Let me tell you about another of my fond memories. When I
was in nursing school a long long …long time ago, we were taught that you must
present reality to confused patients. You were to continually reorient them to
the reality of the moment, the date, the time, the place etc.  Well although this is the correct nursing guideline, it really is not the
reality of the situation.

This is the story of a young patient that I cared for who
had quite a problem with alcohol. In fact she had become dangerous to herself
and required restraining. This was back in the day when patient restraint was a
part of accepted practice. We used to use the restraint called a posey jacket.
It was a vest with long straps that you could tie under the bed or behind the
chair the patient was in to keep them safe and out of danger of falling.

This young patient (she was in her early twenties) was in
the hospital for detoxification and required medication to help control her
blood pressure, pulse and anxiety. She was easily agitated despite the
medications and proved remarkably adept at getting out of her posey jacket. In
fact we didn’t seem able to keep her safe as she was determined not to be
restrained. And let me tell you a patient that is determined, no matter how
well you believe you have them restrained, is not going to be kept in a
restraint. Period!

Well this was the case with this young woman. Well occurred to
me that I needed to figure out what it was that she felt she needed to be
doing, that she could not rest. As I was talking with her we got on the subject
of what she liked to do. She said when she was in high school she enjoyed
playing basketball and apparently she was quite talented. We talked for so long
about this she actually got tired and appeared to go to sleep.

It wasn’t even an hour later and she was untied and running
all around the end of the corridor and her room jumping and running and
pivoting. She had tied the long tails of her posey jacket around her body
several times and she had written a number on a paper towel from her bathroom
and she had taped it to her chest. When I came down to intervene, I knew right
away what she was doing. She shouted out, ”Free throw, Get behind the foul
line, cheater! Two points!” 

She was playing basketball. And having the time of her life.
My nursing companions didn’t see it exactly the way I did and wanted to add
chemical restraint to her regime. But I protested, explained what she was going
through, and said I would be responsible. After about 20 more minutes, she was
exhausted and was able to sleep without the posey being necessary.

It was remarkable to watch this young woman recede back
about 10 years into a time she was happy and under much less stress. We need to
all remember that alcoholics are people that were once NOT alcoholics. They led
normal lives and had people in their lives that cared for them. Many alcoholics
are aware they are doing harm to themselves. But the disease will not allow
them to quit without significant help.

Interestingly enough, this same young woman, the next time I
saw her, was no longer requiring her posey jacket. She no longer wondered away,
and was good about staying in her room. But she was quite confused and still
very disoriented. Unfortunately she had done a lot of damage to herself.

When I came up to her to say hello at the beginning of my
shift, she was so happy to see me, although she had no idea who I was. In fact
she immediately began a conversation that was relevant only to herself.  But she was very busy folding very carefully
paper towels from the bathroom into very neat and perfect little squares. She had
already done many of them. The nurse prior to me said she had been busy at it
for well over an hour. When I asked her what she was doing, she said she was
getting ready…that’s it, no other explanation. So I continued to observe her.
She really didn’t seem to know I was there.

 Well about an hour later she began stacking them all
together and then she headed for the door to leave her room, which she was not
allowed to do. I called to her, but she was not listening. She was very intent
on her mission. She was handing the folding paper towels to everyone she came
in contact with in the hallway, visitors, nurses, staff, doctors, anyone! And
with each carefully folded paper towel, she sincerely told each person that
they were invited to her wedding, and she hoped they would be able to come.

Not one person laughed at her or made her feel self
conscious. They also did not present reality to this confused very sick young
woman. Reality is sometimes the thing that causes people to become in the
condition they find themselves in. Fantasy was a better treatment for her at
that moment. Who knows what it is that drove her to start drinking. That made
her so sad and insecure and lacking in self confidence that she hid from
reality. We’ll never know.

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