"Stop Trying to Help Him---He's Not Worth It"

.......or is he?? Nurses Announcements Archive Article

"Stop Trying to Help Him---He's Not Worth It"

We should never have gotten involved with this guy.

First of all, Donald Lee* (name changed to protect privacy) was, in my humble opinion, much too young for assisted living. A short, compact man with salt-and-pepper hair, he was barely three years older than I, and experience had taught me that Baby Boomers thrown into a communal living situation with seniors old enough to be their parents generally don't do well. Then there was the pesky fact that he was a formerly homeless, family-less, friendless alcoholic with multiple psychiatric diagnoses whose mere presence would probably frighten the living daylights out of our customary population. He had just failed his second adult foster-care placement when his Medicaid caseworker came to my executive director, pleading for a "favor" and offering the moon and stars if we would just keep him off the streets temporarily until she found more suitable housing for him.

That was almost a year ago. In the weeks and months that followed, Don consumed more of our time and resources than all of our other 85 residents combined, with repeated ER visits for suicide threats and ongoing behavioral issues such as burning himself with matches and stealing employees' cell phones from the break room. We careplanned and careplanned again; he continued to be disruptive and contemptuous of our efforts to help him manage his outbursts. We encouraged him to keep his counseling appointments, to no avail. We advocated for mental hospital admission, and learned that not one such facility in the entire state would admit him unless he actually tried to kill himself or someone else.

Even his primary-care physician didn't really want to have anything to do with him. As was my duty, I called and faxed the office with updates and suggestions on a weekly, and sometimes daily basis until one day he faxed me back with this terse reply: "This patient has been in my care for the past 10 years. He is beyond help. You need to stop trying---he's not worth it."

In late August, Don's state funding dried up, essentially granting our secret petitions to God that something would force him to move. He was viewed as a pathetic, freakish loser who couldn't be trusted as far as you could throw him, and he was certainly not adjusting to living among the older generation as he rarely, if ever, came to meals or even spoke with other residents. He was also demanding, abrasive, and verbally abusive to staff on top of everything else......the sooner we were rid of him, the better!

In early September, he had a heart attack. This hospital admission was swiftly followed by another for complications relating to the MI.

The ED and I fought hard and long to get Don admitted to a skilled-nursing facility for some rehab, but with no insurance and no funds to pay privately, he boomeranged right back to us as soon as the hospital could discharge him. Fortunately, some of his psych meds had been changed while he was hospitalized, and for a time after he returned he was better than we'd ever seen him. He no longer screamed at staff or hid out in his room; as he told me one day, the MI had scared him sufficiently to make him realize that he really did want to live after all, and he was willing to do whatever it took to stick around. Meanwhile, the ED worked with Don to organize his finances and stay afloat until we could find him a better placement, because he would literally become homeless again once we "kicked him out" and then he'd be society's problem.

Some of the staff said, "Better society's problem out there, than our problem in here." I could only disagree half-heartedly; he'd cost me vast amounts of time, effort, worry, and mental gymnastics ever since his admission, and there'd been absolutely NO reward in any of it. Despite recent efforts in the right direction, we waited for the other shoe to drop, and I often thought his PCP was right about his being beyond help. And if truth be told, I didn't think he was worth it either.

Then, in early October, the drinking started. After a self-reported five years of sobriety, he'd fallen off the wagon, and now all bets were off.

Now he really WAS a headline-in-the-making. Mental illness, antipsychotic meds, and alcohol were a disaster waiting to happen, and we all knew it. Sure enough, the suicide threats started again; he appeared in common areas overtly intoxicated at all hours of the day; and now he began to threaten physical harm to others: "I'm gonna set my room on fire one of these nights," he was overheard telling a staff member one evening, "and we're ALL gonna burn, even those sweet little old ladies who're nice to me sometimes."

Out of all the crazy-sounding statements the man had ever made, this one scared me. I'm no expert, but as a recovering alcoholic myself, I sensed that he'd reached critical mass and feared that he no longer even cared if he took innocent people with him when he finally decided to end it. But there wasn't a blessed thing I could do about it, for the ER sent him right back to us after we shipped him out for a psych eval. His PCP didn't care, the state had washed its hands of him, and the police refused to take him into custody for his own protection. Now, each night when I left the building for home, I wondered if it would be there the next morning.....if my son, the night-shift med aide, would be OK.......if there was anyone who could, or would, help Don and save us all from becoming the featured story on the five o'clock news.

What happened the Monday after his last ambulance trip to the ER for visual and auditory hallucinations that were telling him to "end it now!" is still up in the air as to its ultimate significance, for no one knows what lies ahead. But I am firmly convinced that somebody much wiser and greater than I brought Don to my office door that morning.

Now, I had never had a huge communication problem with him, and he knew the ED and I were his only real advocates---his Medicaid case manager having dropped him like a hot potato---but I didn't relish the prospect of hearing any of his sob stories and wild delusions. I was worried for my other residents and my staff, and I really wasn't in a mood to deal with him; however, it's part of my job, so I invited him inside and inquired as to what I could do for him. That's when I got a really good look at him.

He was stone. cold. sober. His gray eyes, recently so bloodshot, were as clear as I'd ever seen them, and so was the voice that had been so slurred as to be unintelligible. He told me he was scared to pieces of being "thrown out of this place" and winding up back at the homeless shelter, or worse. He said he knew he'd "screwed up royally" and probably deserved eviction, but also that this was his last chance at having some sort of life and if he became homeless again, he didn't think he'd make it because no one would be there to make sure he got his meds.......or had something to eat......or even got into a warm bed when he fell asleep on the floor late at night.

That's when I told him I understood more than he knew about being an alcoholic, but I couldn't help him unless he was willing to admit he was drinking again. After all, I said, you can't BS another BS'er.

And he did.

He admitted everything. He told me exactly when he'd bought that first case of beer and why (losing his state support and being threatened with the prospect of homelessness had sent him over the edge, he said), and that he hadn't had a drink in the previous 48 hours because that last ER trip had really scared him. And I believed it, because he was as sober as a judge and thinking as clearly as he was able, given his psychiatric issues.

I don't know why I broke my personal rule about disclosing my own history to patients, but it obviously had an impact. Suddenly words he hadn't known how to say for God knows how long came tumbling out in a rush. I won't share them here because of confidentiality and space considerations, but it was amazing how much Don opened up to me in those forty-five minutes. He repeatedly verbalized astonishment at the fact that I'd been fighting the same disease for nearly two decades, and never let my guard down because I still crave alcohol (at times) just as badly as I ever did---"You can still taste the booze after all those years? How in the hell do you stand it when the cravings get that bad?" He reminisced about his days as a sponsor in AA and quoted familiar passages from the Big Book as I looked up local meeting times online and urged him to get to one ASAP.

Well, it's too early to tell, but in that brief meeting of two addictive personalities, I felt that a connection had been made......if only for a few moments. But even if it doesn't last, I'm feeling a little easier in my soul for having reached out to this sad, sick man yearning---like everyone else---to belong.

As to whether he's 'worth it'........that's a story which has yet to be written, but in my heart of hearts, I already know the answer.

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VivaLasViejas

About VivaLasViejas, ASN, RN

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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Specializes in ICU, Telemetry.

Sounded much like one of my cousins. However, he didn't have a Viva in his life, just a string of people who enabled his addiction, made excuses for everything he did, made sure nothing, not the DUI, eviction, conviction and jail time, none of that was his fault or responsibility. After multiple suicide attempts (not true attempts, and he would always tell someone what he was going to do, where and when so he could be "rescued"), I believe he accidentally committed suicide when the person he'd told didn't believe him and went to work. She came home, and he'd been dead from carbon monoxide poisoning for hours, his bag for the hospital packed and a roll of quarters was in his hand, because he always yelled at the ER nurses to get him things from the snack machines while he sat waiting for mental health (again), social services (again), or the county sheriff's department (again). Not the sign of someone who thought they were actually going to die. He always had an "attempt" when he wasn't getting his way or had to go to court. My cousin not only didn't think he was worth saving -- he didn't think he was doing anything wrong that he needed saving from.

Maybe you helped your patient find his way out when he hit bottom. He decided he was worth saving, and you're what made him feel like that. :hug:

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Specializes in Hospice, HIV/STD, Neuro ICU, ER.

Wow. Incredibly powerful story! Thank you so much for sharing!!!

This just proves that even the most seemly "worthless" pt can make some progress. Being a part of that process is an incredible blessing. Congrats to you for pushing your limits and boundaries to help this man feel better - even if it's only for a short time :hug:

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Great story, excellent example of real life. There are many "Donald Lees" in this world, and with the wave of baby boomers working their way up the life span, many more to come. Let's just hope there are enough "VivaLasViejas" like minded professionals to have the fortitude to care enough the see and free those souls from bondage just as you have shown, I have learned from your example, Thank you. :yeah:

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Specializes in Family Medicine, Tele/Cardiac, Camp.

I think that when you reach a point with a certain patient or family member, self-disclosure can be really beneficial and totally okay. I'm not an alcoholic. But I did grow up with one and went on to date many. I had a patient one night who had tried to kill himself because of his depression and drinking. His wife had finally left him and that was that. She came with him to the ER and was sobbing after we got him admitted to my floor. Long after he had settled in,sShe seemed frenzied and kept trying to keep me in the room for a while. I told her I had to check on other patients, but I'd be at the nurses station when I was finished if she wanted to talk.

A short while later when I was checking charts she approached me and thanked me. I hadn't told her anything about myself. I had just been in the room and listened a little to his story. Or maybe she felt safe to leave him with me for a little while instead of taking care of everything herself. And she told me it's just so hard. And I nodded and said, "Well...it's none of my business, but good for you for having the courage to make the changes that you have. It's really important." And she started crying really hard and hugged me (! Not something that happens too often) and thanked me some more. And I asked her if she knew about Al-Anon and she said she did and I said to keep going. Because I understood exactly where she was coming from. And I know, from the tone in my voice and the look in her eyes, that she believed me.

We're human too. I think it's really important that patients know that.

Thanks for the great post, Viva.

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I know I should'nt but. I agree yes you are trying where others do not. I mean thats what a lot of people became nurses for to try to make a diffence. If your in it for the money or the recognition you really fooled your self.

My old man was an acholic and quite handy with his hands and body when he was drunk, an exstream rarety for him not to be.

As a young boy of 8 I was told my old man was no good useless and worthles. I fought many a battle but slowly got him sober by my self, at a time when it was exspected of men to drink alchol, just a fact of life everyone did.

He turned out to be a very good tradesman when sobber and fought many battles to stay that way. He never was short on the respounce that his famly where the ones that got him there and made him everything he was. we had many problems of our own, and our own making, but he never back away from them. Yes he often had to call us up in the middle of the night to come get him and walk him home becuse he could not get home by him sel, becuse he had to go near a bar or a liqure store.

He never lived down the story of how he was drunk on the floor, and his son came out and the guy who had put him there an adult of 28 wanted a go at him an challenged his 7 yr old son to a drinking contest. Or how he once threw his son into the furnice to get the bottle he had trown in there to keep it away from him. But yes he fought those battles and stood up to them.

I grew up and became a teenager hating everything and everyone. Before I turned 16 I became a diabetic. It was still the 70's. I was told I was costing the goverment to much money and should just die. Yes straight onto insulin and no one telling me I would stay on it for life. A senior nurse who was bragging one night about how great some african charity drive dinner went, and they gave her some big spread at it. Told me straight out they could make a villadge live for 2 months in africa on the money they had spent on me over one week keeping me alive.

When the family abandon me and said we can not cope. Guess who stood there and said I don't give a dam! what does it take and we will do it. We where both told I would only live for another few years.

I went on to do volunter rescue work, becuse everyone else was to important and could not be spaired from work. I assisted in road rescue operations. I joined the local construction union after seeing a lot of freinds hurt and maimed that could have been avoided.

My old man said I was an idiot becuse I would never get a job or steady work like the family and me needed. Why did I put so much effort into something that would never pay out. I said It was a bad habbit I got into once.

Today I am a trainey EN I do my practicle training at the local childrens hospital.

Point being there are a lot of things that are a complete wait of time and you will never get a monitery return from them. However your there and you got to live with it later on. I survive by trying to do the decsion I know I can live with afterwards. I had a lot of fights battles and arguements. I can also not say I won anyway near the majority of them. However I have had a lot of people come back to me and say you tried or you did the right thing. I have done CPR on a drug adict that everyone said leave her shes a drug adict let her die. I looked after a man in the middle of the main street of the capital city high on drugs until the cops arrived. I pulled three children from three different car crashes, a few elderly people. I also was able to stop a number of dagerouse accidents happening by pulling people out of the way or yelling at people.

Theres no money figure here, but I gave back better then my effort put into me.

You did good take that home with you, You made a differece and it was a good one. :)

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Specializes in Cardiac nursing.

love it!

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There but for the grace of God, go I.

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Touching. Glad he finally reached a point, for now, where he is able to be helped.

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Specializes in LTC, assisted living, med-surg, psych.

It gets better..........Yesterday was this resident's birthday, and when I wished him a happy one he was genuinely shocked that I'd remembered. He was even more shocked to find out that the activities staff also remembered, and gave him a balloon with a gift card and some candy bars.

Somewhere in our conversation a couple of days ago, he said he wished he could have a birthday cake again. He hadn't had one since he was a kid, and he liked chocolate best of all. Well, after a couple of caregivers told me they overheard another resident tell him at breakfast not to expect anyone to celebrate his birthday because "no one likes you"......well, let's just say a chocolate cake sort of mysteriously appeared in the late afternoon and was given to him at dinnertime by the med aide.

Doggoned if I know why he thinks I did it, but he told me just a few minutes ago that he thought that was about the sweetest thing anyone's done for him in YEARS and that he'd even teared up. It was the best birthday he's had in a long time, he said, and he wanted to say thanks for making it happen. Even though I didn't do it. ;)

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Very moving story.

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Love is the answer ;) Let it flow ;) If I was in front of you V and if you would allow it I would give you a big giant hug. My brief experience says that a carefully metered dose of self disclosure can go a long long way and you just proved it :)

Awesome!!!

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