Should what happens in the hospital…stay in the hospital?

iStock | Maridav

“And then I stuck a whoopin’ big needle—“ I looked up and saw my host’s eyes widen in surprise and fear. The entire table of six grew silent and I mentally slapped my hand against my own forehead. I’d done it again: tried to share a work story with friends, forgetting that the average person is uncomfortable with blood and likely scared of needles.

Americans are all about work. Some people’s job details 
are boring, others too technical for non-initiates to understand, but mine tend to make people sick. I hadn’t anticipated this aspect of nursing—that it’s socially isolating—when in midlife I decided to return to school to become
an RN. I was so excited about entering the world of healthcare I assumed others would share my excitement. In many ways they did. But I’ve learned the hard way that the bonds of friendship and family cannot make the details of a dirty job tolerable to the average person. In fact, there are nursing stories I’ve 
never shared with anyone outside the hospital because they’re just too odd, too much a departure from normalcy even in the world of healthcare, where we routinely shove tubes in people’s rear ends, collect stool samples for the lab and carefully measure volumes of urine before flushing it down the drain.

One story: the patient we called “the turd burglar.” I’m going to leave out all possible identifying details and say only that this patient had cancer in his brain and his mental status was extremely compromised. His slipping grip on reality manifested itself bizarrely: He liked to hold onto, and sometimes hide, his own stool. One day his nurse found a large turd nestled in his empty Kleenex box. Another day a group of nursing students mistook the brown mush in his hand for leftover bran muffin. “No,” I told them, “that’s his own feces.”

A normal reaction after an upsetting encounter like this at work might be to call a friend and talk it over or unwind while cooking dinner. Turd burgling was the last thing I wanted to think about while I prepared food, and no one in my circle of friends would react with anything other than horror and disgust when hearing about this poor patient.

We’re all supposed to be repulsed by behavior that is scarily outside the norm, especially when human waste is involved. But taking care of this patient was a normal work experience and I can think of myriad similar situations. The proverbial “ass-plosions,” the confused patients who walk around and defecate on the floor. Even the example all nurses joke about: diarrhea, which we discuss over lunch or drinks. Non-nurses would be better off eating or having cocktails somewhere else, and we’d like to join them, except it would mean talking less about what’s really on our minds.

The unmentionable work absurdities aren’t limited to stories involving stool. One day I walked into a room to greet an octogenarian. After a quick mention of his rectal abscess and how he was sure I’d want to see it, the patient dropped his pants and showed me his rear end faster than I could take in what he’d said. Then there was the time an MD and I needed to examine a labial lesion. Was it herpes or something much more worrisome? The patient was physically uncomfortable and happy to show us her private parts since the right diagnosis would presumably lead to her getting better. The average person’s workday does not involve looking at stranger’s bums or genitals, meaning that despite their oddness, or really because of it, these kinds of stories cannot be shared.

Witnessing death, a regular occupational hazard for many nurses, is the biggest conversation stopper. Having patients die is one of the hardest things nurses face, and it’s also the most socially difficult topic of all. Who’s eager to talk about it? As a result we nurses often keep our grief to ourselves, to be shared only with people from work.

Another story: A patient, dead now, developed a rare but usually lethal neurological complication of stem cell transplant. A gentle man of varied and always interesting conversation, his speech in all ways sounded as it always had once this complication set in, except that everything he said was nonsense. He strung words together randomly. None of his sentences had any meaning at all, but the cadences of his speech were the same as they had been, his gestures and eye movements perfect for the man we had known. It was unbelievably painful to have him be so much the same, and yet, when I listened to what he was saying, understand that he had held onto the sound of himself without the sense.

Writing this, I feel tears stinging my eyes. As a floor we shared the pain of this patient’s decline, including his protracted and hopeless stay in intensive care. Yet I personally haven’t told this story much. I would have liked to tell my friends, shared my upset with my family, but where would I even start?

This enforced social silence means that my clinical fears, worries, knowledge of just how bad it can get, turn inward, and sometimes pop out in the rest of my life in ways that are also socially jarring. Recently I became implacable about a perceived driving danger. As a kid I rode unsecured in the back of my grandfather’s pickup truck, enjoying the wind blowing my hair back. Once I became a parent, I followed the car seat rules, but in a ho-hum, this-is-what’s-required sort of way. Last year, though, I stubbornly refused to allow our minivan, which was built for seven adults, to accommodate two more, irritating and inconveniencing my entire family.

It wasn’t the risk itself that scared me, but the imagined aftermath of an accident involving nine people. How many ambulances would that take? How many yards of IV lines, milligrams of narcotics, hours in the OR, X-rays, braces, casts, crutches, days spent in the hospital struggling with pain? And that’s assuming no one went to the ICU, or died. The small amount of time I’d spent in the ED as a nursing student allowed me to picture the scene too well: the stretchers coming in, the exhausted-looking neurosurgery resident drilling a hole in a woman’s head while his pager beeped repeatedly.

Car accidents can happen any time and many people worry about them, but a tactile familiarity with the worst-case scenario made me confident about the specific danger we would court with an overloaded Honda Odyssey. To me, the incontrovertible truth of the risks meant that nine people should not, under any circumstances, go anywhere in our van. I refused to give in, rather unpleasantly, because of the suffering I’d seen myself on the job.

No matter how much nurses might wish it otherwise, there will always be things that happen at work that can only be talked about with other nurses because they are too gross, too sad or too scary to bring into regular life in a casual way. Then, suspended by these work events we can’t openly discuss, we’ll sometimes find ourselves a little too reactive when our work life unexpectedly, and forcefully, intrudes on the everyday.

The personal price we pay for our intimacy with blood, physical vulnerability and outsize sadness is that at times, despite the community we create for ourselves as nurses, we feel very alone outside that world. I wish it weren’t so, but being there for our patients may mean not always fitting easily into the most ordinary parts of our lives.

What do you say…when someone asks, “How was your day?”

When I have a bad day, I prefer speaking about it to another nurse who “gets it.” But if someone else asks, I’ll just leave it at “I’ve had a bad day” so I don’t have to “clean up” the story or even comfort them because it upsets them so much. Then, I will call a fellow nurse to seek solace. —Eva Turel Longmire, infection control

I don’t really share details about my day with family and friends with no healthcare background. I’ve tried, but they get disgusted or stressed out, so I make a general comment. They don’t want to hear about death/dying or advance planning for end-of-life—too “depressing.” It’s sometimes even difficult to talk to other healthcare workers who have different patient care backgrounds and don’t understand the stressors I experience in my specific unit or patient population. I do have a few good nurse and physician friends that I can share my stories with and feel understood. —Anna Dermenchyan, cardiothoracic ICU

At the end of the day—whether good, bad, busy, exhausting or pleasant—I find that I have no one to debrief. I would like to share the ups and downs of my day with my mother and boyfriend; however, with HIPAA in mind, I am unable to because explaining, yet summarizing, my day to two “non-nursing-world” professionals proves to be exhausting in itself. —Rachel A. Saeler, critical care

I went out on a second date with my boyfriend, now my husband, and started describing my workday. He excused himself to go to the bathroom. Too much time passed. Finally he came back. His face was green and his lips were white. “You can’t tell me stories like that,” he said. He went to the bathroom to sit down and put his head between his legs. He thought he was going to pass out. —Barbara Glickstein, public health

With another nurse who knows the lingo, I quickly offload the day in shorthand. At a social occasion, I just smile and carry on because I don’t want to burden them. Once I was telling two friends the details of doing a chest compression on a woman who had overdosed—they both asked me to stop. I had been in a trance saying it all out loud and had missed the looks of horror on their faces. —Susan Walton, general surgery