About a year ago, I had a poly-trauma patient (MVC) who happened to be a tattoo artist by trade. As the stereotype goes, this guy was a walking advertisement for his craft. He happened to be in his mid twenties and co-owner of a very successful studio.
As fate would have it, this patient had a mother who did not leave his side and after a few days the uncomfortable patient and his hovering mother began to wear on the nursing staff. The nurse who had been assigned to him for the past three days or so was in her mid 50s and bombarded me with the examples of why this patient was being so difficult. (picture a very annoyed, frazzled nurse who had a heavy patient assignment)
Her biggest bitch? They were putting * gasp * Tattoo Goo on his abrasions!
“Emily, I need you to go in and explain to them why they aren’t allowed to use that stuff!”
I stood there, shook my head a bit, and told the nurse I would talk to the patient. In grateful relief she strode away to check on her little old ladies with hip fractures as I went in to “deal” with this annoyingly needy trauma patient.
As I entered the semi-private room, located at the very end of the hall, I was immediately struck by, not the patient, but his demented elderly room mate who was loud. The patient’s mother was at his side hovering as mother’s do, when they know their child is hurting but there is little they are able to do to help.
After saying hello to both of them, and introducing myself, I addressed the mother first. My initial question? Who did your tattoo? This woman had obviously been through a lot over the past week or so, but took pride in her appearance. She accentuated her ample bosom with her choice of clothing which in turn displayed a gorgeous tattoo on the top of her left breast. After hearing my question, she smiled from ear to ear and began talking about how her son was the artist. The pride in her voice was unmistakable.
Small talk ensued about his tattoos, his shop, my tattoos, and eventually his car accident.
It took all of about 15 minutes for me to figure out that he wasn’t sleeping, his pain was not quite under control, he had no appetite so he wasn’t eating or drinking in adequate amounts, he didn’t remember when he last had a bowel movement and he was somewhat concerned with all the abrasions over his tattoos.
Last I checked, these were all NURSING DIAGNOSES. Why did this take a phone call to the Nurse Practitioner to figure out?
Although his nurse was one of our more experienced on staff, she walked into the room with a whole boat load of preconceived notions about the patient and his mother. Both were very tattooed, spoke freely about “partying” together and even being at a coke party a few days before the accident. The nurse couldn’t get past the way the mother was dressed or her seemingly overly interested body language/doting towards her son.
This guy was broken from head to toe. His injuries would have warranted a lot of narcotics in any other patient, but the perception of “drug abuse” led the nurse to under-medicate him. This was her first mistake based on judgmental notions.
Her second mistake? Not taking the time to figure out what could be done with the noisy room mate. She didn’t explain to the family that he was being transferred out of the hospital that morning. After letting the two of them know this small piece of information, the relief was almost palpable.
Mistake number three: not telling the family to bring him anything he wanted to eat. They simply hadn’t been told that this was an option. This not only made him more interested in food, but gave his mother something productive to do so she felt like she was helping.
More mistakes? Yup. Number four: the nurse didn’t take the time to explain that his irritability was not only related to his pain, and lack of sleep, but also because he hadn’t “taken a shit” (my words exactly) in days. Oh, yeah, and the narcotics are going to stop you up as is immobility! By gaining his trust in the first few minutes of conversation, he eventually admitted that getting on a bedpan and needing someone else to wipe his ass was humiliating. Duh! He is a mid-twentys, otherwise healthy guy. It is humiliating for anyone, but especially men his age.
I talked him into a suppository.
The Tattoo Goo? For those of you unfamiliar with the stuff, I wish I could prescribe it to all my trauma patients sporting superficial abrasions. For those of you who have never gotten one, or have never seen one being done, tattoos are nothing but abrasions with color injected into them. Tattoo Goo is a vitamin rich salve that speeds tattoo healing and in the process helps to minimize scarring.
Tattoo Goo ‘The Original’ INGREDIENTS:
Olive Oil, Beeswax, Cocoa Butter, Wheat Germ oil, Tocopheryl Acetate, Lavender Oil, Sunflower Oil, Rosemary Extract,, D&C Green 6
By judging this patient by his age and appearance, the nurse not only gave SHITTY nursing care, but missed an opportunity to learn about the craft of an amazing artist and business owner.
Such a shame.
After writing very specific pain medication orders (meds around the clock), diet orders and abrasion care orders (ok to use Tattoo Goo) I took a moment to reeducate the nurse in a very tactful manner. The next morning, upon entering the patient’s quiet room (I had requested that he be left without a room mate if bed assignments allowed) I was greeted with smiles from a well rested mom and patient, and was told how right I was about taking a shit! He felt much better and even ate all his hospital food breakfast.
I am happy to report that the patient was discharged 36 hours later which was days earlier than predicted.
Moral of the Story:
Over the years I have heard horrible “tooth to tattoo ratio” comments during rounds and have witnessed the unnecessary defacement of tattoos in the surgical arena. ie: Belly tattoos which were STAPLED closed off centered ON PURPOSE. The reason? “That’s a stupid place for a tattoo anyways,” per the offending surgeon.
We need to realize that tattoos are artwork and a very personal form of self expression. They are an investment just as any other piece of art that hangs on a wall or sits on a shelf. They are usually one of a kind and have deep religious, spiritual and personal meaning. Just because someone has “fuck you” tattooed to their knee caps doesn’t make them a horrible person who deserves shitty care or attitude.
Cultural diversity doesn’t just refer to different shades of skin color, religious beliefs or languages spoken. It also refers to differences in life style choices which may not be something we necessarily agree with.
If I am your patient someday, take care of my tattoos, don’t pray over my bed and don’t be offended if I come out of anesthesia cussing like a sailor. I may be an Ivy League educated white girl from the mid-west, but I am also a tattooed atheist who believes in freedom of choice in any manner of contexts.