Monday, May 13, 2013

Mrs. Brown

Believe it when I tell you that when your pending ambulance run patient is preceded to the ER by a waiting police officer, it isn't going to be a good thing.

And police officers, not frequently given to exaggeration, will seldom capture the full magnitude of the situation with the short form of the story. Only the pain of actual experience will bring appreciation to you like the dawning of the sun. And by then, it's too late to run away. With years of experience, I've worked it out. And sometimes, I still wish I'd tried to run.

Mrs. Brown was absolutely one of those times.

Officer Taciturn's opening line, before her arrival, was attention-getting in its own right:
"When I opened the driver's door, the funk wave drove me back, and nearly knocked me unconscious."

And no, he wasn't referring to her George Clinton CD.

Then he backed up.

"I pulled her over when she blew through a red light. She was pulling out of a drive-through fast food place. So when I got up to the car, I was totally unprepared for the experience. She didn't have a license or registration. But she'd been living in her car for, she said, three years. Apparently, without leaving the driver's seat ever in that time. I mean living in her car."

Which was apparently the cue for the paramedics to arrive, along with a light task force, all eight of them maneuvering 500 pounds of woman into the ER, and to my open room.

I couldn't tell much about her, because they'd wrapped her in two of the big vinyl/Tyvek yellow hazmat patient blankets, and a couple of them were taking hits of air off their SCBAs as they trundled her along.

I can say that the wave of miasma emanating from her gurney cleared a path from the door to my zone.

The firefighters tenderly shifted her off the backboards they'd used, and slid the entire delivery onto our bed, with touching delicacy.

Then I found out it was because they didn't want to disturb any of the...contents, of the package.

The lead paramedic, a gentleman of long acquaintance, apologized for bringing her to us, and specifically to me. "I'm really sorry guy, but here she is. Mrs. Brown, chief complaint of sitting in her car for three years, unable to walk, and sitting in, as best as we could determine, over three years of fast food wrappers and mounded feces. Her welfare checks and whathaveyou are apparently direct deposit, and she goes to the only full-service gas station for miles to fill the tank, and eats every fast food drive up on the planet, so she never has to get out of the car. We would've done a more thorough exam, but she's AOX4, and our eyes were burning out of their sockets, so we just loaded her up and came in, once we got the extra help."

"Don't feel too bad, bud," chimed in Officer Taciturn, "the guys at the Impound Yard still have to inventory the vehicle contents. They're going to die when they see inside her car."

My tech came out, the patient's arms being accessible for BP and other vital signs. He was on the verge of launching his dinner, and excused himself quickly with the muttered benediction "Good luck!"

"Hey Maverick, what was that truck-driving school on TV? Truckmaster?"

I proactively gowned up, face-shielded up, and mentally made my peace with God before entering to do a head-to-toe physical assessment. She did, in fact, have toes, somewhere, in what can only be described as pounds and pounds of her own compost.

The doc, sight unseen, ordered baseline labs and a 12-lead EKG, which I drew. Then I started marshaling my resources for the inevitable decontamination this was going to require while the EKG tech had her turn in the pit.

The charge nurse, in a fabulously understanding act of compassion, discharged one of my patients for me, and moved the others to nurses with other assignments. And our chest pain nurse for the evening was underutilized, and rather than ducking it, selflessly elected to help me on my mission. Usually you don't see that kind of bravery outside of combat.

We arranged piles of towels, washcloths, and basins, and a separate linen and trash bin apiece, and made a deal with the tech I shared: he could stay outside, as long as he brought us all the basins of warm water we requested, until we finished. He said "Deal!" so fast I almost made sure I'd heard him by asking him to repeat it. Too late, because he'd already scampered off to the utility sink with a cart and half a box of empty wash basins. Normally I never delegate "Code Browns" to techs, but I will share them. But clearly, this wasn't normally. Now there was nothing left for it but wait for the chest pain nurse to gown up with me, and head back inside.

Into the Valley of Death rode the six hundred. Or actually, the two.

What made the most sense was to start at the head and work down each side to the knees, then do the other side, and finally tackle the lower legs and feet. I'm not Catholic, but if purgatory exists, the CP nurse and I each worked off at least twenty years' apiece for what we suffered during the next hour. We washed, rinsed, soaked, scrubbed, scraped, and chiseled excrement off that lady, from places on the human body I didn't think you could get poop into, until she was as clean as human hands could make her. We piled the discards, the original sheets, her shreds of clothes, and anything else into not the laundry hamper, but the hazmat burn bags.

Then had three different custodians and the night maintenance supervisor bring all the room freshener they could get. Each one questioned us in turn before entering, then went in, then wordlessly emerged and went straight to the wallphone to ask for more backup, which is how the super ended up showing up with a case of the stuff, and additional cleaning supplies.

Over an hour later, during which time happily nothing more serious showed up (or it did, but no one, and I mean no one, was going to disturb us for something as petty as a mere Code Blue), like the man in The Rime of the Ancient Mariner we emerged, sadder but wiser. And shortly afterwards, so did Mrs. Brown, smelling the closest to roses she had in three years, complete with sores and abscesses, but no longer encrusted to the hips in her own filth.

Report to the floor was a special treat, and the ward charge nurse brought us candy after they saw what they got, versus what they expected.

And yeah, it happened during Nurse Week of that particular year, too.

Tell me again what a wonderful, easy job we have, and that fabulous pay for what we have to do.

5 comments:

  1. The CP nurse and you are angels.

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  2. So many questions....

    What was her emotional state like? Did she talk to you during the job? Aside from the obvious issues, did she have other mental illness?

    Doesn't the hospital have ozone generators or carbon filters for stinks like that? I'd imagine that boxes of air freshener would make her and/or the other patients ill, no?

    And I wonder what kind of car she had that survived years of neglect - and probably constant idling in the summer to keep the a/c on and/or the winter to keep the heat on?

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  3. Oh. My. God.

    Thank you. You don't hear that enough.

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  4. Wow. And, how sad. And, Ann Onny. . .what the writer describes must have been THE SMELLIEST THING EVER. EVER. EVER. No filter, odor neutralizer, or anything would have been able to even match it. There's JUST. NO. WAY. A couple of coffee filters placed around a room with coffee in them will help cut the smell of GI bleed or fecal management system odor leaks. But not this.

    Now, as an ICU CNA and occasional ER floater, I thought I knew stench. But, I can only imagine 3 years of it, contained in a car. I cannot believe the patient still had any intact skin.

    All I can say is. . .holy mother, that must have been something. You guys need a brown medal, or something, for that task. Wow. Just. . .wow.

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  5. Weird solution,but string up iodoform gauze. Like tinsel. Or streamers. It eats smells.
    Aerosols have been banned at our hospital because 'chemical sensitivity.' We have to make do, and smuggle in febreeze.

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