Grandma's had a psychotic break

  1. Long post allert!

    My 78 year old Grandmother (paternal) is undergoing psychiatric evaluation to assess her competancy. Wow, this is a little too close to my work life. As some of you may know, I'm a psychogeriatric nurse.

    She was admitted to the hospital 2 weeks ago to be treated for recurrent CHF and GI bleed. She was diuresed, transfused and was looking a lot better when all this came to the surface.

    She has been living independantly in a Senior's complex with my frail grandfather, with assist from home care. By all reports they had been managing adequately (although she has a habit of firing the home care workers). My Dad has 9 brothers and sisters and most of them check in on a weekly basis. My parents checked on the apartment yesterday, and found there was old feces everywhere and used needles all over the place (grandmother is a diabetic). Apparently the situation was quite bleak prior the the admission, and my grandfather had been trying to care for grandmother (who had become incontinent of B&B). They both have poor eyesight. They're also very good at covering things up.

    God, this sounds way too much like the nightmares I read about in my own patient's charts. Why didn't we see this coming and why didn't we know how bad things had gotten!? There are so many health care workers in the family, and we all work with the elderly!

    Wait there's more. My grandmother has an undiagnosed personality disorder. She is a very manipulative woman, and has done some amazingly cruel things to her own family over the years. If I sound emotionally detached, it's because I am. I emotionally disengaged myself from her years ago, when I figured out her game and became sick of her not being able to distinguish me from my sisters (I have a maternal grandmother who loves me just fine, thank you).

    Apparently, she has been threatening to divorce my grandfather and had secretly gotten her bingo buddies to secure a lease for her own apartment here in the city (they all live in the country 45 min away).

    This week she just flipped out while in the hospital. She has become completely irrational, screams and yells at all hours of the day. She has become completely confused and paranoid and combattive. Has become fixated on walking out of the hospital and moving to the city. It is completely unrealistic that she could ever care for herself at this point in a regular apartment.

    I didn't find out about all this until yesterday. It's been difficult for me to stay out of their situation, but in such a large family, a granddaughter just cannot have her say. I surrendered my rights as a decision maker last year to my father and his sibs. To say that I did not see problems coming on the horizon would be a lie. My grandmother has never been an espeically healthy person psychologically.

    I worry about my father and grandfather the most. My grandfather will possibly have to move to a nursing home once they assess his ability to care for himself. He is taking this all very hard and has always been a very sweet and well-meaning man. She guilts him into visiting her every day, and then screams threats and abuse at him. My grandmother will likely end up in a nursing home. My dad is really suffering. This is all unearthing a lot os memories from his childhood that had not come to surface until now. There is a lot of self blame in the family.

    I will keep you posted.
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    About adrienurse

    Joined: Apr '02; Posts: 4,740; Likes: 104


  3. by   Rustyhammer
    I'm surprised the family hasn't been asking you for your expertise (and then probably ignoring it).
    I was getting called all the time when my grandfather was about to be placed in the NH and a lot after he was admitted.
    They would call me and ask "Why is he so hateful?" He was a demented old geezer and they were all in denile.
    I hope you get through this with a minimum of turmoil.
  4. by   adrienurse
    Denial Denial Denial -- that's been the name of the game for years. They were still living on the farm until 2 years ago. My grandfather was working in the fields with his COPD! Anything I have to say falls on deaf ears. It scares the sh!t out of me that mygrandfather is still chugging down the highway in his minivan with his cataracts and glaucoma.

    As for my expertese, I think I got my mother to listen to me last night on the phone, but as far as they're all concerned, I'm still a kid.
  5. by   emily_mom
    I agree with all of you that the they are cruising down "de-nile". My family never listens to me and when they do, it's always the worst things that I say. They can't accept that we know so much more than them medically and they don't want to know.
  6. by   hoolahan
    {{{{Adri}}} I was about to post a very similar story this week,long post was deleted by accident.

    My title was going to be, "How do you deal with people who you love that hurt you?"

    My grandmother is not senile, but she has been a bitter, cruel person, and has hurt me very deeply at times. The difference being, I am the only one in the area, 15 min away, who helps her w anything. Her own son lives in the same building as her. But he is a sicker psycho than she is. Earlier this summer, she began acting very strangely toward me. I am now certain it must have been due to things he said about me.

    My uncle never helps my grandmother unless there is cash involved. I refuse cash from her, but she always tries to put it in my pocket. She cannot understand why I truly would not want it b/c I don't think she has ever performed an unselfish act her entire life, so for someone else to be that way, it is incomprehensible to her, and to my uncle. He is convinced grandma is handing me cash b/c I helped her so much. He was apparently seething with jealousy.

    He called me one night pi$$ed off at her, and as a matter of fact, so was I. I didn't tell her that, but I needed to vent, and there he was. Well, the a-hole tape-recorded everything I said, of course his nasty goading remarks were cut out, and he played this to my grandmother.

    OK, I was wrong to say it, but what kind of sick person tapes records a conversation in the first place, then plays something he knows would be so hurtful to my grandmother, an old lady who is neurotic enough as it is??

    So, anyway, over the summer, she went on coumadin, and some other new meds. She was so nervous, and getting her meds totally mixed up. Now Rusty, with her, you have to have a penis to give good advice. Since I lack that feature, my advice is never good. So, I tried repeatedly, all systems, a chart, a diary, lists, med box pre-filled. No matter what I did, she insisted she wasn't getting better b/c I was screwing up her pills (probably something my a-hole uncle planted in her head.)

    BTW I should mention I have not spoken a word to my uncle in five years and he has no relatives, abadoned his dtr, and if he were dying in the street, I would not help him.

    Anyway, about 6 weeks ago, we had it out, grandma and I. She accused me of trying to keep her $10,000 cash in her strongbox she wanted me to keep for her while she was away. I didn't get it back to her soon enough, b/c we then went on vacation, and she thought it was b/c I took money and was afraid to give it back.

    OMG was I angry! I took my dtr there with me, and made Kris count out every bill in front of her. Turns out it was $100 short, but she admitted she had taken that out before she gave me nthe box to hold.

    Needless to say, I'm not touching that box again. I didn't speak to her for all this time, until I saw her in the supermarket. She said she was in the hospital three times. I asked why didn't you call me? She says, My son helped me. This way she can tell everyone how her heartless grand-dtr didn't even come to see her in the hospital.

    COOL!! Let him do something for a change, He hasn't worked in years talk about a leech, he is truly one who sucks the system dry.

    Then I went to my doc for a check up and he told me she was in again. They don't know what is wrong with her, b/c basically, they have found nothing to explain her vague symptoms, diziness, etc... Honestly, she enjoys being in the hospital! She likes it b/c all her church friends call on her, and she gets very good care in this place as she is a freq flyer, and she tips everyone, and yes, they accept it. She told me the ambulance drivers were the only ones not to accept the money.

    So, I am finding myself in a place where I have lost the warm fuzzy feelings I ever had for her. And I hate the feeling. I will help her, but it is out of a sense of duty and obligation, and no longer out of a sense of love. The total opposite is true of my in-laws. They have never been aything but warm and kind to me, and I would go to the ends of the earth to help them if they needed it.

    I told my husband the other day, if grandmom ever gets so ill she can't take care of herself, I can only take her in here if she is no longer able to speak. I know that sounds so cruel, but my husband would find me hanging by a noose otherwise, I am serious. I hate to say it but Grandma is mean and manipulative, and I am hating how I feel about helping her.

    She was just hinting she wishes she could move away from her bldg b/c her son gets her so nervous w his antics. She said I was thinking of moving in with my sister. I was really happy for her, her sister wants her there, and she wouldn't be lonely, and her sister is the yin to her yang. Beautiful kind and warm-hearted calm sweet person. It would be good for her, but I think she would miss the turmoil she created for herself when she got her son recommended to move into the bldg, against my advice! I am sure she was hoping I would say, why don't you move in with me?! But that won't happen.

    Oh well, not sure where I am going with this rambling, but it feels really good to get this off my chest!!

    Thanks for listening.

    Adri, old folks are really good at covering things up. Sounds like a 24/7 live-in companion would be a good solution. Keep us posted.
  7. by   Rustyhammer
    Sometimes we need to take care of ourselves first and that includes NOT being around people who thrive on beating us down.
    The love we have for our family can only go so far and if it not reciprocated how can we continue?
    I feel the conflict that you both are going through.
    I think members of the same family rarely grow up under the same roof.
  8. by   adrienurse
    Hoolahan, sorry to hear of your troubles. As I said, this is why I have disengaged myself from the situation.

    here's an update. I spoke to my Mom on the phone a few hours ago. Another (potential) thread topic entirely, but interestingly enough, my mother is an RN at the hospital where she is admitted (small rural yadda yadda). She was charge nurse today. What a nightmare. I swear, if g-ma ends up on my unit, I'll quit. BTW one of my first questions was do you think this is illness-induced delerium? They have so far ruled out UTI.

    Grandmother is refusing to eat (she's diabetic).
    She refused to speak to my mother today. Gotta take turns making people the bad guy -- you know.
    She's depressed.
    Continues to be verbally abusive to husband and children "why don't you just take me home and die....". "It's all your fault that I'm this way".
    Has zero insight into her behaviour
    Is bleeding continually from intestinal polyps (had some cauterized, but continues to have occault blood). Has a poor prognosis.

    Gotta go to work. We'll talk more tomorrow.
  9. by   NRSKarenRN
  10. by   maureeno
    nothing is tougher than living through, with our loved ones, nightmare scenarios we know well from our work experience. We're not just nurses on the job site, nursing isn't role playing, it is identity. Sometimes 'living through' and 'being there' is the best/most we can do. Please hold no guilt for not seeing this crisis coming. Best wishes to you and your family. Use this as an opportunity to check grandfather and dad, mom ,you have advance directives.
  11. by   Jenny P
    {{{{Adri}}}} I've been through this twice with DH's Aunt Hazel, except she is a really sweet lovely lady all of the time except when she was ill this spring after her broken hip and now after her TIA. She hasn't been nasty, just mean and suspicious with all of this delirium. The mean-ness has pretty much disappeared, but they have decided that she now has dementia, and she is leaving us on Monday for a Alzheimer's assisted living home out in New Jersey. We all care about our family members so much that we develop blinders to symptoms that are screaming out to anyone who isn't related to that person. You may call it denial; but I think it is called love.

    My own family asks my advice but ignores it all the time just like you all have said your families do! Must be the genetic thing, huh? They just can't believe that anyone who shares their own genes grew up and knows whatever they may have gone to school for!

    We all are doing the best we can with what we got. We can't change our relatives, nor how they have treated (or are treating) us, we can just accept where those people are right now, accept them at this point and let it be. They are broken now, remember that you are still whole. And move on.
  12. by   BadBird
    I feel so sorry for you, I wish I had some words of wisedom but I don't. I agree with Rusty, you must take care of yourself. At least you are smart enough to see through the games so hopefully you will be able to maintain a safe distance.
  13. by   canoehead
    I too have psychotic family members. Offer them help but don't take it personally when they refuse. Let them know you are there if they need you and then wait for them to ask. Visit and be friendly but don't take responsibility for their outcomes. It is their life and sometimes people get off on making everyone else run in circles around them. Eventually they will tire of the show and want real help. If you establish boundaries and take care of yourself you will be more effective when that time comes.

    Best of luck.
  14. by   kelligrl
    Yikes--this all sounds suspiciously like my MIL. I swear she is just selfish and mean to the core. Plus she's more paranoid than anyone I've ever met--she complains that people are coming in to the house and stealing the caps off the shampoo and the toothpaste...*****!?! Serious mental illness, plus wouldn't do anything for anyone if she didn't get something out of it-I'm thinking personality disorder. Yet the ladies from church love her!! Blech...She can do seriously rotten things and say "I knew God would take care of me..." Shameless...It's amazing the fronts that can be put up....