Under Construction - MHWA Retreat

At work, I have two really challenging patients. One is on hospice, he begs for help, then when you help he resists. He's extremely combative. For example, when trying to change his shirt, because it has urine on it, he stretches his arm out so that I can not pull it through the armhole. Just imagine what it's like changing his briefs. He's incontinent and it actually takes two people to change his briefs: one to keep him from hurting the one changing him and the other changing him. He punches, tries to grab fingers and arms and tries to twist them (apparently trying to break them). Luckily he is not physically strong enough to cause any more harm then maybe a bruise. He's a small man of no more than maybe 5' 4" and 140 lbs.

Oddly, despite his violent behavior, I am able to have compassion. He's been assigned to hospice, which means his life is very limited. He's depressed and his depression manifests into anger. It is almost like he just wants us to let him lay in his bed, soaked in his own feces and urine and die. Maybe he feels that is what he deserves, who knows. So, despite his violent behavior, I still get him out of bed and roll him in his chair around where people are. I've even caught him smiling once or twice when I've made him do this.

The other difficult patient, I am struggling to have empathy. She's got cerebral palsy and is diabetic. She's like close to three hundred pounds and refuses to get out of bed. Even though she can not walk, she still has the option to get out of bed because she has a really nice automated chair and we have the equipment to make the transfer to her chair less painful. Also, all of her mental facilities are fine, so she is capable of a lot. Yet, she acts helpless for attention. Her call light is always on for stupid shit like she doesn't want to feed herself when she can, but she wants to be handfed. All the while, when doing anything for her, she is abusive verbally.

I try to understand that she acts like a vile human because she is in pain. Although, she is allowed pain meds, but refuses them because she doesn't like feeling "loopy". She's a "somewhat" decent human when on pain meds but still demanding and rude.

She does some really manipulative things like say the CNA didn't change her briefs, when in fact they did several times. She'll also take off her hand brace herself and then when the nurse asks, she says we did it. Every time I go into her room, I'm constantly putting that brace back on her hand. She has a brace because one hand is curling closed. Not having her brace on for an extended amount of time will cause her nails to grow into her palm. By the way, the brace is on her left hand. Her right hand is fine and she's righthanded.

Unlike a lot of the terminal patients there, her room shows evidence of a family that loves her and visits often. You can always tell by whether they have their own personal refrigerator filled with personal goodies, their own bathing stuff that is not the hospital brand etc. She is obviously very spoiled by her siblings that visit often but is too much for them to handle full time.

I guess I'm just trying to figure out within my own self why I can have sympathy for the dying man who treats me like total shit and is violent, but not her. Maybe it is because the old violent guy has no one who cares enough to visit, hence does not have anyone who shows him love, while she does, yet she has no appreciation for it.

Also, no matter how combative the old guy is, once I've helped him, he says thank you, while the lady still treats me poorly. I mean, shouldn't someone be thankful for the people willing to change their shitty briefs? One would think so.

Anyway, what are your thoughts? Maybe some of you can read something into this that I can't seem to see myself. I find myself feeling guilty because I just want the bitch to be transferred.