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Can a Smell Kill Me?

In nursing school I completed several clinical rotations. I worked in hospitals taking care of medical and surgical patients and women who just had babies. I learned how to treat people with acute and chronic health problems and how to recognize when they were taking a detour off the road of recovery. The work was challenging, but the most interesting experience was my geriatric rotation at the Veterans’ nursing home in Denver, Colorado.

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Probably erected sometime during World War II, the building still has a lot of the original equipment. And when I say original equipment, I’m including the staff. Most of them have been here so long, they’ve actually taken care of the guys returning from Vietnam. They enjoy horrifying the nursing students with stories of soldiers who had limbs blown off or were full of shrapnel, and take great pleasure in assigning us tasks where we have to dodge the highest possible amount of body fluids. They like to give us the creepy old guy who tries to cop a feel as you’re changing the dressing on his trachea site.

The patients have been here forever, too. One guy has been here for twenty-seven years, although looking at him I am hard pressed to tell. He has avoided many of the complications that can ravage a body that is immobile, like skin breakdown.

The staff is proud of the fact that his skin still looks so good after so much lying in bed. It’s true: the around-the-clock turning, range-of-motion exercises, and copious application of skin moisturizer pays visible dividends. But I wonder if the patient knows or cares. He is in a coma, after all. What good is all of this gloriously soft skin to him? It’s not like he can go out and woo women with it. Hey ladies, check it out. Look at my wonderfully intact dermis. This makes you hot, doesn’t it?

Prolonged bed rest causes other problems. Hospital-acquired infections (also known as nosocomial infections) are prevalent and can take a long time to treat. One such infection, known affectionately in medical circles as “c-diff”, short for Clostridium Difficile, affects the gastrointestinal tract. Sometimes it occurs as the result of continuous antibiotic use, and sometimes it happens because a patient’s immune system is weak. The infection sees an opportunity, finds a foothold, and digs its little bacterial feet into the gut.

There is a slightly sweet smell to c-diff, followed closely by a pungent smell of rotting flesh. It changes the consistency of the poop, too. Instead of a regular bowel movement, c-diff looks like a brownish-grayish gelatinous mess.

I don’t know that I am about to come nose to stink with this most foul of infections.

We arrive to start our shift on Monday at 7 a.m., eager, naïve little nursing students ready to serve and learn. In true “Let’s stick it to the newbies” fashion, they give me the guy with the worst c-diff—ever. We all knew who he is. I don’t need to know his name or room number; I just follow the smell.

Maria, one of my fellow students, leans over and says, “Make sure you wear a mask when you change his diaper, girl. That smell will kill you.” But I’m not allowed to wear a mask unless the patient has a contagious respiratory infection, and this man doesn’t. It is disrespectful to put on a mask just to block an odor from a patient. I can feel little beads of sweat start to form above my upper lip. I hope I can get through this without vomiting.

The morning goes fairly smoothly, or as smoothly as it can for a group of first-timers who have absolutely no idea what they’re doing. The patients have lunch and then it’s time to put some of them back to bed. My c-diff patient is on the list. “But first”, our instructor advises, “make sure you clean them up before putting them to bed.” This means digging in and changing soiled diapers.

The time has come. Yowza. Here we go.

Maria is helping me with my patients. When we get to my c-diff guy, we take a deep breath—and hold it. We bring him into his room and it is obvious that his diaper needs changing. We get him into bed and start in earnest, trying our best not to show how disgusting it is. I look over at Maria, and she is twisting her face in sheer horror. I whisper, “Maria! Stop making that face! It’s disrespectful.”

I don’t want to make a face. Of course this is impossible. The stench coming from this guy’s butt is enough to make me want to pass out. It’s as if some small woodland creature has crawled up there and died. Judging by the stench, that little critter has been dead a long time.

It seems to take forever, but we finally finish and leave the room. As we’re walking down the hall, I glare at Maria. She looks at me and says, “What?” I say, “Why did you make that face? We’re supposed to respect the patient and not show how gross it is.” Maria keeps walking and in a casual voice replies, “You read this guy’s chart, right? You’re forgetting something.” I don’t know what she’s talking about. I’d read his chart, but it was one of probably fifteen I’d reviewed since working at the VA. It’s hard to keep track of everyone and their ailments.

Maria laughs. “We lucked out. That guy isn’t going to care that I made a face. Know why? Because he’s blind.”

Copyright 2009–Hudson.

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