As soon as I clocked in, I knew I had to call the nurse. Over the weekend, I had noticed hard nodules, some quite large, under my patient’s skin on their derriere, to be French about it. They were not subcutaneous pressure ulcers; we all watch him like a hawk for those. No… these were the insidious kind, that build up under the skin without breaking the skin down to telegraph their malignancy: decubitus ulcers.
I hated having to call the agency overseeing the patient. The case manager would be pissy, looking for ways to cast the blame, her net spread far and wide. At least this one should be straightforward.
I noticed the nodules on Sunday, and reported them by phone to his regular nurse, via voice mail, that evening. She rearranged her schedule to come by Monday morning to examine them and confirmed my amateur diagnosis of decubitus ulcers.
I waited for his nurse to finish up her vitals, update her charts. Only then did I approach her, ask if I could speak with her. With a gesture of my head, I indicated it should take place out of the patient’s hearing.
We stood out on the front porch. While it was chilly, it was also blessedly free of the odors of sick bodies. The nurse lit a stealthy cigarette, then looked at me pointedly.
“Well, the thing is, that he is not following the prescribed regimen of two hours per side. He spends maybe 30, 40 minutes before he’s crying and complaining and demanding to be rolled on his back. We’ve all tried telling him, that if he doesn’t offload every hour or two, and stay off his back, he’s going to end up like he did in 2010, when his decubitus ulcers had to be debrided, and he spent a year in bed with a wound vac. I don’t think he’s strong enough to survive it, this time. He says he knows, but he just doesn’t care. What do I do, when he insists on doing what will… hurt him?”
“You mean eventually kill him. It’s certainly a possibility. If he refuses treatment, it’s almost definite. But what can you do? You can’t illegally restrain your client. Ultimately, you’re bound to his will, whether or not you like it.”
“So, I just let this go? I don’t report it?”
“I would mention it, verbally, to your supervisor. If nothing has changed in a week, arrange a formal meeting, including their boss and someone from HR. Then, it’s out of your hands. You’ve done your best, and turned over all the information whose job it is to research such things. Watch out for your career, as well.”
“What do you mean?”
“I mean, his family, or even the company you work for, may try to pin these ulcers on you. They will make your life a misery and ruin whatever quality of life your patient has left.”
The nurse looked at me, and there were centuries of pain and determination in her gaze. “Don’t let them do it. Don’t let them get away with it.”
With her advice illuminating my mind, I collected documentation, “proof,” to put not too fine a point on it, making sure my medical reputation should come through this untarnished. Such a naif, it never occurred to me that the opposition was planning the same… and their budget was far bigger than mine.
It didn’t take long. By Tuesday, the message was in my inbox. I was invited to attend a meeting regarding the well-being of my patient.
The meeting seemed almost anticlimactic. There were a few suits there, no one on my side (were they allowed? I wondered), and a copy of that lie-filled report the case manager submitted. The First Suit opened the file, announced the charges, and left the reading of the writ to a lesser personage. First Suit set himself down ponderously on a leather chair, making it look like a throne ensconcing him. He began his role as the Head Judge.
He seemed irritated by the haranguing of the Second and Third Suits. I made a note to keep that for my advantage.
With “caused the patient’s decubitus ulcers,” the report blamed me. Amazingly, the judge called them out on it. “That is what we are here to decide. As judge, that is my prerogative. Don’t let me catch you putting words in my mouth.”
The First Suit nodded at me, then. “This is your one golden opportunity to tell the truth. And the truth shall set you free, say the Scriptures.”
For a shining, single moment, I believed him… then the doubts crowded in, the intuitions, the gossip about him from the nurses, and I realized that, to win this battle, for battle it was, I would have to win him over.
I gave him my most charming, bashful smile, the one I use when I’m smitten but don’t want to admit it, and I saw his body react to it. He became more relaxed, more receptive. Just because I understood effective manipulations of people, didn’t mean I liked to practice it. Besides, it was always demeaning. More so because it worked.
I chose the maligned innocent. “Sir, all I did is what I was told to do. You can check the log sheets for yourself! I never missed a turn on shifting the patient, and the first time I noticed anything out of the ordinary, why, I immediately reported it. Was I wrong, Sir?” I hid my eyes behind long lashes.
He looked discomfited. “Um, well, for that matter”… he swallowed his decision like a child swallowing a spoonful of nasty medicine… “You did exactly as you should. I see no reason for any further disturbance.”
I wanted to thank him, just to rub it in, but didn’t dare, for fear of what he might do if aroused. Instead, I chose the wise course and remained meek… and employed.
The case manager gave me evil looks, but no one else thought I’d done anything wrong, so things died down.
And, sadly, so did our patient. He continued his slow but steady decline. His ulcers had broken through the surface, and he was on a strict wound regime. I used to slip him ice cream, a candy bar, anything to get a smile out of him. Half the smile was in deceiving “the authorities,” and I delighted to see he still had that much spunk in him.
He was losing weight, losing spirit, and it pained me to see it. Time is the one thing there’s no dodging. His wounds were not healing up, despite all the treatments they gave him.
He talked to me about it, more than once. “I don’t know why I’m still here… I’m ready to go.” He never really shared his beliefs on religion, so I never knew what to say to him.
Then came the dreaded day, when he suddenly turned septic. In less than a day, he was gone. The agency told me — since he went to the hospital, I was off duty. His family didn’t contact me, but I figured they were busy dealing with his death.
I was watching the obituaries, and when his came out, I decided to go to the funeral. He had been my favorite patient, there was no way I would miss my last chance to pay my respects.
Since he had been old-fashioned in matters of dress, I wore a long black skirt, a ruffled shirt with a black jacket over it, a small, “pillbox” hat with a veil, and carried my umbrella, since it was pouring down rain outside.
The service was held in the funeral home, those horrible places. Smelling like lilies and death… Thankfully not like cigarettes anymore. I read the board naming the departed and the rooms they were in. I found his and went to the room, seating myself discreetly in the back, out of the way.
The room filled up quickly, and there were people standing in the back of the room. My old man had a lot more people in his life than he had ever intimated. A stern-looking man, with longish black hair and a black hat on, reminding me of an old-time preacher, stood up front next to the casket.
He expounded, he discussed what a great person my old man was, how much he had given to the community, such a philanthropist he was… Either he was laying it on thick, or this guy was Mother Teresa’s unmentioned twin.
He mentioned no God, so I felt vindicated in avoiding religion in all our conversations together. I realized the preacher-looking man was wrapping it up, and giving instructions to the cemetery for those who were coming along for the graveside service.
I stayed seated, since people had already started to get up and mingle, and I had no desire to impose my presence on these people during their time of grief.
A woman came striding over to where I sat. Looking at her, I recognized the daughter of the old man. I had not seen her often, but she was always polite to me during those exchanges. Now, though, she bore down on me like a runaway semi. And I felt hit, run over, by her words: “If it wasn’t for you causing my father’s ulcers, he’d still be here with us. How dare you show your face!”
I ducked my head, waited for her to collect her rage and leave. Eventually, she did, still looking back at me in sharp glances, until she left the room.
Then I closed my stinging eyes, blocking out the room. Even though I know the medical lore, even though I did everything right for my patient, even though I was cleared from that “investigation,” his family still blamed me. And always would.
I walked out of the room, the last one, still feeling the blazing scarlet letter I wore.