A good bit has happened since I last wrote here. I've had several people message and ask how my special resident is doing and I really appreciate everything.

A few weeks ago things startedgetting really strange. He was being EXTREMELY inappropriate with both employees and residents. There were numerous instances of publicly... well... self-pleasing acts. It was causing quite a disturbance to everyone on that particular side of the building. When people would try to stop him he'd get very angry.

 So often when I'd talk to him he'd call me by his ex-wife's name and he'd curse me, saying how it was over and he was done and for me to "get the f*** out of here!" I knew something wasn't right. I didn't, however, think it was a UTI like most other times of extreme behavior.

Well last Sunday the 17th was the final straw. More and more self-pleasing behaviors and inappropriate comments to staff and residents. No one could stop it. Finally the nurses just parked him at the station, put a large blanket over him, and let him take care of business. Itwas rather disgusting and everyone tried to hide it from visitors as much as possible. The reason they kepthim at the nurses station was because he kept trying to stand. Well as we all predicted, he tried to stand up and remove his pants so of course we all jumped over and tried to keep his clothes on and sit him down. Bad idea. He went crazy. Yelling, kicking, hitting, everything. Finally the nurse decided that the CNA should take him to his room. He resisted her, too, so we had to hold his arms and legs while the CNA rolled his chair down the hall.

Boy was he upset! The supervising nurse called the doctor because she was freaking out and didn't know what to do. "He's a danger to himself, other residents, and staff!" He was screaming and cursing at all of us, and when he looked at me, he started in on his ex once again. I tried to tell him that I was not her but it didn't work. Finally it was decided that he would be taken to the hospital for psychiatric evaluation. I knew that there had to be something chemically wrong with him for him to act like this. I also knew that it had been a very long time since his ammonia levels had been checked. Yeah, I'm just a therapist, not a brilliant nurse or a doctor, but I know enough to know that a man with a failing liver needs to have his levels checked.

I offered to sit in his room with him while the rest of the employees took care of everything else they needed to take care of and so the nurse couldget the paperwork ready for him to go the the ER, but Linda the nurse wouldn't leave me alone with him, saying "I don't trust him alone with anyone. He's a strong guy. I don't want him to hurt you." After a while his CNA came down to sit with me while Linda got the paperwork ready. Meanwhile, J had really calmed down, he'd actually nearly fell asleep. At one point I tried to ask him how he was doing and he was rather calm. But when I mentioned that he might be going for a ride on an ambulance, he got kind of upset. So I quickly changed the subject and he forgot about it. Well, when the EMT's showed up he was rather polite. They asked him wht was wrong and J said nothing was wrong, things were okay. They asked him to come for a ride with them to talk to the doctor and to see the pretty nurses. He said "Nah, I don't need to do that." They couldn't convince him. So finally I spoke up and said, "J, will you go for me?" He looked at me, kinda smiled, then looked back at them as he pointed towards me and said "I'll go for her, not for me. But I'll go for her." That proved to me that he still knew me as me, not his ex.

Against Linda's advice, I followed them to the ER and sat with J for over 4 hours. I answered questions for the nurses and the EMT's, kept J calm, managed him when he started to act a little wacky, and just reassured him that he had someone. I hated to leave before he got admitted, but I was exhausted and had to work the next day.

He was in the hospital for two and a half days, came back to the nursing home on Wednesday afternoon. And guess what it was... ELEVATED AMMONIA LEVELS!!!!! It's amazing the difference his hospital visit has made. His mind is soooooo much clearer! I had an hour long conversation with him Thursday night about his family, including the children. He has never been able to tell me so much about them. And he wants me to find them. He really wants to see them. So now I'm just trying to figure out what I need to do about that. I've found them, at least the 3 oldest and the ex, but I don't know if I should contact them. I don't really know what to do. He loves them. There's no doubt in my mind that he does care about them. I wish there was a way that I could make sure that they know that and that he could tell them himself before he dies.

Thats it for now...

... my special patient's behavior has been horrible for the past three days and I expect that its still going on. I nearly cried on Thursday after he told me to get the F*** away from him and thatit was over. He's been awful to everyone, and it amazes everyone that he's acting this way towards me. Thing is, I don't think he thinks he's talking to me, he looks at me like I'm someone else. When he's angry towards me, he calls me by his ex-wife's name. But when he's talking to Sarah, he smiles and tells me that I'm his girl and that he'll always be there for me. He even came looking for me on Thursday, thinking we were supposed to have lunch together. So obviously he knows who Sarah is but thinks I'm the ex sometimes, too. This is so weird. The behavior changed sooo fast. He was great on Tuesday. Something has to be going on with him medically. I think that his ammonia levels are up from the liver disease. They need to do something before he hurts himself, an employee, or another resident. He tried to hurt my friend who is a CNA last night. This behavior is so scary. I used to be able to stop the anger. All I'd have to do is say "J, it's Sarah. Calm down. It's going to be okay", look him in the eyes, smile, and he's calm right down and smile back. I don't know what to do... this sucks so much