Geriatrics 101

I learnt this lesson in geriatrics early on in my medical career:

Beware of opioid use in the elderly

That, and Always check your gloves for holes before manual disimpaction.

This reminder came about last week. I had the rare opportunity of sharing a patient with my fiancee, who's a cardiac surgery ICU nurse.

I saw Mrs. M before her surgery. LOL (Little Old Lady) with type 2 diabetes, admitted for aortic valve surgery. She was as sharp as a tack for someone who was 79 years old. Single, independent. After surgery, I followed her progress and worked on getting her off the insulin drip. That was when she spent a few days in the ICU. As I did my rounds, I told Mrs. M that I knew she was in good hands because she had my fiancee as her nurse, winking at Kris as I said so. She asked about our wedding, so we talked a bit. Despite her having a chest tube in place still.

After I left, apparently pain got the better of her. And she decided to use the PCA (patient controlled anesthesia, a nifty pain medication pump the patient herself controls). And boy, did the Fentanyl take care of the pain:

• She thought Kristin was her dog, Scruffy, and kept calling her to fetch.
• She said that my honey's face was scaring her (how can that be possible??)
• She thought the laundry bag in her room (for soiled blankets) was a person riding a horse.
• She told her family members that Kristin and I were going to change our wedding date so that she could attend.
• She was singing Jingle Bells and Here Comes the Bride (to which my Kristin sang along to, to pacify/humor her. That, in the ICU, must been quite a sight).
• And when I came by a few hours later to check on her, she thought I had been drinking. I said I haven't, but if she were to find some beer, to be sure to tell me so that we could share. I got a giggle from another nurse with that.

Anyways. 4 days and a pacemaker placement later, I again saw her in the CV Surgical ICU. I asked her who Scruffy was. She looked at me in puzzlement and asked if I was trying to read her mind. She had no recollection of her antics the other day. And so I told her.

Despite being anemic from 2 surgeries, she blushed a deep hue of violet. And made me promise to relay her apologies to my fiancee.

As I left her room, I turned around and told her new nurse:

"No more Fentanyl for her!"