Exorcism in the ER......NOT - page 4

Had a pt come in the other night, female about 40 y/o. She was brought in by her husband and her pastor. She was dragged from the car by them and placed in a wheelchair, and was then intercepted and... Read More

  1. by   Thunderwolf
    An approach that was not tried, from what I've read thus far, was no one separated the patient from the husband and pastor (sort of pulling the patient aside) and telling her that every medical finding was negative in a matter of fact, respectful tone...even if she presented as unresponsive. Laying it out up front and honestly to her may have cued her in that the staff find her in good "physical" health. Next, it may have been helpful to acknowledge to her that she obviously dealing with something that is distressing to her to where she had to either shut down totally or to be needing others (such as her husband and pastor) to become distraught over her. The issue that needed presented to her, again matter of factly and with dignity, was to acknowledge that she needs help, but in a more productive way. I would even have tried contracting with her, even if she presented as unresponsive, because she was still listening. I would have presented her "an out" sort of speak, such as..."when your husband and pastor return back in the room, think about what I said, after about 15 minutes, open your eyes and say you feel a little better and would possibly agreeable to an outpatient follow up when the ED doc recommends it (to sort out the problems)" I used to use this approach quite often when I used to worked in mental health and detox. Often, it was a good approach. Open, honest, confidential with the patient, and reminding the patient that he/she can make better choices to get one's needs met. If the patient declines to respond to the invitation, I would present it to her again before being admitted inpatient. Then, psych should have been notified of her admission. Admitting her as a change of LOC may have not been helpful (she didn't need neuro checks on a medical floor), sort of circumventing the true need of treatment, possibly delaying it further.
  2. by   Granted Fal
    you have to really gauge what consists of a genuine situation or a behavioral axis II type situation... The way this story was explained with the responsive corneal reflexes, and the arms falling but not hitting the face, my main concern as a nurse is to determine the source of the problem. The husband probably hasn't even seen a sternal rub before and the woman's response would have been proof that there was a feigned, at least in part, component to her behavior. At no point did i demean the speaking in tongues or anything, and the soap suds enama was actually a joke... lighten up, you'll have to if you're a psych nurse.... but i appreciate your input...

    Quote from SARAH CONNOR
    wow. what small minds and big egos we all must have to deny others thier beliefs! i wonder what people thoughtwhen they heard about the parting of a whole sea! part a sea, kiss a snake. what ever you believe is ok with me.

    in all reality i probably would have cracked up at the whole incident as well. but generally if some one tells me they are God or the devil, i believe them until proven otherwise. how do i know they are not? could they be crazy? sure. we tend to lean to "crazy or wierd" when beliefs are different than ours.

    i worked in a place where hassidic (sorry if spelled wrong) jews put thier dead relatives on the floor after an arrest as part of thier beliefs, the amish shun thier own family members for reasons, some use medicine men ect. i guess the bottom line is what ever gets the patient better. isn't that the goal? questioning and making fun of others beliefs is why our world is in the pickle it is in. lets just co-exhist and have fun.
  3. by   PMHNP10
    Quote from tvccrn
    No, I don't think she's the only one. But, to go along with something like that makes me believe she is missing something so much in her life, be whatever it may, that she acts this way to gain attention.

    And upon reading your post,my first thought was "hhmm, maybe she's ISN'T the only one there who has a need." So, no I didn't think you were being sarcastic, merely looking at it from another POV. We should all do that for occasionally.
    When I read what I posted I started thinking about how someone on a bulletin board might interpret my short post and wanted to make sure I got my point across.

    I don't know why, but the first thing that I thought of was the husband and possibly a munchausen by proxy. I think the fact that the husband and wife were later overheard talking while staff wasn't around got me leaning in this direction initially. On the other hand, it didn't make sense because the husband would have to do something to make his wife present in the ER in such a catatonic state, whether by threat or some sort of medication. Also odd was that a pastor was present and speaking in tongues and yet they wanted the ER to call another one? Perhaps it takes 2 people for an exorcism? I'm not Catholic (if indeed it's confirmed that the pt was Catholic), so I don't know.
  4. by   NYCRN16
  5. by   stevierae
    Quote from LBLOCKRN
    THIS IS WHAT THEY MAKE RAPID SEQUENCE INTUBATION FOR!!!!!

    Nah, this is what in the Navy we would have treated with a DEEP IM (gluteal, with a 16 or 14 G needle) injection of STERILE WATER. Ouch!

    Works on all sorts of attention seeking behavior and fixes narc seekers right up. They thought they were getting something REALLY strong--"that's why it burns so much--" that couldn't be given by mouth. What it was remained our little secret.
    Last edit by stevierae on May 9, '05
  6. by   stevierae
    Quote from teeituptom
    Howdy Yall
    From deep in the heart of texas

    You mean yall would deny her, her right to religious freedom. I remeber one time at a families insistence before they would let us take their son to the OR for appendicitis, They insisted we call and indian medicine man in to consult. We helicoptered one in from Ok, he did what was necessary and everybody was happy.
    Ps he was an odl time golfing buddy, so I knew how to find one.

    keep it in the short grass yall

    teeituptom
    I can certainly respect that situation--the child with appendicitis had a bonafide surgical diagnosis, and Native American medicine men are very much a part of the Native American culture and their role is integrated into Western medicine, and respected. However, the woman spoken of in the original post was very clearly faking---attention seeking behavior, as others have stated. What a drama queen. Borderline personality comes to mind.

    I, too, am confused as to why the pastor and the husband wasted the ER's time and resources on a clearly non-medical situation. I'll bet she pulls this nonsense every time she isn't the center of attention, as she clearly desires to be.
  7. by   Blackcat99
    Many years ago I worked at the state psych hospital. I was told that one of the patients (not on my unit) truly believed she was possessed by the devil. One night when she was scheduled for her bath the staff decided to pretend to do an exorcism and they put on a good exorcism show for her. They told her the evil spirits were gone and had left her body and gone done the drain in the bath water. I was told that after that "exorcism" she improved rapidly because she truly believed that she was no longer "possessed by the devil." She was discharged shortly afterwards. :hatparty:
  8. by   estrogen
    Quote from stevierae
    Nah, this is what in the Navy we would have treated with a DEEP IM (gluteal, with a 16 or 14 G needle) injection of STERILE WATER. Ouch!

    Works on all sorts of attention seeking behavior and fixes narc seekers right up. They thought they were getting something REALLY strong--"that's why it burns so much--" that couldn't be given by mouth. What it was remained our little secret.
    ...are you aware that that's seriously illegal??? And how the heck is it supposed to be therapeutic for anything, I don't know...
    Last edit by estrogen on May 9, '05
  9. by   MAGIK GIRL
    Quote from falconboy
    you have to really gauge what consists of a genuine situation or a behavioral axis II type situation... The way this story was explained with the responsive corneal reflexes, and the arms falling but not hitting the face, my main concern as a nurse is to determine the source of the problem. The husband probably hasn't even seen a sternal rub before and the woman's response would have been proof that there was a feigned, at least in part, component to her behavior. At no point did i demean the speaking in tongues or anything, and the soap suds enama was actually a joke... lighten up, you'll have to if you're a psych nurse.... but i appreciate your input...
    what i got from her comment was..... when in rome....

    psych nurse or not, we ALL have to lighten up. maybe a good old fashioned vanqishing would work! what ever it takes to get the job done and the pt out of your er! we'll just make fun of them when they are d/c'd anyway.
  10. by   MAGIK GIRL
    Quote from stevierae
    Nah, this is what in the Navy we would have treated with a DEEP IM (gluteal, with a 16 or 14 G needle) injection of STERILE WATER. Ouch!

    Works on all sorts of attention seeking behavior and fixes narc seekers right up. They thought they were getting something REALLY strong--"that's why it burns so much--" that couldn't be given by mouth. What it was remained our little secret.

    and you have to admit, the best attention seekers make the best buds of the best jokes! i like a good laugh so i don't mind those pts. they are fun to play with.
  11. by   stevierae
    Quote from estrogen
    ...are you aware that that's seriously illegal??? And how the heck is it supposed to be therapeutic for anything, I don't know...
    Uh---yeah. (I mean, DUH!) This WAS 30 years ago, after all.

    And it wasn't ABOUT being "therapeutic," it was about making people who were seriously and obviously faking to avoid work (malingering)or people who were seeking narcotics think twice about doing it the next time.

    These were not USUALLY military people; (although sometimes the guys that were in the brig were an exception--they got very creative in their grocery lists of "symptoms" designed to get them out of work and sent to bed, hopefully with a NARCOTIC on board--) more often they were manipulative dependent housewives who were bored and seeking drugs for "recreational" purposes (hence wanting some Valium or Demerol) or attention seeking or trying to keep their husbands from having to go out on submarines (every 6 weeks, ;like clockwork, attempting "suicide" by scratching their wrists superficially, they stating, "Oh, I don't want to DIE---I just don't want him going out to sea anymore. I want him OUT of the Navy." We didn't know the word "drama queen" in those days, but that's what they were. They would have (and often did) refused any psychological counseling---after all, they didn't feel that THEY had problems; they just hated the military (and blamed the military for their inability to cope with ADL) and everything about it, so they just weren't "understood." It was a different world, then, too.

    Lighten up. Gosh, I am betting you are MANAGEMENT--take everything too dang seriously.
    Last edit by stevierae on May 9, '05
  12. by   MAGIK GIRL
    Quote from falconboy
    you have to really gauge what consists of a genuine situation or a behavioral axis II type situation... The way this story was explained..... with the responsive corneal reflexes..... and the arms falling but not hitting the face..... my main concern as a nurse is to determine the source of the problem. ..... At no point did i demean the speaking in tongues or anything, and the soap suds enama was actually a joke... lighten up, you'll have to if you're a psych nurse.... but i appreciate your input...
    P.S. becoming an er nurse?
    you really do need to lighten up and not take everything at face value. things in the er are different. throw your axis' away and don't read into every little thing. it is NOT all text book. you will find that in the er you will never determine the source of the problem of most of the patients. you will have to learn to accept the "treat and street" mentality.
    the er is it's own entity and follows no ones rules.

    good luck and i hope you do well.
  13. by   MAGIK GIRL
    Quote from stevierae
    Uh---yeah. (I mean, DUH!) This WAS 30 years ago, after all.


    Lighten up. Gosh, I am betting you are MANAGEMENT--take everything too dang seriously.


    i like you!
    sounds about right

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