Senior Nurse Mentor

Girls in Sunny Italy

Fortunately, I’d learned some important lessons on Hem-Onc, lessons not all that different from dealing with pain in little children. I knew I needed to win their trust by being as careful, gentle and predictable as possible. I must see myself as a guest and act accordingly.

Fortunately, when I started in the spring, I had it easy. Almost all my female patients could get up and about, so the embarrassment issues were few. Surgery was an occasional exception. A girl might have had an abdominal surgery with a site on her tummy that needed to be checked for two days post-op. Nurses tended to be aggressive about that. For such checks, they would charge up, flipping a girl’s gown well above her waist. They claimed, as one told me, that they needed to “see everything.”

I suspected these girls didn’t want me seeing that much, so I took a more cautious approach. That mattered because for many of them their first contact with me came before breakfast when I did vital signs and checked that surgery site. Remember, I wasn’t concerned with what I could get away with, which was probably a lot given how intimidating hospitals can be. I wanted this girls to remain relaxed and confident. I wanted to care for happy patients not morose ones.

As a result, I was careful. Many such patients had a suction chamber draining their surgery site and hanging beneath their bed. I made a rule to check that first. That gave the girl time to adjust to this strange guy poking about. Then I followed that drainage line up to her, pealing back just enough of her gown to check for bleeding or redness at the incision. That, I hoped, would leave this girl feeling safe and in control. That proved right. Their happy little slumber party continued.

Then summer surgeries began. When I started on the teen unit in early May, fellow staff were already talking about the approaching rush in serious orthopedic surgeries. Many required weeks or even months of recovery, so scheduling them in the summer—starting with the most serious—gave these teens time to recover before school started in the fall. At that time, we did so many of these surgeries that “orthopedic” was a part of the hospital’s name.

Alas, my first experience with such a patient wasn’t pleasant for either she or I. Her surgery was so serious, it came before school was even out. I call her Min in the first chapter of Hospital Gowns. She was Asian, about twelve, tiny, and terribly shy. Her back surgery was so delicate, she was in a body cast extending from just above her knees up to her neck and out to her elbows. 

My job was to come to her every two hours and flip her over, so she didn’t develop sores. If she was on her back, I flipped her onto her tummy. If she was on her tummy, I flipped her on her back. It sounds simple but wasn’t.

That flip terrified both of us. My fear was medical. Remember that most of Min’s body was as stiff as a board thanks to her body cast. She was completely helpless. Her bed was just wide enough that, if I slid her to the far side, when she came down after flipping, she’d be at the edge of the bed on the near side. As I rotated her, I was terrified that her cast would slip out of my hands, flop back to the far side and tumble off the bed. Clattering onto the floor in such a fragile state might leave her paralyzed for life. That’d be my fault, which was scary. Thinking about bad consequences was how I avoided mistakes. I visualized dangers in advance and prepared.

Min was afraid for a different reason, one I understood. For a couple our hours each day, she was taken out of that cast by a post-op nurse, so it could dry out. As you might expect it had openings in the usual places. That’s what frightened her. When I came up to her bed for those flips, her lovely dark Asian eyes filled with terror.

Some of her terror came because I was a guy. I say some, because I knew what the women caring for her on other shifts did. That sheet, which was her only covering, would be swept aside and only restored afterward. That made practical sense. Half my fears of her slipping came because I had to adjust that sheet carefully as I turned her. Pulling that sheet off would have made the flipping easier. For that shy little girl, having a woman doing the flipping made only a small difference. Only a yellow curtain separated her from unexpected visitors. Someone on staff might burst in at any moment. Making matters still worse, her bed was next to a large picture window over the hospital’s main entrance. She had good reason to be frightened.

Unfortunately, for all my care, I didn’t ease her fears. Every time I came to her—three times a day for several days—she was terrified. Looking back, I realize I should have talked to her, promising to handle everything just right.

Why didn’t I do that? The reason would torment me my entire time on the unit—because embarrassing situations are also emotionally intense situations. If I said something, I might say something wrong. My first attempts at dealing with embarrassment, I knew, were likely to be clumsy, so I didn’t make them.

Only later did I realize that there was an answer. Some of my patients were marvelously socially skilled. Whatever I’d said to them, they would take it graciously. They would have given me the practice I needed. Then I’d have the confidence to speak in touchy situations where it really mattered, as with Min. 

Again, that’s where a senior nurse mentor would have helped. Asking the nurses I was working with what to say would have been an admission of weakness. I was too proud to do that. These were people I had to work with every day. But a senior nurse mentor who was only occasionally around would be different. I could afford to appear confused and clumsy in front of her. I know that because I never had a problem asking questions—even stupid ones—of the nurse specialists who passed through the unit on their rounds.

Now we look more closely at that summer surgical rush and its complications.