July 3rd, 2012

crossed heart

Retronurse 1 — You’ll Burn in Hell & a digression on bedsores

Originally published at Cassie Alexander. You can comment here or there.

Alternately titled: You don’t have to go home but you can’t die here.

She’s this Russian lady, and she’s missing fingers on one hand, and she’s got a “history”. She bruised a nurse yesterday. She does not want to be moved. And she doesn’t want pain pills. She just wants to lie in one position, get bedsores, and die.

So we rock her over, and she’s cursing at me something fierce in Russian, and in English, she says, “You’ll burn in hell for this!” and I’m all, “Um, okay. Sorry about that.” It was surreal, she looked like those ladies in Clash of the Titans that shared a tooth.

– excerpt from my nursing school journal

This was the first time I was yelled at by a patient that I can remember. Unfortunately, not the last. The most recent time was yesterday. Same for the time a patient most recently tried to hit me. Although to their credit, they apologized afterwards.

In a lot of ways, a hospital is like a bar perpetually nearing closing time. People don’t realize that when they come here, that we’re going to make them get better, even if that’s the last thing they want to do. Even if they’re not cognizant of why we’re doing it, even if they wince, even if they scream. (Screaming is the worst. This’ll be a common thread in upcoming posts, as will the nature and allowance of patient refusal.)

You don’t have to go home but you can’t die here.

I didn’t get this at the time, with this lady. But oh man do I now. If you’re here we’re hardly ever just going to let you die. Even if you sort of want to. (Although, how much you can actually want to die is debatable, depending on the situation, your mental health status, your ability to make decisions for yourself, your family members willingness to accept your decisions, etc etc etc.)

So let us discuss something easier for this first post. Bedsores.

Any time a patient comes in from the outside world we check over their skin integrity so hard. And we take pictures and we notify doctors and we keep good charting.

Bedsores happen when the weight and pressure of people’s bodies create limited blood flow to a particular area of flesh. That area dies and can become necrotic. They’re more likely over bone. I’ve seen bedsores on people’s coccyx, shoulder blades, heels, scalp. Anywhere there’s unrelieved pressure can become a bedsore. They can be really hard to heal up too, because of the nature of where they’re at — those places don’t have a lot of blood flow already, and usually whatever caused the sores (lying sedentary in bed for months on end) doesn’t always go away.

We get dinged by the state board for anything that happens while a patient is with us, you see, and rightly so — if a patient does develop bedsores on your watch you’re not doing that great a job.

See how I don’t flat out say an awful job though?

Because…*shakes magic eight ball*…sometimes things are hazy.

Sometimes people come in from tragic living situations, homelessness, elder abuse, just wasting away for whatever reason — alcoholism is a big one. They’re one accidentally scraping sheet change away from a skin tear no matter how hard you try. They’re so old their skin is like rice paper, or they’re so starved for nutrients there’s just nothing there — and that skin is resting straight over bone, especially on their coccyx. And then they’re laying on their backs all the time at their sad nursing home because they can’t walk around — because they haven’t walked for years.

My own grandmother who is back in Texas with end-stage Alzheimers hasn’t been able to walk in almost a decade. She’s (somehow, sort of, if it can be called that) surviving on one can of ensure a day, in hospice. I know that she has bedsores, even though she’s in an airbed, and they put her in this air-blanket thing any time they move her to a chair. Sometimes, no matter how good your intentions are as staff, if your patient is starving and nearly immobile, almost nothing can be done.

And even with decent care — back in nursing school I once saw a man who’d had a stroke on his toilet at his assisted living facility. While he lived, he was trapped sitting down on a toilet seat over night. He had a ring of bedsores in the shape of a toilet seat on his ass. It was completely tragic.

So anyhow. Hello and welcome, and there’ll be more of these for as long as I enjoy writing them.