Clinicals...... continued

The residents offered varying degrees of assistance with their showers. Many can’t assist with much and it is a matter of getting them undressed, into the shower chair and rolled into the shower. With gloves on, you start the water, which runs down a tube into a mobile shower nozzle. Testing for a comfortable temperature, you begin applying the water to the resident from shoulders and head to legs and feet. After they are wet, using a shampoo/body wash, you shampoo their hair and then begin soaping their body. Once this is done, you rinse them off. Then, from under the chair, through the hole in the chair, you provide pari-care. Once they are washed and rinsed, you provide towels to cover them as you begin patting them dry. I was usually quite wet by this point. Once they are dry, you wheel them back into the general shower area and get them dressed.

Some residents will wash certain areas themselves, which is a welcome relief. I was usually with Emily, the CNA and sometimes at least one other student. One woman, the retired RN, spent the entire shower chatting with me and telling me story after story about nursing experiences in the Shriners Hospital. While I squatted there talking to her, the other student did the majority of the shower. Her stories were great. She is really sharp.

This shower was on Tuesday. On Monday, I assisted the same woman to empty, clean and replace a colostomy bag. Her bag is attached to her small intestine which means that the stool will be in a much more liquid form. The large intestine absorbs much of the liquid back into your system. The doctors had removed her large intestine and had drawn the end of the small intestine right up through her stomach with the end sewn to her skin. The bag snaps on to a plastic ring. She didn’t want to have to pay for new bags every time one needed to be emptied so we would remove the bag full of liquid stool, empty it into the toilet, wash and dry the bag and replace it back onto her stomach. She would finally through it away when it became too stained.

The gentleman that we showered were, by in large, more feisty and angry then the women. One gentleman refused to get out of bed when we told him he needed his shower. When we reported his response to the nurse, she told us that he had already refused before and that we needed to get him up and in the shower. He was angry and somewhat combative. We got him into his wheel chair and started down the hall. He had a catheter through his stomach into his bladder. It ran through a tube, down under the chair into the bag behind the chair.

He gave us fits trying to get him to stand up against the wall bar so that we could undress him. I was on my knees, threading the catheter bag through his pants and briefs. There were three students and the CNA. I was the only male. I helped wash him and held the water. The three women were chatting it up as we worked and he kept telling them to stop yakking or to shut up. I found it to be humorous and couldn’t blame him. They were loud.

As we finished washing him, I was squatting down and washing his legs, on of the students began trying to shave him. The razor was cheap and disposable and he was not cooperating with her by flattening out his upper lip. When I finished his legs, they turned the shaving over to me. It was not the best job. I told him that were were not going to win any awards. The razor was difficult and dull. It was hard to shave the multiple days of growth, especially on his wrinkled neck. He seemed more cooperative or maybe more resigned with me and didn’t say much while I finished. He was not feeling well and kept spitting into a towel. Later that day, he threw up in the hall on the way to lunch. I was not with him at the time. Although in comparison to what I was doing at the time, I may have preferred the vomit.

We had a difficult time getting him dressed and back into his wheel chair. I dried his legs. The others dried his arms neck and torso. We then got his shirt back on and started the briefs, the pants and the socks and shoes all around his ankles and lower legs. I wheeled him back to the wall bar so that he could pull himself up to a standing position while we dried his bottom. We then pulled up the briefs and pants. He couldn’t hold himself up for long and began slumping back toward us while we were trying to pull up the pants. The CNA Emily and I used our bodies and knees to prop him up while we finished pulling up his clothes and slid the wheel chair under him. I was drenched and sweaty when I finished that shower.

For Tuesday breakfast and lunch, we were assigned to help feed the residents in the acute care unit. They were in a separate dining room in their unit. I helped a younger gentleman during breakfast. He spoke very little. He was a big cowboys fan. He had a cowboys shirt on and, having seen his room, I knew that it was decked floor to ceiling in cowboys gear.

Before his accident, he was an administrator in a Utah school district. He was one who liked to take care of his neighbors. He was shoveling off the porch of an elderly neighbor when he slipped, fell off the porch and broke his neck. His arms and hands were crooked, for lack of a better word, and his head lay at a tilt. He was on a soft diet which equated to French toast and cream of wheat with orange juice. Someone had already cut his French toast.

It was difficult to know what to feed him, how quickly he wanted it and in what order. I wanted to please him but didn’t have much feedback. He would try to point at things and would open his mouth when I offered him a bite of food. I tried to mix it up. We would often make eye contact and I would try to converse with him. I think that, with him and in general, I spoke too quickly. It was also hard to converse with him when it is just a one sided conversation.

I kept finding myself, without thinking, asking him questions or saying things that would normally elicit a response. It was a work in progress. At one point, he seemed to take a deep breath after I asked him about the french toast and he said, in his broken and slurred speech, that they made the best french toast in the world. I was thrilled. When he finished the meal, he, with a shaky knarled hand, reached over and, with a very firm grip, shook my hand and thanked me for helping him eat breakfast. I almost cried. How I take things for granted. He was grateful for my help feeding him.

Lunch allowed me to feed a much older gentleman. He may have been Italian. He didn’t speak, there were barely perceptible nods occasionally and he had an Italian name.
He ate slowly and chewed the food forever. He had shredded chicken and rice with gravy and pears with ice cream. He ate some of the chicken and rice before refusing the rest with slight shakes of his head. He was more than happy to finish the pears and the ice cream though. Oh, he also had orange juice. When he was finished, I wheeled him back to his room.

I didn’t know quite what to do with him. He wasn’t one of my residents and I was to return to the dining room so I put him in front of his tv and turned it on. It was some medical show about babies. I didn’t want to just leave him there but there wasn’t much else to do. We, as students, were not allowed to make any lifts or transfers by ourselves, so I could not put him back in bed. I asked him if the channel was ok and he gave a slight shrug. I told him that his CAN would be around to check on him and I reluctantly walked out.

While Emily and another student were helping one of the residents in his bed, I struck up a conversation with his roommate. There are two residents to a room. He was in his wheel chair, had a prosthetic on his left leg below the knee and was waggling a long unlit cigarette between his fingers. He turned out to be a Redskins fan. My scrubs evoked a response and the beginning of a fun conversation. He was the former interstate truck driver. I talked to him about where he would drive and what he would carry. We talked football as well. As I left, I rubbed part of my scrubs on his tv table and told him that now he would have a little cowboys on his table and in his room. He knew that I was teasing and played with it. He told him not to make throw up or have to throw out the table. He said that if I was walking down the hall in my cowboys scrubs and felt some one spit on them, that to sure that it was him!

One of the final residents that I helped on the second day was a gentleman that I was asked to change. He was in his wheel chair in his room. He originally said that he though that he had already been changed but after a question or two decided that he probably hadn’t. The bed was raised so that he could stand up and put his hands down against it. I knelt down behind him, pulled his brief down around his knees and began wiping him. He then began to pee. I grabbed an adult pullup and reached up between his legs and placed it there so that it would catch the pee. He said “oops.” He said that he was “kind of a dribbler.” I then took additional wipes and, leaning around his legs, reached up and wiped down his front. He was starting to get a little shaky so I hurried and finished with a new brief and got him back into his chair.

I left at about 2:30 pm, took off my soggy shoes while starting the truck, and drove home in wet socks with the heater blowing at my feet.