Wednesday, September 08, 2010

For Eve Who Found the Grace to Fall From Adam (MacLeish)

She was found down somewhere out on the edges. Parts of this megalopolis abut reservation. The highway divides the sprawl from the wispy and scrawny rural fields and widely-separated dilapidated shacks.

They beat her up pretty good. She had a cervical collar on until Neuro-Surg cleared her. Lacerations above the eye and it was swollen shut. I cleansed that area very gently and put some anti-bacterial ointment on it. Nurse K. from the night shift told me that she had pushed a little harder and she could feel the pulpy fragmented orbital bones just beneath the rough laceration.

She reeked of alcohol. Nurse K. couldn't get a history from her. I had better luck during the day as she woke up a little bit. Thinking that she was an alcoholic, the docs had me scoring her for withdrawal. I didn't really see any evidence of that.

She said she had been homeless for two months because her boyfriend stole her truck and kicked her out. She also said that she ran out of her medications, listing Tegretol, Seroquel (which she spelled for me on a scrap of paper,) and Haldol. She took them "to help stop the voices." She had a job at an auto-upholstery shop on the south side. She also said that she only drank occasionally, although to excess, again to "stop the voices."

Don't we all.

Trauma and Plastics were on her case, and we added Neuro, Psych, and a Medicalist to help. Good. The more the better.

The Plastics surgeon did a great job on her but it left her looking rather strange. He shaved the front portion of her hair to expose the scalp, then cut from ear-to-ear over the top of her head. That way he could peel her forehead skin down to work on her crushed-up orbital bones underneath. When her hair grows back she will appear as if nothing had happened to her.

Initially she came out with a mummy-wrap dressing around her head. Yes, we get this stuff all the time on our thoracic telemetry unit. When the Plastics doctor came by the next day he removed the dressing and wrote orders to just put ointment on the staple line. She also had a bulb drain sticking out of the right side of her head. A fourteen-inch tube about an eighth of an inch in diameter, leading to a grenade-sized clear-plastic bulb which, when compressed, applied a little suction to the line and drew bloody drainage from her head to reduce swelling. It fit into the pocket of her hospital gown.

"Well," said the Plastics guy, "I'm all done and she can go home. Just have her see me on Friday."

She doesn't have a home.

She doesn't have her medications.

Fucking A she didn't even have any clothes.

I had asked her about that. She had no family to call, and the nearest thing she had to a home was the downtown shelter. Being a schizophrenic, she had varying unsubstantial stories about how she obtained her medications. She told me she got them from "somebody."

I did not want to discharge her to a shelter with a fucking drain sticking out of her head and a row of coronal staples openly exposed, though she promised me that "would not let any germs get in there."

I desperately called the medicalist and since it was getting late anyways, Case Management wouldn't have time to help us arrange things for her discharge.

"Don't hurry," the patient said to me.

The thing aboiut being a hospital nurse is that you never have the time to hurry.

We finagled her another night in the hospital despite that all the teams had already signed off on her. She kept thanking me.

It's one thing if it were you or me. We could sit home and watch Law & Order reruns and take quite good care of our drains and incisions ourselves. But this was a schizophrenic under-medicated street person with no family ties. Imagine if you were walking down the street and you saw this woman coming at you from other way with a drain sticking out of her head.

Imagine what you might say to her.


Having a nice day?


been there said...

What an amazing nurse u r! I so appreciate that there r caring people out there like u. Thank u for ur words.

wunelle said...

I'd feel so lost. To be her, of course, but also to be faced with her. What can one do? You did all you had available to you to do, but the problems loom larger than what your facility is equipped to handle / solve.

I find I put my head in the sand, trying to feel good about what I do manage to do and pretending not to see all the stuff I am powerless (or too selfish or self-absorbed) to do.

Such a sad story all round.

WinnyNinny PooPoo said...

It's pitiful that mental health facilities are so underfunded; in my state there is only one public inpatient mental health facility left and they are trying to close that. Outpatient works when people have support and are stable, but where do they go when they don't? Glad you finagled another night.