Funny Lookin’

We had just isolated a patient as it seemed they had C.Diff.  How did we know before we even sent a sample?  We’re nurses and rely heavily on the “deck method.”  Y’know, if it looks like a duck, acts like a duck and quacks like a duck, it’s probably a duck.  Translating that into poop, if it looks like the Diff, smells like the Diff and the patient is developing SIRS with a white count of nearly 20, we’re gonna’ guess it’s the Diff.  Lab tests?  Who needs that?  Nurses’ noses show and unbelievable 95% sensitivity and 98% specificity with diagnosing C.Diff.  But I digress…

So in isolation we gown up in the ever-fashionable yellow splatter-proof gowns, gloves and sometimes masks with just a touch of wintergreen oil to care for the patients.  The patient who was isolation thought we were just the funniest thing since Jerry Lewis.  As we walked in she looked up and giggled, “You guys look silly!”

From the mouths our elders…

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Me. And my big mouth.

I did something stupid the other week. Something I regretted doing. It wasn’t dangerous, didn’t put any patients in peril, cause mass calamity on a national scale, nor promise unlimited health-care for all, nor deny inappropriate relations with a well-connected lobbyist, or drive my car into a train tunnel, but it was just stupid, and I paid for it.

About a week ago a resource nurse who comes to our floor a lot and I were talking and commiserating on the fact she had a trio of poopers. “All I’m doing tonight is cleaning up poop. Even though one has a flexi-seal, it’s still leaking out.” she said.

“Well at least you were prepared for it…your undershirt is kind of c-diffy colored…” I came back with.

“Yeah thanks, I know Captain Obvious.” she said, “It wasn’t the best choice. I should’ve known with this floor!”

And then I said it. The phrase that would doom me into poop-servitude: “Y’know, I haven’t had a night like that in a long time.” Stupid. Stupid. Stupid. It’s like saying “q—–” on a full-moon night, or “she’s finally asleep” about the demented old lady who had been trying to climb out of bed all night. In the grand karmic wheel of nursing, I just steeped in it.

So I show up Tuesday night, flushed with excitement from a nice ride into work, changed and ready to rock. And I start looking at my assignment.

#1: “bradycardia, s/p CV“. OK, he’s a walkie-talkie, fine.

#2: “synope” Again, OK, she looks like a walkie-talkie.

#3: “s/p CABG with AVR, post-op delirium and colitis.” Uh-oh…look a little further down the sheet on him, “mulitple loose stools, (c-diff – !)”
“Yep, could be fun but at least he doesn’t have c-dif,” I thought. Then I read a bit further, “Neuro: A & O x1-2, weak, 2+ assist up, left-sided weakness (new?), strict bedrest.” Now things were getting interesting.

#4: “sepsis, due to C-DIFF.” Yes, here it was the karmic retribution for the words so casually spoken the week before. “Neuro: confused and forgetful, A & O x1-2; Activity: up with 2+ max assist. GI/GU: foley, incont. of stool, 1 loose/mucoid stool.” That’s all of the report I needed. It was going to be one of those nights. Karmic payback.

The day nurse then told me, “Yeah, I d/c’d the flexi-seal yesterday.” I nod glumly, knowing that I would be spending quite a bit of time in the room that night.

So as the night evolved, I did the nursing thing. Checking briefs everytime I head into the room. 2100: still ok. 23:00: so far so good. 24:00, “awwww, hell naw”. Blow-out in #4….I felt like paging overhead, “clean-up on aisle three, clean-up on aisle three.” and clean-up we did. Nothing like a full-bed change blow-out session.

Then #3 rings, “yeah, I ate an apple, then I shit,” he says. That’s one of the things I love about old men, they’re so…well…honest. Clean him up. I’m out of the room less than 10 minutes, “Yeah,” as I answered the call-light,”I shit again.” And on, and on, and on. Cleaned him up 5 more times that night. The C-Diff lady? Nary a time after the blowout.

Fast forward to night #2. I still think I have poop on me somewhere. Even though I have new scrubs on and showered twice since being here. I can still sense it. Not really smell it, bu it more like sensing it, just out of conscious smell range, but there, like the lingering after scent of a bad bar night.

Same peeps. New issue though. Find out #3 has VRE. In his stool. That we had been cleaning for days on end. Without gowns. OK, so make that 2 peeps on contact precautions. And still pooping. Lots.

About midnight I call up Materials, “Hey, this is Wanderer up on 4. Can you send up some more of the big blue chux and another 4 or so packs of isolation gowns and a box of the peri-wipes? We’re going through them like they’re going out of style.”

And the battle continued. I think I singed off all of my olfactory nerve endings those 2 nights because I couldn’t smell anything when I go home in the morning. After I left each room, the smell no longer lingered, it’s like there was nothing for it to linger on. They were gone. Which I guess could be a good thing.

Onto Night 3.

Charge nurse (different on from the past 2 nights) hands me my assignment and says, “I took away #3 from you, it’s just not fair to have 2 isolation patients.”

“Uh. OK, I had them both last night…but I’m not going to complain.” I said. But in fact, it was worse. Instead of having 2 poopers, that I know well, and have kind of gotten used to their unique idiosyncrasies (i.e. smell), I get one and a new cast of characters.

In retrospect, it was OK. She was just spreading the love. Out of the 6 nurses on my particular side of the floor, everyone had at least 1 isolation patient, most were contact, for c-diff. So we all had the love that night.

But what did I learn?

Yes, never, ever, open your big mouth. Karma’s a bitch. Even though you know you’re due, just don’t say it. Let it go. Maybe you’ll stay free a little while longer.

That shoe covers are this year’s must have accessory!

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And that I look good in yellow