“He stuck a bottle up his butt.”

Yeah, you heard me right.  This was my first patient I had as a student in the Intensive Care clinicals.  You would have to understand how timid and shy I was back then to fully appreciate how upsetting getting this patient was. 

So, I came in that morning and got my patient.  Frequently, in the ICU patients get transferred off of the unit to another place as is what happened with the patient that I had the day before.  So, I got a new one.  We’ll call him Mr. Jones.  The nurse always gives the student nurse a full report which includes how the patient’s injury was sustained or a synopsis of their illness.  She began, “Mr. Jones was at home last night and had taken a soda bottle and put in pretty far up into his rectum.  When he could not get the bottle back out, he had to go and ask his elderly mother to take him to the emergency room.  Upon further inspection and tests, Mr. Jones had perforated (torn) his intestine and was seriously septic (infection throughout his body).  He is in critical condition and we are unsure if he is going to make it.” 

 Okay, I turned red, then white, and did not know how I was going to face this person.  A soda bottle up his butt?? I mean, I think, I’m pretty sure I knew what he was doing, but geez……HOW EMBARRASSING!  And now he may die from this?  How would you like to have people ask “What happened?  How did he die?”  I mean, the obvious out was “from an infection”.  But can you believe that he actually had to tell his mother about what he did so she could take him to the emergency room??? 

One other gross story was how a nurse friend of mine ended up in the ICU with a similar story, except he had gotten a gerbil caught up in his butt and hurt himself trying to get it back out. 

What is wrong with people??!!!!!

My most interesting patient

I am honestly having a hard time remembering my first patient in the hospital, but do remember it being the first time that I would have to try and get someone on a bedpan by myself.  In the nursing home, we teamed up a lot to work faster.  But now, we had to learn to manage our time as well.  It took me around an hour to get this poor person on the bedpan, wait for them to finish, and get them off and clean them.  And guess what?? It spilled.  So, now, after making a bed on a bedridden patient, I had to do it all over again.  It was horrible.  I kept thinking, “This is NOT what I signed up to do”.  It was not until later that I truly learned how important it was to know everything from the ground up about skills and how to care for a patient because I would certainly be training, delegating, and evaluating those who were also going to be doing these things. 

We finally got to give medications through the IV, in addition to starting IV lines.  My first patient that I started an IV on was a forty year old man who had Diabetes Type I, and numerous complications from it.  I can still see his face grimacing from such pain.  His kidneys had failed from diabetic nephropathy, his lower limbs had experienced diabetic neuropathy, renal hypertension, and he peripheral vascular disease with NUMEROUS arterial ulcerations that had become ridden with gangrene.  It was just awful.  He was a very sweet man, but looked like he had lived a very hard life. 

His current IV line was old and he needed a new one.  In addition, he had just gotten an order for surgery to amputate both legs below the knees.  I had to put in a really big IV since he was going to surgery and it was not going to be easy.  But I managed to strike oil with the first try (and I’m sure this poor patient was happy too).  I went in later to give an IV push antibiotic and ended up sticking myself with the needle (this was before hospitals had gone to primarily needleless systems.  I rushed out of the room and began to cry.  I was so upset.  Now I get embarrassed thinking about all of my ramblings about how I had waited until I was married to have sex, and now I was gonna contract Aids and hepatitis anyway from a freaking patient.  Living right did me no good at all!! I had no evidence that this patient had any diseases other than the non-communicable ones that I listed above.  But really, the guys looked like he had probably gotten around.  A lot.  It wasn’t like I had been stuck with a needle from some little 80 year old grandmother (not that they couldn’t have anything either).  But I just knew right then and there that I was going to die.

So, down to the Emergency Room we went and they drew a bunch of blood to run mine for HIV, hepatitis, etc.  Of course, my was negative.  But they were going to have to ask for the patient’s consent to test him, which he thankfully gave.  I was so worried all week that I would periodically call his hospital room just to hear his voice to see if he was alive.  Of course I’d hang up immediately.  I know that was horrible of me, but I was so scared that he had something and was going to die and I needed to know his status – at least I thought I did.  Anyway, all of his tests came back negative also.  Boy, that was a stressful time!

The following week, the same patient was there in the hospital after having his bilateral amputations of the lower legs.  I got to do an entire teaching session on “Phantom Pains” while my instructor watched and listened.  He was so excited to know that it was normal for him to still feel pain in his lower legs and feet even though they weren’t there anymore!! He understood then that part of the nerve was left, and yet severed, so it was confused.  He even smiled.

That poor man.  I came back the third week and he was somebody else’s patient, but was going to have to have both upper limbs amputated as well.  He would be only a torso.  He was clearly getting depressed.  Completely understandable.  He had a young daughter and was divorced.  I never saw him after that clinical.  I have a feeling he probably passed away soon after as he continued to deteriorate. 

I have to admit though, when asked in an interview who my most interesting patient was, he came to mind.