His room was decorated with mementos of a former life.
Pictures of his friends and family are pinned to a bulletin board next to instructions for all visitors to take BSI precautions. Posters of his favorite band and a few concert t-shirts hung aside a calendar with this months activities at the nursing home. Not the typical decor of Jesus paintings and 60-year-old framed wedding pictures.
His Mother was sitting on a folding metal chair, her small frame enveloped in a yellow gown. She wears a blue mask similar to mine. I could see her eyes, tired and filled with worry for her only son.
The run came across our pagers as a patient with a capped trach going from a Nursing Home to a Wound Care appointment. As we approached his room we're stopped by a large sign warning to use Universal Precautions. There was a mesh barrier with a large stop sign draped across the doorway.
"What the hell...." Partner for the day checks her pager again to see what exactly our patient has. There's no mention of MRSA, VRE, or Acinetobacter. And typically they are very careful about making sure we have that information.
A nurse stops outside the room and gives us the once over. "Gown up ladies, he has massive decubes and acinetobacter."
We climbed into our stylish gowns and masks and enter the room. The nurse wears the same plus a face shield. I give her a quizzical look.
"It's airborne" is all she says as she continues to get our patient ready.
Wait, it's airborne? I didn't realize that acinetobacter could go airborne. Apparently it can. Time to read up a little.
The first time I actually got a look at him I felt my stomach drop.
He was young. He was very young. Far too young to be in a Nursing Home. Everyone knows that Nursing Homes are for the elderly, right? This kid couldn't be older than 18 or 20. I would later ask his Mother what happened... How did he end up severely brain damaged and living in a nursing home?
She tells me a story I'm sure she's told a hundred times. A story about the worst day of her life. The day five months ago when her 19-year-old son decided to indulge in a massive amount of coke and heroin, and how his friends left him for dead. My heart breaks for her. As a Mother and as a human.
The ride to the hospital for his appointment was blessedly uneventful. They had given him a nice dose of Ativan at the Home to keep him calm for the drive. His Mother had informed us to watch out for his hands as he would likely swing if he became agitated.
When we arrived at the Wound Care office they take one look at my Partner and I BSI'd to the hilt and silently ushered us towards the "VIP Entrance". The VIP entrance is a back stairwell landing with barely enough room for myself, my partner and the patient.
Our Patient's Mother headed to the waiting room. She'd been through a few of these Wound Care appointments, and felt more comfortable out there. I promised her that we'd take good care of him. I can't blame her, given the size of his wounds and words being thrown around like debridement... She would be better off out in the waiting room watching Dr. Phil.
We stood in the quiet stairwell, I read my book while my Partner flipped through a two day old newspaper. It was quiet. Noah was quiet and calm. We didn't talk, we just took turns watching him, like nervous mothers watching a newborn baby sleep.
You know the saying It's always calmest before the storm? Well, it was starting to sprinkle at this point.
First his breathing rate increased. We both noticed immediately. I smoothed his hair down and whispered to him.
"Noah... it's okay baby... calm down."
It took a minute, but it did help. We continued to wait for the office staff to put us into a room. Five minutes turned into ten minutes which turned into twenty minutes.
We were doing our best to be patient, we both knew this was a busy office. All that being said I was growing frustrated when the RN opened the door to the stairway we were hidden away in to show us to our room. It wasn't her fault, I knew that. Still I felt my pulse racing.
My Partner and I found ourselves once again sitting in silence in the cramped room watching Noah. He started gurgling. He's gurgling and we're both Basics and as such in the State of Ohio we're not allowed to suction a trached patient. The Nursing Home staff and his Mother have all assured us that he does this and he is always able to clear it on his own. We're nervous. We sit... and we watch him. And we listen.
He's still gurgling after thirty seconds. I jumped to my feet and found the closest Nurse.
"Our patient needs to be suctioned. He has a trach."
All she could do was stare blankly at me. "So suction him then. Didn't you bring a portable unit?"
My mouth dropped. I didn't know what to say. Again, I tell myself it's not her fault.
"I'm sorry, we're not allwed to suction a trached patient as Basic's. The Nursing Home capped it and told us he rarely needs suction. He's having problems. PLEASE suction him." I was frustrated, sick of being “polite” and quickly heading towards being seriously pissed off. This should have been an ALS run.
Had I just passed Medic School.
"Can one of you flip him? I can't get to that sore on his hip." The RN was asking one of us, either of us. Noah was my patient, I stepped up.
"He's trached, I'm not sure you want to flip him on his stomach..."
"It'll be okay, just grab here and..." She grabs his leg and the foley and attempts to show me how to flip him onto his stomach. She ends up pulling on the foley which causes Noah to start swinging his arms. He's moaning.
"Okay, stop for a second. Let him calm down." It's more of an order than a request on my part. I admit that it came out in a tone much harsher than I had intended. I don't feel the least bit sorry about it.
We sat and watch him for a minute. Again I ran my fingers through his hair and whispered to him. "Noah, it's going to be okay... We'll be careful... We'll be careful."
I looked at the nurse and told her in no uncertain terms that given his earlier problems with clearing his airway on his own, I'd rather not flip him on his stomach. I wasn't comfortable with it.
"He'll be fine, we've seen him several times. Now grab him here...” She guided my hand to his hip and we flip him to his stomach.
And he does fine. Noah's head is resting on my left forearm while I hold his right hip so the Nurse can get access to that pesky decub. I was relieved that he was doing so well.
I knew he was severely brain damaged... I knew he probably wasn't processing anything that I was saying to him, but I talked to Noah anyway. He was sweating to the point of soaking my gown covered forearm, but his color was good. His rate was good. His pattern was good. I thought about my own son and how I'd want someone in charge of his care to treat him.
Then that damn Nurse ripped the wound vac off of his leg and all hell broke loose.
I let out a gasp. Noah started moaning and flinging his arms around. I worked with my partner to do our best to keep him still. The Nurse was completely oblivious. She actually left the room to argue with another nurse over which wound should be labeled what number for the pictures she still had to take.
And at this point, I damn near lost my mind.
I realize he's brain damaged. I realize he's another patient to you. I realize that you probably see TONS of patients in the same boat. But he is a HUMAN BEING.
Then he started choking. I yelled at the Nurse to come suction him. She ignored me and continued to argue over whether the sore on his right hip is actually number three or number four.
My Partner grabbed the Oxygen tank and a NRB. Noah's fingers were turning blue. After the longest minute and a half of my life he manages to clear his airway yet again. I consider becoming a practicing Catholic again.
The Nurse returned. "We need to get him on his back," I started. The Nurse completely ignored me and stuck a long q-tip into the wound on his hip. The wound that is exposing muscle and bone.
I considered jumping over our cot and physically attacking her. He started choking again. His fingers quickly returned to that dusky cyan color.
I looked at my partner and uttered the words that would come back to haunt me. “I'm going to lose it very quickly here. TELL her to get him on his back NOW because CLEARLY she is not HEARING me.”
A Nurse popped her head into the room, "Is everything okay in here?" She sounded concerned and all of a sudden I have hope.
"Could we have suction and a pulse ox?" I'm not asking, I'm begging.
It's been a good minute since Noah started choking for the third time. By the grace of God he managed to clear his airway once again. His respiratory rate increased to close to 30 and his color still sucked. We were still waiting for the Pulse Oximeter and for someone to suction him,
I could retype the last several paragraphs at least three times and still be accurate. The Nurse we had completely ignored me and put Noah at risk multiple times. I realize that he managed to clear his airway each time and I thank GOD for that. A patient should not be choking for close to two minutes while simultaneously turning blue before a Nurse intervenes.
What if he hadn't been able to clear his airway?
I realize I'm just a Basic. Somewhere they taught me that we were to be an ADVOCATE for our Patients. I've done my best to be that.
Noah went back to the Nursing Home in one piece. I guess someone decided that suffocating during a Wound Care appointment because his Nurse didn't see him as a human was not the way he was meant to go.
I guess I'm just a little frustrated. I realize that this Nurse was probably a touch burned out. I just wish she had seen him. I wish her eyes had been opened.