Wednesday, December 11, 2013

Of Bowels and Happy Nurses

So nurses, what can make a nurse happier than a constipated patient who finally moves his bowels? Pretty much nothing, I guess. (Be forewarned, the following story is full of sh*t.)

While caring for one of my home care patients this week, I was quite aware that he had not moved his bowels in about six days. This is nothing new, so it's an ongoing struggle for fecal regularity, and since my shifts with him are eight hours long, I have time to make a plan and execute it.

Elderly and chronically dehydrated, with poor fluid intake and no exercise, he's basically a bowel obstruction waiting to happen.


Taking the above factors into consideration, I came into work, did my assessment, gave him a shave, clipped his nails, and then administered a Fleets enema just before his shower, leaving him on the toilet for as long as he would tolerate. After almost fifteen minutes, there were almost no results, just a few sad little turds.

Double sigh. 

With my patient complaining of the cold (despite a blasting propane heater), I transferred him into the shower, and lo and behold, not five minutes into the bathing process, the expected (dark brown) effluent was summarily released into the shower stall with a series of onomatopoeiac plops.

"I think I shit my pants," he said with a glum expression.

"Don't worry, _________," I replied. "You're not even wearing pants! You're golden!" I smiled, held my breath, and soldiered on.

I kept up my bright affect to prevent any further shame and embarrassment on ______'s  part, speedily scooping up his fecal deposits with my gloved hand, depositing them in the nearby toilet as I whistled a happy tune. (Why I didn't place the little bucket under the shower chair until after the first major fecal release, I'll never know.)

Following our little tete-a-tete, my squeaky clean charge was happily snug in his bed, the heater on high and Western movies on the TV.

"Thank you so much for everything," he said with a smile, his immense gratitude overcoming his usual dementia-enhanced monosyllabic communication. 

Sitting on the couch, I found myself having that glowing sense of accomplishment that a nurse sometimes experiences when things have simply gone right (yes, Dorothy, even with a feces-splattered shower stall). With six days of constipation now behind us (no pun intended), I was feeling smug that my basic intervention had met with significant (albeit relatively messy) success.

When a patient is clean, resting, well-hydrated and thoroughly intestinally cleansed, the self-satisfied nurse can sit back, content that he has done his job, valiantly saving his client from imminent colonic rupture and a protracted hospitalization (replete with mediocre food, faceless medical interns and a screaming, demented roommate).

As a nurse, a pile of excrement on the floor of the shower stall is par for the course, and the end result (pun intended) of a happily evacuated patient cozily ensconced in bed can bestow a rosy glow to most any shift.

Needless to say, I was able to return home with a triumphant feeling of an enema well done, and my days' scrubs were summarily placed in my handy outdoor scrubs repository, intelligently separated from the household laundry.

As this job (my only direct patient care position) comes to a close next week, I'm thrilled to be moving on to greener pastures, but will also somehow miss the satisfaction of such hands-on care.

Still, as the singer Michelle Shocked once said, "The secret to a long life is knowing when it's time to go", and this statement could just as easily be applied to bowel movements as it could to one's nursing career.

No comments: