Meet Dean, AKA The Patient I Feared
Working at these psychiatric skilled nursing facilities there were many times I experienced moments of hesitation and fear. But one patient more than any other truly frightened me.
Dean was a tall middle aged man with late stage Huntington’s disease. For those unfamiliar with this progressive neurodegenerative disorder, at this stage Dean was bedridden. Unable to control a majority of all voluntary movement, his arms and legs often flailed uncontrollably, he could not safely swallow the food you or I would eat, his speech was largely unintelligible, and he had lost control of his bowels. As is co-morbid with Huntington’s Disease, Dean also experienced psychological symptoms as well. A majority of the time he lay there in bed with a flat affect, depressed. However there was also a volatile side to Dean- this was the part I feared.
Every day was pretty much the same. I came to Dean’s room and knelt beside his low bed. I would explain what I wanted to work on with him and why. Dean nodded and responded in a haunting tone “OK”. Then as soon as we would begin Dean became infuriated, howling and thrashing his long arms and legs toward me like he wanted to do me harm. I scrambled backwards to avoid his reach.
I immediately backed down, trying to calm him.
“I’m sorry, Dean. We don’t have to do this activity. You said “ok” so I thought you wanted to do it.”
He calmed (sometimes) and I would return to his side.
“If you don’t want to comb your hair, that’s fine, I’ll help with that. Do you want to wash your face?”
But it was the same thing over again. Dean furiously launched himself at me as best as he could.
By this point my hands shook nervously. Approaching him began to feel like a trap. I was unsure if his fearsome aggression was out of frustration with his condition or purely with me.
“Dean I know this is hard but if we work on it together, we can find ways to make it easier.”
“Ok, why don’t we switch gears and work on a few arm exercises?”
I approached again. I explained the exercise and Dean nodded approvingly, but each time after performing a single repetition, he would pull away angrily.
I was about to throw in the towel. Then suddenly Dean offered both his hands to me with a contrite expression.
Encouraged, I smiled and took his hands. Dean’s face suddenly returned to a snarl and I immediately realized I had been tricked. With alarming strength Dean yanked at my arms, trying to throw me to the side.
I don’t even remember what I said to Dean as I scrambled out of that room.
I may have understood why Dean behaved the way he did, but I still didn’t know what I was supposed to do. All I knew was that I was going to have to go back in that room again the next day.
***As always, the names of patients have been changed to protect their identities.
