Helpless at Midnight

Mr G has severe burns affecting 60% of his body, and a tracheostomy. His arms and trunk are wrapped in dressings, his eyes are swollen, and his face reminds me of Frankeinstein.  

Today, I had to change his tracheostomy. When I explained the procedure to him, he tried to gesture with his wrapped arms and lips – Is it going to be painful? I assured him that he would only experience some coughing, but that it would not be painful. He did not seem very convinced, but I had a job to do, before carrying out the many other tasks awaiting me.

The change of the tracheostomy was pretty uneventful, although Mr G coughed frantically for a good 5 minutes, till his face went even more red (I didn’t think it could get even more red than it already was, but it did). He once again gestured - I cannot breathe. The oxygen probe read 100% and I assured him once again, “Things are okay”.  

I quickly left him thereafter, not only to carry out the many other tasks, but perhaps also to escape from that tiny voice within my head, that I’d betrayed his trust, that the procedure was straightforward, and wouldn’t cause him to feel like he was going to die, gasping for air.  

12 Midnight, and the nurses call me to set an IV plug on Mr G. I argue with them that he already has a central line and it doesn’t make sense to set a small plug on him so that he can go for his procedure the next day. The nurses say that “that is the protocol”. I grumble beneath my voice “These protocols don’t make sense.” It’s 12 Midnight, and although Mr G’s IV plug is going to be a HUGE challenge (considering most of his skin is burnt and my aiming skills aren’t the best at 12 Midnight), reasoning (or perhaps arguing) about why he doesn’t need the IV plug, doesn’t look very promising.    

Mr G is asleep, with his radio playing Chinese chanting in the background. I wake him up and explain that he needs an IV plug. He gestures – Why do I need it? It’s going to be painful. I bring his fingers to his newly-changed tracheostomy tube and tells him that he can now speak with the new tube. He struggles to do so, as his arms are all wrapped in heavy crepe bandage. He is physically too helpless to resist, although his mind and facial expressions desperately resist. I apply a torniquet to his leg, assuring him that I will get the plug with the least amount of discomfort, and that he really needs this plug.  

First attempt failed. Second attempt, and to my own relief, the plug is in. I feel pretty proud of myself, after all, I hadn’t had that many attempts to set a plug on this man. Mr G tries to speak to me once again. I think, “he is going to thank me for being so swift with the IV plug, for setting the least painful plug ever since his admission.” This time, I help him occlude the tracheostomy tube better so that he can speak.

He says in Chinese, “You woke me up, and it’s very difficult for me to fall asleep.”

Our patients are sometimes caught in very vulnerable situations. The burnt patient, the stroked-out patient, the demented patient, the bed-bound patient, the anaesthesised patient. Patient’s who can’t move as we repeatedly poke them with needles or perform invasive procedures on. They can’t voice their pain. They can’t push us away.

Perhaps tomorrow I will go into Mr G’s room just to ask him how he has been, spend a little time with him, not doing some invasive painful procedure. Hopefully, his third encounter with me, will be more pleasant than the previous two.