Discoveries by scientists like Antonie van Leeuwenhoek and Robert Koch connected microbes to infectious disease. These discoveries formed a way of thinking called “germ theory” that said a specific microbe caused a specific disease. With widespread use of antibiotics beginning in the 1940s, people zealously tried to rid their lives of any and all microbes, spreading the anti-microbial mindset to personal and household cleaning.
But today, scientists are starting to reevaluate germ theory. Using antibiotics to treat bad germs will remain an essential, life-saving part of medicine. But repeated or unnecessary use of antibiotics prevents our bodies from establishing the community of microbes it needs. Scientists now suggest that we look at microbes in context, understanding that microbes (Helicobacter pylori, for example) can be both beneficial and harmful
Overusing antibiotics has pushed microbes to evolve resistance, making them less available for general health care or surgical procedures. Clostridium difficile (pictured) is an example of a strongly antibiotic-resistant microbe. Successful treatment of C. diff. happens when a patient’s gut community comes back into balance, often by introducing a new microbial community from the stool of a healthy donor.
When I saw my admission’s ‘reason for admit’, I groaned.
“Anemia, GI Bleed”.
I was having a shit day. Not to mean it was a crappy day (although it was that as well), but that every one of my patients was admitted for something related to their poop. Two divertics, one cdiff, one bleeding ostomy, and now this GI bleed admit. On a renal floor, of all things. An understaffed renal floor that I was floated to and subsequently swamped and left in the weeds alone. Oh, the life of a nurse.
He was young; in his 50′s. So, on the upside, he’s at least likely to be a walkie-talkie, which is great, as it hopefully means he can clean himself up. If that sounds callous, you’ve probably never handled a GI bleed. When you’re a nursing student, you hear the horror stories of cdiff smells, but let me tell you, an acute GI bleed is a much, much worse smell.
When he gets up to the room, he hops off the cart and walks over to the bed. Internally, I do the “booyah” dance as none of the rest of my patients are self-cares today.
I go in and start the admission process - a million mundane questions to annoy the shit out of my patients (pun intended) - partly because they’ve been asked half these questions already and our idiotic EMR doesn’t carry them over from the ER, and partly because they don’t feel good and don’t want to sit there and answer questions about if they’ve traveled to Africa recently.
A&Ox4, lungs are CTA, belly isn’t even tender, his wife is darling, and he’s super pleasant. I won the GI Bleed lottery, guys. His only symptoms, besides you know, blood in his stool, is fatigue. I check his counts from the ER…and see a hemoglobin of 5.6.
“Did they give you blood in the ER?” I ask.
“Yeah, but I’m not sure if it replaced how much they took out of me!” he jokes. His wife confirms he was given two units. All his radiology is pending. I set him up with all the finer things in hospital life - comb, toothbrush, cheap ass pack of off-brand tissues - help him into his gown, and toss up a bag of normal saline before I go to page the hospitalist for the rest of my orders.
Several hours later, I was hooking him up to a protonix drip after the GI doc had finally been in to see him. He’s still jovial and sweet, as is his wife. The doc catches me on my way out, and pulls me aside. “I put a consult in, please make sure it’s called quickly.” I nod. I stop by the unit secretary to ensure she calls the consult while I head back to my cdiff room to change them for the 32139th time.
In the cdiff room, I was checking my orders when I saw the consult order on the screen. To an oncologist. Even in the big blue plastic gown in a sweltering room, I went cold.
I quickly opened the full chart and flipped to radiology. I opened the CT and read the report of an extremely large mass in his cecum.
Then I saw “multiple lesions noted” in the liver, that were “suspicious for metastasis.” My heart broke.
I yank the gown off as my tech and I finish cleaning up, and as I exit the room, I see the oncologist walking down the hall towards his door. I’m not ready for this. I hate this part of the job. I’m selfish for feeling this way, I know. My patient is about to be diagnosed with a life altering disease, and I’m feeling pity for myself. But in just 7 hours, I feel like pals with this patient. I’ve ooh’d and aah’d at pictures of his kids, congratulated him on his youngest graduating from middle school this spring, and talked to he and his wife about their jobs and plans for the future when their nest is empty.
I was looking forward to having him reassigned to me tomorrow, to following his progress with his bleed.
Now, I’m watching his face - his wife’s face - as they’re told he likely has Stage IV colon cancer.
I got into this job because before I was even 16, four members of my family, including both of my grandmothers, died from lung to brain cancer. I always thought I’d go into oncology, but it turns out, I can’t deal with it. But no matter where I work, cancer sneaks its way in.
Normally, we’d do chemo first, but because his mass was causing a lot of blood loss, a fairly big colectomy was going to be the first stop. I took care of him a lot over the next week. Even post op, when he was still drowsy from the anesthesia, he’d have a smile for me whenever I walked in. He never complained about the NG tube, the foley, the wound vac, the IVs.
He was finally discharged yesterday. He has a long road of chemotherapy ahead of him. He has a wonderful family who has rallied around him.
A lot of things get easier as a nurse. You aren’t afraid of germs. Poop -obviously - doesn’t scare me. I can tame the wildest CIWA patient, and literally have held the hands of someone dying.
But this doesn’t get easier. No matter how strong they are, it’s never easy to watch someone told they have a potentially terminal diagnosis. Cancer, MS, CJD, ALS. Among many, many others.
And as much as it sucks, I know that if I keep doing things right, this part never will get easy.