cleaning up my act

I'm having a surgery on August 30th. I'm cleaning up my system in preparation. Pain drugs don't do very well by me, so I'm hoping that this might help. This has given me time to reflect - among other things, on my early training as a nurse.

I had a nursing instructor who smiled only twice in the 2 years that I saw her nearly every day. The second time was when I graduated, which touched me. The first time was in the first year of class, and probably the first semester. This was "Essentials of Nursing Practice."

She was a tall, bony, old-time New Englander, with dark hair knotted at the base of her long, angular neck, pale skin, and pursy lips. Her voice was very nasal and her tone permanently dry. It sounded like she was somewhere between being peeved at, and making fun of, the entire universe.

She described herself beautifully once, in her flat Yankee drawl, when describing how another nurse was with her mother's 88-year-old roommate: "She came in to say good night, tucked her in, gave her a kiss on the cheek, and called her 'sweetie.' I couldn't believe it, but the patient loved it. This 22-year-old calling her 'sweetie.' It worked for her, and that's great; the nurse could carry it off. It wouldn't work for me. I couldn't carry it off. I'm just not cuddly."

Understatement of the century.

I learned a lot from her.

Speaking of nursing, let's talk about bedpans. - All right, I'll talk about bedpans, and you pretend not to be shocked.

Nurses deal with bedpans a lot, and not just when there's a shortage of aides. I've spoken to a number of people about this, and most of them, doctors included, say, "I couldn't be a nurse. I just couldn't deal with bedpans." While I was still a nurse, I was always too shocked to clothe my thought in words: "You don't get it. Bedpans are the least of your worries when you're a nurse." People tend to think of them in terms of, well, piles of crap.

All right, I can understand that. But try, if you can, to put aside your well-practiced "Ew, gross!!" reaction, and think about it objectively. (Not objectionably, but objectively.)

Poop is the ultimate end-product. (Sorry, I couldn't resist.) Please accept my (courteous but unfelt) apologies and stay with me here:

1. You start with a really fabulous dinner, say linguine al fredo con frutti di mare (that is, spaghetti and cream sauce with shrimp and squid) or, perhaps, a broiled steak and fresh salad.

2. You chew it. While chewing, your teeth work, your tongue and cheeks work, and enzymes are released that start digesting the sugars and starches in your food before it even heads south.

The results of this tell us something about how well your teeth and jaws work, and whether your throat muscles are up to the task of coping with long strands of noodles or that steak that was a little too tough because you left it too long on the flame.

- See? Already we have information about your health, not to mention your cooking. And this information can easily be understood by anyone working the stomach pump; trust me on that.

3. You swallow it. This is where it gets interesting.

4. Assuming it hasn't met any insurmountable obstacles (esophageal perforation, in which case you'd be in too much pain to eat; massive thoracic cancer, in which case you'd feel too sick to eat; or, possibly, a serious system backup due to an impassable plug down the line, called an impaction - you don't want to know about that - or due to an untie-able knot, called an intussusception), it passes into your stomach.

See how much information we have already? You can chew (at least kinda); if your esophagus is in trouble it's not interfering with your food intake; and your overall system can still process throughput. This is exciting stuff! If your system has ever broken down in any of these respects, this is solid gold, fantastic stuff, trust me.

Okay, next adventure: further processing and digestion.

5. The food gets mushed around by your stomach muscles, while your stomach lining secretes more digestive stuff. (Have I scared anyone off yet?)

6. I won't tell you the consistency it gets to, because you wouldn't like the analogy, but it gets pretty well smoothed out by the time it heads into your upper intestine.

Lots happens in the upper intestines, but the parts I'll mention are these:

6.a. Your gall bladder secretes bile to break down fat and oil so your body can use it for vitamins and energy.
6.b. Your pancreas secretes insulin to escort sugar molecules into the individual cells fed by your bloodstream.
6.c. Other stuff happens, which collectively means that all that juicy protein you just ate can be absorbed and used by your body. The calamari I'm not so sure about, but the shrimp and beef are taken care of.

One of the cool things about understanding digestion is seeing how the process goes from the macro scale (steak or prawns on plate) to the micro scale (wow, those cells really do need vitamins, fat, protein, and sugar, or the whole system crashes!)

7. It goes through the lower intestine for quite some time - miles, as I recall. It proceeds by a process called peristalsis, which has a lot to do with the smooth muscles (smooth muscles? - long story; striated muscles are the kind that move your arms and legs, smooth muscles are the kind that move everything else, except the heart, which is weird & unique) ... where was I? Oh yes, smooth muscles, which contract regularly, like a cat's paws on your favorite shirt, sort of nudging things along.

Some drugs make those muscles slow down, or even stop. Believe it or not, a stopped intestine is deadly: losing the nutrition isn't so much of a problem as getting all those waste products building up in your system. Between not being able to keep water down and not being able to get poisons out, you die. It's a, well, fill-in-the-adjective way to go.

8. Lots of things happen in the lower intestine:
8.a. Digestion finishes happening (assuming there's nothing to interfere with that process, like inadequate gall bladder output.)
8.b. Nutrients get taken up from it (assuming there's no interference, like certain kinds of disease.)
8.c. Wastes get put into it (more assumptions, here.)
8.d. Beneficial flora (you've heard of beneficial flora) crank out vitamins and other nutrients we haven't even noticed yet.
8.e. Your body uses some of the stuff that it doesn't digest - such as fiber - as a sort of scrubber/sponge combination to clean up the intestinal walls. Because, believe me, a lot of crap gets piled up in there.

What do you think, is a well-rounded diet sounding good yet? Or are you stuck at the stage of never wanting to eat again because you'll have this horrible litany of digestive facts spoiling your appetite?

Forging onward to ...

9. The big finale: the large intestine! Ta-da! This is where the last of the extra fluid gets absorbed, given half a chance (it doesn't get half a chance if the contents are whizzing by thanks to food poisoning or whatever); the appendix does something amazing for your immune system (which we still haven't figured out yet) and dumps the leftovers into the colon; and it's sort of like the end of the end-of-release work party, when the secretaries and the natural parents run around with wastebaskets, finishing off the wine and throwing everything into bins - last chance gulch, you should pardon the term.

10. After that, it all goes out the "Out" door, unless something's in the way, like horrible hemorrhoids or another impaction.

By this time, what comes out bears the physical and chemical signatures of everyone and everything it met along the way. What's the quickest way to evaluate a chemical signature?

Anyone?

Oh, come on, let's not always see the same hands.

Here are some hints: physical entities have physical properties. We have some highly-developed, naturally-available ways of evaluating physical properties.

Got it yet?

In case you haven't already guessed: scent and sight. We won't discuss taste or texture because even I have my limits, and I just ate a fabulous meal which I don't want to see again for some time.

In any event, even the involuntary gasp which you make on retrieving a particularly impressive bedpan from under your patient (or whatever) is going to hand lots of information up to your higher brain centers. You could instantly tell that Mrs. Croft's sugar has been out of control, Mr. Thatcher was eating spinach again, Ms. Bean has developed lower intestinal bleeding, and Mr. White, who was admitted for an intestinal workup, definitely has a gall bladder problem. Sometimes this information can make the difference between life and death. Sometimes it simplifies diagnosis and treatment, making everyone's lives a little easier. Sometimes it's just more than you want to know, but you learn to live with that.

It's easy to take bedpans lightly, but only when you haven't had to deal with any substantial results.

Wow, that was an image.

Anyway.

That nursing teacher I mentioned, that indelible Yankee character with the dry, dry tones, told us something unforgettable after our first semester of dealing with real bedpans:

"People laugh at us old nurses because of what I'm about to say, but the thing is, we're really right." She leaned forward, and chopped on the lectern as she spoke the immortal words: "It all comes down to what goes in, and what comes out."

The entire class erupted. It was so true. She turned faintly pink and, for the first time that I knew her, she smiled.

After spending two days trying to get things straightened out in my personal world, I have a new appreciation for that. I just hope the drugs go easy on me this time. I meant it about the stopped intestine being potentially fatal. It really stinks. You just have no idea.