Let's Make a Deal

One of my very first patients off orientation as a new graduate nurse was named Ida (name changed for obvious privacy reasons). Ida was a morbidly obese lady in her early 70s. Nurses General Nursing Article


Let's Make a Deal

Ida came to us from an understaffed and unsafe local nursing home. She had type II diabetes and as a result, had necrotic toes on her feet. Infections were common in her feet, and they tried relentlessly to treat in the nursing home. But one of the sad things about state-run nursing homes are the not so good doctors that oversee too many patients. Her doctor put her on some pretty heavy duty antibiotics which ended up being toxic to her kidneys and landed her in Acute Renal Failure. On top of everything else, Ida was developing pneumonia from being bedridden for so long.

I walk into Ida's room on the first day I was assigned to her and she just gave me a hollow look. I smiled, introduced myself, and informed her I would be taking care of her for the day.

"Ida, I'd like to do a quick assessment on you to see how you're doing, is that alright?"

"Okay," she answered me in a raspy voice. I would go through my assessment noting extreme edema, coarse breath sounds, and a fungal rash on her skin. I pull out her pharmacy of morning meds and go through each one with her, dropping them in the medicine cup one by one.

"Alright Ida, can you take your morning meds for me?"


"Why, not Ida?"

"Not now, later. In a few minutes."

A few minutes pass. "How about now Ida?"

"Okay." I place the first pill in her applesauce and try to give it. "No, please. Not now, later." It circulated like this all day. I never got one pill in her.

Ida was not able to move on her own, therefore we needed to turn her every two hours. With Ida being a rather large lady, we needed three nurses to attempt to budge her. It was awful trying to move her and Ida wanted nothing of it. She would scream and yell every time we would touch her, "No, please. No, Please. NO, PLEASE! NOOOO, PLEEEEEAAAASE!" But we had no choice but to do this every two hours so she wouldn't develop painful bed sores. It was harder and harder to find other nurses every two hours to help me turn her. Nobody wanted to deal with her screaming, thrashing, and hitting if they didn't absolutely have to.

Ida also kept spiking really high blood pressures one day I was caring for her with pressures in the 190s/110s. After receiving orders for IV anti-hypertensives, I had to check her BP every 15 minutes due to its potency. I came into put the cuff on her. "No, Please."

"Ida, I need to keep track of you pressures so they don't fall dangerously low."

"NO PLEASE. I'm done, no more. I don't like it. NO PLEASE!" I placed the cuff on her anyways. She screamed and shrieked when the cuff inflated. I held her hand and attempted to console her but she wanted nothing of it. She repeated this every 15 minutes when I needed to retake her pressures.

On the third day I took care of her, she was beginning to get dirty and unhygienic. She refused her bath every day from the CNA and did so that day as well. I told the CNA not to worry about her, and that I would get her cleaned up today. I filled up a pink tub with hot water and soap, place a couple of washcloths in the basin, and swung some towels over my shoulder to dry her off with.

"No, NO BATH! I don't want it!"

"Ida, I need to clean you up, you are getting sweaty, dirty, and uncomfortable and this will make you feel better. I promise this is for comfort, you will feel better."

"No, no, please." But she said this with less force this time so I took my chance and got in there and started cleaning. Once we got into it, she accepted it more and let me. She however still did scream when I had to lift her arms, get between her legs, or clean under her fat folds. I was trying to make conversation with her throughout the bath, but she wanted nothing of it and ignored all my friendly advances. Finally, to break the awkward silence, I turned the TV in her room on. She immediately turned her attention to it realizing it was there for the first time.

"Ida, do you want to want to watch this station?" She shook her head, so I changed stations until we got to an old game show. "How about this Ida?" She nodded her head. "You like game shows?" She nodded her head again. "Ida, what is your favorite game show?" I didn't expect her to answer.

"Let's Make A Deal," she croaked. I was flabbergasted. After three days of yelling at me and ignoring me, she was connecting with me on a friendly human level. It was at that point I no longer viewed her as a combative difficult patient, I saw all the humanity and suffering within her. There was a real woman in there that had been broken by her terrible situation.

Ida didn't communicate with me any further for the rest of my time with her. She didn't communicate with anyone. Doctors would come into her room and ask her questions and she would just ignore them, or lead them around in circles. The doctors would then look to me for answers, not that I had any. I knew Ida didn't want to live anymore; she didn't want any more treatment and tried to be my patient's advocate and communicate that to them.

Ida never married, and only had one living niece. She came in and visited with her one day for a mere 15 minutes. She couldn't handle seeing her Aunt in such an awful situation. She stayed only long enough to give her blessing as her power of attorney for a DNR/DNI order.

A few days later when I had a different patient assignment, I walked by her room and noticed that it was occupied by a different patient. I figured they discharged her back to her nursing home and didn't think anything else of it.

The next day at during lunch time I was flipping through the local newspaper. I happened along the obituaries and noticed a familiar name. There was Ida, written that she died at the hospital two days prior. I was floored and couldn't believe that she passed a mere day after I cared for her. When talking to the charge nurse who knew of this, she informed me that Ida took one look at her nurse stated that she was done with everything turned her head to the other side of the pillow and died.

I was sad but knew that was what she wanted most. Sometimes patients die; actually, they all do at one time or another. Ida was an important learning experience my first week off orientation and is just one of the many sad stories I've come across every day during my short time so far in this profession. It has made me a stronger nurse and I will carry Ida's story with me always.

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297 Posts

Specializes in ED, ICU, Education.

Sounds like you did a wonderful job with Ida. I'm sure she died happier because you took the time to care for her in her final days. In my experience, a bath has ALWAYS made the patient feel better. You should be proud of yourself. "It was at that point I no longer viewed her as a combative difficult patient, I saw all the humanity and suffering within her. There was a real woman in there that had been broken by her terrible situation." That quote was my favourite part btw.


1 Article; 60 Posts

Specializes in Emergency Department.

that was a beautiful story. i have been there. i used to work in a nursing home and dealt with those types of residents. what made me smile was your title lets make a deal. that is the game i played with some of them. i would say let's make a deal... if you take all your meds, or if you let me do your dressing change , if you go to therapy...i will... it was something simple like singing a song, reading them a story, ect. however it worked and we both got some good memories out of it. bless you for caring!!!:redpinkhe

Orca, ADN, ASN, RN

2,066 Posts

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

Sometimes just giving a little of your time, and taking the time to listen, makes a world of difference. You made Ida's last full day on this earth brighter because you took the time to see her as a human being and not just a duty assignment among several duty assignments.


23 Posts

What a touching story...and one we can all relate to I'm sure. We all have an "Ida" close to our hearts.


137 Posts

Specializes in LTC, assisted living, home-care.

God Bless you Arievilo... Your jewels for your crown will be awaiting you in Heaven. You are a heavenly earth angel. You care.


6 Posts

For Ida it was her experience, and your lack. wouldn't it have been better for her that you to talk to the DR's about her resistance to doing things that probably made her more miserable and ask them to reduce the stress items so she could be comfortable. We feel so pressured to do what the Dr orders and not question for the good of the patient. Good luck there are tough calls to be made.

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