In June, the complex orthopedic surgeries began. Perhaps because I was the only guy on the nursing staff, I spent much of that summer alternating between the two clusters with boys or girls who’d had those surgeries. I had more strength to move them in bed or to steady them while walking to the toilet.
The boys were in a four-bed room on C cluster. Their surgeries were often self-inflicted and due to sports injuries or motorcycle accidents. That sometimes meant traction, which left them even more dependent on nurses and hence unhappy. Those who could walk, ever so slowly, to the restroom worried me most. Some were football players so large that, if they’d started slipping, I wasn’t sure I could keep them from crashing onto our hard linoleum. I decided that I had to be quick to stop a fall before it progressed too far.
The girls were in a four-bed room on B cluster. Their surgeries were often to correct excessive twists in their spine. Even the thought of what that involved—placing two steel rods alongside their backbone and changing how muscles and tendons connected—gave me an enormous respect for them. They were brave.
Their surgeries could last for as long as eight hours. Afterward they typically lay on their back for weeks, occasionally moving from side to side, but unable to sit. That left them dependent on nursing care, which often meant me. If one of those girls had asked what my work responsibilities were, I could have answered, “Everything you find embarrassing.” All too true.
The crisis came with my first assignment to those girls B cluster. Within minutes, I realized that they and I were in a complicated situation. None had a scrap of clothing under their flimsy gowns.
At first, I blamed the nurses I worked with: “Can’t they dress these girls better when I’m around?” Only later did I realize it wasn’t their fault. The girls themselves were making that decision. Boys and girls are different. Boys wore their undies with an almost religious intensity because it didn’t cause any problems for them when they used urinals. For girls, undies make bedpans a major hassle.
That’s why in Hospital Gowns I tell my teen readers one of the unfortunate facts of being a patient. In an hospital, I write, you have to deal with three great ills—pain, hassle, and embarrassment. Often you can eliminate only two of the three. You have to endure the third. These girls considered the hassle of bedpans with undies worse than the embarrassment without them.
Initially, I didn’t understand that. My first day of caring for them was like my first days on Hem-Onc, but with embarrassment rather than pain as the central issue. That dread First Fear had returned.
To make sure I made no mistakes, I adopted a role-playing attitude much like I did when caring for dying children on Hem-Onc. With dying children, my chief fear was that I’d withdraw, make my visits to their room as brief as possible, and not look them in the eyes or get close to them. Those are normal ways to act, but they’re the last things I wanted to do with a dying child who felt fearful and alone in the middle of the night.
So when I went into those children’s room, I consciously took on a special role and acted in a specific way. I made sure my visit wasn’t hurried no matter how busy I was. If I needed to talk with them, I’d crouch down beside their bed and look them in the eyes. I wanted them to know I’d be there for them to the very end.
I took a similarly careful role when I came into these girls room. I‘m a visitor, I told myself, so I need to behave as such. In that role, I did my best to win their trust.
I didn’t linger, although that mattered little. As needy as they were, they were two-thirds my work load. I created virtual privacy. As I worked with each girl, whenever possible I faced away from the others. That made it almost like I wasn’t in their room. Last of all, I always glanced away from something embarrassing and certainly didn’t stare.
Perhaps the only way I could have been less intrusive would have been to walk around looking down at my shoes and running into beds, chairs, and IV poles. That, I suspect, they would have found amusing and certainly unnecessary. As I soon discovered, these girls were willing to compromise. If I did what I could, they’d accept what embarrassment remained. They clearly wanted to continue living in relaxed, sunny Italy.
After I few weeks, I quit worrying that I’d make these girls as unhappy as the boys. The First Fear passed and I relaxed. Like the Hem-Onc kids, these girls would smile when I came into their room. This chapter opens with a picture of one of those girls, although she’s a later patient (note the winter coat) who had leg surgery.
But despite that personal success, I remained frustrated with how nursing handles embarrassment—primarily by pretending it doesn’t exist. I was angry because the techniques I was taught for bed pans and linen changes was ill-suited for some situations. Efficiency and speed were everything. Avoiding embarrassment mattered not. That I hated.
Over that summer, other problems resolved themselves. My more clever patients—in Hospital Gowns I call them the “sensible girls”—showed me techniques that worked as well as the official ones, took mere seconds longer, and were far less embarrassing.
That was a relief. Now, instead of being angry that I’d only been taught those speed-above-all-else techniques, I became angry that I’d not been taught alternatives. If you’re interested, you’ll find them in Hospital Gowns. They should be a part of every nurse’s training and used with opposite-sex patients. They really do work.
There was, however, one fear involving these girls that never left me. What I had first noticed on Hem-Onc remained true the teen unit. These girls varied enormously in their attitudes about modesty. Fortunately, I never had another patient as frightened as Min. In fact, I never had another patient who seemed frightened by me at all. I had learned to communicate that they were in control. That freed them to relax and make their own choices.
No, my remaining fear hinged on how some girls chose to game the system. When they needed something embarrassing, they’d wait until just the nurse was in their room and ask her. That’s where they were smart. If they’d asked while both the nurse and I were there, most nurses would have said, “Mike will take care of that” and dart away. Then that girl and I would be stuck with one another.
Since those clever girls were often among my favorite patients, I didn’t want that to happen. I was delighted that, as busy as they were, the nurses were kind enough to oblige them. But I also knew our evasion of the unit’s strict division of labor lay under a threat. During that period, the nursing administration was growing increasingly demanding and critical. The teen unit’s head nurse was one of the worst.
In a chapter of Hospital Gowns called “Overwhelmed Pala,” I illustrate just how bad the problem was. It happened just a few weeks after I’d clashed with the head nurse for “wasting time” with Dan.
Pala was a slender, fourteen-year-old girl newly diagnosed with leukemia much like Dan. On her second day, I assisted in a spinal tap by a resident so incompetent he failed to get fluid despite three attempts. He stalked off without a word, leaving me with a girl so traumatized, she had wet herself during the procedure. Her clothes needed changing, and that put me in a bind. My shift was about to end. I’d been behind before being asked to help with the procedure. I was now hopelessly behind. That might make my evening replacement angry enough to talk to the head nurse.
This clothing change would push me still further behind. I’d dealt with enough little kids on Hem-Onc who’d wet themselves to know that I had two choices. I could either change her quickly myself, or I could turn around and wait while she did it herself much more slowly.
I knew the former was what I was expected to do. Speed in everything was one rule in the hospital. Staff are not male or female was another. The head nurse would have no sympathy for this unfortunate girl with a fatal illness any more than she’d had for Dan earlier. But I knew that my turning around would be a kindness to a girl who’d been through enough in the past two days. That might be the only ray of sunshine she would get for weeks. I opted to risk getting yelled at. What were they going to do, fire me? By that point I was one of the most experienced assistants in the hospital. That seemed unlikely.
But there was another risk. Unfortunately, behind my willingness to avoid embarrassing Pala lay a danger that was never far from my mind. If our head-nurse-from-hell found out about that or a similar situation, she might get hot and bothered. She specialized in being bad tempered. It was perhaps her only talent. She might issue orders that all the embarrassing assistant work must be done only by assistants—meaning me. Of course, both the nurse and I would cheat. But those orders would complicate our little acts of kindnesses.
In fact, the nurses and I were already cheating on one order that came directly from physicians. When I first cared for a girl with anorexia nervosa, the nurse told me: “The doctors have two rules about these girls. First, never talk to them about food. Second, they can’t go to the toilet. They must use a bedpan.”
The nurses and I obeyed the first of those orders scrupulously. We ignored the second without exception. Given their self-starvation, the rule might make sense with some patients, but none of ours were that wobbly on their feet. In fact, one got so fed up with her treatment, she dressed in street clothes, walked out of the hospital, and found her own way home. For us, the bedpan rule seemed punitive, so we gave these girls a bed near the toilet and let them take care of themselves. I wasn’t the hospital’s only secret rebel.
Finally, to be fair, I should mention that behind all their bustle and assertion, the nurses I worked with felt much the same about their care of those almost-grown teen boys as I did about the girls. They didn’t like embarrassing situations either. On one occasion, a nurse asked me to assist her with placing a urine catheter in a paraplegic boy of about sixteen. I went along, wondering what there was for me to do. There’s wasn’t anything. She’d just asked me along to make herself feel better.
Another occasion was even more revealing. We had a tall and muscular young black man of about twenty who’d been admitted with a sickle-cell crisis so painful, his pain medication had rendered him unconscious. Probably because he’d felt hot on admission, he had not a scrap of clothing on—not even a gown. Thrashing about in his pain, he would kick off his sheets. As a guy, that mattered not. When I checked in on him, I’d simply place the sheets back in place and move on. No big deal for me.
Ah, but in a remarkable display of stupidity, I got ticked off at his nurse. “He’s getting a huge dose of morphine,” I thought. “She should check on him more often.” Yeah, like she really wanted to do that. If I’d had any sense, I would have put an adult diaper and a gown on him for her sake. Unfortunately, that thought never came to me.
That’s where a senior nurse mentor could have served in a useful role, making female and male staff aware of the embarrassing complications the other was experiencing. She could had even held a candid discussion on the topic with nursing staff, something the hospital’s staid administration would have never in a million years have considered.
Next, we look at the role that avoiding avoid controversy played in my silence.