First and foremost, Grand Rounds is up at Grunt Doc's place.
"He looked so well-cared-for last week!"
The patient's wife was obviously distressed. Her husband was partly uncovered, in restraints, and unshaven. She was upset with me mostly about the "unshaven" part, and couldn't understand why I hadn't managed to get four days' worth of beard off his face. She was also upset (but less so) about the soft restraints on his wrists.
He had constant myoclonic jerking--uncontrollable, spastic movements of all his extremities and his head--and facial grimaces. Last week he could walk, with two people helping him. This week we'd had to restrain him to keep him from gouging out his own eyes accidentally. There was no chance we could've shaved him; his head kept bobbing up and down of its own accord, and I didn't want to cut his nose off. The jerking of his legs had thrown his covers down around his ankles.
"He just looks so much worse this week than last week."
I had to find a kind way to tell her that yes, he did look worse, but that with CJD, he would continue to look worse every week until he died.
A note to all nursing students who read this blog: Please Bathe.
Especially if you are a tall nursing student. My nose will be right at armpit level every time I work with you, so I will notice if you haven't bathed that day. Or for several days.
This is Nursing 101, folks. I know you're in a well-regarded, prestigious four-year program, on your way to getting your BSN. But frankly, not bathing daily would not have made it in my podunk two-year program.
If your nails are not clean and short, if you smell of pit-funk, if you have the remnants of last night's makeup on your face or a three-day growth of beard, I will not precept you. If you show up in wrinkled scrubs, with dirty shoes, I will not precept you. Period. End of story. I will send you back to your teacher with instructions to keep you out of the public eye for the day.
Frankly, you don't have enough knowledge yet to dress like Dr. House. None of us do. Looking professional--and smelling professional, for Christ's sake--inspires confidence in your patients.
So fucking BATHE, already.
Do not bring your long-haired chihuahua into your room at the hospital and expect me to keep it a secret. Especially if you're in reverse isolation because of a compromised immune system.
That is all.