Standing by, powerless, as a man is left to die

My belly hurts me real bad." I assessed Mr. B., and could not believe my fingers. His stomach felt hard, like a basketball. He had a history of alcoholism and an enlarged prostate. I fetched his nurse. His nurse narrowed her eyes. "It's not hard," she said. "You need to learn the difference." She seemed to know something but wasn't telling. Mr. B. was a troublesome patient -- needy, demented, always wetting himself because of his prostate and too delirious to find the urine container by the bedside. I was changing the linens for the third time before noon and let the docs know it. "It's a pity he never sought help," his doctor murmured. The patient's stench overtook the trail of sweet cologne the doctors left behind. Mr. B.'s stomach was harder at noon. Maybe this is what his nurse meant. I told her, but she shook her head as she charted on another patient. My heart pounded and my back ached. I was wearing a velcro back brace like loading dock workers wear. The financial guy came around and counted the braces at the end of the shift. A coworker said she was going to start a side business stealing back belts and reselling them. "Let's put Home Depot out of business," I whispered. She screeched in appreciation. But today I tried to concentrate on Mr. B. "His stomach hurts him," I said. I had to continue singing this song. "I gave him something. It won't hurt him much longer," his nurse said softly. What could she mean, if she gave him his pain meds at 7 a.m. and he wouldn't get another dose until 3 p.m.? What about Mr. B. was not worth more action? That he was an alcoholic? A black man? Gone out of his head? "Please, my belly hurts me," Mr. B. said after I took away his tray and dumped the dribble from his stinky urine bottle. His pain made him lucid. He reeked again and needed another sponge bath somehow. I put him on my list. My neck hurt. "I will tell the nurse, Mr. B. She'll be coming around to have another look here shortly." He threw up midsentence. I grabbed a kidney-shaped basin. Deep red blood blew it out of my hands. Everything turned red. My coworker, an experienced nursing assistant, grabbed a bath basin to measure the quantity of blood he lost. I leaned on the call button with one hand and tossed bath basins to the tech with the other. His nurse appeared in an instant and said, "Here we go." She beeped the doc. I ran to the toilet and back to dump the basins of blood, lost count and was shaking. The nurse and doc muttered to each other. No code was called. Mr. B. was dead in a matter of minutes. Right before he died, Mr. B. reached both large hands out to us. His eyes were ringed and sunken. Mr. B.'s expression froze and he moved his mouth wordlessly. "Go in peace," whispered his nurse. She patted her ungloved fingerpads around his carotid, searching, and stroked his face. "Keep moving," she told me. Silently, I emptied the basins into the toilet, wrapping the used containers in red biohazard bags. "I hardly think you need that many baths basins at once," the financial manager interrupted. His walk-around management style did not include walking into patient rooms. I whirled around and almost punched him. He shrank away. The man was dead. It didn't matter. I bandaged Mr. B.'s gaping jaw shut and bound his desiccated hands and feet. I filled out his tag and tied it to his longish big toe. Mr. B.'s expression of fear and pain had softened into a look of horrified surprise; perhaps a terrible joke had been played on him. He died of ruptured blood vessels of the throat brought on by long-term alcoholism. Hospitals are full of guys like Mr. B. Yet the U.S. lags in funding drug and alcohol treatment beds, even though the costs are far outweighed by the benefits. As managed care causes hospital budget cuts, end-stage alcoholics become unaffordable to manage. Policymakers exploit folk beliefs that alcoholism is a weakness and not a disease. Managed care plans promised to focus on prevention, but proven treatment regimens and early intervention techniques still await implementation. We don't need a higher defense budget or all of the conservative tax goodies. We need to fund progressive prevention in order to heal our nation.

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