Monday, April 20, 2009

In Which I Am Reduced to Tears

They say that every nursing student encounters something that makes them question their motivation to be a nurse. Mine came today.
At first he seemed like any other patient- a little younger than some, in his mid-50s, with no acute cardiac problems, or anything critical. A few days ago he suffered a dizzy spell and collapsed on the toilet, after seeing blood in it. So he went to the ER at Spiffy Teaching Hospital. They, being reasonable people, decided that while they were transfusing him, they should probably see WHERE the blood was coming from. So they CT scanned him and found...Cancer. LOTS of cancer. Somewhere upward of 15 distinct metastases, on at least 4 organs, including BOTH lungs, the liver, one kidney, and a mass in the bowels. Some of the metastases were bigger than a fist.

So, because he had a prior cardiac history of some sort (HTN, high cholesterol, cocaine abuse) they sent him up to telemetry. Then a Gastroenterologist got involved. You see, he decided that it was important that this patient be given a colonoscopy. After all, the medical team wanted to see what KIND of cancer was in the bowel (even though, by his own admission, the patient was almost certainly inoperable, and with all the metasteses there would be no way of ridding him of ALL the tumors without a minor miracle). So they ordered a gallon of Go-Lytely.

And that is where I came in, at 7 in the morning. He didn't want to be assessed, only "left ALONE". The nurse overheard this, and my quick check of his bodily systems (lungs, bowels, neuovascular, vitals) and told me to "just come back around 10 to finish up with him after giving his meds". So I gave the meds, left the Go-Lytely in reach, and went to go keep an eye on my OTHER patient, a 90-something, delightfully confused gentleman who kept trying to sneak off the floor, because his dead wife was telling him to come home. After all, Cancer Patient was fully self-care, not even on fall precautions.

So, around 10, I came back into the room. After all, I'm a student, and I have to get my assessing done. The Worst Smell In The World greeted me. I gloved up, and lifted the blankets to find a SEA of feces, from his chest to his knees. "What HAPPENED????" I was devastated- had I left the call-bell out of reach? Was he conscious?

Oh yes. He was fully A+O. He "just hadn't WANTED to get out of bed. It had "Seemed pointless, since I'd be sitting there for so long". Why no call bell? "Didn't feel like it" Why keep telling me NOT to come in? "Didn't want people around". So, frantic, I ran and fetched the nurse to help me clean him up. It was NOT a one-person job. So we double-gloved, gowned, and masked, and went in to clean him. I was apprehensive (ok, terrified) but determined to prove I could handle this. After all, I want to work in Emergency medicine. And then the smell, coupled with the patients flat refusal to help us in any way (including refusing to turn to his side) hit me, and the sound of it, and the sight, and I started gagging as I tried to contain it all. Fortunately I made it out of the room, to an unoccupied one across the hall, where I was violently ill, and promptly started to cry.

But I couldn't leave the poor nurse alone in there with all I wiped my eyes, rinsed my mouth out at the sink, regloved, and went back in. Where it took the next half hour to get all the feces up, and off the patient, and sanitize everything afterwards.

I felt like a failure- after all, nursing school taught us that we MUST simply "get over it" and do the job at hand, that "maybe you aren't cut out for nursing if this bothers you", and that "you can NEVER show disgust, because the patient will feel worse", and "this is just part of the job". All of it implying that we have to somehow be super-nurse from the very first day of clinical.

And that, after removing gloves, masks, and gowns, and washing our hands up to the SHOULDERS, is when the nurse hugged me. "THAT," she said, "is as bad as it can get in my opinion...and you came back in. You'll do fine".

I still want to be a nurse...but maybe not on a GI floor.

Update: The patient was sent up to the GI floor, and did eventually get his colonoscopy. I have no idea what they found.


M.I.A. said...

I am really proud of you! The nurse is right; you came back. You cared more about getting the insufferable patient clean and taken care of than you own response.

Don't get too detached from everything, you need to be able to respond to things. I haven't had the pleasure of experiencing that (yet...) but I hope I can handle it the way you did!

Joy said...

I probably would've thrown up myself! I can't imagine how horrible it is to deal with a noncompliant patient and I hope I remember that next time *I* am a patient at a hospital!

Life on Pause said...

I'm glad you responded to that. I've had nurses before that seemed so...uncaring. I wasn't able to get out of the bed because I was having such bad frequent attacks, and I was embarrassed about having to use a bed pan, and instead of trying to help me be more comfortable with it, she took the pan and told me that if I was too much of a baby to use it I would have to use a diaper.

So again, I'm glad that that incident made you respond. It shows you care. And it shows your human. And I'm proud of you for going back in.


WardBunny said...

Woo you made it out the other side!
Everyone loses it sometimes. Glad you went in.