It's Hard to Hide When You Just Don't Care

“She’s always like this,” the chubby woman shrugged her shoulders and looked away. She finally arrived to see her mother, though the old woman had arrived several hours ago.  I looked at her, hair perfectly arranged in a curly mullet, nails recently manicured, fingers clinking with shiny bands and jewels, and a smart little designer bag on her shoulder.  You would never guess they were related, Mrs. Stuck-inthe70’s and her mother, frail Mrs. Stuck, the poor thing delirious from the fever, thrashing her weak limbs as best she could, wearing nothing but a crumpled hospital gown and an adult diaper. She moaned and soiled herself. Her daughter raised an eyebrow and primly stepped out behind the curtain. She didn’t want to be there when the smell hit. 

We cleaned Mrs. Stuck the best we could, holding her hot little body still as we wiped her and changed all her linens.  When I made the list of belongings, I checked her body for anything I might list.  The hospital gown and diaper were not worth listing.  I checked her left hand- I take it as a sign of someone being well cared-for if she still has a wedding band on, if nothing else.  Nothing.  Although it might be taken off for safe-keeping, I like to think that in whatever state of mind, if a person looks down at that band on their hand that had been there for so long, they might still feel something.  I felt sad writing “no belongings with patient.” 

I also notice the general condition of the areas around the eyes, lips, nose and teeth.  The smell of a person, the presence of wounds, areas that are crusted over, dry, inflamed, otherwise abnormal tell me about the level of hygiene at any given institution.  At least Mrs. Stuck was in a good nursing home- she seemed otherwise clean. Mrs. Stuck-inthe70's must be paying a lot for wherever her mother must be living, in money, not necessarily emotional support.

Mrs. Stuck-inthe70’s poked her head in again, to say that she had to go, fingers clutching at her rhinestone-studded iPhone.  She left the room once more and as the scent of her faded, so did my annoyance.

Maybe it’s not that she doesn’t care- maybe she just gave up a long time ago.  Maybe it’s healthier this way for her, to be able to let go, though I think it’s totally disrespectful to “let go” before Mrs. Stuck was actually gone. In a time not far from now, I could imagine her crying crocodile tears at her mother’s funeral.  Too little, too late. 

S

Trauma Clouds

There is a common superstition about working in trauma. Certain people have "black clouds" and elicit groans from all staff working that day when they find out they have to work with you.  Having a black cloud over your head means that the bloodiest, blackest, most heart-wrenching traumas will more likely roll through the door when you are present than not.  You could be a doctor, a nurse, a tech- anybody. People will whisper and shake their heads; you are cursed.

I have the opposite problem, for better or worse.  When I work in trauma, I hardly get any. I average maybe 2 light ones per shift, whether 12 hour or 8 hour.  Several times, after a shift totally devoid of traumas, I hear overhead "full trauma now, full trauma now" as I am walking out the door on my way home.  They like to tell me that I've cursed myself by saying it, but I've been saying it for months. It's just the luck of some people, I guess. Nurses clutch at me for protection when I leave, maybe trying to stand under my "white cloud" for a little while.

I had 2 traumas yesterday, both crush injuries occurring between man and machine. One man got his fingers sucked in by a commercial dryer. Several of his fingers were slashed open and nails were shorn off, but he luckily avoided any nerve and bone damage.  The other was more serious, where a man crawled under heavy machinery to flip a switch when it fell on him, pinning him, shattering his pelvis, and rupturing his bladder. Not good.

Take care out there, gentle readers. Don't do anything silly when working with machinery or equipment or work without having your wits about you; the machine has its own intentions for which it is made and it takes  only a few seconds to change your life forever.

S

Improbable Imposter

Ms. Federica Garcia Lorca was a lovely little lady, slight of build, clear skin, shiny hair, big eyes.  She had abdominal pain and I was the one to situate her and show her to her room.  Exceedingly polite and rather charming, she claimed to speak very little English and so I spoke with what Spanish I knew and we got along swimmingly.  She seemed to understand me quite well in English or Spanish, though the nurse that went in later said she really needed an interpreter because she didn't understand a word.

Through the hours I checked up on Ms. Garcia Lorca, fetched her pillows, blankets, glasses of water, vital signs, EKG's, etc, I realized she knew more English than she let on.  Sometimes speaking slowly helped, other times it didn't. Words I used before were suddenly incomprehensible now. Something was a little strange.

A friend came to visit her and 5 hours into her stay, the woman in Ms. Federica Garcia Lorca's room was named Juana Ramona Jimenez.  I thought we had a new patient, but I peeked in, and there she was, feeling "much better." It was so strange, because I make it a point to address patients by name- now I didn't know what to call her.

An astute registrar, Spanish-speaking, was in the room when her friend was talking and realized that her friend called her something different.  She changed the registration name, so there were two names under the same medical record number in our computer system.

Ms. Garcia Lorca/Ramona Jimenez was discharged with one name and received prescriptions with the other due to a computing glitch.   I have had had patients who gave me false names before, but I would never have guessed that the sweet little lady was playing games with the system.  She just seemed too... clean-cut.  I learn something new every day about people and how little I actually know about them.

S

The Doctor I Will Never Be

Mrs. Unlucky had terrible abdominal pain, but test results were delayed for a long time because she had a prolapsed urethra and we couldn't get any urine on her. The catheter wouldn't pass through the nodule of protruding tissue.  http://en.wikipedia.org/wiki/Prolapse

The lack of urine sample was the least of our problems, though. Throughout the day, I took her vital signs, which were normal, every two hours.  Suddenly, in her sixth hour, her temperature shot up to 102.5F.  Her test results confirmed that she had a perforated colon, a dangerous and emergency condition where the bacteria were entering her abdominal cavity and causing a raging infection. All this confused her, as Mrs. Unlucky was a blue-collar worker with very little formal education. All she knew was that she was in pain and she was terrified.  Unfortunately, her problem was one that could only be helped by surgery, and I needed to do a pre-operation EKG, since she was going to go under full anesthesia.  The surgeon came in while I was setting up and stared at me in a patronizing manner. Perhaps he thought I was moving too slowly.  As I placed a sticker on her chest and whispered to her that the EKG wouldn't take long, he stood up straight over me and said nastily, "you need to stop what you're doing." I looked up in surprise. "Why does she need an EKG?" He quizzed me. Because she is going to be admitted for surgery, I wanted to say, but in this instance, I felt uncomfortable answering him.  It was beyond my "scope" to say so as a technician to a surgeon, in any event, and people have been fired for far less than saying things they don't have the authority to say. So instead, I replied simply,
"I was asked to do one."
"You'll need to do it later, then, because this is important," with an ever so slight emphasis on "this." He stared at me and waited for me to leave the room, and I did so without another word, feeling my blood pressure heighten and my face flush.

I had been part of a very nice team of nurses and doctors taking care of Mrs. Unlucky for many hours and now she was subject this surgeon's very different- abrupt and impersonal- care.   After he left, I found her crying, bewildered. The doctor had given her the choice of having a colostomy or an ileostomy, a bag that is connected to the intestines for waste removal, while the surgery site heals.  She didn't want either and didn't really know the difference, but she was pressed to make a decision, since he had to go get set up for her surgery immediately. I understood that he wanted to move quickly, but she was completely overwhelmed by how quickly the transaction came to pass.

May I never be too busy or haughty to intimidate patients or staff. That sort of manner doesn't at all come off as powerful or efficient. Rather, it just makes a person look like a total jerk.

S

Adventures in Sitting: The Strength of the Strongest Bond

"S, we need you pull you out of your current assignment to sit in urgent care." I gave the nurse a strange look. People that require sitting- alcohol abuse/substance abuse/psychiatric problems- aren't supposed to go there.  "I know," she said, "it's a special situation. They'll explain when you get there."

It was a beautiful late summer day and the afternoon sun was still dappling through the trees that were rustling gently in the sweet breeze.  I reluctantly entered the glass doors of the clinic to see that in room one was a woman, feeding a baby, speaking tensely with our manager.  The manager pulled me aside and explained: Mr. and Mrs. Feckless came today because he needed stitches removed from his hand.  They came to urgent care but it became glaringly obvious that both of them had had alcohol, both breathalyzing above .300.  DCF was called and we are waiting for them to arrive- Mrs. Feckless knows this.  "Where is Mr. Feckless?" I asked. "In the drunk tank," the manager said, "just stay in the room with her to watch her with the baby."

I entered the room and introduced myself.  Mrs. Feckless saw me and said, "I don't need to be babysat with. This is my baby, I would never hurt her." I diverted the conversational path by simply asking, "so how old is she?" She scanned my face and decided there was no intention of harm. With the indulgence of a proud mother, she smiled and said "7 weeks tomorrow." I admired the little one, who could not? The minute fingers, perfectly arranged little eyebrow hairs and eyelashes, a bow around her head, little stubby legs, the fresh smell of new life.  She is going to be such an exotic beauty, with olive skin and dark blue eyes.  This skein of conversation let Mama Bear put her guard down, and she told me about caring for Baby Feckless, bathing her, feeding her, rocking her to sleep.  Meanwhile, the baby was cradled in her arms and didn't make a peep, her gentle eyes at peace with her surroundings.

She was so gentle with the baby, knowing exactly what to do with every hiccup, burp, squeak, or kick of a little leg.  They knew each other better than anyone else.  The baby rested comfortably in complete trust, nestled on the mother's chest; it was the epitome of Madonna and Child, transcending time, space, culture and it was beautiful to see.  They gazed at each other with an unspeakable bond that was almost visible, shimmering in the air.

Mrs. Feckless looked younger than she was, but the lines on her face told me she didn't have the easiest life.
"She is the best thing I have. The only thing I have," Mrs. Feckless sighed, "I used to live in a half-way house. Then I met my husband. Everything changed. Everything bad that happens to me happens because of him!"
I paused, "... is he good to you?"
"Oh, he's the best. He's my best friend and we understand each other. We love each other so much.  It's just that he can be so stupid sometimes. Never shuts his mouth and now look, DCF is coming again."
"Again? You mean this isn't the first time?" I was incredulous.
"No, hah, it's ridiculous. The day she was born, I was alone. He was drinking and being an ******* on the streets. Then he realized he was gonna be a father and started calling my cellphone nonstop, screaming at me and the nurse telling me to hold it while he comes in the room. I mean how can you hold it? I was having a baby! The nurse told him never to call again and not to come in, but he burst in and caused a scene cause he was drunk, you know.  They called DCF that day.  But he's good to me, he really is."
On the day the baby was born. Unbelievable.

She was comfortable with me and made easy conversation, cradling the baby close.  The baby had dozed off and slept comfortably, positioned next to her mother's neck.  Maybe she never had anyone to talk about this with or maybe I was just a receptive listener, but she relished in the details of describing exactly how the baby would smile only at her, and how to decipher the squeaks that the baby used to communicate with her, and how gentle, quiet, perfect this baby was compared to her now teenage son, who was a nightmare baby.

"You don't have any children, do you?"
"Oh, no," I laughed, "that's... far in the future."
"It's a good thing. I was your age when I had my first. I was barely a baby myself and I had to grow up real fast.  If I had any advice for you, since you're nice and sweet, it would be this: travel, go to school, have fun, and never settle."
"Oh, I'll never settle, don't worry about that one."
She smiled at me and DCF walked in.

"Can you step out?" asked the severe woman wearing severe high heels.
"Of course," I said, feeling a chill and they shut the door behind me.
The tech that brought DCF over pulled me aside. "When those drunk fools came stumbling in, you know what he said to me? He looked me in the eye and said *****, get these ******* sutures out of my hand now. And I was like uh, hold on, sir. I told them he was drunk and was like you need to call DCF. You know what, they deserve this for being idiots. That baby is not safe with them."
I listened in silence. Maybe... but could anyone else take better care of someone else' baby when the mother is already attentive? Mrs. Reckless didn't seem very drunk at all- in fact, I would consider her to be more competent than many mothers with very young children I've seen in the ER so far.

The door cracked open and I heard, "I need to call my supervisor, so just hold on."
"Please don't take my baby from me, please, I'd die without her, please."
"I said I would call my supervisor. Please wait a minute."  The she-wolf in heels nodded at me and I went inside.

"I told him not to drink, but then he got ME drunk, and I never drink. You can ask any of them and now look!" Mrs. Feckless started crying and I got her a box of tissues, "He ***** up so many times. I do it once and now I'm being punished for it. It's not fair! I've done everything I was supposed to do- I sat here quietly, I waited, I didn't make a scene... but I'm still being punished."
She cradled the sleeping baby in her arms and kissed her several times. "Never, never... They're all liars. I don't believe a word they say.  She wants to put my baby with a foster family and says I'll get her back, but I don't trust her. I don't trust none of them. I just want to go home with my baby!"

I heard the clinic door open and watched 3 county officers walk in.  DCF came back in and I exited the room and grilled the officers.  Mr. Feckless had been arrested and Mrs. Feckless was papered. She may well be arrested as well. That would get her fired from her hard-won job at a supply depot.  I couldn't help but feel a cold horror, like I was taking part in something terrible and wrong, like a hapless grad student working in the monkey room under Harry Harlow.  http://en.wikipedia.org/wiki/Harry_Harlow

DCF came out once more and asked another tech to go inside and "distract her" with the paperwork. Mrs. Feckless was helpless and laughed bitterly, "I know what you're doing. You're taking my baby away."
"No, we're just making sure she's healthy," DCF said as she slowly wheeled the stroller out of the room.
"But what about all her clothes and things?"
"Well, do you have a bassinet at home? If you give us your keys, we'll take what she needs for her stay."
"But how am I going to get in and out of my house?" Mrs. Feckless looked so worn.
"We'll figure that out."
"Where is my husband? Did he get arrested? I'm have to leave him... this is too much, I can't take this. I'm losing my baby..."
"You won't lose her forever if you go to the session tomorrow as it says on this paper, since it is your first offense. If you do everything like we say, you'll get her back soon." The DCF woman said.
"How soon? Tomorrow after the class?"
"It depends."
It was too cruel.

Quickly, matter-of-factly, efficiently, it was all done and she was asked to leave.  I gave her a hug and told her to take care as she was escorted out, silent and broken, by the officers into the gorgeous afternoon. I watched her look longingly as they walked right past the van where DCF was tying in the still-sleeping baby.

S

Contracture Conjecture

Imagine waking up in the morning and having a stitch or something in your neck. Try as you might, you can't move yourself just right to get rid of it. In fact, you can barely move, maybe your arms will flutter stupidly as you try to grasp the railing on the side of your bed, but they won't work, stupid things.  The nurse will come in to see that you've wakened and give you your morning medications. You try to say something to her, but all that comes out is stuttery nonsense. You take a deep breath and try again.  "I...I...I'm m m m huun huh huhhn...g gr gry." "Ok, honey," she will say off-handedly and arranges the bedding, "We have to do a bunch of things. We will have to shift you first."

You can't move because your legs are twisted up so tight from contracture that they are half-crossed up to your chest and you can't even pee.  It's like being curled up tight in fetal position- forever.

http://en.wikipedia.org/wiki/Contracture
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/dupuytrens_contracture_slideshow/PRinc_rm_photo_of_dupuytrens_contracture.jpg (Imagine this, but with your hip flexion...)

They had to drill a hole in your suprapubic area and insert a catheter directly into your bladder.  The contortion isn't painful, per se, but staying in one position will make the bones from your spine and pelvis bore into your skin.  Sometimes, this might cause sores. Depending on the stage, the sore can vary from just a red and tender patch of skin to terrifyingly open, ulcerous, boring caverns.  Luckily, you have people who love you and take care of you 24/7.  It's impossible to even imagine what you would do without them.

Today, however, your catheter seems to have been pulled or something- and urine is leaking out of the hole.  It's time for another trip to the Emergency Room, where so many nice nurses, doctors, and techs know you by name.  Luckily, it's not serious today- you've been here for this before and you don't even feel pain.  The inexperienced nurses will have no idea what to do with you, and will baby-talk and condescend, but the urology resident will greet you warmly.  He does a great job and that technician that held your hand earlier and had trouble prying your legs open for the procedure, she was nice too. She was really worried that she was hurting you, but it was fine, nothing you haven't experienced before.

That technician came in a lot of times to take vital signs. She chatted with you like you were anybody else and didn't use the sickly sweet voice.  You were glad she was the one to take you back downstairs to get taken home by the ambulance, and she was nice enough that you decided to take a chance and ask.

Ms. Bedbound: I-I-I-I w-was - w-w-won-d-dering g- - -if--you c-c-could---do--- a f-f- f -favor -for m me.
S: Of course, what can I do for you?
Ms. Bedbound:  D-d-d-don't-t-t g-g-get ma-ma-ma-d.
I couldn't even fathom where that came from. I felt so sick that she would think I would get mad.
Ms. Bedbound: C-c-c-could... -I -I -I- c-c-could-d- - -have- - a sn-sn-n n-ack-k?
S: Do you like graham crackers?
Ms. Bedbound smiled widely and nodded: C-cr-c-r-crack-kers-s w-would -b b-be n-n-nnice.
S: Do you want peanut butter?
Her eyes widened and she shook her head no. Her hands fluttered and hit the railing several times before she got a grasp on the two little packages I gave her.
Ms. Bedbound: Th-th-th-th-thank you!
S: No problem. Are we all set to go?
Yes, but Ms. Bedbound was agitated and was trying hard to say something I couldn't understand. I paused to look at her and she took several deep breaths to try again.
Ms. Bedbound: I-I-I-I-I'm...s-so hap-p-p-py!

I felt a chill.  Maybe it was because my heart was warmed, but there was more than that.  I couldn't imagine what her life was like, to be utterly dependent on other for every detail of her life.  Of all the things that could go wrong, she had almost all of them, as a young girl about my age.  Immobile, infertile, incontinent, totally dependent. Yet, she could say she was happy and mean it. She looked in my eyes and there was something so childlike in her glee- she let me know that at that moment, she was truly happy.  The catheter tube problem was fixed, she was leaving the hospital, and she had graham crackers clutched tightly in her hand.

My problems are not problems compared to hers. Meeting her made me want to stretch out in the sun and bask in thanks for the life I have.

S

Humor in the Time of Overcrowding

"Do you have time for a short story?" Mr. Professor asked as I was pulling my nurse-on-a-stick vital signs machine out the door. I stopped, "sure."

"So on Good Morning America this morning, this is a true story, mind you, there was a guy who got his foot stuck in some machinery and had the strength of will to cut off all five of his toes. When he called the ambulance, his friend said to him, why did you call the ambulance? Why didn't you call the tow-truck?"

I laughed at him for being silly, but he insisted, it was a true story- how great it is to have a sense of humor like that in such a time. It's true- it's a sign of the just how deep the friendship was and how smart the guy had been to do what he could to make his friend feel slightly better about the situation. Mr. Professor quickly became my favorite patient of the day. A local college lecturer, he had been in the middle of a class when the room suddenly felt very warm. After a dizzy spell, he came in to visit us and we observed him for changes in troponin-levels- something that signifies damage to heart-muscle.

Every time I came in, he would greet me warmly and I would open up and talk to him, tell him stories of what I had seen, including when I had a full half-hour's worth of one-sided conversation with a man who was completely deaf. He was surrounded by loving family who carefully and tenderly cared for him. A man with a great sense of humor and presence, who really made my night.

S