Home Healthcare: Memoirs of a Nurse

In home health nursing, there are sad, humorous, emotional, and fearful aspects, which make it imperative to be aware that it requires more than just nursing skills. It takes a special person to enter into a stranger's home in order to provide home healthcare. I worked 2 years in the field and have interesting stories to recount, so memorable even after almost twenty years.

One of my first clients was a farmer out in an isolated, rural area of a small town. In order to alert his relative of any medical problems, he used his shotgun, firing once into the air. After discharged from the hospital for treatment of throat cancer, his physician ordered home health nursing. The client required a tracheotomy (hole in throat for breathing) to treat his cancer, therefore he could not speak.

Most of his communication was by hand gestures and/or writing. Obviously, he did not advance past middle school because of the difficulty interpreting his writing. He became a farmer earlier in his life; now he was 75 years old.

On my first visit, I observed him exiting his field with a bunch of greens in his very dirty hands. He reached into his shirt pocket to remove a suction catheter and used it to clear the mucus from his throat. I thought, oh yeah, he really needs teaching. The body odor almost made me ill. Except for his bedroom, he blocked the entire shack off with pack rat materials. His tomcat walked across his stove in a kitchen rarely used.

Our visits occurred in his unclean bedroom but I did not feel threatened. This man made no advances at this point except when he returned from an out of town visit. Apparently, I misinterpreted his attempt to hug and greet me as a sexual advance; our company discharged him from our service. He and his family visited our office to apologize for the misunderstanding. He decided to move in with relatives for non-nursing care; he no longer required our services.

In my own small town, a fire caused major damage to an elderly man's home. None of his family responded to his need for shelter, so his neighbor decided to take care of him and manage his finances. When I first met the neighbor, I admired her for her kindness. It was clear that she suffered from a functioning mental retardation, a very mild case.

Whenever a client visits a doctor, the nurse goes out the next day to see if there are any changes in care; Medicare does not allow same day visits. Unfortunately, I did not arrive in time before she overdosed him on a new heart medication. He died on the way to the hospital. I later discovered the problem. She misunderstood the instructions on the new prescription to read take medication every three hours, she admitted not disturbing him for the three a.m. dose. The instructions actually stated to take three times a day. This tragic event occurs when clients and caregivers do not clearly understand their prescriptions. A major component of home health nursing is educating and empowering the client.

One of the most memorable clients lived at least 60 miles from the office. The physician sent me out there to confirm the client's claim that he accidentally spilled his pills into the can he used for urinating. On arrival, I could not believe my eyes and nose. In the yard, I observed over 10 dogs tethered to chains and loudly barking, a trailer full of dog food, a large 2 story house with teenagers (later found to be runaways) on the porch. In front of an airstream trailer sat the 65-year-old client, in a wheelchair with urine and tobacco can attached. He extended his hand to shake mine but talk about chronic tobacco use and unsanitary, I could not do it. He asked me to go into the trailer and check his bed for the empty pill bottle. As I approached the bed, I thought of how filthy the sheet appeared until, to my shock, those were actually flies.

I inspected the refrigerator and realized he grew his own penicillin due to the mold-covered food. A box of kittens lay on the floor next to the refrigerator, at least 5 of them. Appalling was the only word I could think of, after observing that the can contained pills, I called his physician to confirm the client's story. As I left the property, I noticed what appeared to be a small horse dead in the front yard of the house. I notified the social service that discovered it was actually a large dead dog in the front yard. Thank goodness, I did not have to visit again.

Once I locked my keys in the car at what I thought was a mobster type client. While awaiting AAA, another mobster type friend of my client arrived. That was the scariest moment I experienced. Once I left the house, I noticed two blooded women waving for me to stop. Apparently, their truck ejected them and landed on their friend's right side from the face to her abdomen. The women screamed for me to help her but I knew she was dead. Waiting for someone else to stop and take over seemed like a long time but it was actually just 10 minutes. I left the scene, called the office to inform them I had to go home, I was just overwhelmed. I never observed an accident with a death before, so it really stunned me for a few days.

If you desire to enter this field, be prepared for the inundation of gifts. I have had clients offer money and when I declined, she slipped it in my pocket. I accepted two dogs from different clients that brought joy to my family and me. Food and garden vegetables are a favorite. Once I received towels and other small tokens of appreciation. These clients insisted I take the items and I obliged. It is also very rewarding to observe your nursing care and the client's response to it, especially wound healing. It takes a special nurse to do homecare nursing. If that is you, I encourage you to give it your best effort.