Critical Care by Theresa Brown

Critical Care by Theresa Brown

Author:Theresa Brown
Language: eng
Format: epub
Publisher: HarperCollins
Published: 2010-06-13T04:00:00+00:00

SEVEN

Openings

My patient that day was young enough that I thought of him as a kid, although nothing about his mien, or the physical ordeal he had been through, was at all childlike. He had a biblical name, Abraham, that went well with his history. He’d had a small abdominal tumor he spent a year trying to heal with prayer. During that year his tumor grew so large that the pain eventually drove him to the emergency room. The surgeons operated to remove it along with part of his bowel, which left him with a colostomy and a large abdominal opening. The tumor had been big enough that, paradoxically, once they took it out, he didn’t have enough skin to suture the opening back up again.

I’m not sure why, but I liked him, even though most of the nurses on the floor thought he was a pain in the neck. He wanted his IV lines arranged just so, his pills given in a certain order, his table at a specific angle relative to the bed. He refused to have vital signs taken during the night, and some of our nurses found this an unacceptable health risk, or an unacceptable challenge to their authority, or both. They and he kept up a guerrilla war of insisting on and refusing vitals and arguing over where the IV pole and the table should be. When he got particular with me about aspects of his care, I just sassed him right back, and he took the teasing OK.

I felt sympathetic. Here he was, in his early twenties, with a colostomy, a gaping wound in his abdomen, and a struggle for his life that had been made much harder by the year he spent delaying treatment. He had tried to control his illness with prayer, and that choice had been a complete failure. Now his disease—and the inpatient care that disease required—controlled his life to a degree he found intolerable. So he wanted his table positioned a certain way, his pills doled out according to his specifications. There are patient quirks that drive me crazy, but Abraham’s I seemed to understand intuitively, though I couldn’t put my finger on what about him or me made that understanding possible.

His abdominal opening had been packed and dressed by the wound care team at the hospital, and I wasn’t supposed to mess with it. For complicated surgical wounds, this special team sometimes does all the care—floor nurses on medical floors just don’t have the expertise to use the available high-tech dressings and bandages the right way. His abdominal opening had been covered with a wound vac, which is about as high tech as wound care gets. The wound vac requires that special highly absorbent, dense sponges be placed in the wound. Then an airtight dressing gets put over the sponges, and part of that dressing connects to a small machine that sits by the bed, plugged into the wall, generating mechanical suction. The sponges draw up moisture from the



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