Midnight Delirium


A short story about a real encounter on an overnight medicine shift-

My first job as a PA was on the hospital medicine night shift service. There were usually one to two attendings and about four PAs manning the service at night. The bulk of our work was admitting patients to the medicine service from the ER, though we were also expected to handle any issues arising from the inpatient service overnight. This frequently involved managing acute or worsening delirium, usually precipitated by an infection of some sorts.

         One night on service, I was paged to the wards to assess an elderly lady who was ‘harassing’ the nurses at the nurse’s station. Upon my arrival I found a short eighty-three year old female with curly snow-white hair, oversized glasses, and a hospital gown not quite closed enough. I introduced myself and inquired about the problem. She informed me that she was late for work and if we didn’t allow her to shower and get dressed she would “surely call the authorities”. 

         The first line of treatment for acute delirium in the hospital is to try and reorient and redirect patients back to reality. I gently reminded her that it was the middle of the night, she was in the hospital, and perhaps going back to bed would help clear her mind. It took some negotiation and reassurance from others around me, but she finally allowed me to escort her back to her hospital room. 

         I stayed in her room for a few brief moments as she climbed back into her bed. I reminded her of who I was and why she was in the hospital, and that by morning she should be feeling better. She looked me in the eyes as if she understood her outburst was inappropriate but couldn’t figure out why. She started to open her mouth as if to ask a question, but she hesitated and looked away from me. 

         “What is it?” I asked her. She looked at me again inquisitively. 

         “You look like one of them boys on TV” she said with a straight face. I am sure she saw me blush a bit. I was certainly surprised by what she had just said, and frankly I felt complimented. 

         “Oh really? Which boy do I look like?” I inquired. 

         “I don’t remember” was her response. I shouldn’t have been too surprised. 

         I thought I would take the lead. “Well maybe if you remembered what show it was, I could look up who the actor is?”. 

         Without missing a beat she answers “The Three Stooges”… 

         “Get some sleep” was all I could reply. 


Joseph Ciavarro