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.