I wasnt alone in thinking that it should be left in; all the nursing staff agreed. But the doctor didnt even budge when the charge nurse stepped in, and so the catheter was taken out.
The next day Mr Groom began to have some problems.
As predicted, he was not managing with a urine bottle.
Even after the previous days shower, the smell coming from Mr Grooms lower regions was getting bad again.
Michelle was the nurse assigned to Mr Groom this shift, so it was up to her to deal with Dr Grey, but I was by her side when she confronted him.
Can we put another catheter in? Michelle asked. The doctor hesitated a moment, then looked at me, almost for confirmation. I nodded my head, and Dr Grey consented.
Of course, Dr Grey was not going to replace the catheter, because that was the nurses job, and so that fell upon my friend Michelle.
I have known Michelle from my training days; she is a pretty blonde with a ready smile, a quick wit and a habit of over-dramatising things. Off she went with catheter in hand and the faithful rubber gloves. She came back from Mr Grooms room 15 minutes later.
Can you lend a hand? she asked me, a blush touching her cheeks. Im having a bit of trouble.
Trouble? There shouldnt be any trouble; hed already had a catheter so there shouldnt be any obstruction.
Sure, but what sort of trouble are you having? I replied.
I cant find it, she told me.
Find what exactly? The right equipment or the right size catheter?
Michelles face went red.
No I cant find his penis.
With this statement, Michelle began to giggle. I walked back with her to Mr Grooms room to see if I could sort things out.
Whats the matter, doc? Mr Groom asked me as I walked in the room.
Mr Groom couldnt see what was going on because he was lying almost flat and his stomach was in the way.
I didnt know what to say. I couldnt tell him that Michelle was unable to find his penis.
Nothings wrong, I lied. Michelle just needs an extra pair of hands.
I quickly put on some gloves and got down to business.
The penis wasnt there there was absolutely no sign of it. Mr Groom was so overweight his penis seemed to have been sucked up into his belly. There wasnt even any sign of a scrotum. I glanced at Michelle who was redder than a beetroot and refusing to make eye contact with either me or the patient.
Can you try pushing a bit over here? I instructed Michelle, as we tried to coerce the thing out, by pushing on his bladder while I dug my fingers into the crevice where his penis should be.
Hold this bit for me, I instructed Michelle, as she used one hand to hold back his stomach.
No matter how hard we tried we couldnt find the penis.
Whats the problem, doc? Mr Groom asked me again.
He didnt sound worried, just curious. Its just as well he couldnt see past the roundness of his belly because he couldnt see either my or Michelles face. Michelle looked like she was having a spasm her shoulders were shaking from trying to repress a dose of the giggles. I felt like slapping her, not just because it was so inappropriate, but because it was infectious. Nothing in my training had prepared me for this. But I was not going to let Michelle contaminate me.
I had to answer Mr Groom, but my mind struggled to come up with an answer that would not take away any last remaining shreds of dignity that we had not already stripped. I finally settled on a reply.
How do you usually pee? I asked as casually as I could.
I just feel around for it a bit, Mr Groom said, but I cant find it lying down, and when I need to pee, I cant stand up quickly enough.
It all sounded very reasonable but his answer made me think.
When you say you feel around for it, does that mean that you dont actually see your penis?
There, Ive just humiliated the man completely, but it might make our job easier if I know what were up against.
Havent seen it in a few years, he admitted, then fell silent.
Not wanting to admit defeat I went in again, while Michelle pushed down on his bladder with one hand while holding up his stomach with the other.
The conversation and situation were too much for Michelle and she began to cough, a cough which sounded suspiciously like a chuckle to me. She raced from the room, saying she had to go to the bathroom urgently. I told Mr Groom I was going to get the doctor and walked into the office to find Michelle red faced and worried. Do you think he noticed? Michelle asked me. I could see Michelle was feeling guilty for not being able to keep away the giggles, so I reassured her shed done the right thing by leaving the room, and that I was sure he hadnt noticed.
Eventually, we called the doctor and between the three of us we managed to find his penis and insert the catheter. The doctor was subdued and to his credit looked guilty while Michelle and I were just relieved we could keep a straight face.
Mr Groom was eventually discharged home; he weighed 30 kilograms less and felt like a new man.
Youve done good for me, doc, and dont be too hard on yourself, it was pretty fucking funny.
Beware of toilet
One of the challenges of nursing is that you are constantly encountering new things. As a young nurse in my first year of work, everything was new. But there is one particular first experience that I will never forget.
Mr Smith was 82 years old. If he could have had it his way, hed still have been living independently in his three-bedroom house with his quarter acre of land. His children and grandchildren, however, had convinced him that the best and safest option was for him to move into a small apartment that was part of a rest home a nice balance between independence and supervision. But, after forgetting to turn off his stove several times in two weeks, Mr Smiths meals were now cooked for him, and after a fall getting out of the shower, he had an aide who helped him with his bathing. Still, other than that, Mr Smith looked after himself, which is pretty independent for an 82-year-old man.
Mr Smith was brought into the ward at eight oclock on a Sunday evening. His chest was heaving as he strained to pull air into his lungs; you could hear him wheezing, coughing and spluttering from outside his room. Mr Smith had been a bit off-colour for nearly a week. What had started out as a mild cough had gradually stained his handkerchief with white, then yellow, then green and now red speckled sputum. The infection had crept insidiously into his lungs, spreading lower and lower like a cancer. The nurses from the rest home had advised him to come to hospital earlier, but like many men in his position, he was stubborn and refused to move. By the time he agreed to go to hospital, he didnt really have a choice: it was go to hospital, or die.
I liked Mr Smith instantly.
Im only being a burden; just put me out of my misery, he said between gasps.
He even managed a brief smile. It says a lot about a persons character when they can joke at a time like this.
I told him to stop talking rubbish; that once the medicines kicked in he would be feeling much better.
Forty-eight hours of intravenous antibiotics later, and Mr Smith was rapidly improving. He could speak whole sentences without getting out of breath. He was not coughing up so much sputum. He even managed to get himself up out of bed and into the reclining chair.
Watching your patient get better, knowing that you are one of the people responsible for making the difference, is one of the greatest feelings in the world. Though, while Id love to be the one to take the credit for his progress, its always a team effort. It wasnt only a matter of antibiotics fighting an infection: nurses cleaned, dressed, toileted, exercised and talked to the patient; the physiotherapist came in twice a day to exercise his chest; the laboratory and X-ray people visited daily to draw his blood and irradiate him.
Between us all, I was sure we would get Mr Smith back home.
It was Wednesday, Mr Smiths fourth night in hospital, and he and I were discussing the merits of a commode versus a regular toilet.
Like most patients, Mr Smith had never liked using the commode, but up until now he had been too sick to risk taking too far from the bed. I wont sit on that disgusting thing again. There are other people in here and it is embarrassing.
He had a point: theres no way to completely hide the smells and sounds that go with taking a dump in a shared room.
Im not using it and that is final. Mr Smith was adamant, and began to get out of bed. You could try making yourself useful by handing me my walking stick.
I had a vision of Mr Smith collapsing in the middle of the corridor: Please, wait a moment and Ill grab you a wheelchair.
To make things easier, I used a portable shower chair, so that once I had him seated I could just roll it straight over the toilet and he wouldnt have to move one bit. As I wheeled him down the corridor I noticed he was still wheezing, not nearly as badly as he had been on admission, but I still set him up with some portable oxygen to help things out.
Naturally, I wasnt keen to leave Mr Smith alone, so I waited discreetly outside the partially open bathroom door, calling out every 30 seconds, Are you okay in there?
To which he responded, Cant a man take a crap in peace?
But on my fourth call, Mr Smith was silent, and then I heard a thump. My heart leapt into my throat as I rushed in.
Mr Smith was still sitting in the chair, but he had slumped against the wall with his eyes staring sightlessly ahead. His nose and lips were a bluish purple, and darkening before my eyes.
This was it: my first arrest.
Id actually felt a little envious of fellow student nurses who had been involved in an arrest during their training. Id also heard experienced nurses casually talking over lunch break, Oh yeah, Mr Brown, he was in VF and we shocked him a number of times; we got lucky he pulled through.
But this wasnt exciting like Id imagined. I couldnt ever envisage casually discussing this over a sandwich. This was a nice old man whom I liked and who seemed to like me. A man who had been getting better.
An arrest can refer to arrested breathing, or an arrested heart. In Mr Smiths case, he definitely wasnt breathing, and if his heart hadnt already stopped, it would very soon.