In every job there is always that one thing that throws off the balance of the day. When I was a teacher, it was fire drills. As a chef, it was when a piece of kitchen equipment broke in the middle of service. But for nurses and staff working in an emergency room, our proverbial wrench in the gears was something tiny. Super tiny. And gross. Crawly. Nothing messes up the flow of our ER worse than the moment someone would pause, squint their eyes, peer a bit closer, and say, “Hey, is that a…bed bug?”
Located in an impoverished city, our emergency department saw the best and worst of humanity. It would not be uncommon for us to receive patients from an ambulance stretcher who were neglected, covered in their own filth, and riddled with bug bites. Every once in a while, these patients would present to us with hundreds of crawling bed bugs in their hair, clothing, and all over their body. Our protocols had us immediately isolate these patients and perform a decontamination procedure.
“Decon” was our LEAST favorite job in the ER. I’m sure our patients didn’t enjoy it either, being that it meant being hosed down in our ambulance bay, shielded from the sidewalk and the outside weather only by heavy vinyl curtains. We would dress ourselves head-to-toe in Tyvek suits, head coverings, boot covers, and we’d double up our gloves. Every seam in our decon outfit was sealed with tape. Once geared up, we’d trudge to the closet to get a stack of towels, the heavy-duty soap, and a freshly-made stretcher (with plenty of extra blankets).
No matter how sealed up we were in our suits, we would always get soaking wet during decon, especially our shoes. Decon in the first few hours of the shift meant sloshing around in wet sneakers for the remainder of the day. We would move our infested patient by stretcher outside into the ambulance bay, activate a waterline on the side of the building, and strip the patient down to his birthday suit. We then had to blast the patient with a high-pressure hose, douse him in soap, and scrub him with hospital towels that were just a tad softer than 80 grit sandpaper.
This process was time-consuming, messy, and miserable, especially in the winter months. Despite the high-pressure hoses and exposure of the patient, I was always amazed that some patients were grateful just to have been cleaned up. For many, this was the first of any sort of bathing they had for what seemed like weeks.
We did our best to keep what was an otherwise dehumanizing process as comfortable as possible for the patient. There was always a pile of blankets ready to wrap them up with and that new, clean stretcher. But mostly, it was our attitudes, body language, and conversations with these patients that made the biggest difference. If I could make someone smile through the shivering and scrubbing, I believed I could put their mind at ease. There were very few times that a patient, after having been scrubbed from head to toe in our ambulance bay, wouldn’t say “thank you” from under all those blankets.
I think back on our “bed bug patients'' and the decon process as an example of how important our communication, both verbal and nonverbal, is to our patients. As nurses, we will see many people at their worst, yet we will be in a unique position to make the situation better. We can only do it if we stay kind, speak to our patients with respect, and offer as much dignity as we can.