By Rachel Merton
When I was applying for nursing school, none of the interviewing professors mentioned anything about leeches. Or violent octogenarians, or the dangers of a Bojangles’ hospital diet, or the vital skill of balancing on a rolling IV pole at four in the morning. My formal nursing education prepared me for the majority of the tasks I would need to perform to provide top-notch patient care; as it turned out, a college boxing class and an ability to improvise proved just as valuable.
Most hospitals break in their new nurses by having them switch between night and day shifts to familiarize them with the whole 24-hour-care cycle. (Plausible, but I think it’s also to get nurses so disoriented that they forget how many hours they’ve worked and are too dazed to say no to working overtime.)
Nights tend to be quiet, unlike the nurses who work them. Anyone who’s spent a night in the hospital will complain about how loud night nurses are, but we’re just doing what we have to do to stay alert. We fend off sleep with caffeine fueled dance-offs and IV pole races. These are races in which two nurses line up at the end of a hallway, each standing on her own rolling IV pole. Another two nurses then give the contestants a hearty shove to see who can roll the farthest and the fastest. It’s important to have a lookout when the races start; I once rolled past an attending physician while I was channeling my inner Michelle Kwan, sacrificing speed to complete an “arabesque à la pole.” The physician never said hello to me after that, but it was a small price to pay for winning the artistry competition that night.
I thought of my first night shifts as being like a slumber party. You get to stay up all night with other young, inexperienced nurses while the grown-ups (experienced nurses, administrators, and most of the doctors) get their beauty rest. Just like slumber parties, the night shift can get scary, and sometimes we wished the grown-ups were around. The worst bumps in the night came from the “sundowners”: patients with dementia who are perfectly pleasant for the day-shift nurse but become increasingly agitated and confused as the sun starts to set. That cute little lady who reminded the day nurse of Mary Poppins turns into the Wicked Witch for the night nurse, pulling out IVs and urinary catheters and screaming at her would-be helpers. When her nurse finally comes to the rescue, she is often rewarded with scratches, slaps, bites, or being spat on in the face.
Not all the sundowners were unpleasant, though. My favorite was Ms. H, who I was convinced really wasn’t confused at all. She never spoke to me, but every time she threw her juice on the floor or pulled out her IV, she’d flash a mischievous smile that said, “If you think you’re in charge here, kid, you’ve got another thing coming.”
When my shift started, Ms. H was on her third IV, which she was determined to remove like all the others. After hours of attempting to distract her, I resorted to pleading: “Please don’t make me put you in the mittens, Ms. H.” The mittens are a soft restraint, used to keep patients from pulling at lines or scratching themselves, and when applied, they tend to make the wearer look like a not particularly intimidating prizefighter. But Ms. H continued to yank at the line, leaving me no other option.
As I gloved her up, Ms. H grumbled but she didn’t resist. Actually, once her mittens were secured, Ms. H looked satisfied for the first time that night. I lowered the head of her bed and tucked her in, hoping she would finally go to sleep, but I left her door open so I could still keep an eye on her.
The next time I walked by her room, I saw the reclining Ms. H throwing punches toward the ceiling. She was belting out the Rocky theme music, hopefully training to take on her day nurse and not me.
Turning a sundowner into a prizefighter was an accomplishment, but the first time a nurse saves a life is a landmark achievement, no matter how absurd her method. My first save came when I assumed care of Mr. D, a man who had undergone extensive hip surgery a few hours earlier. Patients fresh from surgery are put on a clear liquid diet until active bowel sounds prove that their GI tract has recovered from the paralytic given for the operation. Unfortunately, sometimes patients’ loved ones think this rule exists only for the sadistic pleasure health-care workers must get from starving their patients, and these loving family members don’t see any danger in shoving solid food into the mouth of a person who is liable to fall asleep mid-conversation. Mr. D’s doting wife was one such liquid-diet skeptic.
About an hour after I thought I’d gotten Mr. D settled, his wife flailed her way to the nurse’s station, shouting, “He’s choking! He’s choking!” Another new nurse and I ran to the patient’s room and smacked the staff emergency button. Mr. D’s hip surgery limited our options for Heimliching him: he couldn’t stand, he couldn’t sit straight up, and he couldn’t allow his legs to cross or even come close together. The other nurse helped me roll Mr. D on his side, and while she held his leg up in the air, I began punching him just below his sternum. (Where was Ms. H when I needed her?)
Other nurses arrived to help hold the leg while I kept punching, to no effect. Suddenly I remembered the boxing class I took in college. “This is no time for a jab,” I thought, “this man needs an uppercut!” And with one last upward wallop, Mr. D’s beloved Bojangles’ fried chicken flew from his trachea and landed on my shoe.
As I walked out of Mr. D’s room, I passed the first-year resident who got the emergency call and who had been standing at Mr. D’s doorway watching the action. All color had drained from his face as he helplessly watched our bout. “Don’t worry, Doc,” I told him, patting him on the back. “We got this.” I hummed the Rocky theme to myself as I went to check on my next patient.
Though I’ve never been thrilled to punch my patients, or watch them regurgitate partially digested food, I know there are worse things I could be experiencing. Every nurse has that one task she tries to avoid but knows she will eventually have to face. For some nurses, it’s tracheotomy suctioning. For others, it’s enemas. For me, it was leeches. I had successfully dodged them for more than two years when my time finally came. Worse than knowing I would have to handle them was the common knowledge on the unit that every time leeches were ordered, one would get lost. The only way to track down the missing leech was to follow its signature trail of blood, which usually led under the patient’s bed or into the hallway. I had no interest in adding “rogue leech bounty hunter” to my resume.
Medical leeches are used to salvage compromised reattached muscle tissue, usually in fingers and limbs. The leech’s saliva—a natural anticoagulant—along with its inherent love of bloodsucking, makes it great for relieving venous congestion, when the amount of blood entering an area through the arteries is greater than the amount the veins are able to remove from it. If the blood remains pooled, it can lead to necrosis in the replanted tissue, ultimately resulting in an amputation. A successful round of leech therapy can help patients avoid such a fate.
My leeches were ordered for Mr. M, an active-duty soldier in his early twenties whose right leg had been crushed in Afghanistan. He had already been through two military hospitals (one foreign, one domestic) before he was finally sent to us. Our team of world-class orthopedic and plastic surgeons were his last line of defense against an amputation. The surgeons took muscle from Mr. M’s right calf, as well as skin from his left thigh, and grafted them to the missing part of his right shin.
A day or two after surgery, when Mr. M’s graft was purple and cold to the touch, the leeches were called in. I was to apply two leeches to the site every two hours. They would feed for ten to sixty minutes, and when they detached I was to put them in a jug of rubbing alcohol—I called it the Jug of Death—where they would quickly dissolve.
With a quick call to the Facilities Department, the leeches were delivered from their secure location to my unit. They arrived in a clear container of sterile water, which, fortunately for me, was covered with a paper bag. I convinced myself the leeches weren’t disgusting but a necessary, cutting-edge medical intervention. I read the hospital’s official leech policy at least half a dozen times so I could fool Mr. M and his family into thinking I was a pro at leech attachment, but I gave myself away as soon as I pulled the leech container out of its bag in Mr. M’s room. I couldn’t help making a revolted face and holding the container at arm’s length as I revealed the swimming slugs to Mr. M’s family. Fortunately, I had developed a good rapport with Mr. M’s parents and his wife, who had quit nursing school to become a full-time military spouse. They were rooting for me when I used tweezers to catch the first leech. “It’s just like fishin’ bait, darlin’,” Mr. M’s father reasoned with me. Drawing on my extensive fishing knowledge, I secured the “bait” and attached the first two leeches.
The four of us leaned over Mr. M’s leg, mesmerized by the movement of Mr. M’s blood being digested in the leeches’ slimy little bodies. As the day went on, we all became more comfortable with the leeches, and everyone took a turn picking out a leech and finding it the perfect feeding ground on Mr. M’s leg. His wife and I came to an agreement that I would apply all the leeches and she would keep watch and put them in the Jug of Death when they detached (the part I really didn’t like). Some might call this division of duties a cop-out on my part; I called it family-centered care.
The next day, Mrs. M, whose interest in health care had been rekindled during this hospitalization, asked me if there was such a thing as a leech therapist. I told her I wasn’t sure. “I think that’s what I’ll do,” she decided. “Even if it’s not a thing, I could make it one. Do you want to go into the leech therapy business with me?” “Sure,” I told her, “there could be big money in it. People love trendy designer medicine. Just look at the doula industry.” “You’re right,” Mrs. M said, rubbing her hands together, “but where are we going to find enough rich people crazy enough to pay us for putting leeches on them?” “Ah, there is such a place, where rich people run wild and pay exorbitant fees for trendy beauty enhancements. I have been to this place.” I paused for dramatic effect. “They call it California.” “Yes!” she shrieked, waking her husband. “Honey, when your leg’s fixed we’re going out West to start a leech farm!” California, here we come.