Realisations Who can know the true intimacy of medicine?

Ever since I was young, I assumed I would end up following in my mom’s footsteps and become a nurse. I liked the gory stories she often told at the dinner table. I liked that she never had to decide on professional business clothes, and I was comforted knowing there would always be job security. Other than that, I never gave my choice much thought. I never truly understood exactly what it meant to be a nurse until I was tasked with placing a rectal catheter in a sedated and ventilated patient in the Intensive Care Unit.

After nearly four years of nursing study and logging countless hours interning in multiple specialties, I got to learn how to do many kinds of procedures, many of which involved sticking tubes into various orifices on the human body. I inserted tubes up noses, down throats, and into bladders. I dealt with chest tubes, breathing tubes, and IV lines that trailed from chests, necks, and arms. I once assisted a doctor insert an IV into a person’s shin bone, and I got to insert feeding tubes into surgically made holes in the abdomen, called stomas, to facilitate easier long-term nutritional support for those who couldn’t have tubes in their throats.

Although all of these procedures gave me performance anxiety, I made it through relatively unscathed so when Penny, the official nurse who was in charge of my passing or failing my internship, suggested (rather, voluntold) that I insert our patient’s rectal catheter, I agreed immediately. After all, it would add another hole to my repertoire.

Was I ready for this?

Apparently that question did not matter because my preceptor pushed me to Room 6 rattling off the list of supplies we needed to get. Penny pulled back the curtain for privacy. It was just her, me, and the patient who had been log rolled to his left with his top knee bent in a recovery position, making him look like he was scaling a horizontal wall. His joints were all padded with foam. His intermittent pneumatic compression (IPC) device inflated and deflated over his calves in unison with the rise and fall of the ventilator. The hollow sound of suction hissed. On one of five IV poles hung a huge bag containing his cream coloured meal, slowly dripping into his feeding tube. This week the tube was placed to his left nostril to give his other nostril, chafed and red, a chance to heal.

How the body works: what goes in, must come out.

Seems simple, right?

Not quite.

Even though this patient was receiving one-hundred percent liquids, his body did not quite know what to do with it in his incapacitated state. When the body goes into what is essentially survival mode, everything either slows down or shuts down entirely. The patient’s bowels had shut down—that was a problem. He had not been able to pass his crap for about a week, so now it was time to perform two interventions, which I was given the order to perform.

“Emily! I said wash your hands, gown up, goggle up, and glove up,” she barked, realising I was stalling.

“Yes ma’am.” I replied.

Penny, my preceptor, was not one to be trifled with. Born in England, she had been a nurse over there for twenty two years, and moved to the United States to work for another twenty. She should have retired that past year, but due to staff shortages, management begged her to remain for a bit longer. Tired and gruff, she agreed, but only on the condition of having her student nurses do the heavy lifting. That, and a big raise.

Penny had thick hands that were more graceful than a ballerina’s, yet stronger than a bricklayer’s. She wore her curly, salt and pepper hair in a bouffant, her huge glasses around a chain that clipped to her scrubs, and show wore spotlessly white orthopaedic shoes. When she walked into a room filled with physicians and their puppy-like medical residents, they always handed her the stethoscope. She wasted no time with idle chat. She charged right into the details of each patient assigned to her care. Penny was scary and highly respected. She was magical. I wanted to be just like her.

I did as she commanded and watched as she marched over to the side table with a tube of lubrication and the biggest rubber catheter I had ever seen in my life. The tip was mushroom shaped and the colour of macaroni. It was smaller than a tennis ball, but bigger than a golf ball.  The tube was extra long to reach a connector that was commonly referred to as a “Christmas tree.” But there was nothing merry about it. The Christmas tree was an adaptor for another long tube that connected to a lidded bucket.

But before the catheter would meet its own fate, my finger would enter. Penny ordered me to stick out my index finger where she squeezed on a dollop of lube and directed me to the crack of the pale buttocks that now appeared from beneath the gown.

In technical terms, the procedure is called digital stimulation. The goal is to stimulate the nerves that help the colon evacuate waste. In non-technical terms, I had my hooked finger up this man’s butt and gave him a thirty second massage. It worked. The patient involuntarily evacuated his bowels. We cleaned him up and waited before repeating it two more times. Perhaps the catheter would not be necessary after all?

Penny was pleased. Well, pleased enough for a Brit with a very stiff upper lip.

I was pleased.

I also thought I was done.

I was not done.

You know that panicky-icky feeling you get when the toilet gets clogged and the water line and whatever comes with it overflows onto the bathroom floor? Having unclogged the patient’s intestines, I was dealing with involuntary leakage of caramel coloured faeces with the consistency of hot pap, the result of stagnant faecal matter that had been reluctant to leave his colon for about a week. Needless to say there was a lot of it.

“Emily! Pick up the catheter and insert it gently. Don’t shove it,” she advised.

The patient was leaking faster than I could visualise the opening, so I had to go in blindly. If I inserted it at the wrong angle, I could tear his rectum. If I shoved it in too fast, I could cause him to start coughing violently, also known as bucking the ventilator. Both would have terrible repercussions.  I squinted and aimed that huge, mushroom catheter toward the left side of his pelvis for the best point of entry. It went in as more substance squeezed out around the sides. We had to contain the spillage by placing layer after layer of disposable pads which seem like a decent size when on the shelf, but never large enough when we actually need them to contain spills.

“Farther in, Em!” said Penny. I mentally willed the flimsy catheter to stay stiff and held my breath as I guided it in further. A few more centimetres in, I felt the patient’s annular muscles take over and suck the catheter into whatever counted as the “rectal sweet spot.” I said as much and she exclaimed, “Bingo! Now tape catheter down, connect the end to the Christmas tree and let’s get him cleaned up.”

I did just that and watched, oddly proud, as the patients excrement drained into a bucket. I looked down at my gown that was now smeared with victory. I was sweating through that impermeable material, my eyes watered from the smell, and I was gagging back the morning’s breakfast. We cleaned up the room, charted the procedure in his patient record and moved onto the next patient. It felt almost as if the moment never even happened. The procedure was far from fun but not altogether dreadful.

One hour later, I was summoned to Room 6: “EMILY!” She always said my name like that. I always felt like I was caught doing something wrong. With no nonsense she simply said, “A resident was doing rounds and tripped on your patient’s catheter and managed to pull it out. You’re up.”

So I did.

But the second time around, while ignoring all the smells and orifices that make us simply, well, human, I got it: being a nurse was not just about enduring another wrestling match against a tube of latex, or leaving the hospital with poop smell smell stuck to my skin. It was not about creating holes or filling holes, nor job security, or the excuse to wear pyjamas everyday. Being a nurse meant committing to others and when they needed us the most especially when they were in their least desirable moments.

I was lucky to see this patient re-stabilise enough to have all of his tubes removed one by one and eventually discharged. That he never knew me nor the intimacy of what I performed, did not matter. I knew it.

Emily Schlink is an American writer and nurse. She lived in Namibia where she was a founding contributing editor of Doek! She made her foray into writing eight years ago when she landed in Romania. She learned her writing craft through blogging and newsletter editing. Her fortes are travel and memoir writing.