Thursday, March 03, 2005


Delusions are fixed, false beliefs as compared to hallucinations which are false sensations ("My tea cozy tells me things") and illusions which are misperceptions of reality ("There's a monster [IV pole] by my bed"). My patient had a hell of a delusion today: the patient believed that feces and urine were soaking the patient's big toe. Therefore, the only sensible thing to do is rip off your toe nail. Yikes. I've never seen a nail-less big toe before and let me tell you it is a sore, oozing, unnatural-looking thing.

I got to be very psych-nurse-y in my approach: "I see you've ripped off your toenail. Can you tell me about that?" (Probing, non-confrontational question). "I understand: you feel as if your toenail is impregnanted with feces, is there anything else you think it's important for me to know?" (reflection, which continued probing). "How do you feel about not having a toenail anymore?" (internalizing question).

I felt a bit better being on the floor today and a tad more confident. In some ways, it's easier to act confident and take charge in this setting as noone will challenge you if you do but they certainly will if you don't. I also got to treat multiple lesions of unknown origin on my patient's hands, face and legs which was unpleasant but it was grounding to perform nursing tasks to which I'm more accustomed.


Blogger Ilan Muskat said...

Etan's big toenail came off when he was little... he was 3 or 4.

He'd smashed his foot somewhere, and his toenail was loose, and one day when he was wearing galoshes, the toenail just came off. A new one eventually grew back.

When Nate reads this comment, he'll think Etan is a code-word for his name (since it's "natE" backwards). He'll be wrong, frighteningly so.

Delusions and de lesions.

12:58 AM  
Blogger Stephen said...

Wow, you seem pretty good at that.

9:15 PM  

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