5 Insane Things TV Forgets To Mention About Nurses
It may seem like we're intentionally seeking out just the grossest, most horrifying jobs in the world for these articles, but we assure you we're not doing it on purpose. It's just that lots of jobs are way more disgusting than they're depicted on TV (since there are certain things people don't want to watch while eating) and, in our minds, that makes the people who do them all the more heroic.
Which brings us to the two nurses we're speaking to today -- Samantha and Ben, one in the U.K., one in the U.S. We wanted to learn more about what it's like to care for the hideously sick among us, including those whose flesh is literally rotting off of their bones, and here's what we found out ...
Deadly Diseases Can Put You On Lockdown
Between when we first contacted her and when we wrote this article, we lost touch with Samantha for a while. It turned out her whole hospital (located in the U.K.) went on emergency lockdown because the lab spotted anthrax in a patient's blood and tissue. This wasn't weaponized anthrax, which is much more dangerous, but it was still a rare and scary enough situation that it was time to put up barriers and break out the respirators. And, a little bit later, depending on how things went, it would be DEFCON 0, which means mass vaccinations and decontamination procedures.
The full response would be intense but necessary.
Then it turned out the patient didn't have anthrax. She just had ... flesh-eating bacteria. Phew!
The patient was an intravenous drug user, and there really may have been traces of anthrax in some of the stuff she'd taken ("That's becoming more common with IV drugs," says Samantha), but the disease chewing away at her was necrotizing fasciitis. We've told you before about this particular beast. "It's a really nasty infection to have, as it's a flesh-eater. The best way to get rid of it is to cut it out. And if you miss any, it will come back just as aggressive as before." Just talking to the patient, the nurses had to shield themselves like they were performing surgery, with floor-length aprons, gloves, masks, the works. "The last thing anyone wants is a needle stick from a patient like that," says Samantha -- accidental needle sticks are otherwise reasonably common for nurses.
We recommend wearing a suit of armor at all times.
Ben says that hospitals like his across America have protocols for every kind of exotic disease, but the real dangerous outbreak is the humble flu. Each year's flu vaccine just predicts which strain will be prevalent, and last year, the experts got it wrong. Flu swept through the wards, and people died. And as for personal fears, the last weapon to tear through Ben's skin wasn't a needle but a set of teeth. Family members came to visit a patient, and one teenage girl got overwhelmed and sought comfort by chewing on Ben's fleshy arm.
"The risk for exposure is very, very low," he says of the wound, which required antibiotics, "but I still have that feeling in the pit of my stomach that it could get really bad. The worst part about being a nurse in the ER is that you see people at their worst. You see infections that go on for way too long before seeking treatment. All the oozing, inflamed, stinking, swollen wounds that people allow to fester to the point of almost being beyond treatment. And that's all I can think about."
Fun fact: Hospital food is actually delicious, but no one has an appetite.
And while we're on the subject ...
You Deal With Lots Of Zombified Flesh
"I was admitting an older man who had been neglecting himself at home and had become unwell," recalls Samantha. This case, as far as the hospital knew, had as much to do with social issues as any kind of medical care they were prepared to provide. But they had to get to the bottom of it, and Samantha was tasked with starting the guy off by getting him undressed and into the shower. "I pulled off the sock on his left foot and nearly fell over. All the way up his foot and to just above his ankle the tissue had at some point died and had been left for so long that it had the appearance of a mummified limb connected to a healthy leg."
They burned the sock. For hygiene, and to break the curse.
Yeah, it turns out rotted flesh always horrifies you, even long after you're used to working around blood, shit, and vomit on a daily basis. Ulcers get seriously bad, and sometimes they burrow their way through the muscle and expose the bone. With these ulcers, which can begin just as a bed sore, you can actually see the bare leg bone rotate in the hip joint. We're not talking about during surgery -- it's just exposed, always.
Ben, too, says the grossest thing he's ever seen was a leg ulcer. The patient was a Vietnam vet. "From the knee down: weeping, sloughing gangrene. No pulse, no decent blood supply ... his leg was literally rotting. When he would stand up, fluid would just start oozing to the floor, and it was one of the most disgusting smells I've experienced."
Holes in the floor still smoke today.
Both the vet and Samantha's patient wound up with their legs chopped off. That's how you stop the undead. Speaking of which ...
Sometimes, The Work Sounds Like Witchcraft
When the hospital's usual arsenal of body science produces nothing, they turn themselves next toward the weird stuff. Now, the weird stuff isn't total nonsense. Ben in particular resents the phrase "alternative treatments": "When I hear the term, my gut reaction is 'treatment that doesn't work, but it hasn't been researched, so we can say it might.' When things work and we have the studies to prove it, we just call it 'treatment.'" But these methods often sound like they're stolen from tribal shamans who live in another century and possibly on another planet.
An old lady with poor circulation once knocked her leg and got a sore the width of a fist and a couple inches deep. When Samantha's team couldn't treat the injury with normal methods, they dropped a pile of maggots on her. "It's much more precise than surgical intervention to remove necrotic tissue and can stimulate healing," says Samantha. It also involves worms eating you, which reportedly hurts. But at least the maggots are specially bred in a hospital lab, so no one has to be scared of dumping new worm germs into the leg hole.
There's video. Afterward, insert a fork directly into your brain.
The maggots didn't finish the job. So next it was time to make like cannibals and lather the woman with honey. Authorities are officially skeptical about "Medihoney" as a treatment -- the ancient Egyptians used it, but most people stopped when they discovered antibiotics. But practitioners still say it's an awesome way to keep bacteria from growing. "You see it quite a bit in the nursing home and occasionally in the hospital," says Ben. And, sure enough, no deadly infection took the woman over, but that wasn't enough. To heal, she needed more.
Samantha's team next applied dressings containing pure, shiny silver. Silver kills all kinds of bacteria, nurses say. Staff talk about how, back in the '40s and '50s, no one got infections from IV drips like they do now. Today, says Ben, IVs use catheters with plastic sheaths. "Back then, they just left a needle in your arm. What was the IV needle made of? Silver." So, you might think experiments would confirm silver's healing powers. Well, not so much, but that doesn't keep the U.K. from spending 25 million pounds annually on silver to dress wounds.
If only there were another source lying around handy ...
So, Samantha treated this woman like a corpse, then a ham, then a werewolf. And in the end? The leg healed. Samantha convinced the patient to install a couple handrails at home for future protection, but the woman was mainly happy that she was strong enough to get back to bowling.
Meanwhile, if you show up at many hospitals in the U.S., says Ben, the nurses might whip out something that will surprise you even more. In the emergency department, they carry cocaine. Small amounts, but it's there. It's not leftover from the Christmas party -- it's a last resort for extreme nosebleeds. "You see," he says, "topical application of cocaine is a powerful vasoconstrictor; it essentially shrivels your capillaries in your nose and effectively stops the bleeding. Pretty cool stuff."
The procedure was pioneered by a Dr. K. Richards of England.
And that brings us to ...
Caring For Victims Of Crime Is Tricky
When Ben first saw the emergency contraceptive drug Plan B in the medicine room, he laughed. "Who the fuck thinks plan B is an emergency?" he says. "Then it hit me. 'Oh. Oooooooooh. Awwwwww noooooooo.'" Once he learned a little more, he thought of going into forensic nursing and becoming a sexual assault nurse examiner, collecting rape evidence for trials and guiding victims through the process. Then, once he learned more still, he realized a 200-pound, 5-foot-11, tattooed guy like him wouldn't be the best person to handle anyone -- female or male -- who finds themselves in that situation.
But all nurses eventually end up treating victims of some kind. Kid looks like her father is beating her? It's time to call the social worker (not the cops), and the nurse never hears what happens next because privacy laws forbid following up. Senior citizen looks like his kid is beating him? Then it's time to call an agency devoted to elder abuse. Ben recalls one old man who came in dehydrated and malnourished, his whole lower body covered in sores from lying in his own mushy feces. This guy, Ben was allowed to follow up on, and he wound up healthy enough and happy a couple months later in a well-run state nursing home.
"Government nursing homes: Now with feces-free beds!"
The social workers may or may not call the police -- but that's their department. The hospital will never call the police for anything short of a gunshot wound. "Unless they tell us that they want to call the police," says Samantha, "we can't break confidentiality. Even with domestic violence or rape." Ben routinely gets calls from police. He cooperates just fine when they need a report about a traffic accident or something similar, but other times, they ask him for health records, to confirm suspects' whereabouts, or to hold patients in custody. He just replies that he has no obligation to assist them.
"Cops hate that answer," he says. "They will scream at you." But the public has to feel they can trust the hospital. Or the next time they need help but have the wrong sort of chemical in the bloodstream, they'll play it safe to avoid jail, stay at home, and die.
They're also discreet about injuries that are embarrassing but legal.
Meanwhile, if you're in the hospital when worse comes to worst ...
Resuscitation Doesn't Look Like It Does On TV
As we've mentioned before, the first crucial difference between CPR as done on a TV hospital drama versus real life is that the latter is far more violent. If done right, you're going to break ribs -- you're trying to compress the heart through a cage made of bone. In a movie or TV show they're doing gentle compressions as not to abuse the actor or stunt person; that's why they're able to do things like give chest compressions to a patient on a stretcher. That doesn't happen in real life. Stretchers are too flimsy -- you'd just be bending the stretcher and watching it bounce back while the patient remains unchanged and quietly dies.
If you're doing it in an ambulance, your goal is to have it banging like a low-rider.
The force involved is also hugely tiring on the nurse, which makes it impossible to keep up for an extended length of time. "You are trying to compress the chest about an inch and a half in," says Ben. "After compressing someone for two minutes, you are drained. Do that for five more rounds, and your back and arms are practically useless." In the hospital, they don't even do compressions by hand most of the time. They start off by hand, but then they pass the job off to the chest-squeezing robot. And if that seems too impersonal for your sexy nurse fantasy, here's more bad news: Nurses don't do mouth-to-mouth. That's pointless compared to chest stuff, and the chance of you throwing up into their mouth is too high.
But, really, getting felt up by a killer robot is the ultimate fantasy.
When patients flatline, nurses don't reach for those shock pads. The defibrillator resets an irregular pulse; it can't restart a stopped one. But they try plenty of other procedures -- they don't give up in 30 seconds like on television and start sobbing about how "it never gets easier!" They'll put in an IV. They'll drill a hole into the bone for more meds. They won't call a death before at least 15 minutes pass without a heartbeat.
And, surprisingly, nurses want family members in the room during this whole process, despite all the infection and interference you'd think they'd bring. "Families that are watching stay the hell out of your way," Ben explains. "They don't want to be a distraction; they want you at the peak of your game just as much as you do. They are not at all critical. Yes, they are crying and emotional about the situation, but when they can actually see you go for 30 minutes trying to resuscitate their loved one, they only have respect for you."
For more insider perspectives, check out 5 Terrifying Things I Learned As A Drug-Addicted Nurse and We Can Let Babies Die: 6 Realities Of Neonatal Nursing.
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