It wasn’t the body that surprised me.

I’d heard there had been a death on our unit; someone from the local mortuary was on his way. No, what surprised me was that the door to room 110 was wide open. I could see right in there, see the body carelessly covered with a rumpled sheet.

I was a little offended. Show some respect! I couldn’t imagine any of our nurses treating a deceased patient this way. That door should be closed! And that sheet over his face – we never pull linens over anyone’s face! We courteously tuck the person in as if they were sleeping, plump the pillow, smooth the sheets, and close the door for privacy. Leaving him like that – a sheet thoughtlessly thrown over him, in full view of the nurses’ station – was disrespectful to the patient, to his family, and to visitors.

Some people might find it very unsettling, walking past the room and seeing someone like that.

Mind you, I didn’t really know who had died. No one had said to me, “Gosh, my patient in 110 passed today,” or “When the mortuary staff arrives, direct them to 110.” I just knew someone had died, somewhere on the unit.

But I didn’t trouble myself with the details. It was obvious, wasn’t it? I mean, you see a body lying motionless under a sheet, what else could it be, except a dead person?

Nobody would sleep like that, would they?

The answer, of course, is yes.

So the mortuary guy shows up.

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My patient had liver failure.

A lot of bad things happen with liver failure; one of them is a tight swollen belly. The liver isn’t producing proteins properly so fluid seeps out of the blood vessels, filling up the abdominal cavity, making the belly drum-like, firm and distended. We call the condition ascites. 

Ascites can be very uncomfortable, making it hard to breathe, even hard to move, so we do a procedure called a paracentesis. The doctors stick a needle into the belly and siphon the pale yellow fluid out, often great quantities of it. Like: two, four, six liters at a time. Yes, the fluid just builds up again. A patient with liver failure will likely need multiple paracenteses. There’s a lot of fluid in there.

My patient had undergone a bunch of these procedures in the past week. His belly, still stubbornly swollen, was covered with bandaids from all the needle pricks.

That particular morning, I was helping my aide change his linens. I had turned him towards me and was firmly bracing him with my body so he wouldn’t roll all the way out of bed. His swollen abdomen pressed against me as the aide washed his back and placed fresh sheets on the bed.

You know when you sense that something isn’t quite right?

Maybe there’s a faint tickle, a soft sound, a fleeting shadow – something that barely registers, something that makes you take a casual glance around – and you discover something awful, something you didn’t expect? And then, due to circumstances, you can’t shriek or recoil or faint, but you have to calmly carry on with a straight face, as if nothing were amiss?

Nurses and aides know what I’m talking about. Parents, too.

As I held my patient snugly against me, I became faintly aware that my thighs felt odd. Cold, maybe, or – I don’t know, something. Different somehow.

So I glanced down.

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My patient Harriet is a 91-year-old lady with dementia, in the hospital with a urinary tract infection. She lies in bed, sleeping soundly. I creep up to her at the start of my shift.

“Hello, Harriet,” I croon softly to her.

“Hello, dear,” she responds sleepily.

“Can I check your blood pressure, Harriet?”

“Yes, honey, of course, whatever you need,” she answers sweetly.

So I gently pull down her sheets, and she clutches them tighter to herself.

I gently push up her gown’s sleeve, and she pulls away with a deepening frown, eyes scrunched shut.

I gently place the blood pressure cuff on her arm – and my sweet little patient suddenly explodes.

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I was a nursing student, doing my summer internship on a Labor and Delivery floor. Patients were generally-healthy young women who were either in labor or had given birth to generally-healthy babies.

It was a happy place, and I found myself in tears nearly every day.

“This is such a beautiful moment!” I would sob each time a baby was being born. The new mother might be panting, bearing down, possibly screaming. The father was likely hovering anxiously nearby. And there I was, the supportive little student nurse, happily gripping the groaning mother’s knee. Tears spilled freely down my cheeks, as did the words from my trembling lips: “This is so wonderful! This is the best day ever! I’m so happy for you! I’m so honored to be here!”

I got a lot of odd looks from family members that summer. Continue reading →

Jack was a big guy. He was big-boned, with a big belly and a big laugh.

He had come into the hospital with abdominal pain from badly inflamed intestines. So badly inflamed, in fact, that he’d had to have a bunch of his intestines removed. Like, half his colon. A hemi-colectomy is a big surgery. But he was going to be fine.

His wife and his brother sat at his bedside. “I don’t have a colon like you guys anymore,” he joked to them, eyes twinkling. “I have a semi-colon.”

“It’s okay to have a semi-colon, Jack,” his brother quipped back. “As long as you don’t have a period!”

That was Jack and his family. A bunch of jokesters.

Jack wasn’t laughing for long, though. He ended up with a complication, an ileus. His remaining intestines went to sleep, temporarily stopped functioning. His big belly swelled larger. We had to put a tube down his nose, into his stomach, and attach the tube to wall suction, to decompress his abdomen. And just wait helplessly for his intestines to wake back up.

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My patient had a fever. He needed Tylenol.

He was a confused little old man, bedbound. And he couldn’t swallow. He was NPO, meaning no food, no water, nothing by mouth. He would choke. Choking was not good. Even a new nurse like me knew that.

So I needed to give it rectally.

I asked the more experienced nurses: “How do you give Tylenol rectally? Just … ???” Wondering how you put a little pill up there.

“Yes!” they assured me cheerfully.  “Just give it rectally.”

I wanted to be clear. “Just put it in? Just … ??”

Their confirmation was unequivocal, unanimous. “Yes! Just stick it up there!”

Sounded easy enough. Unfortunately, the experienced nurses left out one small but vital detail: Tylenol comes as a suppository.

I was a new nurse. It would have been helpful to know that.

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I was a student nurse, and my preceptor was watching as I filled up an enema bag with warm water. “Just insert the tubing carefully into her rectum, up to this little black mark – see? – and then open the clamp,” he advised me. “The water will flow in. If she experiences any cramps, stop the flow for a minute.”

I nodded gravely. I was a serious student, learning how to administer an enema. I wanted to do things right. I went over it in my mind: Insert the tube. Stop at the black mark. Open the clamp. Pause if she cramps.

Got it.

We approached our patient, an alert and oriented, bright-eyed 82-year-old lady, slight, bird-like, cheerful. We explained what we needed to do. She nodded. No one much likes an enema, but she knew she needed one.

I lubricated the tip, then gently inserted the tubing up to the black mark. I opened the clamp. Warm water gushed and gurgled noisily into her. She didn’t report any cramps.

But perhaps I should have noticed her expression.

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I was taking care of the sweetest little lady. She had Alzheimer’s disease. She didn’t know who I was, who her daughter was, what her own name was.

But she beamed delightedly at everyone she saw. “Well hello!” she would exclaim joyously. “How very nice to meet you! How very nice of you to stop by! What a pleasure! Tea?”

She had been admitted to the hospital with constipation which had now resolved, as evidenced by the copious liquid stool that she was freely passing. She certainly hadn’t needed that stool softener I’d given her earlier that morning, I thought regretfully. Drat.

That afternoon, glancing in as I passed her door, I saw her standing uncertainly in the middle of the room. Uneasy, sensing something was amiss, I entered her room and cautiously looked around.

And I saw her hands were covered with stool.

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I was setting up a PCA (Patient Controlled Analgesia – a “pain pump”) for my new patient.

I didn’t really have time to be doing this. It was one of those busy days. Everyone was calling me. The pager in my pocket rang constantly: Pain meds! Anxiety meds! When will the doctor be here? I want to go home! Move my Kleenex box two inches to the right!

I would leave a room, and would get called right back in. I couldn’t make any forward progress.

My new patient had just had surgery, and was in pain. She called me every five minutes, telling me the pain medication wasn’t working. I was pouring morphine into her, and finally called the doctor for a PCA, so she could push a button and receive a dose of pain medication whenever she wanted.

Taking the time to set up a PCA would ultimately be better than being paged to her room every five minutes. I could get to my other patients, who were also calling constantly. And she’d have better pain control. Win-win! If I could just get it set up quickly!

Because I really didn’t have any time.

The pump already had batteries in it, located on its underside. As the pager rang in my pocket, I turned on the pump and programmed it with the settings given to me by the doctor. Hooked the tubing up to the patient. Explained that she could hit her button whenever she wanted, that the pump would prevent any overdoses. Stepped back to admire my handiwork, satisfied – Did it! Got it done! – ready to move on to the next room –

And pop went the battery door to the PCA.

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