AUSCULTATION, CONSTIPATION, METASTATIC BREAST CANCER, PALLIATIVE CARE, VITAL SIGNS

WHEN WAS YOUR LAST BOWEL MOVEMENT?

The five vital signs are blood pressure, pulse, respiratory rate, oxygen saturation, and temperature. There’s a sixth, unofficial but oft requested, vital sign: pain level. As in, “Between zero and ten—zero being no pain at all, ten being the worst pain you can imagine—what is your current pain level?” A nurse or nurse’s aide has to take your five (or six) vital signs every four hours.  Inevitably, vital-sign-taking-time comes when you’re trying to nap, eat, heal, visit with friends or family, read the final chapter of a great book, have a cry, convalesce, write, go for a walk with your IV pole (on doctors’ orders), rehabilitate, text friends begging for more visits, or discuss your case with a wandering specialist. 

Wandering specialists are plentiful: wound care specialists, infectious disease specialists, occupational therapists, physical therapists, palliative care specialists… I call them wandering specialists because they wander in all day. 

Obviously, they charge by the visit. 

The palliative care specialists are tasked with trying to improve the quality of life of the most seriously ill patients. The palliative care team must have a computerized alert set to pop up the minute a patient they’ve designated as “terminal” (like me) shows up in the hospital. These days, when I settle into a hospital room, I know a wandering palliative care specialist cannot be far behind. It’s usually Nurse-Practitioner Wellmeaning, a hipster in his mid-forties, I’d guess, with those earlobe-expanding earrings and artsy-looking facial hair. He seems like a really nice guy, so why does he always start a conversation with me by explaining his job and purpose—as if we’ve never met before? We participated in the same hospital-sponsored meditation class four years ago. In my file, which Nurse-Practitioner Wellmeaning brings whenever he visits me, he has notes from several conversations he, in his official, palliative capacity, has had with me over the years. He can quote me to myself. but I’m pretty sure he has to have my file in hand, or he wouldn’t remember my name.

Whoever wanders in from the palliative care group, the conversation always winds up the same. Sitting at my bedside—soft-voiced and long-faced—they ask if there’s anything they can do for me. 

I always say, “Yes, thank you. I’m not a believer. You can do me a favor and make sure the hospital doesn’t send me a chaplain.” 

“As you wish, of course,” the palliative care specialist replies. “We will not send a chaplain.”

They always send a chaplain.

Auscultation—that’s the fancywork with the stethoscope. Hospital specialists (those wanderers), shift nurses (jewels of the hospital staff), and doctors (yes, there are doctors in the hospital—rare but not extinct), all have to run through the auscultation drill. In my experience, it goes like this: it starts with four listens to the lungs from four different places on the patient’s back, accompanied by four of the patient’s deep breaths. Next come four listens to the heart from the front of the chest (while the patient—who has begun to hyperventilate—now attempts to “breathe normally”). And finally: three listens to the “tummy.” I don’t know what they call it when the patient is a tattooed, 250-pound Harley Davidson biker dude, but with me they always call it my “tummy,” as if, if they asked to check my stomach or intestines, I’d look at them blankly and ask, My wha-a-at?

IV pump in close-up in hospital room background.
IV pump in hospital room.

Whenever meds are administered—pain pills, laxatives to reverse one of the side effects of taking pain pills, anti-depressants, nerve-pain pills, vitamins, the solutions in the IV bags—the administering nurse has to ask the patients’ name and date of birth. Well, everyone asks for name and date of birth. I’ve so far never forgotten mine.

And there’s one more thing EVERYONE asks: “When was your last bowel movement?”

When I checked into the hospital last month and ended up spending three days there (you count the day you check in and the day you check out as full hospital stay days or, at least, I do. Five minutes in the hospital is a full day, in my opinion.) Anyway, when Nurse Hehe, whom you might remember from last week’s post, checked me in at the ER on the 23rd of April, I answered without concern that my last bowel movement had been two days before. I was (still am) on a lot of pain pills and a lot of anti-constipation pills as well. The two go together. So, I was doing my best to keep things balanced… uh, regular… or as uh, regular as possible. Besides, I was being admitted to the hospital to deal with the infection in my left boob, not my digestion.

But Nurse Hehe gave me a serious look. “Are you, hehe, constipated?” she asked.

Dreamboat, standing in a corner of the tiny ER examining room, took on that blank, faraway look that means, I am listening or not listening—whichever works best for you, Baby.

“No,” I told Hehe. “I just had a bowel movement two days ago.”

“Well, you let us know if it becomes a problem, hehe. You’re on a lot of pain medication, hehe, and that can be…”

“Constipating,” I said. “I know.”

View from hospital room window: bed railing, orange Naugahyde window seat, trees.
View from hospital room window.

The next day, I had visitors. Dreamboat, my sister Angela, and one of my best friends spent the morning with me. At one point, the shift nurse—competent and unfairly forgettable—was about to ask the bowel movement question, when she looked over at my visitors.

“It’s okay,” I announced to Nurse Forgettable. “They want to know about my bowel movements as much as you do.” 

We all laughed. 

But when I admitted that, by this point, it had been three days since I… you know… Nurse Forgettable’s eyebrows flew up.

That afternoon, I had a mini family reunion at the hospital: Angela and my two brothers, along with one brother’s wife and son, plus Dreamboat and Progeny. Nurse Forgettable tracked us down in the visitors’ lounge, gave me my meds, and whispered the critical question. “Did you have a bowel movement today?” When I answered in the negative, the nurse said, “Oh dear. Would you like some…”

“No,” I whispered back.

Up went the eyebrows once again. When I looked from Nurse Forgettable to the assembled tonnage of my family, I saw their eyebrows were all raised. 

I cleared my throat. “She was just asking about my bowel movements,” I said, and everyone relaxed.

That night, after all my visitors left, after the nightshift nurse did her obligatory exam, after the hall lights were dimmed—I had a bowel movement. 

No one asked about it.

I slept well though, knowing that the next day, I would have a better answer to the BM question.

The next day, when the morning nurse asked, I was proud to say I’d had a bowel movement the previous night.

“Oh,” he said with concern. “But have you had one today?” 

🖤

NOTE: In this post I mentioned some important people you haven’t met yet: one of my BFFs, my brothers, sister-in-law, nephew. Don’t worry, I’ll introduce them in more depth when the time is right.

UPDATE: After two weeks on Doxycyline, my left breast is looking better. Yesterday, one of my breast doctors planned to aspirate some of the fluid under the implant but, using ultrasound, couldn’t find enough fluid to make the procedure worthwhile. Which is great! It seems like my left boob might not kill me after all.

ALSO: Angela returned to her home back East. We miss her.

AND FINALLY… Please take a moment to sign up so you never miss an update to THE THING ABOUT CANCER. The sign-up widget on your laptop screen is up there ↗️. On your iPhone, it’s down here⬇️.

🖤

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