumber." We started laughing again, and of course all of us thought he was making a dirty comment until he added, "For my salad!"

"Get your minds out of the gutter, guys," laughed the RT. Poor Larry continued making out-of-pocket statements, confused as ever. The doctor decided it was probably just hospital delirium, so after making sure he was stable, the team dispersed. Suddenly, Larry snapped out of it completely and became fully oriented again. Fortunately for him, he had no memory of what happened, but I still had one question I just had to ask...

"So, who is Shelley?"

"I don't know a Shelley," he replied, looking confused.

"Well, you seemed pretty convinced I was Shelley."

"What? No you don't look like Shelley." My charge nurse perked up.

"So there is a Shelley then?"

I suppose we will never know for sure.