The intimacy of care

I was on my knees on the floor, one tiny, slight student nurse was hauling the man over on his side as I stuck a rigid sigmoidoscope 30cm into his KY jelly (cheap NHS version of actually, not the branded KY) lubricated rectum. 

I inserted a Faucher tube (largest one on the shelf, 36F) and stood back. Hurtling towards me down the tube came litres of gas and liquid stool, the noise was quite dramatic and was heard by the rest of his 6 bedded bay. 

The man’s abdomen decompressed and he could breathe again, but there was shit everywhere. It was pooling round his wasted, skinny little buttocks. I cleaned him up with the patient cleaning mousse, wiping his thighs and buttocks and scrotum clean and the nurse and I got a fresh sheet for his bed. 

We tucked him back in, abdomen almost normal again, flatus tube stuck securely to his thigh to keep his colon deflated. It was the fourth time I had seen this man, the fourth time I had decompressed his volvulus, he is paralysed and condemned to blow up time after time. 

As I kneel there, wiping and cleaning his pressure sore covered sacrum, I look at my bare arm splattered with faeces and  I hope that it will never happen to me, that I should never be where he is. That I couldn’t bear what he does with such dignity and composure. 

Afterwards I explain again what the plan is, ask him if he feels better. He thanks me for doing it, tells me he feels much better now. His dignity in the face of what he has to endure is humbling. My eyes fill with tears, partly due to tiredness and partly due to doing something so simple and easy that has made someone instantly better. It cost me nothing, it took no real skill, used just 15 minutes of my time, there was no ego, no risk. Just me, on my knees, covered in shit, making someone feel better. 

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14 thoughts on “The intimacy of care

  1. Wow! Written in a way that came at me as hard as that stuff came at you.
    Right now I’m in the self-righteous angry part of grieving the loss of youth and the multiplying doctor appointments. I’d like to be more stoic, yes, I think that’s the word, stoic and grateful for what Is left.

      • Your comment has caught me off guard in a great way. I mean it.
        I don’t know how to rage about me.
        My legs and arms work. I don’t know why it feels like I’m freaking out on the inside.
        No, that’s a lie. I do know. Per a one year old MRI, I have moderate to severe central canal stenosis at L4-5 and a annular tear. Cymbalta has become less effective and the pins and needle feeling in my right foot is annoying by 1 pm. I’m also moving to the bathroom a little quicker, fearful of not being able to hold my bowels too well.
        I often pre-op patients for fusions, reconstructions, sometimes two and three levels. They all look so beaten down as it is not their first visit for back surgery.
        I’m either becoming a hypochondriac or in denial of the need for a surgical consult. Admitting I need one means accepting that the five months following will suck.
        Thanks for letting me whine, vent, and stomp my feet on the ground.

  2. Brilliantly written. Seriously, have you thought about collecting these together and writing up into a book?

    • Thanks Jeff. That’s kind of you to say. This blog is like my diary, I forget it is public and don’t think I have enough to say or learned enough lessons to be published anywhere. Maybe in 30 years!

  3. Pingback: Medicine – beauty amidst chaos | The Knife and me

  4. Beautiful post!! There is great potential for us to share many moments like this with our patients. We just have to be willing to get shit on sometimes, literally and figuratively. Many docs are not….

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