Eeek! I knew it would be hard to keep up with this blog the way I wanted to.  I didn’t know I’d find it nearly impossible to write when I got home from a shift. This old girl can’t seem to take daytime 12s like she can take night ones, for some reason. Usually it’s the reverse. I leave my house BY 6 a.m. and get home by 8 p.m. Well, to get up again the next day at 5, I need to be in bed by 10 (never happens), so there’s not a lot of time for dinner, a shower, packing the next day’s lunch, and making sure there are clean scrubs for the next day, let alone time for blogging. Anyhooo….

The title of this post is the way in which our hospital identifies patients who are inmates of the federal prison somewhere in our area. They don’t get to use their names (maybe it’s like the equivalent of HIPAA for prisoners?). All I know is that they all start with FED followed by one of the longest strings of numbers known to man.

So we got this prisoner on Tuesday. I was just intrigued with this patient all three days, though I didn’t have him yesterday.

We came to know his real name over the course of caring for and talking with him, but I won’t use it here. I’ll call him Fred.

What an interesting, fascinating case. I’d seen many prisoners as patients throughout the hospital in my work as a unit secretary, but this was the first time I actually got to care for one.

Fred’s history (medical and otherwise): 33 years old. Gang member. Paraplegic at T6, since 1993 due to a gunshot wound. Arrested in 2006 for selling drugs on school property (no kidding!). Above knee amuputation of the left leg. Colostomy. Urostomy. Admitted with a Hgb of 4. He’d been on coumadin for two weeks because the prison infirmary where he stays suspected a DVT in his right leg (we found no evidence of this).

Fred’s condition was one of those things that medical professionals say you might see once in a lifetime. Doctors and nurses came from other floors to check out Fred’s backside. Because of the years of sitting in his wheelchair and having no feeling from the waist down, and probably due to limited access to medical attention in a prison, Fred had developed a series of decubes. Over the years, they’d been debrided and operated on so many times that Fred literally had no backside. It was the strangest looking thing I’d ever seen. I don’t know how to appropriately and tastefully describe it, so forgive my crudeness. Fred had the beginning humps of “buns” at the top (I”m not saying “buttocks” — can’t say that word since Forest Gump without laughing), but they only descended about two to three inches. Everything else had the appearance of being sliced off, or carved out until the back of the legs. I wish I could describe it. I wanted to take a picture to post here because the minute I saw it I knew I’d be writing about it here.

The numerous surgeries he’d had over the years left this area full of tight, shiny, bright skin, strange discolorations and in strange configurations and folds all over the area. Like a series of hills and valleys. He came in with a 12×18″ dressing over the entire area, which was literally soaked (and dripping) in blood. And for the first time in my short exposure to the medical world, I saw shock, horror and confusion (as in “what the hell do I do with that?”) on the faces of seasoned nurses, doctors, and the prison guards who must be present in the room whenever the privacy curtain is drawn.

Because of the coumadin, poor Fred was literally bleeding out from the various active wounds on his backside, as well as showing blood in his urostomy and colostomy, hence the Hgb of 4. He was dizzy and disoriented and in hypovolemic shock. By the time I left work yesterday, he’d received 12 units of PRBCs and at least four of FFP (that I know of).

But what really struck me about Fred is what a really nice guy he was. And how taken I was with him.  I wanted to know more about him, size up his psyche. He was friendly and engaging, though he didn’t initiate any interactions. He’d chat openly as we tended to his dressings, hung his blood, etc. We didn’t ask him about his crimes or sentence, but he’d talk about them. When the endless stream of docs and specialists came in to see him and all asked him the same questions about his paralysis and amputation, he’d answer them matter of factly about the shooting and then the car crash. (Sidebar: Why do doctors all ask the same questions over and over? The info was all there in the patient’s chart.)

Fred was 100% polite and grateful. I imagine a stint in a real hospital might be a little bit like a vacation for the incarcerated. He had a nice private room (all the rooms in our entire hospital are private) on the fourth floor with a breathtaking view of the New Jersey pinelands. He had his own TV and got to watch whatever he wanted. He salivated over his hospital meals like he was dining at an expensive steak house. He thanked us, his caregivers, profusely for everything. He took care of his own urostomy and colostomy (SO refreshing — I’d never seen a patient do this!). In all, he was a model patient. I hear that this is pretty much the status of all federal inmates who grace our beds.

Anyway, me and my silly social worker’s heart: I wanted to “reform” Fred. Not really, but I was determined to treat him as a person. Not just that nasty prisoner who sold drugs to school kids. Most everyone in the place disagreed with me. ALL of the nurses, and doctors, I must say if I’m being honest, were completely kind, courteous and professional to him. The guards, not so much. Behind closed doors, though, the staff sang a different tune. I learned very quickly to not share my recurrent private thought: “I feel so sorry for this guy.” Whenever I did, I was shot down with a quick, “I don’t. He did something he shouldn’t have done and now he’s paying the price.”

It really got me to wondering: at what point in a new nurse’s career does he or she lose her compassion for the patients? I am SUCH a bleeding heart it’s almost embarrassing. Seasoned nurses say that in time, you learn to not become emotionally involved because it drains you. Does that mean that you stop caring? Always? Do you care less because someone “deserves” the medical issues they’re having? What’s a good fit, professionally, for someone who believes in second chances and who actually likes becoming a little bit emotionally invested in her patients? I don’t want to be gulliable. I don’t want to be a pushover. But I don’t ever want to stop caring, either. So where’s the happy medium?

Fred’s up for parole next April, he says. I’m such a pollyana I actually hope he’ll change his ways. Get a “real” job. Make something of his life. Help kids. Change. But I’m also a realist. He probably won’t. It’s easier to stay with what we know than to change. Change is scary. I don’t know. The whole thing just makes me sad. I wonder about the circumstances of his life that led him down this path. I wish him all the best in the world. I won’t ever forget the first federal inmate who came under my care, that’s for sure.