A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the fourth in what I plan to be a series of vignettes on my experiences in the hospital.

He looked like a caged animal.  I went into his room in the morning, and he was there only in a diaper, a grown man probably in his 70s, a retired farmer, on his hands and knees on the bed, which was covered with a mesh enclosure to make sure he didn’t get out of bed during the night. I was supposed to wash him up and have him ready for the occupational therapist, who would help him get his clothes on.  I wasn’t used to washing up a moving target.  I asked the nurse aide to help me—she was a little put out I couldn’t do it by myself.  His diaper needed to be changed as well.  And the bed linens, but that could be taken care of when he got up.

I had been with him the entire previous weekend down on Neuro Acute.  He had fallen down the basement steps and hit his head, causing internal bleeding.  He had more tubes and lines when he was down there.  A central line, a feeding tube down the nose, telemetry leads, a catheter.  He picked at everything—it was a constant battle so he wouldn’t pull things out or off.  The tele- leads weren’t a big deal, just an annoyance, but the others were serious.  I couldn’t let him get a hand on them or it would be big trouble.  He grabbed all of them at one point or another.  I would grab his hand so he couldn’t continue pulling.  Then I had to pry his fingers off one at a time from the tube or line.  Sometimes he would try to roll over or get on all fours, which was a problem with so much attached to him.  I felt like I was wrestling him in order to keep him safe.

He looked like a writer I had known while I was in grad school.  In fact, the resemblance was rather unnerving.  It made me feel protective of him, that he was in my charge, that his care was my responsibility.  So that’s why it especially hurt when I got chewed out by a nurse down on Neuro for not alerting her right away when some machine started beeping.  Things were always beeping in his room: bed alarms, telemetry monitors, IV pumps.  I was still pretty new at the job and didn’t know what was a priority and when I should get the nurse right away.  This time it was a leak from his central line.  I put on the call light.  Eventually his nurse was able to come to the room and check, only to find that some med that he needed had leaked onto his chest.  The connection between the central line and IV pump had been tenuous.  Instead of putting on the call light, I should have found her immediately.  Now she couldn’t properly chart how much medicine he had received.  I had screwed up.

When he was upstairs later in Rehab—a halfway unit intended to transition patients out of the hospital and where I found him on all fours like a naked animal—he did manage to dislodge his feeding tube.  I couldn’t stop him in time.  It was the last evening I spent with him before he was transferred to a nursing home.  Earlier he had begun to smile and even make jokes.  He pretended that he was going to drop a cup, and then smiled broadly when I fell for it.  He still couldn’t talk, but I could see the pleasure he got from this normal human interaction.

Before he left for the nursing home, he curled up on a couch in his room (the couch was a pull out bed for guests).  Still tethered to an IV pump on a stand with wheels, he seemed like my sleeping child that I was watching over.  I put a blanket on him so he wouldn’t get chilled.  My shift was almost over.  I turned the lights off in the room.  It was already dark outside on a late November afternoon.  And we both waited to leave the hospital.