As a nurse, what made you most uncomfortable when a patient took off their clothes?
Not as a nurse but rather was for a short time an EMT. I was helping a young woman remove her blouse to have an injured elbow examined. We were about the same age, had attended the same University both women and there was no need for removal of her practical sports bra. It was not the undressing and I did not become uncomfortable, what happened next I will never forget. She was using both her arms to cover her belly, bent slightly to do so and when she met my eyes I saw hers were full of tears. I asked if she was in pain, asked if there was anything she needed, anything I could do. She motioned me closer and sat on the stretcher tears falling freely now, she took a deep breath and took her arms from her abdomen. The scar was ugly, it was not surgical, a serious wound left this still bright red scar. Through her tears she looked me in the eye with fearful desperation almost begging me and said, "Please don't let them see. They won't understand. He wasn't angry, we're not fighting, this was an accident." Like I flipped a switch I was suddenly "The One" who was going to do something about this. The police, the social workers, I even tried to get her on a psych hold however she insisted her abuser, the man who had recently stabbed her and broken her ulna and radius as well as dislocating her elbow, throwing an ashtray at her head that required 17 stitches it goes on. She tried not to go the same ER or urgent care twice, the name she'd given turned out to be false. Her fear as she hid her abdominal scar was palpable, I was frightened for her without yet understanding why. The epitome of hopelessness, protecting someone who would hurt you this way, who would hurt you at all. She defended him as she wept, she asked me to phone him, tell him she was asking him to come. I could not refuse her request and would not pass it off on a Nurse who was too busy providing hands on emergency medical care. I called the boyfriend and he did arrive quickly wanting to take her home. All I could do was cause delay after delay in her discharge process as I tried to find some way to get her away from that man. I failed as she repeated in a monotone that he had not hurt her, would not hurt her and she was so uncoordinated. She walked out out of the exam room in her bright pink cast and blue sling, looking like a tired little child, out of the bulding and out of my life. Sadly I was wrong about out of my life. A number of months later, I was called to clean a corpse in Trauma 4. There she was, now her clothes cut off, her pretty eyes open, not staring, empty as she was gone. She loved that boyfriend, that sad excuse for a man, whom she protected and defended, she is now dead by his hand. I see her eyes as she hid the scar he'd stabbed into her flesh, I see her empty eyes even though mine are closed. There should have been more I could have done, nothing was well hidden, anyone taking a close look would have seen this coming. That young lady did not have to die and I will always see the removal of a dark purple silk blouse being an unconditional surrender and a harbinger of death.
Ok, we all have pretty much seen it all.
Nothing fazed me into being uncomfortable with a patient, the worst stuff just made my heart go out to them.
Uterine cancer poking out of a female abdomen like the head of that thing in the original ALIEN movie? Nope. Entire buttock missing down to where you could see the hipbone? Nope. Missing limbs, genitalia, noses, necks, half faces, etc? Body twisted and locked into one plane by ankylosing spondylolisthesis? Nope.
But, once I did get uncomfortable in the ER.
A twenty-something drop dead gorgeous female came in accompanied by her forty-something mom. When I came into the curtained space, I asked the daughter what brought her in.
She showed me a bruise on her arm, and said "I'm worried, I have these everywhere!"
I promise I'm not writing a fiction with purpose.
She immediately pulled off her shirt and slacks in a trice, and tossed them on the cart, and was standing there in pretty skimpy Victoria secret type things, with the physique on par with their models.
Her mom said "Oh, honey...". She replied "Oh, it's no big deal, it's nothing you wouldn't see at a beach", as she was turning and pointing to bruises in various locations "...see? Here, and here.... and here..."
My mouth went totally dry, my mind thought "...what ...bruises....what?..."
The moment I could speak, I said "...uh...let me get the doc." I whisked myself out, made an instant deal with a female partner RN to swap patients as I called for the doc.
Before and after that encounter, I had never been overwhelmed like that, even with intimate procedures or care for similar patients in hospital- but this particular scenario just vaporized my clinical detachment. It felt like an emergency to me to get my happy posterior out of that space ASAP.
It's not that I would have "done' anything- but if something like that could snuff out my inner nurse, I was the wrong person to be there- Even if I could bring the whole thing to a clinically acceptable resolution in concert with the doc.
I had to get out before my lizard brain talked my moral and professional brain into sticking around for the "show". I have a healthy distrust of my own judgement, and fallback parameters to ensure I don't do stupid.
It's uncomfortable to come face to face with your limitations- but a man, and a nurse, "...gots to know his limitations" as a Clint Eastwood character once pointed out.
Especially in medical care.
That's the only patient I walked out on and didn't come back to. Way too uncomfortable.
That's humbling, I must say.
Added info: lots of folks asked what the diagnosis was-.
A wise ER doc went to the patient. He knew the score the moment he walked in.
After a long consult, he got the daughter to admit, in front of her mom, that her boyfriend was physically abusing her. Mom had spotted the bruises, and the daughter was creatively covering that up to 'protect' her abuser. Abuse and threats kept his treasure under control and in line, ready to casually lie when asked to avoid even worse.
In retrospect, there were a lot of disseminated bruises across her body, most of which wouldn't show when she was dressed in shirt and slacks- good pre-planning, eh?
Regardless- it was better to get someone else to look at them all. In some ways, I couldn't quite see them anyway. This isn't a tale I'm proud to tell, it shows off a clinical weakness I had.
The daughter was in denial about her problem. I'm glad I'm not in denial of my own shortcomings.
Ok, requeue embarrassment and wisdom.
Well, it is more something I didn't notice.
We were admitting a patient - a middle aged, conservative, modest woman - into the hospital, who we suspected had pneumonia, she was coughing up nasty, green phlegm; short of breath, and had horrible lab results...I can't remember what all, but she had a white blood cell count of nearly 30,000, a fever of about 103, and just generally felt awful. She had been to the doctor a couple days earlier, and had become markedly worse since then.
Coincidentally, this same doctor was a friend of mine, and he happened to be our on call physician that night at the small, county hospital I worked at then. So he knew when she presented to our small ER, that she was sicker and that we were going to need to admit her for iv antibiotics. All of this stuff was kind of happening at the same time, and we had not gotten her sent for a chest xray yet, but that was getting ready to happen.
As we were admitting her, I was quickly going over an inventory list that we were supposed to do of patient belongings, to ensure everyone left with what they came in with. I asked her if she had any jewelry, and she says, "Just my nipple rings." I laughed, she laughed, you know where this is going. Of course it wasn't a joke.
The way I found was I heard the doctor in reading the xray and laughing. (No one else was around, and she did not hear this. He was not being obnoxious.) I went in to see what was up, and there they were, bigger than Dallas, a big barbell in each titty. She had not been wearing them in the xray a couple days earlier. Why she chose to put them in prior to coming in that evening, I have no clue.
For what it's worth, she was a very nice woman, who made a quick recovery and was discharged home a couple days later, nipple rings and all. It just struck me as funny because I wasn't expecting it from a fifty something wife and mom. But it's whatever.
I have read two answers, that are very sad. My story is neither sad, or horrible, just a bit funny. I am a Respiratory Therapist. When I was new to my career, I worked night shift in a hospital, where we were, among our other duties, expected to also do EKG's. IF you ever have had an EKG, you know there are pads we put across your chest, and up your rib cage.
I have always worked in elder care. Home health, hospice, palliative, assisted living, SNFs, the whole nine yards.
I remember a home health client whose case I'd picked up. When I got to the house, his children wouldn't let me come in at first. But after a lot of talking, I finally convinced them to let me in.
So I go to the room where the client is lying in bed. I can't see very much, since the client is under blankets, but there was such a strong stench in the room that it made me dry heave a bit.
I go over and talk to the client. Ask a few questions, but the client is nonresponsive at the moment. Okay. This isn't unusual. So I pull back the blankets to examine his skin.
He was covered from head to toe in bruises.
I stood there in shock. All the client had on was a hospital gown and clearly hadn't been properly cared for, as the client, bed and everything was soaked in urine and crusted with feces.
Before I could stop myself, I started to cry. Because the client couldn't get up or ambulate without assistance, if at all, I knew this was blatant abuse.
I immediately called my boss and had him come out and asked him to make a few calls to get this client out of this situation. I slowly started to clean up the client, my hands shaking the whole time. To say that the client was mostly a walking bruise with swelling would be totally accurate.
It took me damn near four hours to get the client cleaned up. I tried, I really did, not to cry. But it was such a sad situation. My boss came and unbeknownst to me, called the police. I later learned that the client's children were taking turns to provide care and I guess they became frustrated and angry and took it out on the client. I managed to get the client out of bed and into a shower chair and sorted everything out.
I will never forget the state I found that client in. I also later learned that the client had several fractures; I never did find out what was used to inflict those injuries. I remember the ambulance arriving and taking the client to the hospital and when they were ready to go, the client reached out to me and said, "Thank you for rescuing me."
It was the most heartbreaking thing I ever had the displeasure of witnessing and experiencing. People, if you are a full-time caregiver, please seek help or respite care if you're overwhelmed. The elderly and infirm can't help that they need care. In this case, I would have definitely recommended 24-hour care in the home or a facility.
This was completely preventable. I still cry about it sometimes.
I'm not a nurse; this was in my starter job at the hospital, where I worked ER Registration for a couple of years, mostly evenings/weekends and holidays.
I can't remember what the woman came in for, but she was sitting quite calmly in the triage room as I was getting everything situated with her chart. When I came to the question about living wills or advance directives*, she wordlessly tore open her shirt. Just popped the buttons right off, like Clark Kent in a rush to become Superman.
I've seen DO NOT RESUSCITATE tattoos before (more on those, and their ethical implications, here: What to Do When a Patient Has a 'Do Not Resuscitate' Tattoo), but this was different.
This was the ENTIRE TEXT of her DNR order. Paragraphs. Tattooed as if someone had pulled the page out of the typewriter and applied it directly to her skin. Beginning to go a bit fuzzy as she and the tattoo aged. Words down one breast, across the sternum, up the other breast. All the way to her stomach, where the patient and witness signatures went.
And in the middle of it all, a giant, colorful and enormously impressive Virgen de Guadalupe. The text was spaced to fit around her.
I was stunned. Had some near-death incident led her to this? How long must this have taken? Did she have a hard time finding an artist who would agree to it?
But she just looked at me impassively, and I clicked the box that said yes, she did.
*it's sometimes enormously difficult to ask this question of an incoming patient. The "advance directive" thing is often misunderstood by ill or confused people and a registration person isn't in the position to do much more than hand them a pamphlet as they're wheeled away. The "will" word is even worse...I've been screamed at by irate people who think it means the hospital gets all their stuff if they don't make it.