There was this guy see, as per the preview of the other day. Depressed, suicidal, shotgun, face. Baaaad things, man. Bad things. So he awakens in "The Baptist" (the local colloquialism for our hospital) in the Trauma ICU... without a face. Literally. I had heard of this before, but this was my first time seeing it. The blast had taken the front of his lower jaw off, only his molars were intact. His tongue was relatively uninjured. The hard palate, or roof of his mouth, was completely gone back to the back of his throat. His nose (and the nasal passages, etc.) was completely gone as well. He had packing where one eye had been and the other eyelid was sutured shut, because presumably he "may" have vision in it eventually. It's too early to tell. So, basically, think of it as a hole you could slip your fist in, fully, right in the center of his face. They had sutured his chin up so that the skin was intact up to his lower lip. He had a lower lip as the border to the bottom of the "hole" and a line of intact skull protruding and connecting between his eyebrows as the upper border. The sides were jagged tears where his cheeks should have been.
We had to place moist gauze dressings in this wound three times a day. He had been "trached" in the OR upon arrival so there was no breathing tube in the way of treating his face. This man was fully conscious a couple of nights later - lacing his fingers together, writing on a clipboard, asking to smoke - though he couldn't talk for obvious reasons. He complained of the dressing being hot on his face and wanted to put ice in it. We couldn't do that. At one point in the night, he became upset and agitated (this had already happened a few times) and that is when it became personal to me; a rare thing at work, as I usually dissociate rather effectively.
I was nearby, helping another male nurse with his patient, when I turned and saw "Face" pulling the dressing off, and out of, his wound. I shouted for him to stop and ran past him to get some gloves from a box on the wall. The other nurse ran and grabbed one of his hands. I then gloved and grabbed the other. He was no longer on the ventilator, but was receiving oxygen to the trach tube in his neck via a "trach collar" which is pretty much a very small oxygen mask that fits over it with a strap around the neck. He had also pulled that off, so the tube would spew mucous when he coughed or expelled air forcefully. We were careful not to let him point this toward us. He continued to struggle against us as we held his arms and called for some wrist restraints. He would turn his head toward me and attempt to put his right hand (the one I was holding) up to the hole in his face. Then he would do the same with the other hand. As yet another nurse arrived with restraints and we began to hold him so she could put them on, we had to hold his hands instead of his wrists and he tried to claw us and dug his fingernails into our hands. All the while he was breathing harder and harder, and spewing, and flailing around with his gross wound exposed, nearly managing to smear us with it.
I was trying to talk him down during all of this. I told him if he wanted to touch his wound, we would let him, but we would have to put a sterile glove on him so he didn't contaminate it. When I told him this, he attempted an ironic, sarcastic laugh that only made a whistling sound as air blew out of his trach. I will never forget the grotesque image of his entire face/wound quivering as the remnants of it attempted a laugh. I had to explain to him, as he began to calm down from the IV drugs we gave him, that he had shown a lot of determination in his attempt to kill himself, but that he hadn't quite succeeded, and now we had no choice but to keep him from harming himself. I told him that if he still wanted to die, he would have to get well enough to leave the hospital, then he could do whatever he wished. I said, until then, our job is to get you better and if you fight us, all it does is make more work for us and yourself.
I have thought a lot about his position since. He was a fairly handsome guy prior to this and I coudn't help but think, if he did this to himself when he looked normal, how could he possibly cultivate a desire to live now? It is a normal thing for suicides to be asked if they desire for the medical team in the emergency room to "make every effort" to save them, or "make them comfortable." However, if they are unconscious, EMTs, paramedics, and ER personnel are required to initiate life-saving procedures.
He should have done it where he couldn't have been found. No, he shouldn't have done it at all. But, he should have done a "better job." It is troubling, but I feel selfish to allow my own feelings in such a situation.
When I got home from work that morning, I was putting dog food out, preparing to let "the boys" out, when I saw a cat sneaking along the fence in the back yard. We don't have a cat, but I had just put out poison to get rid of the rats that had taken up residence back there, so I figured this cat had seen a sickly rat flopping around and come to investigate. I watched as the cat walked halfway toward the front yard, where I was, and turned and went to the back corner again, then across the back fence a few feet, then back. Ah! I thought, the dufus is "caught" inside the fence and isn't sure how to get out. So, I left the gate open and went back to try to herd it out. I spoke gently to it, but it wouldn't let me get too close. It began to head toward the front, where the gate was, but halfway up, it turned back toward me and decided to try to run past me to the back corner again. As it reached the back corner of the fence, now running full speed because I had tried to grab it, it ran face first into the back fence. It then got up, as I was approaching, and did the same thing twice more, before running along the back fence, trying with each step to jump through the fencing like it wasn't there. Or like it couldn't see it. Then I understood. It wasn't blind, but it was nearly so. I came in the house and thought about it a few minutes, then I went back with new determination to help it leave the backyard. After a few more headlong leaps into the fencing, it somehow found a way out, though I wasn't able to observe exactly where because I was on the other side of our outbuilding.
I came back in, and as I sat here staring blankly at my monitor, reading LJ and trying to forget about my night AND my morning, something occurred to me. I thought, "Do you not see that these events are the same?" You cannot help someone, or something, that does not want your help. All you end up doing is fighting to help them, as they attempt to hurt you, or get away from you.
I guess the best I can hope to do is learn something from this. Maybe the lesson is that I should never try to hurt someone who is trying to help me. Or, don't try to help someone who obviously doesn't want it. Or, only give your help when someone gives you their permission; approach them with a humble attitude and offer genuinely. That's all you can really do, I guess. After I talked to Face, he stopped struggling against the restraints, allowed us to replace the dressings, and even gave me a thumbs up that he understood what I was saying about our responsibility to him, in spite of what our feelings or his intentions might be.
I've thought about this a lot, because I think I'm missing something, though I'm truly clueless to what it is. It's better, but the festering isn't quite gone. I still have that feeling of a splinter in my mind that keeps getting my attention when it's rubbed the wrong way. I'd rather not think about it ever again. I'd rather forget everything I saw that night/morning last week. I'd rather not have to learn some of the harder lessons in life, but I know I need them. I know they will make me a better person, a better nurse, a better husband and father. I pray learning them from patients and stray cats will be enough. I pray that I will never need a more personal lesson than that.