In my 3-year nursing career, I’ve cared for maybe two or three patients with a listed history of schizophrenia.  However, they were taking their medications and had their symptoms fairly controlled.

I finally had the pleasure of experiencing 12 hours with an actively hallucinating schizophrenic.

Not my patient.  The patient’s daughter.   And she wasted no time.

I had just introduced myself to her when she started telling me about the voices.  At first I thought she was just being upfront about her condition.  You know…something like : “Hi.  Just thought you should know that I’m schizophrenic, and I sometimes hear voices. Just in case it comes up…”

I started to respond by saying something like, “It’s good that you’re aware of what they are.  Is this something that you expect to cause you trouble today?  Is there anything I can do to help?”

And that’s when I realized that she was not hearing me at all as she was in the middle of her own conversation.  One of the voices being Bob Dylan.  Oh, and the government had killed her mother and dog and was actively trying to kill her father now.

That entire day was the strangest experience for someone who had never really seen the schizophrenic symptoms in full display.

It was also the most frustrating shift that left me with a raging headache by the end of the day.

Her two sisters called early that morning to warn the staff of her condition and noncompliance with meds.  They reinforced that this lady was not to be allowed in any decision-making process regarding their father’s care.  She was not a threat, but she was certainly a hindrance to her father’s care.   She would verbally deny anything we prepared to do, but she did nothing more to stop us.

She had no expressions. She was unable to hold a normal conversation.  She would approach me with a question, but by the time I answered she was off on random, mumbly tangents.  During this time she would look down to the side and seem unable to hear me for a long period of time.  It got to the point that I finally started excusing myself as politely as I could and just walked away.

No matter what needed to be done, she’d question the action and who was behind it.  Of course, there was no explaining anything to her.  She would start to tell me I was talking too fast, repeat a few of the points I made, and then be off on another conversation without me.

She would walk up between me and another person I was talking with to interrupt and start all over again.

It was a long day.

It became more interesting  when the patient was discharged and I was preparing to transfer him back to his nursing home.  This daughter was insistent that he didn’t go.  After I repeatedly told her that he was going that night, she then attempted to get me to delay the transfer.  I had already spoken to the oldest daughter and power of attorney.  Reports were given. The ambulance had been called.  I told her so.

She then changed tactics and told me to let her feed him first.  He’d already had dinner.  She said not to call the ambulance until she said they were ready.  I told her if she wanted to get food she needed to go right away.  I couldn’t promise how long it would take for the ambulance to arrive.  She hung around the station for 30 minutes or so (in various conversations) before finally going downstairs.  She then took almost an hour to come back up with food.

And her father was gone.

She came back to the station holding the tray.  I explained that she’d been gone an hour, and that the ambulance could not wait for her.  She said again that I was supposed to wait for her.  I explained again that we had already discussed that he was going that night.  His doctors were ready, and her sister and power of attorney knew he was returning.  She dropped eye contact and began her conversations again.  I was about to turn away when she suddenly looked back at me and said that she knew I had tried to explain things as best as I could to her.

I asked her if she needed me to call a ride for her.  She said no.  She said the voices were bothering her.  I asked her if they were hurting her.  She said they wanted to but that she was stronger.  I asked her if she saw anyone for help or if she took any medicine to help keep the voices away.  She said that she did before, but she didn’t like how the medicine made her feel.

Then, just as suddenly, she broke eye contact and went to the empty room with the food – mumbling the whole way.