Ode to taking a crap

Let's call him Brian. He is 66 years old - and was born with cerebral palsy. He has been admitted to our hospital twice in the past two weeks - both times for abdominal pain. He is no more than 4'11 when stretched out, but probably about three feet in length as he lays in the bed, his legs contracted and bent perminently towards his head and his hands unable to strighten, perminently bent at the first knuckles. He is unable to bend and maneuver his thumb, which renders him unable to push our non-handicap-friendly call bell to let the nurse know he wants to chat. He has charcole gray hair and a beard.

Chatting. Brian loves to chat - but cerebral palsey has rendered him unable to do that easily as well. His tounge, which seems too large for his mouth and without muscle control to create words, does not serve him well. He has no teeth ("they pulled them - rotten.") He explained to me one day, as I guessed over and over at what he was trying to say. Regardless of the gravity of his words ("I have pain." and "Why me?") he always shows a huge smile when someone finally guesses his words.

Brian is smart - as he explained to me the first day I worked with him - "My brain" (he said over and over, pointing to his head) "Is just like yours. But I can not talk." "That must be so frustrating," was all I could say. After the 15 trial and error attempts - I am surprised by the cleverness of his words. He stops at nothing to tell a good joke. Even a knock knock joke (which was a tough one, being all about timing...) When explaining to him why I was giving him another brown plastic cup of lactulose (a nasty, orange flavored laxitive), I said "Bottom line - you need to poop before we can let you go home. We think your pain may just be constipation" He responded in his mumbled way, which sounded like "I aaaa caaaa". I made guess after guess. Finally he rubbed his thumb against his fore fingers. "I'll pay cash?" I guessed. His eyes crinkled up at the corners and he gave me a huge toothless grin.

Smart alack.

When I came in on Tuesday, a week after he had been admitted, no progress had been made. His pain was still there. He had not pooped. And the doctors seemed to have all but forgotten. He was discouraged, as was I. "I'm fed up." He kept saying. At one point in the afternoon, after giving him another does of morphine and paging his doctors (conflictingly, because morphine constipates), he told me that he wanted to die. I heard him clearly the first time he spoke - but did not want to repeat it to ensure I had heard correctly. "Brian - what can I do to make you feel better. I know we are going round and round and you feel discouraged. "I want to see a shrink," he said. His eyes looked sad. They did not crinkle when I guessed correctly. He just nodded. I went out to the nurses station and paged our social worker. No, she had not met him, yes, it sounded like he should talk to someone, maybe we should get a psych consult. "Psych consult?" I said. That takes at least a day. We need a referral. I want you to come in and talk to him." She didn't know if she had time. "He says he wants to die. He needs to see someone. Please come talk to him, at least explain the services we offer." She came up - and saw the patient. It was the least I could do. I then paged the medical resident. "he is not doing well. Please come up and see him. He is frustrated. He is sick. Things need to move forward. She promised to come up as well.

Being a nurse is gratifying for me in the same way that it is frustrating. If I advocate for my patients, the people with whom I spend 12 hours straight, things can happen. Decisions can be made and be pushed forward. I can speak for my patient who's tongue will not cooperate and run to the phone for my patient who can not walk. I can help him tell his story. But once I ask, I have very little further recourse. If the medical team takes their time, there is not much I can do but explain what is happening to the patient. I had to leave at 8 that night. The medical team had not come. I hope he is not still laying in the same bed, getting morphine. And hopefully he has taken a crap.