High Lithotomy

2 Jul

She’s here for his respite.
“She likes zoom zoom.“, he tells me. “ Like oatmeal, with other stuff in it. It’s hard to find. The brand name is Kruz, Krus…”
“Crusty‘s?’ I ask. I try to keep my face neutral. I reckon the brand might sell more if  regular people could pronounce the name. (Krusteaz; get it? )
On the menu today.
I have neither the nerve nor the heart to tell him she will not spring back to normal just because she is hospitalized. Maybe she spent much or even most of his childhood locked up in a psychward not as accommodating as this one. His parents met there, even.
I try not to think about his unfortunate genetic loading, or his sad,soft face with it’s puppy eyes and hopeful smile, and instead stare at my patient as if this alone could reveal why something is not right today.
He goes off, probably to work. Maybe it’s his lunch clutched in the red and white Target bag. I tell Pauline I’m gonna get her dressed. Her turn to stare. One time she said, “ Oh! You have scars all over your face!”  Since then, I haven’t liked her. She is able to scoot, stand, bear weight.
In the bathroom, her diaper is dry. I slip the gait belt around her waist. We walk slowly to the day room. I fuss with the remote, and after a time I find Drew Cary holding a slender mike, in a toupee. I leave her there to go tell Cindy.
“I thinks Pauline’s retaining urine. I need your help to make an assessment.”
She shrugs. “Get the bladder scanner.”
The scanner is not where I think it should be, in biomed. I am told to call Terrace East, then Garden East, and finally Main East, it‘s home, to where it must be returned.
I put Pauline back to bed. The scanner tells me, magically, that she has 681 mls in her bladder. This is better than 861, but not as good as 168. Penny tells me to call Dr. Shoddy and get an order to cath the loquacious old dear.
I page Dr. Shoddy overhead. I am not allowed to do this, so I  actually have to call the PBX operator to page Dr. Shoddy overhead. They are real snotty if asked to page anyone not an MD. Today, who cares? Shoddy doesn’t respond. I call his office down at Ryebread Ranch and give a clear message to his girl, but he still doesn’t call back. An hour has gone by. Penny comes out of the med room with a catheter in one hand, and a kit in the other. She is mad. She is busy, and Shoddy has ordered IV Gentamycin. Pauline doesn’t even have a line in. She tells me to come with her so we can “at least cath the patient!”
Cindy says, “You know, I don’t have sterile gloves on; because…I don’t get how we can maintain a sterile field with every thing that’s DOWN THERE.”
I have no gloves on. I offer to raise the bed. I turn on the lights.Cindy is trying to get Pauline to open her legs. We pull her knees apart, but her thighs remain locked. There is not nor will there be anything resembling a sterile field for the next half an hour.
We need more help so we call in Lynn, who looks alarmed but does as she is asked. Cindy’s poured Betadine all over Pauline’s privates. Try as she may, she can’t insert the catheter, 14 French.
“Cindy. That’s her clit.” She again tries to insert the thing under the hood of Pauline’s clitoris. Pauline is squirming and lets out a howl. The sweat is pouring off me.
Break. I ask Lynn to go get a flash light. When she returns, I have on gloves. Clean, but not sterile. It is Cindy’s idea to hold Pauline’s legs high off the bed, as if she were in stirrups for childbirth. We do tell Pauline what we are going to do. This is cursory, as we are talking about her as if she isn’t there, and frankly, it could be argued that she IS NOT. I turn on the flashlight and leave it on the bed between her thighs. Penny and Lynn, both big girls, are holding the patient’s knees apart by grasping the back of her thighs just above the knee, swinging her hips wide while her lower legs are off the bed, toes pointed downward, a position known as high lithotomy, but without the stirrups. I spread her labia with my left hand, holding the catheter in my right. Thank god for the Betadine, which has seeped into anything that resembles a groove. Her urinary meatus is just above her vagina, as it should be. Her old labia has folded over the opening like dusty drapery in a haunted mansion. I attempt to plunge the catheter tip there, but the first two tries end it up in her vagina.
“Put your thumb in her vagina; that way you can’t miss.” says Cindy.
I never knew that trick! On the fifth pass, I hit urine. It trickles out slowly, onto the chux. The bedpan Cindy brought to the room is on the floor, I think. She decides we need to inflate the balloon and leave the catheter indwelling. I take the 30cc syringe of water and fasten it to the lumen of the balloon. A tug reveals it’s not going anywhere. Pauline is quiet. Maybe it IS the UTI that is her most pressing problem. Proteus. Not susceptible to the PO Levaquin that Shoddy had her on for the past several days. Urine continues to trickle out. But we have no collection bag!
I strip off my gloves and run. It is so much cooler out on the floor! I have to scan my badge to leave the unit, waiting for the beep. I scan into the CDU and ask the first person I see to get me a urine collection bag. It is Natasha, the RN from Moscow who once told me, on a visit home, she dared not tell anyone she was a nurse, or she would not have been able to leave again. She took a job walking ponies in a circus for a few months. She is getting fat.
“Maybe she’s pregnant,” I think, as I race back to Basement Ward with the collection bag.
Once back to Pauline’s room, I fasten the collection bag to the catheter, not bothering to put on gloves. There is urine all over my hands as I work the cone shaped tubing tip into the floppy flesh colored catheter. I uncoil the rest of the tubing and hang the bag on the bedrail.
I wash my hands.
When I come out of the bathroom there is almost 300 ccs in the bag. The urine is the color of Earl Grey.
***

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