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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.
I think my most stressful day at clinical in the nursing home was near the end of my rotation. We FINALLY had a resident who needed a catheter changed. She had an indwelling foley catheter and was bedridden. A very nice lady who was more than willing to have students learn at her expense. Our instructor had us huddle together and asked who wanted to change the catheter. Nobody volunteered. Honestly, this was primarily because we were told that if we did a skill improperly, we would possibly fail. So, the obvious choice was just to never perform skills for as long as no one caught on, and then just learn them once we graduated, when we weren’t getting a grade for it. Okay, so this is a rather stupid idea, but it did run through our heads. I mean, wouldn’t it make sense to provide a more conducive environment for learning, rather than one that was motivated only by fear of failing. We were frequently so afraid that we just went blank many times, simply from fear.
There was a lot of opportunity for practice on a dummy in the nursing skills lab. All of your catheter supplies came in this nice kit so it was easy for you to maintain sterile technique and get it all down pat. But let me tell you, it is NOTHING like putting it in a real person. First of all, women are FAR harder to insert a catheter in than a man is. (That is, unless the man has an enlarged prostate and then you continue to meet resistance and the catheter coils within him. Ouch!) So, this one poor girl, we’ll call Hope, was selected. The instructor stated that she’d be back in 15 minutes and asked Hope to review her skills and collect her supplies and they would meet in the room. Hope began frantically reviewing the procedure and then went to the supply room. Poor thing, I was just as overwhelmed as she was. Okay, so you look for “catheter kit”, right? At least that’s what they had in our skills lab. Well, this nursing home was being rather cost effective and decided it was much cheaper to not only use a different company that sold catheter supplies, but to also buy each piece separately. You had to also remember exactly what all was in that so easy and wonderful catheter kit that they didn’t have there. So, you choose what size French catheter you want. You mean there’s a difference? Uhm, maybe the size in the middle? Okay, a 14 french sounds good. (No idea what the difference is between it and the others except it looks a little bigger.) Now, you get to (without wasting) decide how many times you’re going to screw up, so you’ll want to get that many catheters. Now you have to pick out a bag. Do you want a regular foley bag, a leg bag, or a bag with a urometer? Uh, not sure she looked beforehand, so we’ll go with a regular foley bag. Okay, we need sterile gloves, and a few pair in case you mess up. Okay, choose a size. I have no idea what size I wear, and Hope didn’t either, because the kit comes with a one size fits all. Again, she just picked one of the middle range sizes—Hope looked like she had average hands, anyway. Were we forgetting anything? Yes!! We needed some sort of cleanser to clean the lady with before inserting the catheter. They didn’t have those super nice prepackaged betadine swabs like we were used to. We only saw this bottle of betadine that was big enough to put in fifty catheters. Were we allowed to take that into the room? Well, it was all we could find; so we took it. But what were we gonna clean her with? This stumped us. There were none of those gigantic cotton swabs like we’d previously used. Maybe some sterile gauze? Grabbed it and took off.
We met the instructor in the room. She stands there waiting for poor Hope to begin. The lady resident was so sweet and let our entire group of seven students watch as Hope began to shake just opening the packages. She opened them out of order (not being used to doing it this way), the catheter size was incorrect, and the gloves were too small. We were not allowed to take the betadine container into the room because it was now considered “contaminated” and we had to waste it all after using it. Apparently, we were supposed to get a sterile urine specimen container and pour it into that and that could be brought into the room. We forgot a chucks pad to put under her bottom so as not to stain her bed and mattress. What a nightmare!!
Okay, so after correcting all of this, Hope began. One student held a flashlight shining on the woman’s private parts as seven students and one instructor all watched. Uh, where’s the hole? We were all looking at the instructor and Hope wondering what in the hell you do when you can’t find the hole! She had a bladder and uterus that had dropped which severely complicated things. Uh, well, finally she found a hole, so she inserted it. No urine flowed back into the tube. Okay, so was her bladder simply empty, or had she stuck it into the wrong hole? We learned that she had stuck it into her vagina instead. She left it in the wrong hole and began to search for the correct one. So, we remembered this trick where you ask the patient to “bear down” like there gonna pee (praying they don’t pee in your face). When they do, the urethra “winks” at you, and for a brief moment you see it open. Well, it worked!!! We saw it, and poor Hope made a second attempt. She kept pushing it up into her and she struck gold!! Urine, that is. The entire group applauded. It was kind of comical. The poor lady resident was trying to give Hope all kind of tips, but none of them were remotely applicable. But the resident felt she had just given the group the greatest experience of our lives. She was so proud she helped.
That was one heck of an hour on one of our last days. I can still see this scene in my head. 
