Having survived now almost three years of nursing training, I’d pretty much say that my experiences in the clinical field can be summed up into three colours: Black, Red and Yellow.
My first scary incident, was when I was working as a practical nurse at a neurological ward one summer. I had very little hospital experience, so every new thing evoked from me a wide-eyed gasping response. So imagine this scene, the call bell rings, its late afternoon, the ward is slightly understaffed as usual and I’m tired. The first sight that hits my eye, causing my sympathetic nervous system to spark is a huge dark-red stain on the floor.
It turned out the dark-red liquid was blueberry soup, which the patient spilled because she had impaired muscle function in her arm due to a stroke. Another patient rang the bell so that someone could come to clean up the mess. That image was probably burned into my memory, which explains why blueberry soup sometimes causes my left eye to twitch.
Back to the code: German Flag
Yellow: probably the most common colour you would encounter on any ward. Starting from pee, to pus, to sputum, to jaundice, to stomach acid, to disinfection liquid used in sterile procedures. I’ve had urine collection bags leak onto my uniform, had to clean pee from the floor, had a patient vomit onto me, a baby boy pee straight onto my shirt, suction sputum from countless patients dying from COPD to prevent them from suffocating. It may spoil your appetite in the beginning, but you’ll get used to it.
Black would signify slightly more serious matter, such as necrosis, severe hypoxia, and Iron fortified Poo. Black can also be substituted with blue and brown when needed, by the way. Concerning black poo, however, its not so serious provided the patient is ingesting Iron supplements (excess iron turns poo black), usually a result of blood loss from major surgery such as hip replacement.
Red, on the other hand is a special colour. If you find red anywhere where you are not supposed to expect it, it usually means something really bad (In my defense, Blueberry soup does not belong on the floor, that is just a bad and ungrateful waste!!).
If you find red pee in the bag where there is supposed to be yellow pee, (and the patient is not taking tuberculosis meds or other meds turning pee red on purpose), thats bad.
If there is reddish-brown poo, (and its stinks like a rotting carcass), that is Melaena, and is really bad. Red infusions, usually a bag of blood is also not a very good sign, meaning the patient has such a low Hemoglobin value that they need donated blood in order to survive. Usually blood is transfused before patients become critical.
One such case was a female patient in her seventies who had a major operation, which left her with incontinence problems (inability to pee) and too little blood. She also displayed peculiar nervous behaviour, attributed to Alzheimer’s disease. This patient was relentless with the call bell, finding any excuse to call for a nurse, and talking continuously. Although the patient never did anything outrageous, her behaviour was agitating, and it felt like a tiny bit of myelin was stripped from my nerves every time I left her room.
One day the doc ordered two units of blood to be transfered, because her hemoglobin was low. I was alone in my wing and fully responsible for six patients, carrying out the work a registered nurse should be doing, working through a 14 hour shift. The patient had probably contracted a UTI (urinary tract infection) and even though she was able to urinate spontaneously, she still needed to be catheterized about twice a day and had a constant urge to pee. Because of her restlessness and pain, she was on strong sedatives and narcotic painkillers. This one evening though, it seemed like the medication was having no effect.
Once the blood finally arrived, the doc placed a cannula, which unfortunately did not allow for smooth flow of infusions. Despite this we decided to hook her up with the first bag of blood, which only flowed when the patient’s wrist was held in a certain position. The next few hours were almost unbearable though, because the patient was nervous about everything, and needed to make several trips to the bathroom, and I had to watch like a hawk that the infusion was not obstructed. I was starting to sense that this patient was getting more anxious by the hour, and in the back of my mind sprang the thought that she might need need to be catheterized sooner rather than later. I decided I would leave the catheterization for last, because she had already urinated spontaneously on several of the many trips to the toilet.
I missed my food break, my coffee break and any other break I could have had during the latter part of my shift. My nerves were rather raw and I had stacks of paper work waiting for me before shift change. The blood dripped only when I held the patient’s wrist down, and so the patient’s demands for attention increased, demanding for her perfectly clean shirt to be changed (which was tricky with the transfusion going). All this time I tried my very best to try and stay calm in front of the patient (best tip with dementia patients: if you’re calm, better chance they will calm down).
At 20:30, I had already experienced a full german flag (patient defecated black iron fortified poo on the floor just next to the toilet, don’t ask me how, another patient managed to also miss the toilet and peed on the surrounding floor, and then the battle with the blood transfusion). I decided to take 15 minutes to do the charting and prepare for the upcoming shift change.
At 20:45 I gathered the gear to catheterize the same patient, when upon entering her room, the first sight that hit my eye was a huge red puddle on the floor. The second sight was the infusion tube, still intact with the cannula swinging from the drip stand dripping freely. The patient was covered in blood, and she had removed all her clothes. The patient was shouting, claiming to have pressed bell many times because she was bleeding and that no one came to save her (the bell did not ring once), and that she needed a change of clothes.
My nerves were at such an end that I felt like strangling someone. At that point, assessing the patient was in no immediate danger, I closed her door and dashed off to find another nurse to take charge of the situation, and administer extra sedatives (being alone I would have completely lost it otherwise).
The bright red cherry on top of it all was the fact that the first two nurses I asked for help, who were doing nothing told me to fetch some one else, the next one told me to ask another nurse and the finally the last nurse I could ask started lecturing me on the importance of restraining and observing delirious patients that are on a drip. 15 minutes before shift change and without further ado, we washed the floor, removed the infusion tubes, clothed the patient in clean pajamas, catheterized her and tucked her very tightly into bed, and eventually handed over my six patients to the night nurse.
When I clocked myself out of the hospital at 21:30, I remembered my blueberry incident, and at the same time noted how much my reaction had changed in two years from gasping with shock to a weary sigh.
That night I came up with the shift code: German Flag. And with a smile, I went to sleep.
Health tip: Be kind to nurses, please don’t rip out your I.V. Cannulas!
P.s. Check out my friend’s Caricatures: Caricature a day. He is very talented, and welcomes caricature suggestions, which he does whenever he feels like it.
in rear-end hygiene. You learn to do it in many different styles, in different positions, in different situations and for different reasons.
