Oh, Gross! Again.

Now that I'm working in the hospital, I see waaaaaaaay more disgusting things than I did in assisted living. I won't say that hospital is definitely more disgusting than home care because sometimes people's homes are just beyond nasty. But assisted living tends to be pretty decent.

So now that I've been exposed to more things, I figured you all would be delighted to know what I find the most icky.

1. The Worst Smell Ever; when someone keeps vomiting blood and poo. It's just so, so bad. I mean it's three unpleasant things all mixed together. And it smells ungodly.

2. Trach suctioning. I know, not nice. It's necessary. Sometimes people need that tracheostomy (a hole at the base of their throat in front) to help them breathe. And sometimes that hole gets plugged up with mucous. And then that mucous must be suctioned out. And yep, it's exactly as oogy as it sounds. Especially if they're coughing and end up with puddles of phlegm pooling on their chest, which then also must be cleaned up.

3. Pulling out lines. This is more of an "I feel phantom pain imagining this" reaction on my part. The people who do this aren't with it enough to be as bothered by it as a normal, alert person would be. But the sight of someone ripping out their own IV, or (God help them) other lines or tubes just makes me shudder. Doesn't matter what the line is or what it's putting in or out of the body, the idea of them ripping out really grosses me out.

...and lastly, one that I'm surprised is not that bad to me? Wound packing and unpacking. When someone has MRSA or whatever and it eats a hole into them, that wound must then be frequently packed full of stringlike bandaging, then have that removed, and replaced with clean packing. It sounds awful, but it's actually pretty cool. It's what allows people to heal from the inside out, rather than the outside in. You wouldn't want your skin to close up over a big empty pocket in your body, because that wouldn't be structurally sound. So instead this way it heals properly. But it does look pretty weird.

A Butt-Sized Bra and other stuff

Things have been pretty busy over at the GreatRep, what with activities department people quitting by pulling the ever-popular no call/no show, and caregivers getting pregnant and then never staying through a shift. I laughed and laughed when one of my charge nurses got snippy about that, saying "I worked here throughout both of my pregnancies. I've vomited in almost every room in this building! She needs to get her butt in gear and work through it because this illness? Is SELF INFLICTED!"

So we're all pulling extra shifts down there to try to keep it running smoothly enough until we can get more staff hired. And I'm tired, but I still like my job.

Highlights of my week: I have this resident, Mildred, whose children do not speak to her. I don't know why, I assume she did something to them to make them dislike her back before the dementia, and she's certainly a handful now. I genuinely like Mildred and find her funny, which is lucky, because as one of the two Med Aides at my facility, it falls to us to help Mildred wash her panniculus daily. Panniculus is a fancy word for "apron fold" or, less politely "big belly that hangs down enough to make a crevice that gets ouchy unless kept clean and dry at all times". Mildred's Granddaughter is a huge pain, and refuses to get her Grandma any new clothing that is the correct size for Mildred and her panniculus to fit into. So I'm at Goodwill the other day, looking for scrubs (found a cute pink top, too!) and I see a GINORMOUS bra there. Big enough that I could almost fit my butt into one of the cups. Perfect for Mildred! So I spent the $2.99, bought it, embroidered her name onto it, and brought it into work. Then, not wanting the buttsized bra to fall victim to our industrial washing machines, I wrote the following note, complete with illustrations of the bra, and taped it into Mildred's closet:

"Attention Caregivers! I got lucky and found a Mildred-Sized bra at the Goodwill. Let's only wash it on shower days so that the hooks can survive longer; I bet I won't find another one this big at Goodwill again. Thanks, Polly"

So hopefully it'll survive and Mildred will start being a little more ... contained. By her garments. Speaking of which, if anyone has maternity pants with those giant elastic waistbands, size 18-ish? Send 'em along. I'll embroider those with her name too, and then she'll be comfy and modest, both of which would be a welcome change to all of us over at the GreatRep.



Then the very very best part of my week was that the visiting wound care nurse came, and very enthusiastically showed me the pressure sore she's treating on another one of our residents, and the stuff she's using to treat it, and all sorts of awesomely disgusting and wonderful things! I told Mr. Polly about this, and his response was "There's such a thing as a wound care nurse? Why aren't you that? You would be in heaven. You should go be that." And he's right. I frickin' love that stuff. I googled the Tree Man (have you?) and am fascinated by burn treatments, weird rashes, deep pressure sores, etc. We don't get much of that at the GreatRep because really, there's no excuse for our residents to be developing pressure sores that get beyond a stage 2.

The wound care nurse was in for a lady whose pressure sore got deeper than we'd have ever let it get because she had MRSA. Not because we didn't position her correctly, or use cushions, or any of the other stuff we did. Just so you know.

So much as I'd like to see pressure ulcers that go down to the bone, and wound-vacs, and tunneling wounds... where I work isn't the place to get all that.

But I looooooooove when the wound care nurses come in!

The Opposite of the Tooth Fairy

One of the things I was really excited about when I got my job at the GreatRep was that (although I don't have health insurance) I get dental insurance! I used to love going to the dentist when I was a kid and never had a cavity.

So I happily made an appointment for the first time in 8 or 9 years. Woohoo, I thought! I'll get a cleaning and be on my way. Plus the dentist I picked is kind of gimmicky and they give you a paraffin wax hand treatment and free tooth whitening if you're a new patient with them. It'd be nice! Like going to get a haircut, right?

I was wrong. So wrong.

They did x-rays, and then said I had 5 cavities. Oh no. I got scared.

Then they said they could fix all 4 little ones right then and there, and I wouldn't even need to be numbed. I relaxed and thought okay, this must not be any big deal.

Then I found myself with my jaw jacked open wide by a plastic tubey mouthguard that was sucking up all my spit, fighting off panic as the dentist drilled into my teeth and it smelled like something was burning and my only means of communication was to raise one of my stupid flippered hands (still sandwiched into giant oven mitt thingies because of the stupid paraffin wax). Raise my left hand if I'm not okay? OW! I wanted to raise my left middle finger.

Anyway, I got the damn slippers off my hands so I could at least give a thumbs up or down, and got some numbing something to help me make it through the end of Fire And Brimstone In My Mouth.

My God, no wonder people hate going to the dentist! I never understood until now. But I have to go back 2 more times this month. And get the muscle inside my mouth (the one that's just below where a labret piercing would go) cut and cauterized. Oh shoot. This is not the way I remember trips to the dentist, people. Everyone now has my sympathy. Everyone with and without teeth, bless your hearts, every single one of you.

And here's a visual of the labret piercing. Not mine, I don't have one. All I have is an about-to-be-slaughtered muscle behind there. Crap.

Maybe I can give the dentist one. With a dull needle.

Vasovagal EXTRAVAGANZA!

We had a new nurse on 2nd shift tonight, so all us aides were trying really hard to be helpful, make sure she knew who each resident was so she wouldn't give them the wrong meds, tell her who to take seriously when they did/or said things and who to ignore and they'll stop.

But because she's new, she didn't know the difference between "Polly gently flagging down the charge nurse to come into a resident's room" and "Polly panicking and trying desperately to get your ass in here STAT but I can't leave this woman alone right now". So NewNurse wasn't as fast as I wanted. But it all turned out okay.

You see, there's a little thing called "vasovagal response" or, as you may learn to call it "fainting because you need to poop or are pooping".

This clip from Scrubs illustrates it very nicely:



Yep, it's a real thing. Pooping and fainting. What a combo.

There are a few of my old ladies that have this occasionally, but the one I was working on tonight had not ever done so since I've been working at the GreatRep. So you can see why I was alarmed when Nellie lay limp and unresponsive (but not dead! I checked that first!) in her wheelchair. I patted her hands with increasing force. Called her name with increasing volume. Patted her face. And then I brought out the big guns. Nellie HATES it when you touch her mouth or brush her teeth, and the absolute most annoying thing you can do to her is stick your fingers in her mouth. I popped on a glove and stuck a few in there, to and got no reaction, which is when I panicked and desperately waved NewNurse to come in NOW.

She also couldn't get Nellie to come to for a while, but after we both hollered and patted and pestered the hell out of her for a bit, Nellie cracked one eye open to glare at us, at which point I started breathing again. And got a whiff. And then a big, poo-shaped light bulb went off over my head. It spelled out VASOVAGAL in morse code. And Nellie woke up in time to have the biggest BM I've ever seen her have in my life. I mean softball sized, and round like one too.

Sheesh.

So my little poop-weasel is all right, and was back to normal within a few minutes of passing that beast.

And you know what? Seeing it didn't make me faint too. Whew!

PS Next weekend is my last weekend of clinicals which means I'll have a real live day off on St. Patrick's day! I cannot wait!

Crossing the line

The other day, in between shifts, I stopped at a fast food restaurant for a rice and bean burrito. Tasty! Since the home I was headed to doesn't have any toilets without "hats" in them to collect urine, I figured I'd better use the bathroom there. I walked in and was hit with that cloying, suffocating smell, and instead of thinking "Oh gross, jeez!" like a normal person, I thought "Oh! It smells just like Mrs. So-and-So's bathroom! Does someone in here have an ostomy bag?". Then I saw that one of the stalls had an out of order sign on it and probably something ungodly was in there.

That's when I knew I'd crossed the line and would never have a normal sense of what is and isn't disgusting again. I think it's inevitable when you spend your days toileting, changing, bathing and all around dealing with sick and elderly people.

It takes something really beyond the pale to get to me anymore, and if something does manage to grab my attention through sheer revulsion on my part, it's probably making me laugh at the same time.

So in no particular order, here's the short list of things I still get grossed out by. It's not for the squeamish!

1. Changing a brief or doing peri-care on a male who has a "#3" in there. If you're not familiar with this term, use your imagination. It's not a #1 or #2, although the presence of either or both of these increases the horror exponentially. Nope, a #3 is the other thing that can exit the urethra. Yep. Ew.

2. Poop on the shower floor. Something about the wet plopping sound and the way the steam just turns it into a vaporizer of fecality that will have you longing for Vicks or anything strong and mentholated to coat your nasal passages in. And the cleanup is a real bastard.

3. The smell of old, stale urine, especially if the urinator has a UTI or has been drinking alcohol. You wouldn't think it could possibly smell as strongly as poop, but it sure can.

4. The smell of blood mixed with any of the preceding three ickies. Adding in the smell of blood to any of those is the only thing that currently makes me gag and dry heave immediately.

What about you all, which of these is the grossest to you? If anyone says "none" and means it, you deserve a bronzed section of intestine to show what a strong stomach you have.

See, it stuff like this that makes healthcare workers into a subculture. No one else wants to hear about this junk, let alone thinks it's as funny as we do!