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 sixth in what I plan to be a series of vignettes on my experiences in the hospital.

“C’mon.  Let’s go, Hiawatha!” he told me at one point during the day.

A stroke can be devastating; a mind and body laid waste, I think to myself.  This guy yells for people who aren’t there—an Ed, a John, a Bob—yells cocksucker and fuck you and occasionally messes up a phrase like son of a fish.  Sometimes he’ll yell for help or just declare that he loves you (though not to you, but to someone else he thinks is there).  Other times he will talk of conspiracies or about business files or stocks.  His right arm and side hangs limp, and he seems not even aware that it is part of his body.  After he bit his hand once, I spend the rest of the day preventing him from doing it again, a half dozen times or more.  It’s a wrestling match.  His legs and arms are covered with bruises and sores from where he has kicked the side rails of the bed.  His left arm, the whole left side really, is very strong.  It’s easy to imagine that he had once been a powerful man when at full strength.  He can still twist his body wildly or squeeze his hand very hard.  But he can’t manage any basic functions.  He had a colonectomy decades ago that causes him to have loose stools ever since.  Now he’s on tube-feeding and that doesn’t help a bit.  He has a catheter for urine and a fecal management tube for bowel movements.  His buttocks are raw from the wiping of shit.  The fecal tube (held in place by a ball inflated with water the size of a nectarine) should help with that, but he ripped it out the night before.  He’ll throw pillows and pull off his gown.  He’ll push himself with his left arm so he’s leaning far to the right on the bed or in the cardiac chair.  The nurses try the chair to give him a change of position, but it’s hard work getting him in and out of it.  Fortunately, the chair has two safety straps to keep him in.

* * *

The doctors say he isn’t going to get better.  In fact, he’s gotten worse since the last time I saw him.  He still yells for Ed to help him or for John, but then feels betrayed by John (which happens to be the name of his nurse today), but he still loves him.  “I love you, Ed.  Did you realize that?”  He says it as if he is just discovering it, too.  I wonder who it is, and if he realized it.  A childhood friend?  His brother?  A business partner?  He keeps pulling at the binder around his chest and belly.  It’s a girdle-looking thing that’s velcroed in the back.  They put it on him so he couldn’t pull out the feeding tube that goes directly into his stomach.  It would have been impossible to place an NG tube (nasogastric).  With his movement and thrashing, a lot of the hair on his chest and back has rubbed off around the binder.

* * *

Now he is in restraints.  Actually, only his left arm, the strong one, is tied down, but this is even while I am in the room.  Normally, patients are not restrained when they have a constant observer because that’s why I’m there.  But he is too much.  He hits.  He still tries to bite his right arm.  He no longer seems to have any idea where he is or who is there.  It’s hard to tell what is left of him in there.  The nurses say the family will have to decide what to do next.  The only option seems to be heavy sedation and keep him in a nursing home.  At times, the drugs have no effect.  He disturbs all of the patients around him.  His fecal tube leaks.  They finally discovered that it’s broken.  And when I say leak, I mean that the ball of water that is supposed to keep all of the liquid stool from seeping out isn’t doing its job.  It’s supposed to direct all of the waste through the tube in order to keep his buttcrack clean, but it isn’t.  His butt is much worse.  It’s so raw he is bleeding in places.  It’s horrible.  The nurse puts in a new tube while four of us hold him down.  It’s like pinning down a wild animal.

* * *

So now he’s dead.  I ask a nurse who had cared for him what happened to him and she told me he died a week earlier.  We both agree it’s probably for the best, that he’s in “a better place,” whatever that means.  She hopes he isn’t in that “other place,” as she puts it.  I start to tear up as I talk to the nurse.  It’s all so sad.  Sad that he is dead at age 50, leaving behind a wife and kids.  On the dry erase board his child (for some reason I imagine a daughter, though there was nothing in the handwriting indicative either way) had written “We miss you, Daddy.”  It’s heartbreaking.  I hate to think of his children or wife seeing him in that state, on the bed, confronting a shell of the man they knew.  One who yells obscenities and calls out for a childhood friend.  Who can’t eat food or control his own waste.  Who doesn’t know where he is.

He was gone long before he left.