Yankee Doodle Delirium

“Why hello there!  Yes, yes, you there, I’m talking to you.  Haven’t you ever read a story where the characters decide they like talking directly to their readers?  I know it is a bit unusual because so many tales pretend you aren’t even there, but it’s you and your imagination that really makes the story come to life!  Why, I was just talking that over with Humpty Dumpty after his fall the other day, but… oh don’t get me started… 

Well, anyhow, it’s so nice of you to join me on my birthday!  Yes indeed, I was born on the fourth of July in 1776 believe it or not.  Not?  Hmm… well, if it helps convince you any, my favorite colors are red, white and blue… still not buying it?… Well, it is true and you shouldn’t be so skeptical on a man’s birthday, least ways not to his face.  It’s just not nice-like you understand and I have a right mind not to tell you the rest of my story, hmph… 

What’s that you say?  Oh, my name?  Why, I am so glad you asked… cue the music honey! … do, do, do, do

I am Yankee Doodle Dandy

A Yankee Doodle, do or die

A real live nephew of my Uncle Sam

Born on the Fourth of July

I've got a Yankee Doodle sweetheart

She's my Yankee Doodle joy

Yankee Doodle came to London

Just to ride the ponies

I am the Yankee Doodle Boy

Yankee Doodle went to town,

A-riding on a pony

Stuck a feather in his hat,

And called it macaroni.

Yankee Doodle, keep it up,

Yankee Doodle dandy

Mind the music and the step,

And with the girls be handy!

                “Haha!  Now that’s the way to celebrate a man’s birthday!”

                “Wait, Norman, what are you telling these poor people?  It’s not your birthday for another 6 months!”

                “Oh pipe down there woman!  Sorry about that.  This here’s my wife, Suzie Lou, my Yankee Doodle joy, hehe!  She keeps tabs on me to make sure that everything’s in order.  Oh look!  They’re setting off fireworks in celebration of my birthday!  Don’t know why they’re doing it in the middle of the day, but you know what they say… Fireworks are as American as… um... McDonald’s hamburgers, New York pizza and crisp apple pie!”

                “Oh Norman, you sure are tellin’ tales today!  There are no fireworks going on outside right now.  They save that for when it’s dark so as you can see ‘em better.”

                “Quiet woman!  This here’s my story!  Anyway, like I was saying earlier, it really is so kind of you to join me and make this day a wonderful celebration.  This all reminds me of a time earlier in my life when I wrote a magnificent, glorious song.  I bet you’ve heard it before, but I’ll just go ahead and sing it for you anyway because I’m in such a jolly mood.

O say can you see by the dawn's early light,

What so proudly we hailed at the twilight's last gleaming…”

                “Norman!  You know very well you did not write that song, so quit telling these kind folks such falsehoods!  Honestly now, I just don’t know what’s gotten into you today!”

                “What do you mean woman?  Of course I wrote the Star Spangled Banner because I’m a Yankee Doodle Boy!”

                “Are you feeling ok Norman?  Come closer and let me feel your head.”

                “I’m just fine Suzie, so leave me alone!”

                “Why Norman!  You never raise your voice to me… are you sure you’re feeling ok?  You just don’t seem to be yourself today.”

                “Of course I’m ok.  Just because I can’t seem to sit still is no reason for you to be asking me such silly questions.  You must be out to get me… you all are, aren’t you?!  You didn’t really want to celebrate my birthday, did you dear reader… you just came to laugh at me!  JUST LEAVE ME ALONE!”

                “Why Norman, just calm down dear.  Um, did you wet your pants?”

                “My name is Yankee!  MY NAME IS YANKEE!!!”

               

                “Ok, ok dear, just sit down.  You’re so wobbly on your feet that I’m worried you’re going to hurt yourself.  How about we just take you in to see… “Uncle Sam,” he’s over at the hospital right now, you know.”

                “He is?  Ok… ok that sounds good.  I think I’ll just take a nap right over here.  You go ahead and say hello for me.  Just tell him I’ve been a good Yankee Doodle boy.”

………………………………………………………………

                “Um, hello there, reader?  This is Suzie, Norman’s wife, just here to tell you Norm’s ok.  He just had a bad case of delirium (caused by severe dehydration, don’t ya know).  I’ve told him and told him to keep up his drinking in all this heat, but he must not have listened.  By the time I finally figured out what happened, we rushed him to the hospital and the doctors fixed him up right nice like.  Don’t know why he was wantin’ to tell such tales, but… well… no harm done.  You have a safe celebration now, ya hear!”

Happy 4th of July!

Medical Morales to Remember:

• Delirium – sudden, severe confusion that occurs with physical or mental illness, reversible if underlying cause treated quickly
• Dementia - subtle, slowly progressing changes in cognitive, functional and behavioral characteristics
• “Delirium affects an estimated 14–56% of all hospitalized elderly patients. At least 20% of the 12.5 million patients over 65 years of age hospitalized each year in the US experience complications during hospitalization because of delirium” – National Institute of Health
• Considered medical emergency because, if underlying cause not treated, it may cause permanent, irreversible brain damage or death
• Symptoms – altered level of consciousness, hallucinations, delusions, fear, anxiety, paranoia, short attention span, disorganized thinking, restlessness, agitation, drowsiness, lethargy, emotional changes, incontinence
• Causes – medications, physical illness, dehydration, fecal impaction, malnutrition, infection, head trauma, sensory deprivation or overload, surgery, pain, poisons, electrolyte imbalances, etc.
• Treatment - determine and treat underlying causes (if underlying cause treated, pt should return to baseline mental status within several days)
• Nursing Considerations - pt safety and fall prevention, family education, monitor pt outcomes

Additional Resources:

• Mayo Clinic - Delirium
• MedlinePlus - Delirium
• National Institute of Health - Delirium in Elderly Adults

Can you tell the difference between dementia and delirium?  Have you ever worked with a patient or experienced a love one in a state of delirium?  What was done to help them recover?  Tell us your tales in the comments section below!