People often ask me what I find to be the hardest part of being a nurse.  More often than not, I hear the phrase, "I could never be a nurse…I just don't think I could wipe someone else's butt." If only it were true that the hardest part of my job happened to be the wiping of butts.  I would actually probably consider myself way over-paid if a little poop constituted the most challenging part of my work day.

Wiping a butt?  Bring it on.  I'll wipe butts all day if I have to.  Once you've wiped a few hundred of them, it almost becomes mundane.  I've had extremely close relationships with other people's poop throughout my 12+ years as a nurse.  Including, but not limited to, getting in on my shoes, my clothes, all over the floor, the bed rails, my face, and the ever-enjoyable turd smear that hits just above the wrist in that no-man's land between the end of the glove and the beginning of my shirt.  There's a reason I no longer wear long-sleeved shirts at work.  I can wash my skin if it gets a little filthy.  My shirt?  Well, it just has to come off, and given the cut of scrub tops and the questionable behavior of some of my male patients, let's just say I'd rather not be leaning over them without an undershirt on.  So t-shirts under the scrubs it is.  This may sound odd, but there's something very therapeutic about doing something for a patient that they can't do for themselves, and this extends to cleaning their behinds.  We all know that there's nothing more uncomfortable than unclean nether regions, and in the hospital this is paramount.  So, if my patient is incapable of getting him or herself clean, then I make it my mission to do it for them, and to do it probably better than they would have done it themselves anyway.  It's the least I can do, really.  And it's funny…the majority of the people who wrinkle their noses up at the mere mention of butt wiping, have children whose butts they've had to wipe a myriad of times throughout their childhood.  So they know what it's like to wipe a butt that isn't their own.  Granted, wiping an adult butt is somewhat different than wiping a child's butt, but the basic concept is the same.

The hardest part of my of job is actually much more complex than poop.  How I wish it could be that simple.  In the 12+ years that I've been a nurse, and in the many different hospitals I've worked when I was a travel nurse, I've started to see a shift in healthcare.  Sometimes I think what I'm seeing is regional, as the difficulties faced in one hospital are completely different from the difficulties faced in another.  The hardest part of my job, no matter where I'm at, is this: dealing with people who have no interest in taking responsibility for their end of the healing process.  Getting healthy and staying healthy is a two-way street.  There are things that we can do as healthcare providers, but we can't do everything…and that's where the patient comes in.  They have to want to get better, they have to commit to obtaining a healthy living plan and stick to it.  Hospitals don't cure people.  Doctors don't have magic pills that make everything go away.  Just because a person shows up sick to the hospital, doesn't mean that he or she will leave in perfect health.  You'd be surprised at how often patients leave the hospital disgusted and disappointed because we weren't able to cure them of their ailments.  Ailments that arose from years and years of self-abuse, of poor eating habits, of a sedentary lifestyle, of drinking too much, eating too much, of completely ignoring the genetics with which they were born…somehow it's our fault that we can't reverse a problem that's been years in the making.

I struggle the most with the alcoholics and the drug addicts.  It's one of my weak points as a nurse, and it's something that I try very hard to be aware of when caring for this patient population.  I try to remind myself that no one aspires to be an alcoholic or a drug addict.  Simple as that.  No five-year old on career day stands up and announces to the class that he can't decide between being a veterinarian or an alcoholic when he grows up.  And not that I'm comparing alcoholism to a career, but given some of the people I've taken care of over the years, the same amount of time and effort spent getting to the bottom of a bottle is the same as what one would spend working a full-time job.  It's like being drunk IS their job.

And what's even more sad to me, is that the largest concentration of alcoholics and drug addicts that I've cared for happen to live in what I consider some of the most beautiful parts of the country.  Working on the Gulf Coast in Florida, I saw more prescription drug abuse in the 13 months total that I worked there than in the rest of my 12 years combined.  That's insane.  I don't know why we even bothered drug testing the majority of the population, because so many of them tested positive for opiates.  Opiates that they had obtained legally by prescription from one of the thousands of pain clinics that prey on patients throughout the state.  And the patients felt entitled to it.  I couldn't tell you how many patients would scream at me, ask for narcotics by name, dose, and route of administration.  Well, I probably could, because there was probably at least one patient every shift who behaved this way, so all I would have to do is count the number of shifts I worked, but that would be depressing, so I'd rather not.  I remember going home and asking myself, "what could possibly be so bad in these people's lives that they felt the need to be drugged up all the time?"  Maybe it's hard for me to understand, given that I've never really been addicted to anything.  I would just sit out on the beach, drinking a cold beer, enjoying the sunshine and the waves crashing at my feet, and think, "this is the life!  This is why I work so hard…to enjoy these days off!"  And maybe that's it…maybe a lot of them didn't understand the concept of working hard and having a nice day off at the beach as a reward.  It was ironic to me the number of Floridians I met who never went to the beach.  They would go years without putting their toes in the water and their behinds in the sand.  Why live in Florida if not to enjoy the ocean?  Maybe what some of those people needed was a beach day rather than 4mg Dilaudid given via IV.

The saddest thing about drug abusers is that eventually they'll overdose, and sometimes they might be found in time to receive medical attention, and sometimes they might not.

In northern Arizona, it's the alcoholics that come to the hospital in droves.  Again, this area of the country is so beautiful; it's sunny, there's so much to do outside, there are so many things to see and do…I just don't know what these people are missing in their lives to resort to needing to be drunk all the time.  Every time I would mention this to people asking about the trials of my job, they would automatically assume that since the hospital is so close to the Navajo reservation, that all of our alcoholic patients were Native Americans.  But that just isn't the case.  It's people from all walks of life, and the number of them is staggering.  An Emergency room synopsis of "patient found down, unresponsive, alcohol level >400" is a frighteningly common occurrence.  An alcohol level of >400 would kill a person like me.  Admittedly, the hospital serves a very large area, so we definitely see the worst of the worst, which is scary in its own right.  How many others are there who we don't see?  How many of them go to the emergency room, are treated and released, only to reappear days, weeks, or months later, often for the same problem?  Some seek out treatment, some don't.  Some have family members who are there to offer support, but a lot of them don't.  A lot of them are caught in this vicious cycle, where they know that they need to quit drinking, but everyone in their family drinks, their friends drink, their kids drink…it's tough as nails, if not impossible, to be the only one not drinking in those situations.

Alcohol detox is no joke either…it's one of the few substances that a person can die from during the withdrawal period.  There's usually about a 24-48 hour window between the time of their last drink and before the withdrawal symptoms start.  If the person is a hardcore alcoholic with no intention of stopping drinking, it's actually easier to treat their medical issue as quickly as possible and send them on their way before they start to withdraw.  Sounds terrible, I know.  But honestly…detoxing someone who's just going to hit the bottle the minute they leave the hospital is an exercise in futility.  It's not that we've given up on these people, but the majority of alcoholics who show up at the hospital have been to and failed rehab several times.  Withdrawing from alcohol is very dangerous…not just for the patient, but for the staff as well.  Patients in the throes of withdrawal literally lose their minds.  Almost every time I've been assaulted or nearly assaulted by a patient, it's been by someone withdrawing from alcohol.  Days later when the alcohol has cleared their system, they won't even remember it.  Assuming they remember anything at all.  There is an ugly side to detoxing a functioning alcoholic...sometimes they don't recover their cognitive function.  Their brains have been so damaged by the years and years of alcohol abuse that there's no recovering what's been lost.  I've seen 50 year-old men assigned to nursing homes for the rest of their lives after being detoxed because they cannot safely take care of themselves.  It's a strange concept for someone outside of the hospital setting, but it's very real to those of us in the trenches day in and day out.