Oops! Poops!
The following are two stories with the same response tactic. Both patients were suffering from dementia.
The Elf Man
It was 1981. I was a second-year resident in training. About a third of our training time was based out of a VA Hospital. At the time, if you were a veteran, you weren’t turned away. We were in Vermont, which is a predominantly rural state. There were always veterans that came out of the forests with non-traditional living experiences. Some people would call then hermits living in squalid conditions. With one such fellow, we had to bath him four times until he didn’t smell bad before the staff would do an intake. Often, they were “rescued” from themselves by government authorities.
This is the story of an elderly man who ended up getting the nickname of “The Elf Man” or “The Elf” for short. He was “rescued” from the woods by the state police based on a citizen complaint, and, since he was a veteran, they brought him directly to the VA. He was diagnosed with dementia. He was non-verbal, but he seemed to know what he was doing. He didn’t have any serious medical problems and after about a week, he was considered a “social admission”. The staff let him wander about the Medical Service floor without much supervision. He was pretty calm, but somewhat mischievous. For example, he would crawl in bed with other patients in the middle of the night. Once he was found asleep in a vacant ICU bed. He, sort of, became the floor’s mascot! He was there for months.
In training programs, third and fourth year medical students rotate through the various services similar to the interns and residents. At the time of this story, we had four medical students, one of which was a somewhat stern young woman. I’ll call her Jane. She had little patience for the Elf man, considering him a nuisance.
Typically, when admissions occurred, medical students would either choose or be assigned a patient, and they would usually do an admission history and physical (H&P) first, so they wouldn’t be influenced by the intern or resident’s admission H&P. The student was supposed to try to accurately make a list of the patient’s problems and describe how they were going to confirm diagnoses and treat known conditions.
Jane was assigned a newly admitted patient and dutifully went into the patient’s room to do her admission H&P. At that time at this VA, these rooms were mostly “quad” rooms, meaning, there were four patients to a room separated only by curtains you pulled around the beds for some degree of privacy. Jane pulled the patient’s curtain and began taking a history when the Elf snuck in and stood watching what Jane was doing. Jane shooed the Elf out and continued. The Elf snuck back in and began watching again.
This infuriated Jane. She began yelling at the Elf and pulled him by the arm, marching him out of the room and ordering a nurse to “take care of him”. Then Jane went back to doing her admission H&P. After completing the history and review of systems, Jane put her “doctor’s bag” with her physical exam equipment on the chair next to the bed that visitors used. It was near the foot of the bed. She opened the bag and was in the middle of examining the patient when she heard a rustle. She turned around and saw the Elf standing next to the chair with a wry smile on his face. Jane started to yell at the Elf when he pulled up his hand in which there was a well-formed stool which he rapidly proceeded to throw into Jane’s doctor’s bag, soiling all of her equipment! Then he bolted out of the room. Of course, it was his own stool, he had pooped into his hand!
Of course, Jane became hysterical. A huge commotion resulted. The Elf was transferred to a long-term care facility within a week.
The Man With The Cane
It was 1984. I was in the National Health Service Corps. At the time, I was the Medical Director of the Nursing Home and 2/3 of the residents there were mine, about 50 of them. The remainder were followed by their respective PCPs. When you were on call for the hospital, you were on call for the Nursing Home.
One night when I was on call, I got a call from the Nursing Home at about midnight. The charge nurse called and said a demented elderly resident had come out of his room armed with his cane, swinging it at the staff and was now at the end of the hall slamming the cane into the door that was the exit. The staff was afraid he would escape, and they said they couldn’t de-escalate the situation and weren’t able to get the cane away from him.
I immediately got dressed and walked down to the Nursing Home, 1.5 blocks from my home. I walked past the nurses’ station and there at the end of the hall was this scrawny elderly man who couldn’t have weighed more than 100 pounds in a baseball player hitting stance standing by the safety glass and chicken wire exit door which had several smashed areas where the man had struck it with the cane. Keeping a safe distance was 5-6 nurses and nurse aides who were trying to talk the man into putting the cane down. When they saw me, they all (at once) started telling me about his belligerent and violent behavior.
I looked at the man and then the nurses and said, “I can get that cane in less than one minute.” It seemed to me that he was so debilitated that he couldn’t possibly swing that cane with any significant force that I couldn’t handle.
I walked up to the man to within the length of his cane and urged him to swing it at me, which he did. As the cane came around at me I easily grabbed it out of his hand. Instantly there were five nurses on him. They ushered him down to his room which was about 20 feet away, all the while the man was fighting to get loose. I followed the nurses into the resident’s room. The nurses plopped him onto his bed and I walked up next to the bed by the resident’s head. All of a sudden, the man became completely calm. There was a communal sigh of relief by the staff. They started tucking him in when all of a sudden, I saw his hand come up from under the covers. It held a formed stool! He had pooped into his hand!
I yelled for the nurses to watch out as I pulled the bedside curtain toward the foot of the bed creating a barrier between me and any nurse standing next to me and that stool. Everyone hit the deck! The man threw the poop at the nurses at the foot of the bed. Luckily, they had ducked behind the foot board!
Pandemonium ensued! I was laughing my butt off!
The nurses restrained the man’s arms. He finally calmed down; I think he just ran out of energy. We didn’t medicate him. It never happened again.