Head Bugs

On this particular night my patient, I'll call him Ray, approached the nursing station with his headphones in his ears and his big black glasses on. You know, the kind they give you after you get your pupils dilated. He wore these, with cotton balls in his nose to keep the "bugs" from getting in. Ray had only been at our facility for about a week.

He knocked on the desk and I asked him if he needed something. He said, "Do you think you can get these bugs outta my head?" Ray was schizophrenic and had a lot of other mental disorders. He often talked to aliens, bugs, etc and said that they told him to do different things and were trying to invade him. This had been repeated time and time again in his h&p. I explained that he didn't have any bugs in his head and encouraged him to watch television.

Several hours passed with no further mention of the bugs, but just as soon as I thought we were passed it, here Ray came, running down the hall with his hands clenching his hair, and him frantically rubbing the top of his head. "They're everywhere, they're everywhere! I feel them crawling all over me. HELP. HELP." Of course, I saw no bugs. I tried to calm him down, and explain that there were no bugs on him. An Ativan and 45 minutes later and we were doing alright. I'm thinking things are only going to get better from here.

I began charting the events of the day when the nurse aide hollers for me to come down the hall. I quickly make my way to Ray's room where I find him sitting on the toilet naked with numerous empty bottles of cologne, some of the house keeper's disinfectant, and baby powder scattered on the floor around him. He had poured it all over himself, coated it with baby powder and then wrapped his head in toilet paper. The smell was awful. He looked up and smiled, "I'm gonna kill 'em." Again I explained that there were no bugs "in" his head and we assisted him in taking a shower.

He seemed to calm some after his shower and I resumed my regular duties. Continuously thinking about how awful it must be to truly feel like your mind had been invaded with bugs. My heart was beginning to break for this fellow. I got him a cup of hot chocolate and made my way down to his room to check on him. He was working on some "protection" from the creatures in outer space. I sat down and talked to him for quite a while. As I got up to return to my desk, I looked at him and said, "Ray, I'm so sorry. I can't imagine how you must feel going through seeing these bugs, hearing these bugs, and feeling these bugs when no one else can." He said, "Well if you'd quit talking so much and look in my hair, you'd see them."

So, I did, more to calm and comfort him than because I actually thought something was there. I parted his hair with a comb and almost jumped right outta my skin. This man had the biggest head lice I had ever seen with huge scabs all over his head. This is what he had been trying to tell me, and me, blindsided by his h&p had just assumed he was "crazy". I shook my head and said, "You're right, you do have bugs."

He screamed and began hitting his head over and over again with his hands, "Don't let them in. Don't let them in!" He jumped up and took off running. So, I guess he wasn't talking about the lice, strike 2 for me. I went after him and was able to get him to calm down enough so that I could explain to him that he had head lice and that we would be able to get rid of them. He wasn't buying it. Lots of explaining, role-playing, and some Lindane later we were no longer lice infested, but Ray was permanently traumatized and wore a bandanna on his head from then on out. And he lovingly called me the "Exterminator."