So, Saturday, in the afternoon, I admitted maybe the dirtiest person I have ever seen in my life.
"We're sending you a dirty old man," the OR nurse informed me. I had no idea.
He was filthy. He'd rolled his tractor and broken his c-spine. They'd fixed it with a posterior fusion. So he'd been laying in a field for awhile before they brought him in, but this was more than that. This was personal filth that had accumulated for decades. Mildred, our Zimbabwean nurse tech (who is the most beautiful dresser in the hospital--her mother sends her cloth from Africa, which she has made into scrubs) and I spent 45 minutes scrubbing him. Our washcloths turned black. We dislodged ancients chunks of toejam the size of caramels from between his toes, practically peeled sheets of filth and dead skin from his stomach and groin. Then we discovered the burns on his knees and feet--burns upon burns, some partially healed, some brand new.
We finally got him clean. It was the most emotionally exhausting bath I've ever given. I couldn't believe a person could be in this condition, a human being. I've never seen anything this bad. Mildred and I kept holding up trophies of detritus to marvel at, silently, we didn't want to hurt his feelings if he could hear us. We washed him and washed him, occasionally each stopping to gag. Finally he was clean. We'd used every washcloth in the room and had gone through two bottles of foam cleanser (to give you an idea--usually a bottle of this lasts for 2 weeks of daily baths).
He recovered. The next day I found him extubated, sitting up in bed and alert and oriented. He had a funny round shiny (now) face, and kind of looked like a possum. Sean, the night nurse, said, "I don't think he likes women."
"Really? What makes you say that?"
"He threatened to shoot Ashley (our night nurse tech)--but he seemed to like me all right." Sean goes on to brag about the success he's had with this patient. Sean's a little insufferable. He applied to be weekend night core, was the only applicant for the position and seemed a shoe-in. But all his colleagues went to our manager and complained. Sean polices other nurses, goes behind their backs, and loves to write ST's (safety threats). I've learned to document any conversation I have with Sean in which he points out something I forgot, etc--any small issue. I put it in writing and copy it to everybody. He generally leaves me alone. Sean also almost never bathes his patients. Lazy. Leaves it for the day.
"Did you find out anything about the burns?"
"No, I didn't. Maybe you can!"
"Good morning," I say, walking in the room. "You look like you're feeling better."
"Too many city people around here." He says. "Running around. Those computers. Those don't do you no good."
"Too true." I agree. I go on to assess him and care for him through the day. We get along pretty well. He's a little cranky and cantankerous, but nothing too unusual. I wonder how he got so dirty? And where his family is? Don't they care about him? We get to the burns in a few hours as I'm slathering bacitracin on them. "Do you know these are burns?" I ask him.
"They're from the stove." He tells me.
"Really?" The word 'really' can get more information out of people than sexual favors.
"I come in, I'm cold, I sit too close to the stove. Can't feel my legs any more so I don't know when I'm burning."
"No heat?"
"Shut it off. No money."
I nod.
"Can't go upstairs any more. Living in the basement."
"Are you taking your insulin?" I ask. His initial blood sugar was 400.
"That's just a bunch of shit they want your money for." He says. "You thought I was dirty."
"That's true."
"You gave me that bath yesterday? You the one? Where's the little black girl?'
"You had a bath after surgery, yes."
"You're not going to give me another one."
"Okay."
"It causes arthritis."
"Baths?"
"Yes. You don't know that?"
"I didn't know."
He's cantankerous but compliant. He holds out his hand for me to take a blood sugar, and let's me change his dressings and get him up to a chair. I've had a lot of patients like him--cranky old farmers, stubborn, set in their ways, but who melt when they're being cared for, grumbling all the way. This is what I've decided about him. Then, at 5pm, as I'm charting his iv fluids, he says,
"If my pecker worked, I'd take you down to the creek and rape you."
I'm not sure I've heard correctly. "Excuse me?"
"I said," he says, more loudly, "if my pecker worked, I'd rape you."
"Rape me?"
"You heard me. Little bitch like you."
"You can't talk to me like that. That's completely inappropriate and offensive."
"It's true." He stares at me, pale blue eyes in his thick possum face malevolent. "You don't have anything to worry about,though. I can't get it up any more. 10 years ago--that's another story."
I leave the room, find Wiz. Wiz has a way with our really nasty patients. He has a way of getting them in line. I tell him what happened. Wiz is clerking. Night shift forgot to staff us with a clerk, so in addition to charging, he's clerking--an impossible job for the clerks, much less someone who's charging as well.
"Is he A&O?" Wiz asks.
"Mostly. Sometimes forgets the year."
"Pain?"
"5-7--sleeps frequently, though. Fentanyl drip."
Wiz shrugs.
I get pissed. "This is not a delirious guy, Wiczoski, and you need to go in there and put the fear of god into him.
Wiz doesn't say anything for a second. Then he gets up. "Okay. Let's go." I follow him down the hall to the room. Wiz has lost a lot of weight. His faded scrubs look baggy and you can see the grey line of his briefs above his scrub pants. But he still holds himself like Barishnikov. I'm suddenly struck by a pang of affection for him. He's having a terrible day. I didn't mean to give him one more thing to do. But I can't go back in there, suddenly, unless this guy sees I have someone behind me.
Wiz goes in. We stand at either side of the bed.
"So she told you, huh? I wish I was in the country. You can say things like that in the country. City girls can't take jokes."
Wiz nods. "She told me. And you are in the city. Now listen, you can't speak to her like that. You hurt her feelings,and she has given you good care. She's a person, too, and you need to respect her. Now apologize."
That's it? I think. Wiz looks at me, sees something in my face, or doesn't see something in my face and looks away. No eye contact.
"Okay, I apologize."
"Apology accepted." What else can I say? But something happens right then and there, and I'm not sure what it was, which is why I'm writing about it ad nauseum. We walk out of the room. But I can't look at Wiz, and I can't look at any of the men there. I don't know what I want.
"I know that was difficult, "Wiz says, as I busy myself going through my CMAR.
I find myself almost speechless. I just sort of sputter. I can't find words. Wiz sort of awkwardly gives me a squeeze but the last thing I want at that point is for anyone to touch me. I feel like I'm going to vomit. I can't even look at him. I try to go back to work, but I find myself crying. Wiz is back at the desk carefully not looking at me. I go into the dark, empty conference room, and start sobbing silently. I can't stop. It seems like everything I thought I'd gotten past has just gotten unearthed by that patient's threat. Every time I ever felt helpless or physically menaced or hurt or sexually exploited--and I guess the worst thing is that just in that little flicker of a gaze by the bedside, I feel that I somehow told Wiz about it, and now it's part of my life--my new life. The one I've put together so carefully--all the debasement and grime and sludge of my old self--and I just could hardly stand it. I never wanted anyone to know or guess those things about me. I am so unprepared for this reaction. I don't know what's happening. I almost never have reactions that are beyond me. But this is like being at my first autopsy. I can't get my emotions back in the box. I didn't even know they were this strong.
I hear someone coming. Of all people, it's Jolene. The one I've told you about--painted like a Geisha, babbling, slow, crazy Jolene. Drives me crazy. She comes into the conference room. She's delivering girl scout cookies. She flicks on the light, "Oh, my! Haley! Heavens!" She says in her Texas way. And then, for once, she does exactly the right thing. She turns off the light and kneels beside me and folds me in her big fleshy arms until I stop crying.
That's more than a 1/2 hour.