Thursday, June 13, 2013

An Unexpected Occupational Hazard: The Nurse Gets Rattled

At the rural New Mexican home where I do home-based nursing care, the pace of work and the 360-degree view of the mesas, mountains and sky is quite different from other nursing milieus. While home care may not always seem glamorous to those in the ICU, trauma or other specialties, sometimes things happen that make me realize how interesting this specialty can truly be.

Like many people living in rural areas of New Mexico, my client lives in a tiny house at the end of a long, rutted dirt road in a dusty compound that also includes his adult son's home, which is located about 100 yards away. 

Some days, I'll hear a noise outside, and I'll open the door to see a herd of Texas Longhorn steer making their way across the mesa as they graze among the cacti and tumbleweeds.

In the spring and summer, hummingbirds dart about, jockeying for position at the feeders that I refill with sugar water every week. 

Once in a while, a "Dust Devil" or "dustnado" (land-based funnels of swirling dust and air not unlike tornadoes but smaller and different in their atmospheric origins) will hit the house, and I've felt in those moments like an erstwhile Dorothy about to be transported (along with my client and his wheelchair) to a faraway land.

And when I used to work at this particular home until nightfall, the coyotes would howl up a storm as I held vigil near my sleeping client, the oxygen concentrator making its quiet gaseous thump every few seconds like a breathing metronome marking the inexorable passage of time.

This is all a far cry from my old days of being a visiting nurse in the inner city, where I provided care for gang members and destitute elders in cockroach- and rat-infested highrises, where shadowy, anonymous youth injected heroin and smoked blunts in the greasy stairwells.

But back to yesterday's adventure before I digress further afield. 

Yesterday, while my client had his late morning nap, I went out to my truck to move it under the carport (it was supposed to reach 93). I then came back into the house, checked my client's breathing, and resumed reading a magazine. 

Thirty minutes later, I heard a loud whistle from outside. Opening the door, I saw my client's son motioning for me to be quiet and saying, "There's a big rattlesnake under the porch steps. Should I kill him?"

I walked gingerly down the ramshackle homemade wheelchair ramp on the other end of the porch, and crouched near my client's son, about 20 feet from the (apparently) dozing snake. We could easily see the rattler resting in the shade of the steps, and my companion estimated that it had eight rattles--a mature adult--with venom to match. Meanwhile, the sun beat down on us like a heavenly spotlight.

"He's sleeping, but that son-of-a-bitch could wake up and bite you any time." He walked to his truck to retrieve a gun. 

As I watched from a safe distance, he took aim with his little .22 pistol from fairly close range and appeared to hit the serpent. However, the poor creature instantly disappeared (probably under the porch) to nurse its wounds, die, or simply plan revenge on us meddlesome humans. I wondered if it would be waiting for me at change of shift, like a drug-seeking emergency room patient who was discharged without his fix. (I later learned from a neighbor that reptiles can take a long time to die, even when grievously injured. And the fact that there was no blood on the ground where he'd been shot was a cause for concern.)

Considering the fact that rattlesnake anti-venom is about $20,000 and the remote house where I work is a good twenty-minutes from the nearest hospital, I began to earnestly ponder the occupational hazards of nursing. 

This led to a related line of inquiry:
If I was bit by a rattlesnake during my shift (not altogether unlikely, as I learned today) and my client's son was not home at his nearby house (which is often the case), what would I do? 

If I were to call 911, the ambulance would take at least 15 minutes to arrive (if they didn't get lost on these dusty and confusing roads), and they would have a dickens of a time finding this tiny, unmarked house. 

Also, would it be considered patient abandonment to leave my client alone as I was carted away by the EMTs--even with rattlesnake venom coursing through my veins, damaging my internal organs as it did so without regard to my state of employment and responsibilities as a medical professional?  

If I lived to tell the tale, could I actually face the risk of disciplinary action and the loss of my license for leaving my shift without coverage? Quite a conundrum, the answers to which I'm still not privy. 
Note to self: talk to supervisor about rattlesnake bite protocol.
At any rate, my shift ended, I left the house unscathed (checking under my truck for angry rattlers before opening the door, of course), and I bounced down the dusty, rutted road on my way back to the main highway and the safety of home. 

Here's the thing: 

While ER nurses face angry drunks and exposure to gushing gunshot wounds and ICU nurses work diligently at the bedside of those hanging onto life by a thread, I care for an elderly man in a tiny house in the middle of a vast mesa with a devastatingly beautiful view and the apparent danger of a rattlesnake bite at every step. 

 Considering the day's events, I will never again accept a comment that home care isn't "real nursing" (whatever that is), and when a hospital-based nurse boasts of finding a loaded handgun on an ER gurney, I can respond with stories of rattlesnakes hiding under steps and dustnados threatening to send me and my client to kingdom come or Oz, whichever is closer. (Then again, for those nurses serving in harm's way in Iraq or Afghanistan, I gladly tip my virtual nurse's cap in deference to the danger which they face daily with the greatest aplomb and bravery.)

It takes all kinds of nurses to make the healthcare world go around, and home care in the desert Southwest can apparently be as interesting--and fraught with danger--as any other specialty under the sun. 

When I return to work next week, I'll certainly watch where I'm walking more diligently, checking under my truck before climbing inside and keeping the front door closed tight. 

And when considering the relative risk of a rattlesnake bite on shift, I now recall the gang members, drug dealers, rats and cockroaches of inner city home care with something akin to thoughtful affection.
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