Wednesday, April 15, 2009

Ignorance Is Not Bliss

When I saw this little quiz it reminded me of a patient I cared for probably 20 years ago, back when I was Certified Nurse Aid (CNA).

I worked in a long term care facility and there was a patient admitted who was in his late 30's. He was no longer able to care for himself at home because he had AIDS. It had advanced to the point that he required 24 hour nursing care.

The day he was admitted the whole facility was in an uproar. People were scared to death, to say the least. Little did he know, he was the talk of the facility. The nurses didn't feel comfortable caring for him and many of the CNA simply refused. I was just as uneducated as the rest of them. I will not lie, there was an element of fear. However, I knew that no matter what his diagnosis, he was here for us to take care of. He needed us.

I remember sitting in the breakroom before the start of my shift listening to all the "buzz" that was going on. I was hearing all kinds of stories about how he contracted AIDS. I heard he was gay and very permiscuous. He was an IV drug user and just plain white trash. He has had it for a very long time and was knowingly passing it on to other people he slept with and the stories just went on and on.

I was so angry that people would actually refuse to care for him. I was NOT going to be one of those people. However, I was just as ignorant as the rest of them. I did have him on my assignment. I did double glove when I cared for him. I did listen to all the stories, and wasn't sure which ones to believe. It was something for our small town nursing home to have a patient with this diagnosis, let alone one this young.

He was a smoker, and at that time there was a room designed just for the residents of this nursing home to sit in and smoke. Every day he would wheel himself to the "smoke room" and sit there for as long as he could stand it. There was a TV in that room, to keep him company, as well as other residents who also enjoyed smoking. He was young, he didn't want to play Bingo or do crafts. He just wanted to live out the rest of his days in peace and quiet. He wasn't always nice, as a matter of fact he was rarely nice. He didn't talk to much of anyone. He was angry about his diagnosis. He was angry about where he was in life. Basically he was just angry. He didn't like it when the nurses or CNA's would double glove. He was totally offended by this and had no trouble letting us know it. He would yell, cuss, and kick people out of his room.

It wasn't long before word got around to the other residents that he had AIDS. Then the trouble started. He would go to the smoke room and the other residents would leave. He would be alone. They would complain that they couldn't sit in there with HIM. They were afraid, afraid of what they didn't know. They were ignorant too.

As the rumors continued to spread about this young man, people began to learn the truth. Administration had done their best to keep details of his diagnosis away from us. I think part of this was because they thought it would help him in the long run. All we needed to know was that he had AIDS. They thought we needed to know this so there would be no "short cuts" made in the area of universal precautions. However, the rumors were getting out of hand. We needed to know the truth. The truth was, he got a raw deal. His wife had an affair, he had contracted AIDS from her. He had done nothing wrong, he didn't deserve this (no one does), it just happened. He divorced his wife, however she visited him every day. I think there was some guilt she had to deal with. I am not sure, but she was faithful in her visits.

Once everyone knew the "truth", they seemed to lighten up a bit. People were nicer to him, kind of like they now felt sorry for him. In return, he started being nicer too. However the stress of going to the "smoke room" was becoming too much for his body. It was becoming too cold for him to go outside, where he could isolate himself and he still wanted to smoke. I remember working night shift and caring for him. He always had his bed close to the window, and he always kept his door closed. One night as I was doing my bedchecks, I smelled smoke. I followed the smell into his room. He was laying in bed with a plasic cup of water in the window sill and was smoking. He had the biggest grin on his face. I told him he was only allowed to smoke in the smoking room. He reminded me that was impossible at this point. He couldn't make it down there anymore, he was too weak. I couldn't argue that. So I went and spoke with the nurse. Between the two of us, we decided to let it go. I had a talk with him and we decided he could smoke in his room during our shifts. But he had to promise not to tell anyone, because we could get in so much trouble. He had to promise to be careful and could not fall asleep while smoking. He agreed.

Looking back now, I can't believe we allowed this. It is so dangerous, anything could have happened. Even though it was SO against the rules, it helped create a bond, a trust so to speak, between him and me. He would allow me to care for him, and he was happier when I was on shift.

We spent many nights talking in between bed checks. He shared his fears and his anger with me. I began to learn true compassion from him. I began to understand why he was so mean to us in the beginning. I began to truly care for him.

It wasn't long after the night I caught him smoking that he passed. He couldn't fight anymore. He was too tired and frail to continue on in this life. And I will never forget how I learned to have compassion for those with AIDS. I learned to not have prejudgements about people with a certain diagnosis. I learned to overcome my own fear of caring for someone with AIDS.

Fear in this case and in most cases come from ingorance. If we all educate ourselves on the things we are afraid of, some of those fears will no longer exist. Some of those fears are able to change from fear to caution. Now when I care for someone on my current job that has AIDS, I no longer fear their diagnosis. I still remain cautious, and use the skills I have learned to protect myself and them. But I do not have fear.

Education is the key here. Education and compassion.

Some facts about AIDS you might not know. . .
Information found here

According to the CDC, in 2000, an estimated 850,000-950,000 people in the United States were living with HIV and approximately one fourth of these people did not know they were infected.

HIV can be transmitted through the blood, sexual fluids (semen, preseminal fluid, or vaginal fluid) or breast milk of an HIV-infected person. People can get HIV one of these fluids enters the body by way of the mucous membranes (the soft, moist skin found in any opening of the body) or the blood stream. The disease can be passed during unprotected vaginal, anal or oral sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment (or works) including cookers and cottons with someone who is infected.

The following information found here. . .

HIV is NOT transmitted through casual contact including: hugging, kissing, using public toilets, sharing eating utensils, pools or coughing.

There is NO cure for AIDS. Scientists have discovered strong medications to slow down the disease so people will live longer, but there is NO cure.

There are other ways to prevent the spread of HIV and AIDS by blood or body fluids:
Never touch another person's sores, cuts, or blood. If someone at school or at sports gets hurt and starts bleeding, ask an adult for help right away.
Never pick up or handle needles that you might find outside.
Health care workers such as doctors, nurses, and dentists should always wear plastic gloves when working on a patient. Hospitals have strict procedures for handling samples of blood and other body fluids to prevent others from coming in contact with HIV.

What I learned in nursing school . . .

This suprised me probably more than anything in nursing school. It is easier to get Hepatitis C from a patient that I am caring for than it is for me to get AIDS from a patient I am caring for. Rule of thumb. . . treat everyone the same, protect yourself and them, and use universal precautions on every patient.

There is a greater risk of you passing germs to the AIDS patient that will make them very ill, than there is of you catching AIDS from them. Their immune system is so compromised, that is you could easily pass your cold, or respiratory infection to them (if you are at work with a respiratory infection), causing them to become very ill.

So again. . . rule of thumb. . .
Treat each patient as you would like to be treated. Do not judge them by their diagnosis. AND. . show compassion. You don't know what their day/ night was like (in their mind) before your shift started. It could be any one of us in their shoes one day, wishing someone would treat us like a person and not a diagnosis.


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