Tuesday, November 17, 2009

Totally Unnatural

My friend and fellow nurse, Elise, asked me to come into one of the patient rooms with her to help prepare her patient's eyes for cornea donation (actually, the word used is "harvesting" but that just seems too grotesque and industrial).

"She died from thyroid cancer with mets," Elise explained as we entered the dimly lit room. The family had said their goodbyes and gone home. Unthinkingly, my hand flitted to my own thyroid. Although her body was already cold, the woman didn't really look dead. I kept waiting for her chest to rise. It didn't.

I asked what the woman's name was, and Elise told me. Even though we knew somewhere deep down that she couldn't hear us, we still explained what we were about to do. Holding her eyelids open gently, I watched as Elise instilled saline in the woman's already cloudy eyes, and then I taped the eyelids closed. I fought the temptation to wipe what looked like salty tears from her cheeks.

"Should we put another blanket on her?" Elise asked.
"No. She's gone," I said.

We left her with her knitted hat on her head, her hands folded. Chest unmoving.

Death is not natural.

Thursday, August 6, 2009

Surprise

During my last shift, I checked in an ambulance that brought in an 87-year old man. Chief complaint: decreased LOC. His eyes were almost gunked shut, his skin and mucous membranes were dry, and he answered questions with barely understandable words. His body was weak and limp.

I did the usual nursing things....started an IV, drew blood, got blood cultures, took a rectal temp, got vital signs and an EKG, and ordered the typical gamut of stuff. I left the room to chart and check on my other patients.

A little bit later, after the patient returned from x-ray and CT, I looked over to the room and saw, below the curtain, two feet encased in navy blue socks, standing by the bed. Racing to the room, I threw the curtain aside to find my 87-year old man, IV yanked out, blood dripping down his arm, oxygen tubing off, all EKG leads off, gown off, standing completely naked except for the aforementioned socks, peeing on the floor.

He had removed all the wires and tubes that beset him, and climbed over the rails of the bed. Apparently his level of consciousness was not so low after all.

Tuesday, June 2, 2009

Good Question

The other day, a patient asked me, "Do you have any pets?" Immediately, I pictured Spike and his cute little mustached face and hilarious personality. I replied, "Yes, a little Cairn Terrier. How about you?"

She told me about her three Italian Greyhounds, and showed me pictures on her phone.

It struck me suddenly that this is a fabulous question to ask people. It's not invasive, it won't make the childless people hurt, and there may be some fascinating stories behind the answers.

Usually, patients and other strangers ask me if I have children. I say, "No, not yet" and leave it at that, quickly getting back into my therapeutic nursing communication mode to get the focus off me and back onto the patient. But I always feel the ache of having to say "No, not yet" over and over again. It just felt so good to be able to say, "Yes!" to the pet question.

Tuesday, March 24, 2009

Quite Possibly, the World's Largest Vagina

Yesterday, I got report on my rooms, including Room 5. Room 5 was a female, in her late 40's, and weighed somewhere between 250 - 300 lbs. She had come to the ER because her chronic back pain had gotten too intense to handle at home. She was unable to lie on a bed because of her severe pain and had been sleeping sitting up in a chair at home for a few weeks. When offered pain medication, the pt. declined. She also complained of abdominal pain and diarrhea, but since she couldn't lie flat, we weren't able to do a CT scan or MRI or pelvic ultrasound.

We tested her stool and it was positive for blood. She gave a urine sample, and there was also blood in her urine. I told the doctor about these results, and he said that "we" needed to get a sterile urine sample by catheter. "We" in these situations means ME.

About every 10 minutes, the patient had to go into the bathroom to have bloody diarrhea. Her sheer girth made it impossible for her to clean herself thoroughly. She couldn't lie down on the hospital gurney. All these details equaled me wanting to quit my job on the spot.

Usually, a catheter is easily inserted with a patient lying supine on the bed. ER nursing is all about ingenuity. So I had the pt. stand on the floor, leaning over with her hands resting on the gurney, legs spread apart, with one leg hiked up on a chair.... underwear off.... gown pulled up around her shoulders. It was me, on my knees, face to face with The Vagina. I attempted to spread the labia with one hand, used betadine to clean the area, and then with my sterile hand, to insert the catheter tube. My head was basically in her crotch. Trying to find the urethral opening was like searching for a particular crevice in the Grand Canyon. After fruitless poking and prodding, I gave up, threw away my soiled supplies, and got back to my feet. The pt. went to the toilet again.

Totally frustrated and irritated and grossed out, I found the nurse who had given me report earlier that morning to elicit her help. I described the problem. She agreed to assist. It was definitely a two-nurse job.

I told my fellow nurse that I would hold the folds of flesh apart so that she could find the hole and insert the tube to get the urine sample. We steeled ourselves outside the pt. room. Before we went in, I whispered, "If she shits on my head while I'm under there, I'm going home for the day."

The pt. again assumed the position, and we got on our knees beneath The Vagina. Using both hands, I pulled the skin apart to expose the perineal area. It went on and on, seemingly forever. The other nurse looked at me, we both stifled gags and giggles, and we proceeded. My arms were aching already from the strength required to hold her flesh apart, and my knees burned from kneeling on the floor. My friend cleaned the extensive area, and then inserted the tube into what looked like the appropriate opening. The pt. shrieked in discomfort, and we realized she had tried to penetrate too high. I motioned for her to try lower, and then, at the moment I felt I could not maintain my position for a second longer, urine flowed out of the tube. We were in! We left the room with urine cup in hand, and the other nurse looked at me, shook her head, and said, "That must be the world's largest vagina."

A true story of survival and success. I'd like to take this opportunity to thank God for giving me a mouth to breathe through instead of just my nose. I'd also like to thank my fellow nurse for being willing to go in with me, where I'm sure few have gone before. Now, if only I could forget the images burned into my mind.
 
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