To Sleep, Perchance to Dream

I don’t know what the problem is, but I’ve been having trouble sleeping ever since I retired. It’s not like I have a lots of stuff on my mind. The two most pressing problems in my current life are, Where did I put whatever it is I’m looking for? I just had it! And, where should we eat today?

This may not sound serious to you, but me not sleeping–it’s like Guy Fieri having problems with his appetite. It’s like Hillary Clinton not having problems with integrity, or Donald Trump not saying something stupid.

I don’t usually make political references, but I used to facilitate a lots of groups, and one of the things I used to examine was how people tend to stereotype things. Now, stereotypes rarely stand up to rigorous examination, except this example: Are all politicians crooks? And everyone always said, Yes! It was true every time.

So, now that I’ve retired, I can’t sleep. Well, it couldn’t have happened at a better time. If I failed to sleep and I had to work the next day, it would surely effect my performance. I’d most likely run out of gas sometime in the afternoon, and probably sputter to the finish line.

Now that I’m retired if I can’t sleep, I can take a nap any time during the day I finally feel tired enough to actually doze off. It doesn’t have any impact on my productivity because, well, my entire lifestyle has changed. My boss is…me?

Well, technically, my wife’s the boss, then the cat. But they’re pretty easy to please, especially the cat.

Back in my nursing days, I had a lots of bosses. Administration. Management. Supervisors. Co-workers. And finally, my patients. I used to let some of them think they were my boss. It made life easier for everyone. And not all of my many bosses were easy to please.

One of the most common complaints by unhappy patient/bosses was this: I can’t sleep!

As a nurse, you have options. You can do nothing. Tell them to back to bed, stop trying so hard. Relax, you’ll fall asleep. This is generally seen as an inefficient response by the patient.

“I tried that! I’m still awake! That’s why I came out here to talk to you!!”

I would always ask my patient/bosses what they did when they weren’t in the hospital. Smoke. Drink. Take a pill. Yeah, well, we can’t let you smoke. We sure as hell can’t let you drink. Which pill did you take and what dose?

Benadryl. Ativan. Klonopin. Valium. Xanax. I don’t know. The green pill. You never knew what you were going to hear.

If there was a med order, I would dispense meds. The unhappy customer would take his or her medicine and go back to bed. Most of the time it was as simple as that. If there wasn’t a standing order, I could call the POD, Physician On Call, and usually get an order because I had a teacher that taught me how to get what I needed from almost any doctor.

It probably stands to reason that most of these urgent calls for sleeping pills occurred at night, right? Because that’s when it always happened. And I had a different name for the Physician On Call. In my terminology, POD stood for Prince/Princess of Darkness. As odd as this might sound, most of the docs I called in the middle of the night liked that term. Some of them identified with it. And you can get almost anything you want from the Prince of Darkness.

So, there was this guy at the MVAMC. Edison. He was an older guy, late fifties, early sixties. I can’t remember if he was depressed or schizophrenic, but what I can remember is he was the guy that couldn’t sleep.

I worked a rotating Day/Night shift at the VA. During the time in question, Edison was a patient on my unit, and I was working a stretch of nights. He was generally a quiet guy, kept to himself; makes me think he heard voices now. Because he couldn’t sleep, Edison didn’t even try to pretend to go to bed. He sat up in the lounge listening to whatever it was his voices had to say.

Edison didn’t complain about his insomnia, well, not at first. I offered him meds, but he declined. He said meds didn’t work. He just sat in the lounge every night for maybe four or five nights.

Edison started coming up to the nursing station. He still wasn’t sleeping, but maybe he’d try some meds. And that’s when the problems started. Edison wasn’t lying. Medications did not work.

I called the Prince of Darkness, he gave me an order for Trazodone. It’s an antidepressant, but it has one helluva sedative side effect. We used it for sleep all the time.

Didn’t do a thing.

Next night, get an order for an extra dose.

Didn’t do anything.

Next night, Edison says he hasn’t slept at all during the entire time he’s been in the hospital. I have to admit, I didn’t believe him. No one can stay awake that many days straight and not go crazy, or in his case, crazier, I suppose. I got a higher dose of Trazodone, plus a repeat dose if needed.

Didn’t do a thing.

We tried other meds as the nights progressed into Week Two. Haldol. Benadryl. Combos of Haldol and Benadryl. Add Ativan. It didn’t matter what we did, the meds did nothing. Edison asked me to get a big hammer and hit him over the head with it. I told him we already tried Maxwell’s Silver Hammer, and it didn’t do squat.

At some point in time around here I had a night off. Maybe two. I didn’t have any problems sleeping on my days off. When I went back to work again it was for another stretch of nights.

As for Edison, it was allegedly Night 11 of no sleep at all, day or night. I wasn’t the only skeptical person when it came to believing Edison’s claim of total sleep abstinence. No one did. We all figured he had to have gotten a few minutes of sleep here and there.

I couldn’t stay awake that many days in row. I’d nod off for at least a few minutes, if not more, especially between 3:00-5:00 AM. It wasn’t called the dead of night for nothing. That two hour timespan was a killer for me. If I could make it through those hours, I could make it through the night.

It just so happens there’s a threshold/drop dead timeline when it comes for how many days you can survive without any sleep whatsoever.

Anyone want to guess how many days that might be?

I returned to work, and there was Edison, still not sleeping. Also there on this night was my nursing bud and all around best friend, Paul Anderson. This was going to be a great night, I thought.

Edison was becoming more vocal in his claim of not sleeping, not even a goddamn five minute catnap, for Christ’s sake! His voice was starting to incorporate a kind of annoying whining tone.

I checked his medication record. He’d already received everything he could for sleep. I gave him a couple Tylenol and a shot of Maalox, and encouraged him to lay down and try to relax. Edison whined as he walked down the hallway, but he didn’t go to bed, he went back to the lounge.

Paul and I had a great time that night. We told jokes and said funny stuff. And we were working with Gail Sebesta, an uniquely talented LPN who could run with the wolves, and by wolves I mean Paul and myself.

The night seemed to fly by. We were having a minor great time inside the nursing station. I looked at the clock. It was almost 3:30 AM already! This was going to be the best night ever. And that’s when Edison came up to the nursing station.

“I still can’t sleep!” he kind of whined.

“Yeah, I know. The problem is, I don’t know what to do about it.”

“Can’t you call the doctor?”

“Sure, I can call him, but then what? Edison, I’ve gotten orders for enough meds for you to put this entire unit to sleep for a week. I’m pretty much out of suggestions. You guys got any ideas?”

“Hey, Edison.” Paul said. He went through the Mark’s a good nurse and he’s done everything he can think of speech. Maybe more medication wasn’t the answer. It hadn’t seemed to have been very effective so far. Paul was a master of redirection, and when that didn’t work, he was a master at setting limits. All I had to do was sit back and relax.

“But I haven’t had ANY sleep in almost two weeks!” Edison cried, his voice was more whiny, and he was getting louder.

“It’s more like eleven days, isn’t it?” I thought that sounded better than two weeks.

“No. That’s not possible.” Paul disagreed. “It’s physically impossible for you to go that many days in a row without any sleep. Your brain will automatically shut down all by itself.”

“Mine just shut down right now,” Gail added. I laughed. Edison did not. He got louder.

“Why won’t anyone believe me?!? I haven’t slept since I came in here! I. Can’t. Sleep!!”

Other patients were coming to their doors to see what was going on. This was suddenly becoming a nightmare. No night shift nurse wants to take care of a bunch of cranky people at 3:45 AM.

“Hey, bud. Can you turn down the volume a bit, you’re starting to wake everyone else up.” I said.

“I DON’T CARE! I CAN’T SLEEP AND IF I DON’T GET SOME SLEEP SOON, I’M GONNA DIE!!”

“Hey, Edison!” Paul jumped back into the fray. He voice was stern. “You’re gonna have to trust me, man. No one has ever died from a lack of sleep.”

There are moments in every life when everything happens in slow motion, right? Have you ever felt that?

Paul finished his pronouncement. Edison started making these strange creepy-croaky noises in the back of his throat. His eyes rolled back inside his head, and he turned a kind of beet red color. He fell to the floor without even a hint of muscle tone or control. He landed face-first with a smacking sound like unto the sound a beaver makes when it smacks its tail on the water.

“Holy shit! Call a code!! Gail said, running for the crash cart.

There was a phone right in front of me. I called the Operator as Paul went flying by me to try to save the life of the man he’d just assured there was no way he was going to die.

And then everything became a blur. We started CPR, the Code Team flooded onto the unit and took over. But despite Paul’s promise, Edison was DRT.

I haven’t been awake eleven straight days, so there’s no chance I’ll die from Terminal Insomnia. My condition is probably a cumulative effect of all the profound changes I’ve gone through lately that have upset my sleep pattern. Life seeks equilibrium. We’re usually the cause of most of our own turmoil. It’ll all balance out again, soon…

I usually try to wrap these vignettes up in a nice, neat bow, and add a moral or something. But what do you say about a guy that was telling the truth, only you didn’t believe him, and then he got dead? My gut had no extrasensory messages for me, and my head was telling me that guy was full of it.

Maybe Gail summed it up best as we were walking off the unit when our shift was over.

“This only goes to show me what my mother told me as a little girl is true.”

“What’s that?” I asked. Paul wasn’t talking.

“Never trust a man that says trust me.”

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