In my medical career, there have been a handful of patients that I remember well. Like frames on a storyboard, when I think back upon the tens of thousands of patients I have treated, these patients always seem to come to mind.
Perhaps as a precursor of things to come, I even wrote stories about some of them early in my career when I saw them.
I remember the first time that I drew blood on an elderly patient and how it seemed like her room was a prison cell. I’m sure she passed away a long time ago, but I can still remember looking into her eyes and wondering what this poor woman had been through in her life.
I remember one of the first surgeries that I was asked to scrub in on during my Ob/Gyn rotation. They called it a “TOP”. I was excited to be a part of it. Then I learned that “TOP” stood for “Termination of Pregnancy.” I remember feeling uneasy as the resident showed me how to use the currette. I remember almost passing out when I looked through the speculum and saw a tiny white hand laying across the red surface of the patient’s cervix.
I remember almost vomiting as a resident as a nurse told me that an intoxicated patient with dizziness just needed to “sleep it off” … right before he vomited a liter of blood all over her and over the curtain a couple of feet behind her.
And of course there was the lollipop lady. I wrote a post about her already.
Recently another patient was added to the storyboard of my medical career. I’m not sure if there was anything so memorable about her, but perhaps it was her blase demeanor in the face of a rather messy problem. Well … you can decide.
The patient was in her mid- to late-60s, was well spoken, pleasant, and well-kempt. She had changed into a gown and her clothes lay neatly folded on the chair across the room. Her problem was a regulation of her bowels. First, she had diarrhea for a couple of days. She took some Imodium and Pepto Bismol and the diarrhea stopped. But then she had no bowel movement for two days. That was to be expected since after diarrhea stops it often takes the body a day or two to create more stool. The patient became concerned after having no bowel movement on the second day and she took a laxative, thinking that she may have a bowel obstruction. Then she had black colored diarrhea.
Her stool was hemoccult negative, meaning the black color was likely from the bismuth in the Pepto Bismol. Bismuth combines with small amounts of sulfur in your GI tract and can turn your tongue and your stool black.
Examining her closer showed that there was dried black crust all of the way down the inside of both her legs.
She had passed enough diarrhea that her buttocks had become inflamed and it hurt when she sat down, so she preferred to lay on her side. She got a liter of fluid, we got a CBC, chemistries, and a stool sample just to make sure there wasn’t an infectious etiology for her symptoms and that she didn’t have a metabolic acidosis. Everything was normal.
Then the strangeness began.
I went back into the room to see how the patient was feeling. I could hear the lid on the infectious waste container slamming shut as I entered the room. Then I got hit head-on by a foul smell. I pulled the curtain aside. The nurse had donned a gown, gloves, and a mask. Several soiled washcloths were on a chuck pad on the floor. The patient was laying on her stomach on the bed. The lower half of her body was undressed and the gown had fallen off to the sides, exposing her bottom and her bare legs. She was resting her chin on one palm while turning the pages of an open magazine with her other hand. She was kicking her lower legs back and forth in a scissors motion.
All of a sudden there was a large fart sound and a bunch of black liquid came squirting out of the patient’s rectum. The patient stopped kicking her legs for a moment, then when the liquid stopped flowing, she began kicking her legs again as she laid there reading her magazine.
The nurse shook her head in frustration and let out a muffled “Really?”
“Ma’am, this is the fourth time I’ve had to clean you up in the past 20 minutes. Do you think you could use the toilet instead of just laying there on the bed when you move your bowels?
The patient didn’t answer. She just laid there kicking her legs back and forth and reading as the nurse dutifully began wiping her bottom for the fourth time.
I left the room and went into the office to discharge the patient. I asked one of the other nurses to get the patient a pair of diapers and some paper scrub bottoms for her trip home. I told her what happened and she yelled “Why doesn’t she give the patient some toilet paper so she can wipe her OWN ass?”
I thought about that statement for a minute.
By laying on the bed, it was as if the patient expected the nurse to wipe her bottom for her. With “patient experience” and “patient satisfaction” trumping employee satisfaction these days, I could only imagine what would happen if the patient complained because someone didn’t wipe her bottom.
Then the patient argued about being discharged.
“How can I go home if I keep having diarrhea?”
“What would you like me to put as the medical necessity of having to keep you in the hospital?”
“Well what if I have more diarrhea?”
“You can always come back. For now, I suggest you stop the Milk of Magnesia and drink lots of fluids.”
“I’d be happy to keep you in the hospital, but you’d need to sign this Advance Beneficiary Notice agreeing that you’ll pay out of your pocket for the entire hospitalization if Medicare decides that the admission wasn’t medically necessary.”
“Ummmm … no, that’s OK. I think I’ll be OK to go home.”
After the patient was discharged, a poor housekeeper had to spend 30 minutes of her time disinfecting the bed and the room from the stool-soaked sheets and gown.
Thinking back about the patient, I just couldn’t help wondering where else in society there would be an expectation that one able-bodied adult would wipe the soiled bottom of another able-bodied adult.
And people wonder why there is so much burn out in emergency medicine.
Caring for patients, consoling families, saving lives, and … wiping bottoms? Emergency nurses deserve a lot more credit than many people give to them.
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr.WhiteCoat.com, please e-mail me.
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