Nursing Voices

Wednesday, January 03, 2007

Death by Cheese Platter.

Many years ago when I started working as a psychiatric nurse, I was assigned to teach a class about healthy eating. It was back in the days when patients spent weeks in the hospital and we had the luxury of thoroughly teaching our patients everything they needed to know before they went home. It was also during a time when MAO inhibitors were frequently used to treat depression.

The dietary department sent up a fruit, vegetable, and cheese platter every week for my group. They would also send up a variety of snack crackers and a few bottles of carbonated grape juice. I served the juice in plastic champagne glasses as I talked about the dangers of drinking alcohol while taking MAO inhibitors, and other psychotropic medications. The bubbly juice taught patients about the alternatives to drinking alcohol. I used the cheese on the platter as a prop when I talked about foods to avoid when taking MAO inhibitors. Patients not on MAO inhibitors would nibble on the cheese during group while those on MAO inhibitors were invited to snack on the fruits, vegetables, and crackers. The food was good—a welcome change from regular hospital food—and my group was well attended.

One day a patient with a huge chip on her shoulder came to my group. She was prescribed a MAO inhibitor, and she started complaining bitterly about the dietary restrictions associated with her medications. One of the other patients teased her by asking if she wanted “a little WHINE with her cheese.” She said she’d skip the wine but would take the cheese. Then she grabbed a handful of cheese cubes off the food platter and stuffed them into her mouth. After she swallowed, she looked at me, smiled, and said she wanted to die if she couldn't eat what she wanted. I called the doctor and my patient was treated for a sharp rise in her blood pressure.

The patient later told me that she was sorry for her impulsive behavior during group. She said, “I don’t know why I ate that stuff. I don’t even like cheese.” She later came to realize that she acted out as a way of rebelling against her mental illness. I also believe my patient had a personality disorder.

Here’s what I learned from the incident:

1) Self destructive patients are angry people. They need our support, but they must face the consequences of their actions. My patient had a killer headache after her blood pressure hit the ceiling. She wanted narcotics for the pain. We gave her Tylenol.

2) Patient education about good nutrition is a key factor in helping patients stay healthy. (My goodness, these ladies look healthy.)

3) Keep food out of the reach of patients during group. Impulsive eating is emotionally based, and acting out behavior can be deadly.


Blogger LJG aka Pennsylvania Independent said...

I can relate to alot of self-destructive behavior because I have been hospitalized twice because of it. The first time it was because I tried "removing" my own wisdom teeth. I won't go into many details.
The second time I was hospitalized because I fell into a deep depression because I was told by an Orthopedic surgeon that I would lose permanent function in both of my hands, due to Carpal Tunnel Syndrome. That would bring my quality of life to nothing and I would be dependent on someone basically taking care of me. I do have a loving, caring Wife who would do that, but I do not want it to come to that. I am 27 years old now and a young daughter to take care of and I did not want to have to raise my daughter collecting SSI or SSDI. I had no insurance either, that was a huge burden in getting the needed surgery done. My mother and grandmother had paid a good amount of money for me to get the EMG and consult with the doctor. I could not ask them to pay a huge amount of money they do not have.
I have been diagnosed with ADHD since I was 16 or 17 and Bipolar Disorder since I was 20. Falling into the deep depression after being diagnosed with Carpal Tunnel Syndrome sound really superfical, it is not a life threatening condition, but when you are told the muscles in your hands will eventually atrophy beyond a point where surgery wouldn't help and I was near that point then. I had left it go too long. I will admit I am stubborn(a huge trademark with people with bipolar disorder) I ignored the numbness and the tingling in my hands for a long time.
How I was hospitalized the second time is because I had said to my grandmother and my mother that I would not be alive for much longer anyway, so I don't have to worry about getting the surgery or having someone to depend on for the rest of my life.
My grandmother, who is not only a retired RN, but someone who suffers from Bipolar Disorder, took that as a threat of suicide. She decided to basically "trick" me into going to the ER and had me admitted to the Psychiatric unit again.
I was stubborn there as well. The psychiatrist kept telling me over and over again I needed to get taht surgery done before I came to a point of no return. He kept stressing that I was entitle to seek any of the services that the hospital provided. I was more or less blackmailed when the doctor had said he was going to keep me in the hospital until I had the operation done. His reasoning for that was a rational person would take advantage of that opportunity.
Eventually I had the surgery done while I was inpatient and they only issue I had was when it was ignored that I was allergic to latex and started getting a nasty rash. A male nurse noticed it and immediately brought it to everyone's attention that I was developing a rash and possibly going into anaphylactic shock because of it. Without further incident I was put to sleep and woke up in recovery.
Other than that the nurses in the recovery room were the nicest nurses I ever had. They really were attentive to my needs they gave my more IV fluids then gave me a really really cold cup of ice water, which really was helpful because my throat was extremly sensetive because of the breathing tube that was inserted.
Sorry for such a long post, but sometimes I get carried away,

2:04 AM  
Blogger jaz said...


Sorry the patient had such a muenster headache afterwards, but it colby worse. It was gouda you to make that call so quickly.

I guess you can never brie too careful.

9:33 AM  
Blogger The Curmudgeon said...

I sometimes think we gravitate towards foods that are 'good for us' at a particular time -- the classic example is chocolate which may cause other problems but often has prompt and beneficial effects on the snacker.

But now I'm hungry....

10:39 AM  
Blogger The Angry Medic said...

Have I ever told you that you have fantastic taste when it comes to choosing pictures to accompany your blog posts? :)

Happy New Year!

11:35 AM  
Blogger Serial Filler said...

I love this story! I can relate to it so well.

I hope this blog attracts the psychiatrist of your dreams! How could anyone turn down the opportunity fo work with you?

1:56 PM  
Blogger Deacon Barry said...

I've got a friend who's diabetic. Naturally she craves chocolate.

4:34 PM  
Blogger Runs With Scissors said...

Even though I'm not on an MAOI, I think I could probably commit suicide by cheese. I LOVE the stuff!


7:23 PM  
Blogger Bohemian Road Nurse... said...

Now I'm hungry for cheese and crackers!

7:45 PM  
Blogger Kris said...

For real. It's like my deal with migraines, in which the triggers are caffeine, red wine, chocolate, and lack of sleep. Look at that list, and you can tell EXACTLY what I do on a Saturday night. Good nurse, SUCKY patient!

10:08 PM  
Blogger Claude Scales said...

Did you happen to see this article about the "Heart Attack Grill" in Tempe, Arizona?

Obviously, the columnist didn't sympathize with the Arizona Nurses' Association's position. How do you feel about this - harmless joke or offensive slur?

12:10 PM  
Blogger Jean-Luc Picard said...

I love cheese. We all eat foods that can be 'bad' for us at times. What we need is balance.

2:14 PM  
Blogger MadMike said...

This comment has been removed by a blog administrator.

2:57 PM  
Blogger MadMike said...

Although this post is directed at the fairer sex I suspect the same set of dynamics could be applied to the man of the species. From a personal standpoint I do love cheese!

Now, and at the risk of shameless self promotion, there is a very important question directed at the idiosyncacies of men on my blog. It is entitled women and cars. I hope you and your readers stop by for a visit MJ, and add your two cents. Thanks :-)

3:01 PM  
Anonymous Camila said...

Now I come to the doubt bout food being healthy or not. I mean, every rebelling has to do with food;)
Diabetes = sugar desperate need;
Depressive feeling = chocolate exasperating need;
Happines = celebrating with food;
Can't eat the unknown "A" due to side effects = sudden curisity bout "A's" taste.
My father has diabetes and whenever we look at him, he's into Coke. I feel I gotta lose weight, ok, can't live without chocolate... food is just in the top of my quality-of-life list!:D

6:01 PM  
Blogger SQT said...

I know brownies aren't good for me, but they're good for the soul, arent't they?

2:30 PM  
Blogger Laura said...

My favorite food is cheese too. It is a psychological thing I guess, what we can't have we want. I deal with it all the time too. I found that eating 2 hershey kisses will give me a killer migraine but yet I still eat chocolate! Later when I get that migraine I wish that I could take it all back. It's the worst feeling in the world.

8:56 PM  

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