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Views: 776 Created: 2 years ago Updated: 2 years ago

Alan’s Dormitory Medical Care

Alan Becomes an Inpatient

As Alan lay on the gurney, Sarah was on a nearby phone in a rapid fire serious conversation that consisted mostly of short one word answers, “Yes. OK. …. Alright, we will be there in a minute.”

When she got off the phone, she said nothing to Alan as she started wheeling him at a noticeably more rapid speed down the corridor until they stopped at an elevator. Sarah gave the button a few impatient pumps with her fingers. Once they were inside, Alan pleaded with her for an explanation of where they were headed.

“Just upstairs. The step down unit. They have a room waiting for you. Dr Young will be there to check you out and we’ll go from there, ok?”

Of course it could not be okay to Alan with so much uncertainty. The urgency and seriousness of the situation where readily apparent to him despite him not fully understanding the details. “What’s the step down unit?”

“Not quite intensive care, but you’ll get constant close attention and monitoring there.”

When the elevator stopped and they got off, it was a brightly lit hallway area with a bustling nurses station right there. In a few seconds two nurses were standing next to Sarah looking down at Alan, “Hi Alan. I’m Liz and this is Melissa. We’ll be taking care of you while you’re here.”

They turned to Sarah and pointed to a room off the hallway. Small and square with clear glass separating it from the hallway area, it contained a single bed with a bank of electronic monitors above the bed. A half dozen cables and tubes dangled from these down to the head of the bed.

The three of them quickly had Alan moving from the gurney to the bed. He awkwardly tried to keep his gown covering him as he scooted from one to the other.

Liz and Melissa started hooking him up the monitors. A clothespin-like pulse ox went on one of his fingers and a cool fabric BP cuff was wrapped snuggly around his arm. Liz started powering up the monitors and there was rapid succession of beeps. The cuff on his arm started inflating and squeezing him.

Melissa popped a thermometer under his tongue and was standing with the temp monitor in her hands when Dr Young entered the room, “Hi Alan. Looks like you are going to be with us for a while. The procedure caused a perforation of your bowel — an uncommon complication. I’ve reviewed your X-rays with Dr Gordon. She is a colorectal surgeon. We are both cautiously optimistic that since it appears to be a small hole and you are young and healthy, it may heal quickly enough without surgery, but we will need to monitor things very closely for infection. You will go to surgery immediately if we suspect one is developing. You’ll also be started on antibiotics to reduce the chances of that happening.”

Dr Young turned to Melissa, “If his temperature rises above 100.0F, I am to be paged stat as is Dr Gordon. Accurate temps are critical, so they are to be taken rectally every hour for the first 24 hours. Other than that, nothing is to go in his rectum — no fingers, no suppositories, no enemas. Just the thermometer. Understood? Clear fluids only and bed rest.”

The serious terse orders delivered by Dr Young confirmed for Alan that he was in a serious predicament. He could feel his lower lip quiver as he contemplated the prospect of needing surgery. Dr Young quickly insinuated herself to the left side of the bed and had the sheet down and gown up in a flash and then auscultated Alan’s abdomen. He tried to slowly easy up the sheet to cover his genitals. Dr Young then began palpating, “Any tender areas? Tell me if anything hurts.”

To Alan’s relief, nothing hurt. In fact, he found Dr Young’s touch somewhat soothing. He would have preferred Sarah to be examining him, but at least she was there at his bedside.

“Good. A benign abdominal exam. Assuming you have no fever, then we have no signs of a peritonitis developing so far.” She was out of the room and Alan covered back up. Liz followed her to review the orders.

Melissa changed the plastic cover on the thermometer probe and then looked at Alan, “You heard the doctor’s orders my dear patient. I need you to turn onto your side for me and bring your knees up some.” After she said this, she grabbed the curtains near the wall behind Alanof the bed and whisked them around the bed. This enclosed Alan, Sarah and Melissa in a more intimate space. “Do you want me to have Sarah step out for a minute for this?” Melissa asked.

“No, she can stay.” If Melissa only knew what Sarah had witnessed and done to him, Alan thought.

Sarah did not know whether Alan’s acquiescence in her presence for his rectal temperature taking was a heartening acceptance of her role as his special care giver or more a result of him being terrified of his predicament and a need to have the person he knew best be present with him. She moved to the side of the bed opposite from Melissa and sat in a chair facing him. When he rolled onto his side with his bottom toward Melissa, he and Sarah were face to face. Melissa put some purple exam gloves on and then pulled away the layers of fabric exposing his bottom fully. She lifted his upper buttock and was about to insert the thermometer, but hesitated, “You look pretty irritated and sore Alan. I’m going to get some petroleum jelly for your bottom. It will be soothing and a better longer lasting lubricant. If we are going to do this 24 times over the next day, it’ll make a big difference.”

Melissa left and was back in a few second with a small foil packet that she tore open and then squeezed a dollop of the jelly on to her index finger. “Okay, just on the outside.” This was supposed to reassure Alan, and it did a little. Alan felt the slippery tip of her finger gently smear the slippery goo onto his anus. He then felt the slight tickle as she accurately found the very center of his anus with the thermometer tip. Once the thermometer was at the appropriate depth and Melissa let go of it, he could not even sense its presence, inured as he was from what had been done to him earlier in the day. He had been looking at Sarah, but closed his eyes when he felt the penetration. Seeing this dejected resignation, Sarah leaned forward and stroked his hair in silence. He understood that she understood. Alan counted the young women who had seen or touched or penetrated his most intimate place today. Five. Still embarrassing, but hardly anything could shock him anymore.

Melissa had covered him over with the sheet and rested the hand held unit on the bed with its spiral wire snaking under the sheet to Alan’s behind. When the beep came, she lifted away the sheet and parted Alan’s buttocks and removed the probe. “Ninety Eight point 8. So far so good. Don’t cover up yet. I was a little too generous with the petroleum jelly, let me wipe a bit away or you might slide right out of bed!” She gently dabbed away some of the lubricant with a tissue and then let his buttocks spring back together again. He pulled up the sheet himself before Melissa had a chance to and he flipped back over onto his back.

Melissa took off her gloves and announced it was fifty eight minutes until the next time she would take his temperature, but she’d be back shortly to start his IV and get his antibiotics going.

Once the two of them were alone, Sarah reached out to hold Alan’s hand and stood to look down at him in the bed, “Alan, I’m so sorry this happened. I know you went through all of this today following my advice. Its so rare for a young healthy person to have this complication. I hope you understand I got you into this because I was worried about you and I thought it was far more likely to help you than to hurt you.”

“Its okay, I don’t blame you for this. I can tell you’re trying to help me.” He looked into her eyes for a few more seconds then closed his eyes again and the two of them remained quietly there holding hands until the squeak of Melissa’s sneakers on the tile floor announced her approach. Sarah tried to pretend she was checking Alan’s pulse by shifting her fingers to Alan’s wrist, but Melissa was not fooled, “Is the pulse ox accurate Sarah?” She motioned wit her eyes to the monitor over the head of the bed with Alan’s pulse rate of 75 in bright red LED’s. Sarah was caught off guard and was at a loss for words, but Melissa quickly eased the tension, “Sometimes the touch of taking the pulse the old fashioned way can be therapeutic as well.”

Melissa set out her supplies on the table. “Have you had an IV before, Alan?”

“Once. A long time ago”

“OK, so you know — not too bad, just some discomfort when I put it in.”

She put a tourniquet around his arm and began inspecting and feeling the veins on the top of his left hand.

Sarah watched. She caught sight of the color coded package of the IV catheter. Pink. She quietly spoke up, “Eighteen gauge on the hand? Ouch!”

Melissa responded in a tone that acknowledged the unpleasantness, “Well if things head south, we’ll need wide bore access. If he winds up in surgery and he only has a 22G in place, they will not be happy. I’ve been screamed at by Dr Gordon once, and believe me, once is enough.”

Alan was not sure what exactly they were discussing. As Melissa prepped his hand, he felt the coolness of the alcohol and got a whiff of the vapors. When he felt the pain as she inserted it, if felt more like she was tearing his skin rather than piercing it and he drew his breath in abruptly. She nailed it first shot. Sarah was impressed as the blood return showed in the tubing almost immediately. In a few seconds, Melissa had the tourniquet off, the main tubing connected and the fluid flowing. She had pressed a clear plastic adhesive sheet on the site and was already cleaning up. Alan could already feel a subtle coolness extend up his arm as the solution flow up his vein.

Sarah felt a frisson as she watched Melissa. She loved to see someone perform in medicine with speed, skill and confidence, especially if it was a nurse or a female physician. It restoked her burning determination to excel at her chosen profession. Melissa smiled when she noticed Sarah intently watching her. She was not showing off, but when one is good at something, having an audience that can appreciate it is gratifying.

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