Part 1: Who is Mr Groom?
Feeling part of a team was what made nursing truly enjoyable for me. I no longer dreaded going to work each day. I didn’t have that nauseous feeling in my stomach whenever I had to approach a senior member of staff. The biggest improvement was in the confidence I felt about looking after more challenging types of patients, which was fortunate because I was about to encounter one of my biggest challenges yet.
‘Are you okay having Mr Groom again?’ asked Carol, the nurse in charge.
What could I say? No, I’m worn out, he’s too heavy, too much work?
I had been looking after Mr Groom for what felt like forever and was hoping for a bit of a break, but whenever it came time to allocate his nurse there was always a silence in the office.
My adventures with Mr Groom had begun four days ago. I had just returned from my days off. The problem with coming back from time off is that you are at the bottom of the priority list when it comes to picking and choosing patients. To be fair, everyone is generally pretty reasonable when allocating patients, everyone takes their share of the demanding ones, but every now and then there comes along one patient whom no one really wants to be responsible for.
The first time I had met Mr Groom, I couldn’t believe my eyes; before me lay a sweating, rippling, heaving mass of flesh, covered almost head to toe in traditional Maori tattoos. He was one of the most obese men that I have ever had to look after. He must have been at least 180 kilograms.
Carol tried to be encouraging. ‘He needs someone strong and you’ve done so much for him; you’re good for him.’
I didn’t see exactly how I was good for him. We were too different. I come from an average white family, from an average white part of town. Mr Groom is an ex-member of Black Power, a gang with offices throughout New Zealand. Not a group to cross – even an ex-member – they eat boys like me for lunch.
‘Good morning, how are you?’ I asked Mr Groom.
At the sound of my voice he rolled over towards me, the bed springs protesting beneath him, and greeted me with a huge, gap-toothed grin.
‘Morning,’ he replied, then, after pausing to catch his breath, ‘Could be better, bro.’
Poor Mr Groom, he was only 35 years old, but he looked ten years older and had all the problems you would expect in someone twice his age. I could tell just from looking at his swollen legs, that it wasn’t all fat – there was fluid in them, a sure sign of a failing heart. Just to prove myself right, I poked my index finger into his ankle and left an indentation that faded away very slowly. Mr Groom’s joints also looked swollen and I wondered how much longer they would put up with being abused, before giving out completely.
Mr Groom had never been in hospital before, but he’d developed a bad case of pneumonia. In most 35-year-old men, a case of pneumonia would probably not need hospitalisation, but because of his weight he needed to be with us, especially now, because it looked like his condition was deteriorating.
With someone as big as Mr Groom, it’s never really just a simple case of pneumonia. He already had a diagnosis of heart failure. His joints always ached, and it was an effort to walk, even when well.
Mr Groom was drenched in a cold sweat, his hands were shaking, and as I clasped his wrist, I could feel his pulse racing. His eyes had a glazed look about them, as if he was in a world of his own. But it was his laboured breathing that caused me most concern.
‘How long has your breathing been this bad?’ I asked him.
Surely he hadn’t been struggling for breath all night?
I knew the night staff would have done something.
‘It just got bad in the last hour’ – he paused to get his breath – ‘started about six this morning’ – pause – ‘came on really quick.’
He smiled again at me.
‘Why didn’t you call the nurse sooner?’
A rather pointless question, it wasn’t going to help, but I just had to know.
‘They had a busy night’ – pause – ‘didn’t want to bother them.’
Not the answer I was expecting.
There was no time to waste; I grabbed Carol who took one look at Mr Groom and immediately came to the same conclusion as I did. We went into the corridor to discuss our plan of action.
‘We need to get Dr Grey down here right away,’ Carol said.
‘Are you sure?’ I replied. ‘Why don’t we get the registrar instead?’
Dr Grey was the new junior doctor and had only qualified in the last few months. It’s an unfortunate truth that some junior doctors don’t listen to the nursing staff, and it looked like Dr Grey was turning into one of them. Just the other day we’d pointed out to him that one of his patients normally took his blood pressure medications in the evening before bed, because the patient said if he took them in the morning, he fainted. Dr Grey had disagreed and prescribed them for the morning, and sure enough the patient collapsed because of low blood pressure. The nurses were there to catch him. They also suggested perhaps reducing his dose, but this never happened either.
Carol thought over my suggestion for a moment or two.
‘You may be right, but we’ve got to give Dr Grey a chance.’
Fortunately, today Dr Grey surprised us all. He too took one look at our patient and did the wisest thing I had seen him do in three months. He called his registrar. Registrars usually have a minimum of four or five years of experience, and can usually be relied upon when complications arise.
The registrar took Mr Groom’s pulse. It was weak, but pumping along at 110 beats per minute. His breathing was rapid and shallow; he also had a high fever. Mr Groom had developed a sepsis – meaning the infection had got into his bloodstream – and a sudden worsening of his heart failure on top of his pneumonia.
With these added complications, Mr Groom was in a very serious condition. The doctors contemplated transferring him to the intensive care unit, but due to a shortage of beds he stayed with us. He was so weak that he was unable to stand, or even sit himself up in bed; the most he could do was roll from side to side.
‘It’s pretty bad, isn’t it?’ Mr Groom asked me.
It was. He could potentially die, but all he did was smile at me. It seemed I was more worried than he was.
‘Don’t worry,’ he said, ‘I know you’ll be able to fix me up.’
Was he trying to put me at ease, by putting on a brave front? If I were in his position I would be terrified. But his cool calm didn’t seem to be an act. Did he, by some chance, have that much faith in us, a complete belief that the doctors and nurses will be able to do just that? I wish I had that much faith in myself.
Let the battle commence.
Part 2: Mission impossible
To give his medicines, Mr Groom had a tube stuck into the side of his neck and threaded towards the heart, because all the veins in his arms kept on collapsing.
He also had a tube put up his penis to accurately measure the fluids passing through his kidneys – especially important since his blood tests had shown that his kidneys were struggling. It was quite the balancing act, because too much fluid and his heart would struggle even more, while too little and his kidneys might deteriorate further.
Mr Groom had the girls from the physiotherapy department visiting twice a day, pounding on his chest, trying to help move the build-up of mucus in his lungs.
He had multiple blood tests alongside multiple antibiotics.
But for all the poking, prodding and discomfort that Mr Groom endured, he only had one small wish.
‘I tell ya something, doc’ – he’d developed the habit of calling me doc because I was male – ‘get me in the shower and I will feel a new man. I can’t take another bed sponge, mate.’
Imagine spending 24 hours in bed; I guarantee by the end of it you will be desperate for a shower. Mr Groom spent a total of 170 hours in bed.
The job of washing Mr Groom was a team event, with nearly all the staff involved. It took five people in total: three to roll him, one person to hold the bed still, because the brakes were not strong enough, and a fifth nurse to actually do the washing. But for all the sponge baths and changing of bed linen, I could never clean him as well as I wanted, or he wanted. It was understandable that Mr Groom’s greatest wish was to have a shower, but he wasn’t ready for a shower yet, he just wasn’t well enough.
Thankfully, life slowly crept back into Mr Groom and it looked like we were going to win the fight. As his breathing settled down, his legs began to shrink, and he started asking when he would be able to get out of bed and joking about feeling like a beached whale. I laughed along with him, though it didn’t feel quite right, because it was the response he was hoping for.
‘Not long now, maybe tomorrow,’ I always replied – never giving him an exact answer, but we were certainly beginning to make progress. I watched as Mr Groom went from bed to bedside, from there to reclining chair, from that to standing with a frame, then unassisted. It was at this stage that I decided he was well enough to have a shower.
‘Um, I think it’s a bit small,’ said Mr Groom, looking down at the chair.
He was right, too. Even if we could have fitted him in the shower chair, I doubt it would have held his weight. I should have thought of this, and felt a touch stupid. I tried a normal wheelchair, but this was too small as well. I eventually managed to get hold of a chair used by the porters, which was half-again the size of an average wheelchair. These chairs are so big because they’re used to take patients between various departments around the hospital, and the extra space is often used for things like oxygen bottles, notes and IV poles.
‘Oh, that’s pure fucking heaven,’ were Mr Groom’s first words as I turned the shower head on to him.
The water streaming off him was a dirty looking grey colour from the build-up of the sweat and dirt that I had never been able to completely get rid of.
‘Harder. It won’t hurt,’ he told me as I scrubbed his back. ‘I want it red and raw . . . Oh fuck that’s good. I don’t want another fucking bed sponge again, no offence intended, doc.’
I wasn’t offended, just pleased to see him happy. Mr Groom seemed to like having me around and I was discovering that I also enjoyed working with him, even though he was heavy work. I didn’t see before me an intimidating ex-gang member, but a man in need of our help, a man who tried not to be a burden, a man now fighting for his life.
Any preconceptions I had had about Mr Groom had by now been turned on their head.
‘Here, let me stand up and you can give my bum a good rub.’
He grabbed hold of the rail while I prepared to pull the chair away.
‘On the count of three,’ I said. ‘Ready? One, two, three, heave.’
Something unexpected happened.
‘Let’s try again . . . and heave.’
I couldn’t remove the chair.
He turned his head towards me; his face had an almost apologetic look.
‘Guess I need to lose a few pounds.’
‘What do you think?’ I asked the nurses assembled in Mr Groom’s room. ‘All suggestions are welcome.’
I was greeted with silence and shrugged shoulders. Obviously, no one else had had this problem before, and as no one was coming up with a clever solution, I took the lead and tried the direct approach.
I positioned two nurses so they were holding Mr Groom’s arms; another nurse and I held the chair steady, and the last nurse grabbed hold of the bed.
On the count of three everyone began heaving – biceps flexed; thighs braced.
‘It’s not going to work,’ Carol grunted, as she pulled.
‘It has to work,’ I said through gritted teeth. ‘Pull harder.’
Suddenly the chair released its victim and Mr Groom was catapulted on to his bed. The poor nurse whose job it had been to brace the bed was squashed as the bed crashed against the wall. The towels that were being used to cover Mr Groom’s nakedness landed on the floor, and there was a moment of shocked silence as everyone stared at the bare, quivering backside of Mr Groom as he lay straddled across the bed. I grabbed a towel off the floor and tried to cover him.
He began making a strange sound, his whole body convulsing. What had we done?
But I soon recognised the noise, and realised the convulsing wasn’t a seizure, it was laughter. And not just a polite laugh to try to hide embarrassment, but a true, full-bodied, incapacitating, belly laugh; the contagious type.
Part 3: Missing parts
Mr Groom’s sense of humour saved us all from feeling like absolute crap. In my short time as a nurse, I felt that nothing could top it.
Enter Dr Grey.
Dr Grey decided that as Mr Groom was getting better, it was time to have his urinary catheter removed.
‘Surely not yet, doc, he’s only just managed to stand on his own. Shouldn’t we leave it at least another couple of days?’ I asked.
‘Absolutely not, it’s been in there far longer than necessary, he’s at risk of infection.’
The catheter is the plastic tube I mentioned earlier; it goes up the penis and straight into the bladder. It is an infection risk, as bugs can creep up it, but sometimes you have to weigh up the benefits against the risks. In Mr Groom’s case, the risk was of him being incontinent in bed as he might not get a urine bottle in place in time. Urine is very good at breaking down skin, and Mr Groom did not need sores around his inner thighs, buttocks or scrotum. I tried to make this case.
I wasn’t alone in thinking that it should be left in; all the nursing staff agreed. But the doctor didn’t even budge when the charge nurse stepped in, and so the catheter was taken out.
The next day Mr Groom began to have some problems.
As predicted, he was not managing with a urine bottle.
Even after the previous day’s shower, the smell coming from Mr Groom’s lower regions was getting bad again.
Michelle was the nurse assigned to Mr Groom this shift, so it was up to her to deal with Dr Grey, but I was by her side when she confronted him.
‘Can we put another catheter in?’ Michelle asked. The doctor hesitated a moment, then looked at me, almost for confirmation. I nodded my head, and Dr Grey consented.
Of course, Dr Grey was not going to replace the catheter, because that was the nurse’s job, and so that fell upon my friend Michelle.