Every Two Hours

Once he looked me straight in the eye and raised his right hand to give me The One-Fingered Salute. "Hey!" I said, "I gave you pain medicine, didn't I?!" before turning and positioning him.

He was a big dude, over 350 pounds I guess, because he wouldn't fit in our scanner, but if I yanked on his waffle mattress I could cram a few pillows under one side of him just by myself without taking up the nursing assistant's time.

Less than 20 years old, he'd been a passenger in a rollover a little while back. He probably would have grown up (as if he wasn't "grown" enough already) to be an offensive lineman. But now he'd be lucky just to be able to someday sit up in a chair.

That wasn't practical right now, due to the external fixation of his left femur and tibia. Neat piece of hardware, that. Unfortunately the wounds around the pins cultured up oxacillin-resistant colonies of bacteria. And he had a vancomycin resistant enterrococcus strain, but that had subsided enough that the hospitalist gave me an order to pull out the rectal tube.

That was probably the nicest thing I've done for anybody since Christmas.

The hospitalist also let me take the telemetry monitor off the patient. He was tachycardic, probably due to low-grade fevers secondary to all the bugs roaming his body. He was on four different intravenous antibiotics, plus Diflucan through his PEG tube. It wasn't a cardiac problem. He probably never needed the telemetry at all.

Little things like that mean a lot. I always point these out to visiting family members, as signs of progress. One less tube, one less intervention, one more step towards the door out of there. It's visible, even if it doesn't represent a whole lot of progress really.

His visiting uncle, a wonderful man, would ask the patient to point to things. He couldn't talk and his damaged side was paralyzed due to the sub-arachnoid bleed he suffered in the accident. Sometimes the patient would indicate yes or no with finger gestures, so we knew there was somebody home, so to speak.

His uncle said "We're Catholic," and added that he "played drums for the Lord." He was wearing an AC/DC T-shirt.

Care for this patient was a little difficult due to his size, but very routine. I've mentioned this kind of thing before. Turn and position, run the antibiotics, medications and feedings through the tube, a little hygiene, and repeat every couple hours. Pin care, mouth care, change the Tegasorb dressings on his buttocks bedsores (it takes three nurses to do that, two to hold him over and one to wash his backside and place the dressings.)

And I gave him pain meds once in a while, just because. He had hardware.

I always talked to him, a lot, maybe too much. That could be why he gave me the finger that one time, to get me to shut up. And I made sure there was something interesting on the television, music or something stimulating.

Anything to break up the routine.