I have known Michelle from my training days; she is a pretty blonde with a ready smile, a quick wit and a habit of over-dramatising things. Off she went with catheter in hand and the faithful rubber gloves. She came back from Mr Groom’s room 15 minutes later.
‘Can you lend a hand?’ she asked me, a blush touching her cheeks. ‘I’m having a bit of trouble.’
Trouble? There shouldn’t be any trouble; he’d already had a catheter so there shouldn’t be any obstruction.
‘Sure, but what sort of trouble are you having?’ I replied.
‘I can’t find it,’ she told me.
‘Find what exactly? The right equipment or the right size catheter?’
Michelle’s face went red.
‘No . . . I can’t find his penis.’
With this statement, Michelle began to giggle. I walked back with her to Mr Groom’s room to see if I could sort things out.
‘What’s the matter, doc?’ Mr Groom asked me as I walked in the room.
Mr Groom couldn’t see what was going on because he was lying almost flat and his stomach was in the way.
I didn’t know what to say. I couldn’t tell him that Michelle was unable to find his penis.
‘Nothing’s wrong,’ I lied. ‘Michelle just needs an extra pair of hands.’
I quickly put on some gloves and got down to business.
The penis wasn’t there – there was absolutely no sign of it. Mr Groom was so overweight his penis seemed to have been sucked up into his belly. There wasn’t even any sign of a scrotum. I glanced at Michelle who was redder than a beetroot and refusing to make eye contact with either me or the patient.
‘Can you try pushing a bit over here?’ I instructed Michelle, as we tried to coerce the thing out, by pushing on his bladder while I dug my fingers into the crevice where his penis should be.
‘Hold this bit for me,’ I instructed Michelle, as she used one hand to hold back his stomach.
No matter how hard we tried we couldn’t find the penis.
‘What’s the problem, doc?’ Mr Groom asked me again.
He didn’t sound worried, just curious. It’s just as well he couldn’t see past the roundness of his belly because he couldn’t see either my or Michelle’s face. Michelle looked like she was having a spasm – her shoulders were shaking from trying to repress a dose of the giggles. I felt like slapping her, not just because it was so inappropriate, but because it was infectious. Nothing in my training had prepared me for this. But I was not going to let Michelle contaminate me.
I had to answer Mr Groom, but my mind struggled to come up with an answer that would not take away any last remaining shreds of dignity that we had not already stripped. I finally settled on a reply.
‘How do you usually pee?’ I asked as casually as I could.
‘I just feel around for it a bit,’ Mr Groom said, ‘but I can’t find it lying down, and when I need to pee, I can’t stand up quickly enough.’
It all sounded very reasonable but his answer made me think.
‘When you say you feel around for it, does that mean that you don’t actually see your penis?’
There, I’ve just humiliated the man completely, but it might make our job easier if I know what we’re up against.
‘Haven’t seen it in a few years,’ he admitted, then fell silent.
Not wanting to admit defeat I went in again, while Michelle pushed down on his bladder with one hand while holding up his stomach with the other.
The conversation and situation were too much for Michelle and she began to cough, a cough which sounded suspiciously like a chuckle to me. She raced from the room, saying she had to go to the bathroom urgently. I told Mr Groom I was going to get the doctor and walked into the office to find Michelle red faced and worried. ‘Do you think he noticed?’ Michelle asked me. I could see Michelle was feeling guilty for not being able to keep away the giggles, so I reassured her she’d done the right thing by leaving the room, and that I was sure he hadn’t noticed.
Eventually, we called the doctor and between the three of us we managed to find his penis and insert the catheter. The doctor was subdued and to his credit looked guilty while Michelle and I were just relieved we could keep a straight face.
Mr Groom was eventually discharged home; he weighed 30 kilograms less and felt like a new man.
‘You’ve done good for me, doc, and don’t be too hard on yourself, it was pretty fucking funny.’
One of the challenges of nursing is that you are constantly encountering new things. As a young nurse in my first year of work,
everything
was new. But there is one particular first experience that I will never forget.
Mr Smith was 82 years old. If he could have had it his way, he’d still have been living independently in his three-bedroom house with his quarter acre of land. His children and grandchildren, however, had convinced him that the best and safest option was for him to move into a small apartment that was part of a rest home – a nice balance between independence and supervision. But, after forgetting to turn off his stove several times in two weeks, Mr Smith’s meals were now cooked for him, and after a fall getting out of the shower, he had an aide who helped him with his bathing. Still, other than that, Mr Smith looked after himself, which is pretty independent for an 82-year-old man.
Mr Smith was brought into the ward at eight o’clock on a Sunday evening. His chest was heaving as he strained to pull air into his lungs; you could hear him wheezing, coughing and spluttering from outside his room. Mr Smith had been a bit off-colour for nearly a week. What had started out as a mild cough had gradually stained his handkerchief with white, then yellow, then green and now red speckled sputum. The infection had crept insidiously into his lungs, spreading lower and lower like a cancer. The nurses from the rest home had advised him to come to hospital earlier, but like many men in his position, he was stubborn and refused to move. By the time he agreed to go to hospital, he didn’t really have a choice: it was go to hospital, or die.
I liked Mr Smith instantly.
‘I’m only being a burden; just put me out of my misery,’ he said between gasps.
He even managed a brief smile. It says a lot about a person’s character when they can joke at a time like this.
I told him to stop talking rubbish; that once the medicines kicked in he would be feeling much better.
Forty-eight hours of intravenous antibiotics later, and Mr Smith was rapidly improving. He could speak whole sentences without getting out of breath. He was not coughing up so much sputum. He even managed to get himself up out of bed and into the reclining chair.
Watching your patient get better, knowing that you are one of the people responsible for making the difference, is one of the greatest feelings in the world. Though, while I’d love to be the one to take the credit for his progress, it’s always a team effort. It wasn’t only a matter of antibiotics fighting an infection: nurses cleaned, dressed, toileted, exercised and talked to the patient; the physiotherapist came in twice a day to exercise his chest; the laboratory and X-ray people visited daily to draw his blood and irradiate him.
Between us all, I was sure we would get Mr Smith back home.
It was Wednesday, Mr Smith’s fourth night in hospital, and he and I were discussing the merits of a commode versus a regular toilet.
Like most patients, Mr Smith had never liked using the commode, but up until now he had been too sick to risk taking too far from the bed. ‘I won’t sit on that disgusting thing again. There are other people in here and it is embarrassing.’
He had a point: there’s no way to completely hide the smells and sounds that go with taking a dump in a shared room.
‘I’m not using it and that is final.’ Mr Smith was adamant, and began to get out of bed. ‘You could try making yourself useful by handing me my walking stick.’
I had a vision of Mr Smith collapsing in the middle of the corridor: ‘Please, wait a moment and I’ll grab you a wheelchair.’
To make things easier, I used a portable shower chair, so that once I had him seated I could just roll it straight over the toilet and he wouldn’t have to move one bit. As I wheeled him down the corridor I noticed he was still wheezing, not nearly as badly as he had been on admission, but I still set him up with some portable oxygen to help things out.
Naturally, I wasn’t keen to leave Mr Smith alone, so I waited discreetly outside the partially open bathroom door, calling out every 30 seconds, ‘Are you okay in there?’
To which he responded, ‘Can’t a man take a crap in peace?’
But on my fourth call, Mr Smith was silent, and then I heard a thump. My heart leapt into my throat as I rushed in.
Mr Smith was still sitting in the chair, but he had slumped against the wall with his eyes staring sightlessly ahead. His nose and lips were a bluish purple, and darkening before my eyes.
This was it: my first arrest.
I’d actually felt a little envious of fellow student nurses who had been involved in an arrest during their training. I’d also heard experienced nurses casually talking over lunch break, ‘Oh yeah, Mr Brown, he was in VF and we shocked him a number of times; we got lucky – he pulled through.’
But this wasn’t exciting like I’d imagined. I couldn’t ever envisage casually discussing this over a sandwich. This was a nice old man whom I liked and who seemed to like me. A man who had been getting better.
An arrest can refer to arrested breathing, or an arrested heart. In Mr Smith’s case, he definitely wasn’t breathing, and if his heart hadn’t already stopped, it would very soon.
I called out for help, shouting down the corridor, and kept my finger on the call bell, until the doctor and another nurse came running.
The bathroom is not the easiest place to begin CPR and neither is a shower chair.
‘Grab his shoulders and don’t let him fall,’ Dr Jackson instructed as we wheeled him back to his room.
Between the three of us we literally threw him on to his bed and the doctor barked at me to push the arrest alarm.
The alarm was in the corridor. I walked past it dozens of times each day – in fact, I’d often wondered if I would ever get to push it – but suddenly it had disappeared. It should have been right in front of me, but the wall seemed so damned big at that moment.
It could have only been about ten seconds before I found it, but each of those seconds was one more in which the life was draining out of my patient. I jammed my finger on the button – which, of course, had been in front of me the whole time – and raced back into the room.
The doctor yelled at me to begin compressions. Holy shit, compressions. I jumped on Mr Smith’s chest and began pumping up and down at a furious rate, while the other nurse used an Ambubag to pump air into his lungs. The doctor was trying to get some intravenous access, because Mr Smith’s old line wasn’t working – what a horrendous time for a line to pack up. I hoped they wouldn’t blame me for that; he was my patient after all. I could see the swelling around the old IV site where the doctor had tried to inject some medicine.
‘Not so hard,’ the other nurse said to me, as I felt a sickening crunch as a rib or two cracked under my hands.
Within a minute, the arrest team arrived and the professionals took over. They asked me to stand back while they did their work, and in my hurry to get out of their way I knocked over the drinks bottle that was sitting on the bedside. It’s a strange thing to remember at a time like this, but it was a glass bottle full of black-currant concentrate, and when it hit the floor it splattered bright red everywhere, like fresh arterial blood.
As the arrest team got underway, I was amazed at how calm, quiet and confident they all were whereas I was shaking from all the adrenaline pumping through me. I watched as they hooked Mr Smith up to a monitor and wondered if they were going to shock him with the defibrillator, but it was too late for that. He had no electrical activity left in his heart.
In a lot of TV shows, someone yells ‘Stand clear’, and they shock the patient with some paddles, but Mr Smith didn’t need this. In fact, most TV shows get it wrong. Those shocks don’t start the heart, they actually stop the heart. When a heart arrests, the electrical activity which once made the heart beat doesn’t stop immediately: it goes haywire, shooting in all directions. It makes the heart a quivering jelly, shaking with all that uncontrolled current. When we shock someone, we’re trying to briefly stop this craziness, in the hope that the patient’s own heart will start again in a healthy rhythm. Another way to think of it is a lifeguard who swims out to rescue a drowning swimmer, but the swimmer is so panicked, the rescuer can’t do his job, so the rescuer slaps them really hard, to shock them into calming down.
Sadly, Mr Smith died that night and it was not a nice way to die; he was sitting on the toilet for goodness’ sake. The nurse with me during the arrest was Rose. She was in her early fifties, and had been a nurse all her life. She could see how shaken I was and took me aside for a quiet word.
‘There’s nothing you could have done,’ Rose said to me, ‘it’s quite common for people to die on the toilet.’
Registering my surprise Rose told me that it’s not unusual for people to want to empty their bowels before having a heart attack. She then explained that the effort to try to pass a bowel motion was often the trigger that set it off. She even said she’d lost a few in the toilet over the years.
But, instead of feeling better, I began to feel guilty. I shouldn’t have let him go. I knew he should have stayed in his room and used the commode.
‘It’s not your fault,’ Rose repeated, then let out a brief chuckle. ‘There’s no use feeling guilty. When it’s your time, there’s nothing we can do.’
Rose’s words helped a bit but there was still a sense of guilt. I was determined never to let any of my elderly patients use the toilet again; they could wait for the next shift to come on.
Rose offered to help me prepare Mr Smith for his family, who would arrive shortly. This was another new experience for me.
As we began to wash Mr Smith, Rose did something unexpected. Every time she did something to Mr Smith’s body, she would use his name and explain what she was doing, just as you would with a living patient. She was gentle, and spoke softly. You could tell she still cared.