Patient Encounters

I worked as a Certified Nursing Assistant for four years, and I am writing about patient care experiences that truly shaped me.

*All private information has been changed in accordance with HIPAA regulations. Some details have also been changed to protect privacy.

After rounding with the night-shift CNAs, I held my pink pen firmly in my hand and proceeded to search for my assigned night-shift nurses. It had been a few days since I had been on the floor, so my patient list was fresh and filled with new faces. So far after receiving report my cases were pretty typical of my floor – mainly post hip and knee ops, a couple of dementia patients, and a few oncology patients. I had one more patient on my assignment list, which stated vitamin B deficiency and the patient’s age was close to mine- she was only in her twenties. I finally found the nurse for my last patient and plopped down in the seat next to her while she was charting away at her desktop. She began giving me report and noted that the patient was frustrated with her and caused a bit of a hell-raising during the nighttime hours. Anna* was a young heroin addict whose parents were unaware of her addition- so, according to privacy and HIPAA regulations, we were not allowed to disclose any health information to her family. Though I worked on a primarily med/surg floor, it wasn’t uncommon to care for CIWA patients and those struggling with drug addictions. I gathered a deep breath and exhaled slowly. It was a heavy assignment and it was time to get to work.

Soon enough my work phone began to buzz in my pocket. It was Anna calling for the bathroom. I walked towards her room with a handful of fresh sheets/blankets and knocked on the door. After entering I saw her boyfriend asleep on the sofa at the far end of the room. Right away I noticed Anna’s long dark brown hair and striking blue eyes. She was a beautiful girl but appeared far older than a woman in her twenties should look. I introduced myself and rolled-in the Sera-Stedy, a piece of equipment used for mobility assistance.

“How did you sleep last night Anna?” I asked while placing the gait belt around her waist.

“It was okay,” began Anna, “but that night nurse was awful to me.”

I began rolling the apparatus into the bathroom. I lined up the legs of the device around the toilet and positioned Anna right above it. I grabbed hold of the gait belt to help her stand, and slowly guided her down on to the toilet seat.

“I’m sorry to hear that. Would you like to talk about what happened?” She gave me an exhausted look. Anna was wearing a white t-shirt with light green pajama bottoms. She was very fair-skinned, and with the aid of the bright fluorescent lights in the bathroom, my eyes were immediately drawn to the track marks covering her arms traveling all the way down to her hands. From my peripheral, her arms had a blue hue.

“I just knew Jan* was judging me all night. Everyone here has been treating me like s***. All the older nurses anyway. I’m just as much a person as anyone else in this hospital. And honestly, I don’t need this. I want to check myself out of here.”

Anna was done using the toilet so I helped her to stand and bring up her pajama pants. Her thighs were just as blue as her arms were. Anna continued to inform me of her night-shift woes, while I smiled and nodded.

“I’m sorry you feel that way. All I can say is that we are not here to judge you. We are all here to help you.” Anna gave me a half-smile. “I know it’s hard letting other people help you with things that you’re used to doing on your own – like going to the bathroom. I know if it were me, and we are around the same age, I would be having a hard time too. But if you stay here, the doctors can figure out what is going on and treat you. The goal is to get your legs working again.”

“I’ve been here for four days. And so far, you are the first person that has been kind to me.”

***

5 hours later, I decided it was time to help Anna with a shower. She had asked me earlier and said she had not received one since she had been admitted. I gathered up all my supplies: 7 towels, 5 wash rags, 1 comb, and a toothbrush and toothpaste kit. I hadn’t checked to see if she brought one so I thought I’d grab one from the Pyxis just to be safe.

Upon entering Anna’s room, I noticed her boyfriend had left and her mother and grandmother were sitting next to her. We chatted all together for a few minutes discussing the weather and the quality of Anna’s lunch. I noticed Anna was now sporting a hoodie, which I assumed was to hide the marks on her arms. Her mother proceeded to hand me a bag of clothes that Anna’s roommate had dropped off for her after I had set up the bathroom. My stomach curdled at the smell of her clothes- it was a mix of body odor and a molding/rotting smell wafting through the air. I nonchalantly searched the container for any drugs and needles (something we are required to do as healthcare workers) and pulled out the shampoo bottle. I assisted Anna onto the Sera-Stedy and away we went, filling our time together with pleasant small-talk.  

It wasn’t until a minute or two had gone by while I was assisting Anna in the shower that I noticed the track marks covering her entire body. They were everywhere. The tops of her feet, her breasts, her back…they were in places I knew that she couldn’t reach on her own. I noticed a few newer marks on her right shoulder. The wheels began to turn in my head. I hadn’t noticed any major withdrawal symptoms since my shift began. Granted I didn’t have access to her med list, but it did seem odd to me. I soaped up a new rag and helped Anna wash her legs, which were incredibly weak due to her bilateral lower limb neuropathy, and within ten minutes I was helping her dry off and get dressed.

“Thank you again Sarah for helping me. My boyfriend and I were talking and we decided you are the coolest one here so far.”

I let out a laugh while using my forearm to wipe the sweat off of my brow.

“Well thank you for that. And of course, I am here to help. I know it’s not easy asking for help. I’m glad we were able to get you showered and cleaned up. You have to feel better.”

“You have no idea. The clothes I was wearing were really starting to stink.”

I wheeled Anna out to her room and got her back into bed. Her mom and grandmother were carrying on a conversation of their own. Anna was telling me the story of how she and her boyfriend met. I grabbed Anna’s vitals and afterward wiped all the water up from the floor in the bathroom.

“Is there anything else I can help you with before I head out?” I asked while tossing my gloves into the nearest trash can.

Anna and her family members turned to look at me in unison.

“Actually,” her mother started “do you have any idea of what’s causing my daughter’s weakness in her legs? I’m really concerned, they’ve been getting progressively worse since she’s been admitted.”

Her mom had a valid point, Anna had grown weaker every time I got her up into the Sera-Stedy. The day-shift nurse had told me that the deficiency was a consequence of Anna’s drug abuse – the issue that I was clearly told to not speak about.

“I’m really not sure. Anna can probably tell you more once she speaks to the doctor again. Or I can get the nurse for you if you’d like.” I was a master deflector, and I was not about to say anything regarding Anna’s condition. I slipped out of the room quickly after that, but unbeknownst to me, Anna’s mother had followed me out.

“Sarah!” Anna’s mother called after me. “Hi. I know you said you weren’t sure what was going on with my daughter. But can you tell me how serious it is? I just don’t feel like she is telling me the whole story and I don’t want to make her uncomfortable by asking in front of her.”

I took a moment to pause before choosing my words very carefully. I noticed Anna’s mom was nervously twisting a few pieces of hair with her left hand.

“Patti*… I am unsure of the nature of your daughter’s case. That is out of my scope as a CNA. What I do know is that Anna gets to make all of the executive decisions regarding her care. If you want more information, asking your daughter would be your best bet. But I can ask the nurse to stop in the room as well if you’d like.” After an awkward few minutes, Anna’s mother finally retreated back to her daughter’s room.

***

With about an hour left of my shift, I headed to Anna’s room to answer her call light. When I checked on her an hour prior, she was fast asleep, so she seemed a little groggy once I got to her room. I pushed the Sera-Stedy up to the side of her bed as I had done multiple times before during the shift, but this time as Anna got up, I saw two syringes fall out of the folds of her blankets. I must have hidden my facial expressions well because she was facing me and didn’t notice my eyes widen. I let my gaze stay on the needles for just a split second before wheeling her into the bathroom. I shut the door behind me and told Anna I was going to call the nurse to check up on the status of her med pass. On the phone I asked the nurse if she could come to the room as soon as she could.

Shortly after I heard my nurse knock on the door. “Is everything alright in there?”

I peeked my head outside of the bathroom door. “Yes, we are just using the bathroom. Were you able to grab Anna’s meds?” I gave my nurse a wide-eyed look and pointed to the bed. She saw the syringes and also found a small baggie with a small amount of white substance leftover. She turned to show me the drug apparatus and contents and gave me a wide frown.

“Yes, but I forgot something. I’ll be back in a minute.” I could hear other nurses gathering outside of Anna’s room. Soon enough security was called and a tele-camera was on its way.

I was in Anna’s room during the fallout. She was switching from yelling to crying to yelling again. Her cell phone was taken away, her boyfriend was banned from the premises (he was bringing in the heroin), her visitor privileges were revoked, and I had to collect all of her belongings from her room to put at the front desk.

I was assigned to Anna the next day, and although she never once mentioned the discovery of her stash, she was hostile towards the entire staff except for me. Around noon I had helped put her into the lounge chair next to her hospital bed, I sat on the couch and talked with her. We talked about how she missed her family dog, her disappointment in not being able to play her daily crossword on her phone app, and how she was afraid to confide in her mother about her situation due to her mother’s own drug addictive behaviors. I sat and listened as she jumped from topic to topic.

I couldn’t help but notice the obvious signs of withdrawal. She had a coating of sweat on her face and neck, and her arms were shaky when she reached for the water jug on her side table. While a part of me felt guilt over not noticing how new the markings were on her shoulder the day before, I mostly empathized with her and her situation.

What I learned from caring for Anna is immeasurable. While many of my coworkers were unable to see past her rough drug addict exterior, I was able to form a connection with her. As a CNA, I am not as bound to my patient’s medical chart as my fellow nurses, so I am gifted with the ability to focus on ADLs (activities of daily living) and getting acquainted with my patients so I can give better, personalized patient care. I shared moments with Anna that went far beyond her addictive behaviors. It was difficult keeping Anna’s health from her family members and calling swift attention to the discovery of her drug usage inside the hospital, but nonetheless, I was able to get acquainted with her and maintain confidentiality. As a future physician, I truly hope that I continue to pursue personal connections with my patients and remember that behind every case is a person with their own unique story.

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