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November 06, 2004

A lesson in nasty.

WARNING: Do not read this if you are prone to bouts of nausea, seizures, fainting or head spinning around with projectile vomiting when grossed out.

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Ok, I know yesterday's post needs some kind of explanation. I spent my normal Friday observing a hospice nurse doing various home visits in the area, but this day turned out to be particularly stimulating of the senses. Usually I have a pretty strong stomach. Not much makes me queasy anymore (unless it's something I have eaten, in which case everything makes me queasy). Poop. Pee. Vomit. Blood. Nursing homes. All of them mixed together with sprinkles on top. My nose has become desensitized to every smell you can imagine. Except for one. And this one is a doozy.

Nurses talk about the "thing" they have that puts them over the edge. The one smell or sight that makes them want to run out of the room and puke until their shoes come out of their nose. For some people, it's the sound of mucous being suctioned from a trach, for others it's the sight of a wound that needs to be dressed or a central line being fed in through a large vein in the arm.

For me, it's pressure ulcers. Otherwise known as bed sores, or if you want to get technical, a decubitus ulcer. But it's not the sight of them, it's the smell. Pressure ulcers are staged based on how deep they are, and how much of the surrounding tissue has died. They happen when people have been immobile or in one position for too long, which can occur during a long hospital stay. Christopher Reeve just died from a septic infection due to a Stage IV pressure ulcer. A stage IV means that the skin has opened up and has rotted away all the way down through the fascia and underlying tissue.

Yesterday, I experienced my first Stage III pressure ulcer. As we turned a patient to change the dressing for the sore, a wave of thick, putrid odor just about rose up and slapped me in the face. At first I couldn't figure out what it was. Is there poop somewhere I don't know about? But it doesn't smell like poop really. Have they not cleaned this patient in a very long time? Am I just being a stupid? But then it hit me.... it was the smell of rotting tissue. I immediately closed my eyes and waited for that moment where my smell receptors get so overloaded with the molecules of a particular scent that they don't respond to it anymore... but that never happened. The second wave hit and I broke out into a cold sweat and thought I was going to pass out.

After about 5 minutes the dressing was changed and I recovered, but I couldn't get the smell out of my nose. All day. I spent the rest of the day with a bad case of the heebie jeebies, and totally paranoid that I reeked of this horrible smell.

Bahhhhhhhhhhhhhhhhhhhh.

Things people don't tell you.

For future nursing studentees, just remember to keep breathing.

Or, in the words of Dori the fish.... "Just keep swimming swimming swimming!"

Posted by missfitsandstarts at November 6, 2004 05:51 PM

Comments

eeeewww.... I would have run from the room, I think.

How come these things develop? Are these people negelected by their caregivers? That sounds so awful and must be incredibly painful!

Posted by: frecklegirl at November 7, 2004 07:16 AM

Sometimes they can be prevented. A lot of effort goes into educating patients and caregivers about making sure they are turned and weight is taken off the area, that moist heat is applied instead of dry heat (like a heating pad) and other measures. Even with the best care, if a person has been in bed for months, and if they haven't been eating a lot and their body can't use the energy to make new skin and repair the damaged parts, it can be inevitable.

Posted by: Miss FitsandStarts at November 7, 2004 07:57 AM

OMG> I know the smell you are writting about. and yes it is one that stays around for days, I take care of a lady that has a stage IV pressure ulser. She had got it when she was in rehab for a hip replacement. she came home with a stage III. I was told that her Step daughter didnt think she needed assistance with her personal care, and allowed her do care for herself. Well, she was left wet, and her pressure sore grew to a stage IV, When I started careing for her I was horrified to see her spine. I have seen alot in my days doing home care and being a cna for quiet a wile now. But this was the first for me. I feel that this is uncalled for! It only takes a day or so for a pressure sore to develope, and it takes month's and month's to repair the damage of what only took hours to create. I have put in alot of time with my pt's pressure sore. and I have learned alot about wounds care. its so sad, This lady that i care for didnt have this wound, she would be back her old self by now, instead, she is depressed, and cant do much because of other problems that are popping up due to the depression. I try to keep her smileing. She is a great lady, and this is not fair for anyone to have to go through. :-/

Posted by: Janet at December 3, 2004 11:43 PM