Man in a Box

As a nursing student I chose many of my clinical assignments at the Seattle VA Hospital. As a young child I would dream of being a nurse in the United States Navy. My "Barbies" were always my nurses and my teddy bears went through many many surgeries as I secretly studied the human body in my room. (I am probably the only child in the world that begged the librarian to let me bring home encyclopedias at night if I returned them first thing in the morning...) Things happened in life that prevented me from joining the service so I found another way to play... The Seattle Veterans Hospital is a very large facility near the University of Washington...from all the Southern windows you can see Virginia Mason...Seattle's second largest Hospital and the worlds leading medical facility according to the American Medical Association. Once a dream of mine to work as a flight nurse at that hospital...oh back to the story... If possible I would chose my patients according to them being on the South side of the building...lol...allowed me to dream. On a beautiful sunny day I got lucky and was assigned a "one on one" patient in need of several of the procedures I needed to be graded on perfect for a nursing student. The nurses seemed pleased to assign him to me...but I wondered what was up...I have been the brunt of a good joke most of my life...I knew I was right in the middle of one at that moment...just had to wait for the punch line...and hope it did not embarrass me to bad. Now I am not going to name this man Mr. Smith...that would do an injustice to him. I will call him Bill as that was his name. When Bill first came to America we were in the middle of a war in Korea. To gain citizenship he was asked to join the United States Army. Following boot camp he was allowed to bring his wife over too. They had only been married briefly when he left his home country to beg entry into ours. Upon her arrival they had less than three days together before he was shipped out with his brigade. English as a second language proved to be an issue while he was fighting that war. Seven months before the war ended his brigade was under fire. Most died that day but three did not. These three were taken hostage by the Koreans. For a year Bill lived in a box similar to this but buried in the ground. For a year Bill was removed from the box regularly to be tortured. Doing my nursing evaluation on him I realized I could not understand a word he said...and wondered if it was a language barrier. After a few minutes of soft talk and introductions I began my assessment. A 70 something year old balding male, lie in the bed in front of me. His hair was an unnatural grey color...what there was of it. I soon discovered Bill had no teeth. Looking around the room for dentures I saw none, looking on the chart there was no reference to any being seen. I had however found my language barrier. Ever try talking with out any teeth... Now I could understand part of what Bill said to me. Being a person who was taught to respect my elders I explained to Bill what would happen while I was on shift. I never touched a patient with out explaining and educating them first. Bill nodded in understanding as I pulled the sheet back to reveal that he was in a five point restraint...chest vest, wrists, ankles all tied tight to the bed frame...he could not have weighed more than 80 pounds and most of these nurses had REAL big butts!! Glancing up at his face I noted fear in his eyes...this bothered me so much it made me cry. (later in the bathroom...not in his room). My job at the moment was to assess and prepare him for a catheter placement. I had never placed one in a man...and I was a bit nervous...and the fear in his eyes did not help. Vital signs taken I glanced toward his hands tied on the bed. This is when I made mistake number one...I untied his hands. His fingers were turning blue and they needed loosened...but I left them that way...a "no no" with out the charge nurses approval...I learned that day. As color returned to his finger tips I noted that he had no finger nails at all...glancing to his feet...you guessed it...mistake number two...I untied them too as I noted he had no toenails either and four of his toes were chopped off at the first knuckle on each foot. Feeling the lump rise in my throat I looked out the window and spoke softly to him...trying to ease his fear and my tears. (damn years later he still makes me cry)... Putting a urinary catheter in is a sterile procedure requiring a sterile field. I began placing mine together as I talked to him about what was coming up next. Bill nodded his head and a tear slipped from his eye...but the fear eased away in them. Now remember I needed a grade on this, and it is procedure to have another person in the room with you when you do an invasive procedure like this on the opposite sex. So I left and returned with my teacher. Upon entering the room I realized mistake number three...I forgot to tell him I was bringing back another human and fear returned to his eyes. My instructor was a short little gal with a bob hair cut...make up always perfect and nursed in high heels...but she was compassionate. She committed mistake number four and untied his chest vest while softly reassuring him it would be okay. Fear left his eyes as soon as he was completely untied...I guess after a year in a box, being tied down would scare the shit out of me too....he relaxed. You could understand him better because he slowed down to talk. I only wish he could have warned me of the up coming joke. When a bed ridden patient is put in their bed properly...two sheets are used. The bottom one covers only the lower half of the body for privacy during vitals and chest percussion. This also allows the nurse to pull the sheet from the foot of the bed for lower body inspection keeping the patients upper half warm with the top sheet or blanket. After my sterile field was inspected and the mandatory check list checked off...we began. When I pulled the sheet and finished tucking it...i was in for another shocker...his testicles were there and intact...but the rest of him was gone! Now I knew the joke...and it was not on me...it embarrassed me yes...but not nearly as bad as it did Bill...he was crying so hard I could not stop myself... My instructor pulled the sheet back down patted Bill and retied his vest...explained that we would be back in a moment as we forgot a critical supply...A FEMALE CATH! there is six inches difference in these two caths...one made for a man for a reason. We went into the break room and she let me cry. When I was done she asked me why it was I was crying. It was hard to explain to her, but at that moment I felt all this mans pain...not his physical pain...but his emotional pain...it damn near gave me a heart attack it hurt so bad...the life sacrifice he gave to that war. To be an American. We finished what we started and I sat with him for a very long time. I tried hard to understand him but could only catch every fifth word or so. Nurses had claimed he was senile...I say he was toothless and spoke English as a second language...hello! His wife arrived that afternoon, with the news that their 15 year old dog was going to be put down that afternoon. This was the last of their six "children" to leave this world. Here is where I made mistake number...whatever it is...Remember he is in restraints. A restrained patient can not leave the room with out a security officer and a Charge nurse. So I told her I would distract the nurses left at the desk as most were at lunch or charting...while she smuggled the dog in for a last good bye. OOOPS. Guess what small dogs bark...even hospital doors do not muffle this bark. I could not resist meeting this dog when I discovered the nursing station empty...so I returned to the room. On the bed I saw a dying man holding his dying dog and wished they could lay there and die in peace together...he deserved this. But little Fido was dying of cancer not old age...and little Fido did not like anyone near her daddy...after the third bark...the door flew open slamming against the wall with the racket of an exploding bomb! The dog jumped from the bed and began barking at the HUGE black figure standing there. Bill was clinging to the ceiling...or would have been if he had finger nails... then the screaming began...and let me tell you black ladies can scream....then she noticed the wrist and ankle restraints untied... She ripped both sheets from the bed and tossed them back on him when she realized the vest was still intact. I guess she did not take lightly to having her toes stepped on...this is the only hospital that I worked at that required the charge nurse for restraints...most just need her "nursing orders", and a doctors prescription. Next she shoved me from the room and slammed the door screaming about nursing students and head aches...guess i did a big boo boo.... My nursing instructor was there waiting and once again we returned to the lounge to discuss this situation. I had two choices and the best she saw it...I had a better chance of remaining in the nursing program if I wrote up a patient advocacy petition. This required a lot of chart research and family interviews...but it also gave me 200 extra credit points for doing what was right for my patient. But it also required me to attend a meeting with a bunch of people in decorated uniforms to decide if the charge nurse was out of line and needed disciplined...(she was active duty). That makes twice in my life time I have been involved in the "Court Marshal" procedures. Let me tell you that is scary. She was put on administrative leave and was eventualy demoted and moved to a clinic. Burn out had gotten her. Him? after three days of having him as a patient I discovered many things about marriage and life. His wife did not leave him...according to her they have lived an abstinate marriage minus their wedding night. She married him because she loved him and they dealt with what they had been given...freedom. The chance to settle in one place and grow a garden. The opportunity to walk in the woods and not get shot...lol...guess she never lived in Anchorage. The day Bill left this world he left with a smile his wife holding one hand, and me the other. As I once again sat in the lounge and cried for this patient, a fellow student came in and locked the door. She sat on the floor in front of me, placed her hands on my knees and stated this... "That man died a good man. What he gave gave many an opportunity to live." Then she began telling me the story of how her family came to America...Not Korean but Lucian (think I spelled that wrong)Her family fled when the Viet Kong raided her home village. She was three. She watched her male family members die horrible deaths as her mother raced for the shelter of the forests carrying her children in her arms. They walked over 300 miles through mountains and snow storms...burying her brother and grandmother on the way, to get to the coast in hopes of finding safe passage to America. When I returned to his room to once again get "checked off" (post mortem care in not fun nor is it easy) I discovered several of the "Asian" students had visited his room...there were Korean "icons", name tags, flowers, and cards to his wife from class mates of mine that had or were a part of the Viet Nam war.... So not only have I given many years of my life to dreaming of a Navy career given up to parent...spent a few as a wife of an active duty man...I have worked with the soldiers of the past...and I have been educated by the people they sacrificed so much for...I thank God every day for giving me this experience...sad as it was...it made me feel good to allow this man the chance to hold his baby...and to piss off that big black lady...it also brought me many new friends from all over the world.