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Inserted Co-rectally

07 Jul

A friend's picture: The view from our school

 

The other day, I found myself at the butt of the joke but in a great way. I felt closer to my residents, all the way back home in Seattle. Why? Because I was dealing with feces and bowel movements again! Funny that this can make me feel all warm and fuzzy now. I guess I am a bit kooky. When people curiously inquired about my work as a CNA, they always wrinkled their noses in disgust when we get to the part about helping people pass their bowels. They say they “admire me” for my ability to deal with it without disgust. But really, admire me for wiping poopy butts?? I mean, come on, we all wipe our own don’t we? Nobody has a robot in their bathrooms? Is it really such a stretch to think about helping out someone else who is wiping-impaired? Please, choose something else to admire me for! Listen, I know I write about poo a little more than the average person in this blog, but who doesn’t at least think about poop once every day? At the very least. It’s only natural, folks.   

Which is why what I did the other day really wasn’t such a big deal. Certainly not compared to the catheter insertion last week which felt much more foreign, to say the least. Let’s start by saying that I am amazed that I am where I am. In a hospital, providing care to patients in acute respiratory conditions. Turning a patient over is difficult not because of their weight (usually) but rather because of the sheer number of peripheral and central lines and catheters coming out of every imaginable orifice. Yet, I am not “grossed out.” I am not freaked out. I am learning what each line goes to and I am fascinated by its purpose. My thirst for this knowledge is insatiable because I want to be the most adept at helping my patient. I stare at the medication list (which looks like a grocery list in some alien language) and I feel overwhelmed by my ignorance but willing to look them all up. Mechanism of action, pharmacokinetics and pharmacodynamics…these were all foreign terms to me even 1 month ago and yet I already know the drug indications/interactions/mechanisms for at least 30 classes of drugs. In the hospital now, I am not afraid of my patients, I am afraid of not knowing enough. It’s exciting to be learning so much every day. Every patient confirms or illuminates something I read in a textbook or was told by a instructor. Our patients’ pathologies and co-morbidities helped me understand the renal system, the circulatory system, cardiovascular disease, neurological impairment and so much more. Even about poop! I never knew that nearly everyone in the hospital is on some kind of bowel regimen. But it makes sense: less movement may mean less peristalsis, pooping is never easy lying flat and there are so many medications that have constipation (or diarrhea) as one of their drug interactions. The patient I worked with yesterday had at least 17 meds and I counted at least 5 of them that consisted of her bowel regimen (aka: Poop Plan). Yesterday we found out that our poor lady hadn’t passed her bowels in four days! Talk about discomfort, not to even mention other implications. After providing morning care, I had really grown fond of our patient. She was the sweetest yet most stoic patient I have met so far. She caressed our hands even as we caused her discomfort here and there. Her eyes didn’t show any sign of reproach as we fumbled through only our 2nd bed bath with a patient who has so many indwelling lines and a ventilator.   

After the bed bath, our preceptor enter with a nurse practitioner and announced that we were going to be able to watch and learn from a manual probe to look for fecal impaction, which would then be manually removed if encountered. I looked forward to observing. Then my preceptor quickly changed her mind and said to the NP, “Actually, would you mind if we do it so that I can teach my students?” The NP readily agreed and walked out to help another patient. I happened to end up on the same side of the bed as my preceptor, at the patient’s backside.   

Without missing a beat, my preceptor said, “Okay, Rachel, now I’m not going to do it. You are. We are going to take a rectal temperature, perform the manual rectal exam, remove any impaction and then take two swabs for a culture.” And, to give myself due credit, I also said, without missing a beat, “Okay, sounds good. Should we start with the rectal temperature?”   

Without going into the nitty gritty details, I performed all three tasks with ease. The exam produced no sign of fecal impaction, so we decided to insert a rectal suppository, hopefully to induce a bowel movement. It all went so much more smoothly than the catheter insertion! I thank my residents for the familiarity and comfort I feel at the helm of the behind. Not even an hour later, our resident had her first BM in 4 days. She didn’t say as much (again, the ventilator) but I interpreted her silence as relief. I know I would feel relief. It feels so good to be helping. 

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3 responses to “Inserted Co-rectally

  1. Betsy Deutsch

    July 7, 2010 at 9:05 pm

    You amaze me! Your mommy is in awe. I think your attitude is amazingly positive, and that you are learning so much. I can totally believe that my girl is going to be an R.N. in less than a year, and I can tell you are well on your way. I can only ass-ume you know how well you are doing, no ifs, ands or butts. Sorry, I just couldn’t resist making a few cracks!

     
  2. geena epstein

    July 8, 2010 at 8:31 am

    Seriously Betsy..you should do stand-up! …and Rachel…you rock! ( I cannot think of a poop metaphor for the life of me)

     
  3. Francina Nur

    July 24, 2010 at 3:01 pm

    Rachel excelent story which can teach us a lot about things we often take for granted.
    When you have time send me your email address.
    F

     

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