This is a story about work last weekend. If you are male, read carefully.
I agreed to work a 12-hour shift (which ended up being more like 13 hours) because a bunch of aides have left unexpectedly and the hospital is short-staffed. The first six hours of the shift were nice, predictable, and quiet. Walking patients, talking with patients, putting confused old people back in bed before they break bones falling down, washing up old ladies, etc.
We order Italian food. I’m watching the desk so the other nurses and aide can take their break, and munching on some garlicky cheese bread. A call light rings in. I pick up. “Can I help you?”
“I’m bleeding everywhere!!!” An elderly male patient down the hall.
“I’ll be right in,” I say calmly. The charge nurse, L.RN, gives me an arch look. “He’s ‘bleeding everywhere,’ he says. I’ll go check.” I put down my cheese bread and head down the hall.
In my head, I’m pretty sure that this guy has scratched his arm, and is bleeding. Or he’s pulled out his IV by accident, and the site is bleeding a little.
I walk in the door and stop abruptly because the floor is covered with blood. A nice, lovely, coagulating trail of it all the way from the recliner near the window to the bathroom and back again. And there stands my patient, his gown held above his waist, staring down in horror as he bleeds freely from his penis. Yes, that’s right friends. It looked as though the dude was peeing blood.
I do three things at the same time. I grab a pair of gloves, hit the call light again, and reach into the bathroom and grab a large towel. The charge picks up the call light. “Can I help you?”
“I need someone in here RIGHT NOW!” ‘Right now’ is the magic phrase in health care. There’s an enormous difference between “I need your help” and “I need your help RIGHT NOW.” When the second type of request comes in, you run.
L.RN was in the room even before I had the guy sitting down in the chair again. Once he was seated I wadded the towel up against his penis and applied pressure. Two other nurses came running in. We paged the hospitalist, and housekeeping. They got bleach wipes and started cleaning the floor. They opened a biohazard bag and just started throwing away bloody linens — towels, his gown, his TEDS. I, lucky me, got to sit there next to him, applying pressure. I looked down beside his chair and realized what had happened.
A “foley” or indwelling catheter is a tube that sits in the bladder, held in place by a balloon inflated with saline, to allow urine to run out and be collected in a bag and measured. The patient never feels the urge to “pee” because the urine never collects in the bladder. The balloon that holds the foley in place is slightly smaller than a golf ball.
When the patient is sitting in his/her chair, we hang the foley from the side of the chair, which is what we’d done here. When this particular patient decided to get up and walk to the bathroom by himself (presumably to have a bowel movement, although he could have forgotten the catheter was there and wanted to pee), he didn’t call for help. He just got up and walked to the bathroom — leaving the bag attached to the side of the chair. When the foley ran out of tubing (about three feet), the tube pulled out of his bladder, the golf-ball size balloon scraping down as it pulled all the way out of his penis.
And there it was, intact and on the floor, still inflated.
I looked at him incredulously. “Didn’t that HURT?”
He looked bewildered. “No.”
“Does it hurt now?”
“That’s probably for the best.”
Long story short, the MD ordered a continuous bladder irrigation and the nurses from the floor below came up to set it up (they specialize in gynecology/prostate/urinary care). A regular catheter is about the diameter of a pencil. A CBI catheter is about the diameter of a Sharpie. Oh yes — *this* time, he felt it when it went in, and it HURT.
He lost a lot of blood — we called for labs to determine his H&H, but I didn’t see the results come in. I assume the night shift got to give him a transfusion. The CBI did what it was supposed to do — clots came rushing out into the drainage bag, but we already knew he was a great clotter.
How did we know?
**warning — gross part next***
Because his blood had already started to coagulate on the floor, and we could just basically pick up the worst of it with towels.
Maybe I’m wired funny, but I thought that was really cool.
Crisis finally dealt with, I headed back to the station. And ate more cheese bread.
love my job. love.