Saturday, December 6, 2014

At Big Bend Regional Medical Center

             My first hospital was run by the Daughters of Mercy and the nuns said to treat every patient “as if he’s Christ Himself.” But what if you’ve never taken care of Christ? Or Virgin Mary—or Little Baby Jesus? What do you do then? What if the patient is handcuffed to the bed? Not that there's anything wrong with that.
             So, this guy's name was Juan and he was twenty-two or twenty-three years old, at that moment in the custody of the U.S. Border Patrol, this was in West Texas near Marfa at a recent time but, for you, probably far far away.
The patient had been arrested after spending five days crossing the high Chihuahua Desert on foot only to be caught when he reached the outskirts of Alpine where the hospital is. His first stop after arrest was the E.R. while he was checked out, the word from the Border Patrol was that Juan was spotted behind an abandoned building and that’s where he got busted on the outskirts of town.
             So, he actually looked pretty good for a guy who’d been drinking from water holes and sleeping outside, especially this outside, for almost a week. His clothes weren’t particularly dirty, when he was arrested he said he was on his way to Colorado where he had friends, that’s what he told me too. So, like, he was assigned to me and that meant he had to be admitted which is a pain for the nurse not the patient. We went through the list, family history of heart problems, diabetes, stroke, the usual suspects, wasn’t much there and contrary to what the nurse sometimes hears Juan’s history appeared to match Juan’s condition. He looked really good. If crossing the desert on foot did this for people—celebrities ought to try it instead of fat farms or spas or whatever—at least that was my feeling doing the paperwork at the time.
There wasn’t even a pinch of fat around Juan’s middle, he had well-defined musculature like a pro athlete, great veins that had already been tapped by the emergency room for a couple of lines. In build he was an inch or two taller than me but probably twenty pounds lighter—and about two inches shorter and forty pounds lighter than the Border Patrol officer in the room which pleased me too although it seemed unlikely Juan was going to cause any problems or get out of hand. The hospital actually gets a lot of prisoners from the local courthouse or the jail in Marfa that houses federal “detainees,” most of them caught sneaking into the country, yeah, people like Juan. After they’re sorted out and charged or not charged they’re returned to Mexico or wherever as the federal government sees fit. That’s the system. The big question for me as the RN was actually who came to sit with him or her in the room. If—when the Border Patrol grabbed him or her—there were already signs of any kind of medical condition he or she was in the custody of the feds. If on the other hand they were already in jail in Marfa when they got sick or were determined to be sick the Presidio County Sheriff deputies had custody in the hospital.
So, like, my preference was for the Border Patrol.
If you got the sheriff’s people they were nice enough and watched the prisoner well—even when he had to walk the halls, for the hospital cure so to speak, there were two guards, one deputy on either side ready to catch the guy if he fell or catch him if he ran, which is unlikely post-op, the pain and all, but you never know. Listening to their conversations the sheriff’s people seemed to live in their own work-related world talking about who was taking what shift at the Presidio County Jail and the details of their duties in a desolate part of the state best known for the uncertain delights of Marfa and Big Bend National Park. The Border Patrol guys and girls frankly had more game. They were more “cosmopolitan” and able to hold a conversation about something other than work, or their own particular work, and since most of them weren’t from the area they knew another slice of life which is important for a nurse if you’re going to get tied up in a room for any amount of time, you want somebody to talk to. Juan was a man of few words. He was watching TV when he wasn’t sleeping. The London Olympics were on, the Border Patrol guy sitting with Juan was looking out the back window of the room at the desert his prisoner had just crossed, in summer, on foot, the officer mentioned the landscape kind of reminded him of Iraq where he was a contractor back in the day. The only difference he said in Iraq the temperatures could reach 120. And—presumably, although he didn’t mention it—people were trying to kill you.
             So, his comment was interesting only because this area of Texas is all about heat. Practically everybody who gets admitted to the hospital in Alpine for whatever reason, heart problems or diabetes for example, infections maybe—microbes seem to grow really well in the high temperatures—has a secondary diagnosis of dehydration. Especially the old people unless they have heart failure and they’re actually being hospitalized to get rid of extra fluid. Alpine is a nice little town, almost a mile up, usually you don’t feel the sun, there’s a breeze most nights and we’re talking low, low humidity during the day. The sun just sucks the water right out of you and you may not even notice.
We had a patient right after my start on the unit, not that this is important although it kind of is, so he was an older gentleman living on his own somewhere in Brewster County, a little bit of Alzheimer’s or dementia going on—so it’s hot as hell one day and he goes home and turns on the air conditioner but because of the dementia he doesn’t realize he’s actually turning on the heat. Luckily someone went out to visit him, it’s that kind of community, people watch out for each other, someone called the paramedics before this older gentleman was cooked. He made it, he survived. The take home lesson is, like, it’s hot and with the breeze sometimes you don’t even feel it. High desert is still desert. Juan for example was getting rehydrated, he had fluids running, an IV. You know those little cups of orange juice they serve in hospitals? He liked those. But he wasn’t desperate—he wasn’t dying of thirst—his white count was high, that’s probably why they admitted him in the first place, that or just to get a better look at the guy, whoever he was he’d just had an experience that would have killed like 99.95% of the adult population of the State of Texas—and all the kids—but he looked pretty damn good if you asked my opinion which Dr. Luecke did that afternoon when he made rounds. If the federal government even knew what this guy was capable of they would give him a visa—that was my opinion but nobody actually asked me.
So, Dr. Luecke came in and said the high WBC count might be the result of dehydration, with less fluid in his veins his cell counts were all exaggerated, Juan had an antibiotic running just in case he picked something up drinking with cows, he also had air in his chest wall—don’t know what that was all about—the doc said it would probably get reabsorbed. This wasn’t Dr. Luecke’s first time at the rodeo, he’s a good doctor, he’s been here long enough to have delivered like half the county—he has kind of an old-boy aura but he went to Stanford University and his brother is some kind of math whiz at the university in Austin. So, he told Juan in Spanish that he’d be okay. Juan smiled like he already knew.
So, you know, Juan wasn’t a difficult patient but he was interesting, you know? It wasn’t like he was going to kick—or code—just keep a good eye on him for 24 hours or so and he’d live to wade the Rio Grande another day.
             There was a surgical patient in another room who was ex-Border Patrol and he told me that back in the day when he’d pick up guys coming from Mexico they were usually carrying limes in their packs. The water the cattle drink on the ranches is brackish and these guys, on the trek north, squeeze a little limejuice in to adjust the pH to make it safe for humans. That’s what it means saying that you can talk to the Border Patrol officers. They know stuff. Not that the Marfa deputies don’t, no offense, there it is. It's not a difference in knowledge base, it's more about communication skills, the deputies’ conversations are more limited not that there’s anything wrong with that. They’re all—Border Patrol and Sheriff’s people—carrying cuffs and guns, that’s what’s important if you ask me.
             So, like, being in the hospital is an opportunity for a lot of prisoners and if you’re a nurse you have to keep alert, not to intervene thank you very much—even if a patient is trying to escape it’s not in the nurse’s job description to stop him, your job is to render care as if the patient is “Christ Himself,” or whoever, but not tackle somebody sprinting down the hallway, at least not in this RN’s view. So, like, before coming to Alpine to tell the truth my last interaction with a handcuffed prisoner was not so good. That influenced me, certainly.
              And the experience still made me anxious with Juan.

             So, this was in the Pacific Northwest on a neurosurgery unit and a night shift—which is always problematic or seems to make problems worse or at least makes my problems worse working nights. So, at that time, on that shift, my plate was already full—it seemed in my modest opinion that my patient load was already heavier than anyone else on the unit although that was apparently not a widely held belief because the charge nurse called me over and said a new patient was coming to the unit and would need “a male nurse.” So, next thing an ICU nurse was wheeling over a gurney with a patient and a sheriff’s deputy following not far behind.
So, to deal with the most important detail at the beginning the patient was cuffed to a bed rail, but not his wrists.
             The handcuff was actually a leg chain joining him, one hoped, inescapably to his new bed. He wasn’t going anywhere but he had free use of his hands.
             So, like, we got the patient settled in and the deputy sheriff guarding him settled in a chair and then the ICU nurse who was kind of hot—not that that’s important although her exceptionally-steamy appearance did mean she got my complete attention for the five minutes it takes to give report—she took me into the hall to tell me about my new guy. So, of course, first thing the ICU nurse does is launch into the psycho-social aspects of the patient’s case, his home life, my eyes rolling back in my head—but that’s actually when it got interesting. Really interesting. You get cynical working in a hospital after a while, you think you've heard it all—what she was telling me about the guy in cuffs—he'd been found a couple of days before behind the wheel of a vehicle parked in a public park. He was unconscious and covered with blood, that's what the ICU lady said.
             So, he was taken to an E.R. and checked out. He was in a coma at the time, apparently drug-induced, perhaps the result of an overdose, perhaps not, but what most interested everyone in the E.R. was the blood on him and on his clothes. Because—and this is the crucial fact—he had no wounds on his body. Pretty cool, huh? A mystery. The police went to the guy’s house to look for the source of the blood. And they found it. The blood belonged to his wife.
So, the patient looked to be in his forties, balding, milquetoast manner, a pale used-up little guy: the kind of guy you could pass on the street every day of your life and never notice, so someone might say. So, eventually, for whatever reason, he’d lost it and killed his wife, the sheriff’s deputy was sitting off in a corner of the room playing all night with his cellphone but me—you know, doing vitals, getting blood, the assessments and all—that required close proximity which was cool because he was cool, the patient. So, we fed him that night after he came out of the coma and in the morning me getting ready to give report to the day shift, cleaning up the area for whoever followed—this guy’s dinner tray was still there and there was a knife on the plate. A real knife—not plastic—steel, something you could stab people with, which is presumably what he had done to his ex-wife, and the knife was within his reach for like the last ten hours and it occurred to me that if he went off again, like he did with the late Mrs., guess who would have gotten cut? Not the sheriff’s deputy sitting over there in the corner with a nine-mil on his belt.
 In nursing school an old psych nurse told me that if someone has a knife and is within a few feet of you, even if you have a gun the person with the knife can kill you before you can shoot him. Or her. That's a happy thought, so—me being a coward personally—the danger that night made an impression on me and my feeling since then has been it’s always best to check security first, no matter if it’s just somebody like Juan who you have no fear of. Because shit happens. That’s why hospitals were invented, right: Shit happens, that's actually my theory of nursing practice as well, the idea is that shit happens, yeah, but for it not to happen to you.
             Or more importantly to your patient.

Seemed for a while that we were getting a lot of prisoners in the hospital in Alpine not that there’s anything wrong with that.
The inpatient area of Big Bend Regional Medical Center is divided three ways. You come down the hall from the emergency room and turn left to have a baby, go straight if you've come out of surgery or right for any kind of medical condition that requires hospitalization.
              Even though the next few prisoners were all surgical patients they were all placed in the medicine area, on the right if you’re facing the nurses station, because the rooms are bigger and allow the guards to stretch out and because there’s a big exit on that side. Leads out into the desert actually. If the patient does escape which is not likely you want the first thing he sees to be “EXIT,” no matter what’s beyond the door. No lie. The hope at a lot of hospitals is if the cuffs don’t hold ‘em, hopefully an easy out will lure an escapee from the facility. You may say that’s grasping at straws but medicine, it seems, in my modest nursing opinion, is the ultimate percentage game. Generally you have to follow the percentages. Whatever the likelihood that an escaped prisoner is going to be lured by an “EXIT” sign—or not—it’s still better than the alternative which is that the guy decides to go to the cafeteria or visit the nurses station, you feel me?
             The three prisoners along with Juan were also illegal, some people do not like that phrase, it is descriptive, they were picked up by the Border Patrol but by the time they reached the hospital they were in the custody of the good people of the Presidio County Sheriff’s Office: they were experiencing Marfa, you might say, through the bars not in the bars, or in the art studios. All three were appys.
             The first one had gang tattoos which made people a little anxious taking care of him but he turned out to be quite nice or as nice as anybody can be who’s handcuffed to a bed after surgery and has two sheriff’s deputies in close proximity. The guy’s mother, wife and kids actually lived on this side of the border which may have explained his attempts to cross into Texas and they came to see him in the hospital and my responsibility as charge nurse that day was to go out into the waiting room and explain that when you’re a prisoner in the hospital it’s not like being an ordinary patient. You can’t have visitors if the guards say no and the guards say no now. Sorry. Everybody will have to wait for visiting day in the jail. They took it well.
One of the other guys was taken care of by Marisa and the third guy by Jess. So, like, Marisa and Jess are both very attractive young women, and very good nurses, and it was interesting to watch their interactions with the prisoners which was kind of my job on those particular days. Both Jess and Marisa were pregnant which meant they were moving kind of slow but that didn’t affect their nursing skills. Marisa’s husband Carlos is Border Patrol so she kind of knows the population and both she and Jess treated their guys as if they weren’t handcuffed which as supervisor is what you want to see, you want the nurse to treat the patient no matter who he is or why he’s in the hospital like any other patient, or like “Christ Himself” as the Daughters of Mercy would say. There were psycho-social issues too, sure, Marisa’s guy was already in jail when he got sick and he said the other inmates laughed at him when he started complaining of belly pain, calling him a whiner or whatever, they thought he was just bellyaching or whatever—until people realized he really was sick. Jess’s guy was really macho and it was funny because at first he didn’t want to take pain medication from her but he took it from me. You would think a really macho guy would take the morphine from a young female nurse before he’d take it from a male RN but this guy kind of acted like he didn’t want to show any weakness in front of a woman. Dude! If you’ve just had surgery for a burst appendix take the medicine from whoever’s offering it, that was my advice to him. Actually something Marisa’s husband told me kind of influenced my view of prisoners as patients in general and my guy Juan in particular.
 So, before coming to West Texas, Marisa and Carlos were stationed in Arizona and he said sometimes out on patrol in the desert they’d find skulls, not often but often enough to make you wonder how many people didn’t actually make it to arrest. The desert gets them.
              So, like, the take home lesson for me as a longtime city-dweller was that the desert is a bitch, that’s still my feeling now, you may know that already but you may not know how big a bitch it is. My idea at the time taking care of Juan was that the federal government should have a contest—a kind of Olympics or World Cup—a filmed series like “Survivor,” maybe, featuring the U.S Border Patrol, whoever gets out of the desert gets the visa. You feel me?

So, we had a patient one night in the hospital who was attacked by a mountain lion.
             No lie.
             Seems like there’s an attack in the national park about once a year, sometimes fatal, usually not, this young lady was European—not that there’s anything wrong with that, she was from Spain or Portugal, somewhere in there—and so she was walking in the park with some friends when a big cat picked her out to eat.
             So, this was not my night to work to be honest, all of this came to me secondhand and a while later but my source was impeccable. So, first, let me digress. This will lead back to my guy Juan but not immediately. So, like, before getting to the almost-eaten Spanish lady: we had another patient in the hospital once and we were talking and you know—just me and him in the room, just passing the time—you know, me asking him what kind of work he did for a living he told me he was “a mountain lion hunter” which, you know, sounded like complete bullshit to me. Like saying you’re a secret agent—or a rocket scientist, you know?
But later people told me it was really true, hunters really were hired to “cull” lions that attacked cattle on the nearby ranches. So, like, this guy, the “lion hunter” told me the rule with mountain lions, unlike bears, is if you're unarmed you want to make a fuss when you see one. That’s actually useful to know around here near Big Bend National Park and all. So, that was news to me being from the big city.
            Once, hiking years ago in Glacier National Park somebody told me that if you run into a grizzly on a trail your best bet is to act demure, look down, don’t piss the bear off by making a big scene. He or she is either going to eat you or not, it's completely the bear's call. “Never run from a bear!” the expert in Montana told me.
           But not in West Texas!
           How cool is that?
          Working in Big Bend the lion hunter told me the rule is the exact opposite: “Make yourself big”— whatever that means—whoop it up, escape if you can, but mostly make the feline think you are about to be the worst meal she will ever eat. The theory, one supposes, is that cats are basically lazy and even mountain lions avoid prey that looks like too much work. That’s the theory.
           So, that’s basically what the European chick’s companions did. They scared the cat off—whooping and yelling presumably—waving their arms, successfully, whereas if it was a grizzly, which do not live in Big Bend National Park, by the way, whatever the girl’s friends did wouldn’t make much difference. Basically my feeling is if a bear has shown an interest in you your time on earth is very limited no matter what you do—that’s just my view—not that it’s particularly relevant here because we’re talking about big cats and Juan.
So, this Spanish or Portuguese young woman, let’s call her Spanish for simplicity, like Juan she wasn’t in bad shape. She was scratched up pretty bad but apparently nothing serious, the emergency room was going to ship her to a big city to see a plastic surgeon, you want to do that quickly while the wounds are still fresh and before they’ve begun to form scar tissue.
              So, she was waiting for the plane or whatever and she came down the hall from the E.R. to use a shower in an empty patient’s room and the people at the nurse’s station said she looked “spooked” walking down the hallway. Yeah, you think? One minute you’re hiking in a park and the next minute a mountain lion is trying to eat you. You’d be spooked too. Any of us would. So, the point here is that’s the fate Juan escaped too. He was actually a pretty cool guy even if he had just violated numerous laws of the United States of America. He spent five days in the desert, in existential heat, thirsty and facing a possible run-in with a mountain lion, you feel me?
 So my view of him at the time, taking care of him, being proud to be his nurse, not only the respect you want to show any patient—like "Christ Himself" as the Daughters of Mercy say—but feeling awe and admiration as well. This guy kind of reminded me of the athletes up on the television screen showing the Olympics, "illegal" or not Juan was a pretty cool dude, he’d just done something that only a very small percentage of the world’s population was physically or mentally capable of.
He was smart too, maybe not book-smart but certainly clever and resourceful, ambitious or at least he had a goal—in his case reaching Colorado.
My best guess?

He’s there now.

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