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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.
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.’
Beware of toilet (#ulink_c9121400-5c78-54f8-89dc-ad9e67dbd9c4)
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?’
