01 May 2008

Above and beyond

There are a few things in the field of Emergency Medicine that are unsavory. To put it mildly. Not long ago, I saw a homeless patient who had been living on the street for a long time. He was a heavy alcoholic, but to my great surprise, despite being a long-time undomiciled resident, had almost never been to the ER before.

He had run out of money and stopped drinking, so, predictably, he had a withdrawal seizure, which was witnessed and 911 was called and brought him to us.

I have a lot of experience taking care of homeless people. It's part of the job. I am very familiar with the obligate squalor that comes with living on the street and the attendant lack of hygiene. This guy was beyond the pale. It's very hard to explain the degree of filth this guy had. His several layers of clothes were all encrusted with god knows how many years of bodily fluids, old beer, vomitus, and general dirt. His long hair stood straight out from his head as if he had received an electric shock, and his beard was matted and fouled with small bits of food. The smell was horrible, and I was grateful that his presenting complaint did not require a more intimate examination. I was in and out of that room in no time flat.

Except that he decided to seize again. Oh well, back in I go, medicate him with an anti-seizure drug, and re-assess. While standing there waiting to see if he would seize again after the meds, I noticed that he had these little white bits of food in his beard, but also in his hair, which I thought odd. On closer examination, I realized that the little white bits were moving. They were bugs, though the type I cannot identify. Some were big and had wings, so they were not lice or maggots or fleas. Some were clearly lice. There were lots of them, lots and lots of bugs crawling all through his hair and in and out of his clothes.

(I'm itching now just writing this post. I'll bet in a minute or two you, reader, will involuntarily start to scratch as well.)

The patient was pretty sleepy after the medicine, so we left him there for observation to see how he would do. As I left the room I jokingly commented that he needed a "stat delousing."

Not long after, I noticed his nurse and a tech standing outside the door putting on protective gear. Lots of it. Gowns, hairnets, scrub pants over their work pants, masks, face shields, gloves. What we call the "full body condom." They went into the room and they stripped the patient naked. Disposing of his clothes, they shaved off his beard and all his hair, and scrubbed him head to toe with soap and lots of water. They covered his body with whatever medicated anti-lice lotion the hospital happened to stock, and they fitted him with new, clean and warm clothing from the donation box.

I was in awe. The "yuck factor" of this patient was off the scale, even viewed at a distance, and they spent an hour or more cleaning and delousing him, all on their own initiative. What they had to endure to accomplish that task was beyond my intestinal fortitude.

When finally they were done, I made it a point to express my admiration and gratitude in the most direct way I could -- I went down to the hospital Starbuck's and bought them their favorite drinks (white chocolate mochas). And I wrote an email to the hospital CEO and Chief Nursing Officer, praising their dedication to duty. Just incredible.

Nurses rock.


  1. Whether there's an official program for it or if I'm a coworker, customer, or patient, I look for an opportunity to give someone props to their management.

    I don't remember if it was your anecdote or someone else's about how ER staff rarely gets a thank you note after the fact (and cherish them when they do), but that inspired me to present my phlebotomists with a dozen cookies after a year going to them and not passing out once (pesky syncope.) In my case they were just doing their jobs, drawing blood and taking names. In your case - wow - there's not much more you can say than "Nurses rock."

  2. I'm married to one....yes they do indeed rock.

    It takes a special person to do nursing well.

  3. Wow, I'm glad you did something nice for them. I have to wonder if they were hating you the entire time they were doing that;)

  4. gross.
    god bless those wonderful people.

  5. Wow. Thanks for posting that. What wonderful nurses.

  6. As horrible as the experience was, it was truly an act of kindness to get him cleaned up (albeit probably for a short time). It is great that you decided to "pay it forward" and give them a starbucks kindness too.

  7. Wow. This reminds me of a good Samaritan day care provider years ago who was caring for a very neglected kindergartner in my class. The child had lice so bad that I could literally observe swarms of them crawling on her head and MATING. The saddest part was the child, sobbing because her Mom made her go over to the lousy cousin's house over and over.
    The provider knew that the child was going untreated, so she basically put her car upholstery in a full body condom and treated the girl at her home, being careful not to expose the other kids.We then called CPS, and she never got lice again.

  8. What a great post. I started out in ER, and remember doing the same thing. One doc we had would make us bag their FEET before she'd go into the room. I'd just wash the darn things. She was always amazed. Nurse love is cool :)

  9. Thanks Doc. Thanks for noticing, and thanks for taking your extremely limited time to do something good for some people who deserved it. We don't get that very often, and the few times that we do, it means a lot.


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