Nursing On The Porch

The rain was coming down in sheets and visibility was poor as my car coasted down a narrow street lined with tar paper houses with sagging porches.  It was midmorning on a Saturday...a dark and thunderous day with humidity so thick that my skin was wet before the rain even hit it.  I checked the house number on my referral sheet and sure enough- the most dilapidated house on the block was my intended destination. I grabbed my notebook and nursing bag and decided to make a run for the front porch in the driving rain. I slung open the car door and stepped out into the sticky rust-colored mud, The yard consisted of a few stubborn tufts of weeds and a thick red clay mud.  Near the road there was a set of tractor tires that had been spray-painted white some measure of years ago and turned up on the side to form make-shift planters where brown weeds had long since died.   My white shoes squished and stuck in the mud and I stepped out of one shoe.....and my white sock was immediately full of the rain-soaked mud. I managed to slide my shoe back on only to notice that my white nursing pants were splattered in red clay as well, and the damage was more wide-spread with every step. I reached the steps of the porch, a little started by the enterege of 3 mange afflicted half-bald skinny dogs who stopped scratching their open sores long enough to check me out. I could almost literally hear the yelps of the fleas as they abandoned the emaciated dogs in favor of my juicy ankles.  If the dogs were unsettling, I certainly wasn't prepared for the next sight. There was an old couch sitting to the left of the front door, lacking ulpholstrey with exposed springs where the foam was completely worn away. it smelled worse than the poor wet dogs.  Perched on the end of this filthy furniture was my patient.  He was tall and painfully thin and blind in one eye.  His right eye was a milky white, completely devoid of all color and it rolled around his eye socket like a marble in a pinball machine. He wore overalls and a ripped and dirty long-sleeved flannel shirt and on his feet he wore canvas tennis shoes that might have once been white.... with the toes of the shoes cut out so his own toes could curl over the ends of the shoes and scrape the floor when he walked. Everything he wore was filthy and damp. As I walked across the sagging porch, I reached out my hand to shake his and introduce myself.  His first words to me were a bit too loud and cheery, "HI! WELCOME TO THE CRAZY HOUSE!" He proceeded to tell me that the house belonged to his daughter, who had kicked him out of the house because she thought his "shit bag smelt too bad." I was amused that she was able to pinpoint the source of the odor.....just judging from the glimpse of garbage strewn interior of the house I had seen through the screen door. I was dripping wet from the downpour, had a muddy sock and shoe, my white pants were likely ruined and the fleas were biting every area of exposed skin.  The dogs would periodically jump on me with muddy paws, seeing if I had a morsel of food for them and I was almost overcome with the rank odors of the wet and moldy couch, the wet dogs and the unwashed man. I knocked on the front door, such as it was: a ripped screened door sagging on rusted hinges.  I thought that perhaps I could reason with a family member and at least gain access to the bathroom to change the man's colostomy bag and wafer and to wash my hands. An elderly woman with no teeth and an oddly flat face with wide-set eyes and low set ears wearing a thin threadbare calico cotton dress with the pockets torn off came to the door and demanded, "What you want?" I presented my case in a professional manner, mentioning that I really needed access to running water to perform my duties.  she said, "NO! He ain't a comin' back in here.  That shit-bag stinks!" and with that, she slammed the door in my face. In a state of shock, I realized that I would have to regroup and it became apparent that I was going to have to complete the visit on the porch, making do with what I had. Oddly, the man did not mind the fact that the was disrobing on the porch.  The overalls were dropped around his ankles and his shirt was off before I realized and could try to protect his "modesty" He was not wearing any underwear. He was indeed filthy. The most alarming site was the amount of stool dripping from the end of the colostomy bag.  The bag was puckered and the end was open and wadded up with a rubber band loosely wrapped around the end, but not effectively. The man said, "Oh,  that thing don't work too good. I lost a piece off it and tried to fix it with that rubber band.  I guess that's what's a making it stink so bad."  So bad indeed. I cleaned him off as best I could with dry gauze 4 X 4 squares and some waterless antiseptic gel hand cleaner. It seems a losing battle.  After what seemed like hours, he was clean enough for a new bag WITH a clip. He had no clean clothes and the insides of the clothes he was wearing were covered in dry stool, but he pulled them right back up with out a second thought. He asked me for money, which I didn't have to give him.  I did have a pack of cheese crackers and an apple in my car...which he consumed eagerly.  He had slept on the couch the night before and had not eaten.  He told me that he had $16 left from his social security check and that he could always sell his pain pills and get about $4 for each pill, which should feed him for the next week or so. He told me that he planned to go stay with his son who lived across town as soon as it stopped raining. I left him sitting on the porch, eating the apple and kicking dogs away. He smiled and thanked me profusely, as if I had given him a million dollars. I climbed into my car, trying not to touch anything I didn't have to touch, and headed straight home for a hot shower and clean clothes and a call to our social worker.  Just another day of home health nursing.