My Life As A Male Nurse. Geriatric nursing: CODE BROWN.

When the hospital administration decided to close the operating room due to the need to cut back on expenses, it was quite devastating to me.

I really enjoyed the surgical patients. They were people who had correctable problems - most of the time.

They were admitted, medically worked up, had their surgery, recuperated post op and went back to their homes to continue their lives in better health than they came into the hospital with. It was very rewarding to be part of that process in their lives.

Now it would be gone, and those of us left behind either had to adjust to medical problem patients, or other service departments, or find employment elsewhere.

Administration decided to open a different kind of unit.

One with a vastly growing potential in the field of geriatrics. This seemed to be the most promising financially. After all we were reaching the age of "the bottom line" (net profits) being the motivating mentality in this country.

The rapidly growing societal group of the elderly population, and their many problems, could be exploited; and showed the greatest potential for monetary growth in the medical field.

The impending growth of the "baby boomer" geriatric population looming on the horizon, coupled with the increasing diagnosing of Alzheimer's disease, looked like the best bet at the time.

And thus it began.

I was proud to be a part of this new unit, as it would eventually be affecting my family members and myself somewhere in our futures (hopefully not the Alzheimer part).

When i was asked to lead the way, in the nursing aspects of this new unit, i was proud to be part of the team in this great new adventure.

We were converting our beloved surgical unit to one called the "Geriatric Admissions and Assessment Unit".

The "team" consisted of a Psychiatrist (who was in charge of research and treatment), the Medical doctor, A Social worker, Nutritionist, Physical Therapist, a staff of nursing assistants, specially trained in the care of the elderly, staff nurses, and of course myself who would over see the nursing care of these patients.

These patients were referred from community agencies and family members who were unable (or unwilling) to care for them at home any longer.

They required more care with personal hygiene, with safety issues, medical and medicinal issues, than the families could provide.

We would admit, assess, treat as needed (medically and mentally), and then place them in an appropriate facility or other setting on an individual needs basis.

It was a challenging and rewarding experience for all of us who were all in the process of learning as we go - "on the job training", so to speak.

My job was to over see the nursing needs, and provide adequate staffing for all shifts.

Besides that, i did the admission assessments (based on family history, physical assessments, mental acuity, labs and other tests, and family member input).

Since all of my staff were there by their own choice, instead of being 'assigned' to this unit, they gave as much of themselves to this process as possible.

We had a 28 bed capacity on this unit and it was not long before they were filled to capacity. This societal problem was much greater than any of us ever anticipated.

Everyone managed to keep their perspective, and professional attitude, in spite of some really "challenging" patients who had to be watched at all times - not unlike a mother with several small, highly energetic and active children, always getting into some sort of mischief.

I guess the term "second childhood" was most appropriate after all.

It was an ongoing challenge but we all managed to maintain our professionalism and our sense of humor, as well as a positive attitude toward life and its longevity in general.

This field can be rewarding, disturbing, and amusing at times.

A look into our own futures? It's All part of life.

Some of you may find this next part somewhat "gross" or disturbing, but is was one of the strangest things i, or my staff, have ever seen.

We have recounted this story a hundred times over the course of the years. Our first encounter with the dreaded: BROWN CODE.

This old gentleman was admitted; confused, disoriented, extremely agitated, restless and extremely uncooperative.

I had to assign 'one-on-one' staffing to him around the clock to prevent him from injuring himself, or others.

His abdomen was extremely hard and distended (swollen). X Rays showed his bowels (intestines) to be filled with feces from top to bottom.

We have approximately 20 feet of intestines from the stomach to the anus (rectum). He was vomiting brown foul fecal smelling liquid backup from the bowels. The medical doctor decided to try to move the blockage forward with the use of suppositories that promote bowel peristalsis to see if we could avoid a surgical intervention.

The suppositories were administered shortly after everyone had their noon meals. [Thankfully]

Around 2 PM, one of the aides came running up the hallway looking for me. "you'd better come take a look at this now" she said with urgency.

We both ran down the hall and i saw this man standing in the hallway with his underpants, filled with feces, down around his ankles - (soft, brown, and extremely smelly feces).

He would not move even with prodding by the staff who tried leading him toward the nearest bath/shower room.

One of them said: "I think his intestines are coming out".

I went behind him to observe if this was possibly what was happening. He had what looked like it could be a piece of intestine hanging down. I had seen rectal prolapses in the past, but never covered entirely with feces.

I put on some surgical gloves and got closer to get a better look.

I gently touched the protrusion and moved some of the fecal material away with my fingers to get a better view.

It was not intestines after all, it was a piece of gauze. The type that comes in a roll and used to wrap surgical wounds on arms and legs. I gently tugged on it to determine just how anchored it was. Then it started spontaneously being ejected on its own volition - several feet of it.

We just stood there in awe.

I told one of the staff to go close the entrance doors, to keep any early visitors out of the area and close the doors to the patients rooms so no-one would be interrupting us, or bothered by the smell emanating from the brown pile on the floor around his feet/ankles.

After all the gauze was ejected the stool was unstoppable. It took several minutes, but his stomach could be visibly observed getting smaller as the pile around his feet got deeper.

When it was over, he was standing in this pile of feces, literally up to his knees.

The clean up process was horrendous and i would have given all the staff members a giant bonus if i had the power to do so.

Apparently he had somehow gotten his hands on a roll of gauze before his admission and somehow managed to swallow it whole.

Surgery was avoided, but we all could just visualize opening this abdomen on the surgical table in the middle of a sterile procedure. I don't think he could have survived the explosion. And i know the operating room staff would never have gotten over the eruption that would ensue.

There was a community church that had a volunteer group of elderly ladies that would come to our unit with sandwiches and snacks for our patients who were allowed to have them.

One day, i came around the corner of the nursing station and saw these elderly volunteer ladies down at the far end of the corridor.

I always assigned a staff member to accompany them so they would not give the wrong type of food snacks to the wrong patient.

I did not see a staff member present, so i quickly went down the hall toward them.

They were approaching the same patient mentioned above, who was sitting in a geriatric chair with a table in place in front of him. His 'one on one' staff member was sitting by his side and did not see the elderly ladies approaching him from behind her. They approached with their box of sandwiches and snacks extended in front of them as if to let him pick out a snack for himself.

I was rapidly approaching [running toward them] and saying "excuse me" to get their attention.

Before the aide could stand up to intervene, the patient attempted to stand up with the table in front of him and the chair lurched forward - his hand reaching out for the box of goodies and knocking the whole thing onto the table in front of him and on the floor around him.

It was hysterical to watch this comedy of errors.

He grabbed a banana and a sandwich and shoved them both in his mouth at the same time.

I got the sandwich, still wrapped in cellophane, out of his mouth, but the banana with the peeling still on, was gone - lost somewhere in the deep recesses of his stomach and intestinal tract.

Thank goodness it was only food stuff, and the peeling would probably not be a threat to his health.

The old ladies were totally freaked out, and all but ran down the hall and onto the elevator - never to be seen again passing sandwiches and snacks out on this unit.

I had not wanted them to be doing this in the first place, but 'administration' gave them the OK, saying it would be 'good for public relations'.

Not so much.

by: d.william 02/09/11