From Suppositories to Enemas
In the six years I cared for Bill, if it wasn’t one thing, it was something else. Often, he had trouble peeing, and all I could do was let him sit on the commode in the bathroom until he succeeded or gave up. Then a few minutes after I settled him in his recliner, at his computer, or outside, he would insist he needed to go again, and the process would start all over. This also happened at night, and I was often up for an hour or more, waiting for him to pee. When he finally figured out how to pee lying down, the night routine became a lot easier.
He was frequently incontinent. Many times in the middle of the night, I leapt out of bed and made a mad dash to sit him up and give him the urinal, only to discover it was too late. Sometimes while I pulled him to a sitting position on the side of the bed, he was urinating, and the liquid dribbled to the floor. Fortunately, I had a towel in place to solve that problem, but after a night of marathon urine collection, the sheets were soaked, and I had to change them the next morning. Later, it occurred to me to put a pad underneath him in bed, but even then, the sheets got wet.
“Maybe I should go to Sheridan Manor,” said Bill after one such episode.
It was tempting, but the fact that I was tired of constantly washing and changing sheets was no excuse to send him to the nursing home. “Of course not, honey, we’ll figure this out,” I said, more to assure myself than him.
These episodes didn’t only happen at night. During the day, I often dropped what I was doing and rushed to him in the recliner when he said he needed to go to the bathroom. By the time I had the wheelchair in place and was ready to transfer him, the pad underneath him was already soaked, and I had to change his pants instead.
I called the urologist many times and was told to bring in a urine sample. Fortunately, the office was located across the street from the YMCA where I participated in water exercise classes three days a week, and when the weather was bad, I often rode with people who were glad to swing by and wait while I dropped off the sample. Many times, those samples came back positive for infections, and Bill went through quite a few rounds of antibiotics. When I actually took Bill to see the urologist, he admonished him to drink plenty of water, but as with many teen-agers, this advice went in one ear and out the other.
Bill preferred Pepsi and Mountain Dew with his meals and in between. At least he wasn’t an alcoholic, I thought, as I opened can after can of these soft drinks for him. In the morning, he liked to drink peach juice with his breakfast, but that was the only hydration he wanted. One day, Jaylynn, one of his shower aides, told us about Propel, a bottled water that came in several different flavors with no additives or preservatives. “Bill, you’ll love it,” she said. “It tastes really good, and you don’t get all that sugar and other stuff you get with pop. The grape flavor is the best.”
I figured it was worth a try so the next time I went to Walmart, I bought a six-pack. One sip and I was hooked. Bill was skeptical but soon grew to like it and drank more of that and less carbonated beverages.
Bill’s bathroom problems weren’t limited to urinating. He often suffered from blocked bowels. Fortunately, there was no incontinence here, but as a result, he often spent long periods of time on the commode before succeeding or giving up. We tried a couple of over the counter stool softeners, but these didn’t work. One morning when I transferred him to the wheelchair after another unsuccessful attempt, he said, “Honey, I think I should go to Sheridan Manor this time. They can give me enemas and stuff like that to help me.”
“Are you serious? You really want to go back to Sheridan Manor?”
“I have to, or I could die.” There was a note of desperation in his voice.
This was during the time we were waiting for the new lift, and Bill was receiving his showers at Sheridan Manor. I called and spoke to a different admissions coordinator, this time, who was sympathetic and told me I could bring him in when he was scheduled for his shower.
Bill spent a few days at Sheridan Manor and was given suppositories and milk of magnesia, and that seemed to clear up the problem. When he was discharged, the nurse admonished him to drink plenty of fluids and take milk of magnesia or some other laxative regularly, but again, those ideas went in one ear and out the other.
This was in November of 2008. In January of 2009, Dad and I took the trip to Florida we put off the year before because of Andy’s marital difficulties. Soon after we returned, Bill’s bowels started blocking up again. One morning, he said, “I think I’d better go to Sheridan Manor again.”
“You’re kidding! I just brought you home a couple of weeks ago.”
“They need to give me another enema.”
“An enema? They didn’t give you one of those the last time you were there, did they?”
“No, I mean a suppository.”
A suppository, I had one of those in college when I was hospitalized for a high fever. I was sick to my stomach, and when I told the nurse I didn’t think I could get a Tylenol down, she shoved it up my butt instead. I’d heard of people giving themselves suppositories so how hard could it be? However, I realized that if Bill couldn’t wipe himself after a bowel movement, he couldn’t give himself a suppository.
Since the idea of inserting a suppository didn’t appeal to me, I did the next best thing. I called Bunni at the senior center to ask if the aides could administer them after his shower if necessary. My hopes were dashed by three words. “It’s against regulations.” Kathy, our aide at the time, used to be a nurse so she would have known how to do it. How ironic it was that regulations prohibited certified nursing assistants from administering suppositories, but it was okay for an uncertified family caregiver to do so.
Feeling discouraged, I placed another call to Sheridan Manor’s admissions coordinator. “Why don’t you bring him in, and one of the nurses can show you how to give him a suppository?” she said.
I didn’t like this idea any better but figured it was the best solution. However, when I suggested this to Bill, he refused. “Honey, are you sure? We can’t keep traipsing back and forth to Sheridan Manor whenever you need a suppository. Please let me try.”
“No, they need to do it.” To tell the truth, I was relieved. After only two weeks at home with him and his uncooperative bowels, I was ready for another break.
After a week at Sheridan Manor, Bill was ready to come home and willing to let me learn how to give him his suppositories. During his stay, I watched the nurse insert the suppositories and realized that although it was an unpleasant task, it wouldn’t be hard to do. Since Bill could no longer do his business while sitting on the commode, I asked the nurse what kind of bed pan I should use with him at home. She recommended a fracture pan, and since the local pharmacy we used for our prescriptions carried them, I bought one.
When we approached the social worker to ask that Bill be discharged, she offered to have one of the nurses show me how to administer suppositories. Sharon was a nurse I’d worked with before when I was employed as an activities assistant. She gave me a pair of gloves, and after I put them on, she showed me how to roll Bill onto his side, take the suppository out of the package, find his butt hole, and insert it. The gloves made it difficult for me to feel what I was doing, and Bill’s giggling didn’t help. I finally found the bull’s eye and felt that wonderful, familiar sense of elation that came with accomplishing Bill’s personal care tasks. I had more trouble at home, although I didn’t wear gloves, but since Bill still had some feeling down there, he could tell me if the suppository was going in the right place. Eventually, like all other tasks associated with Bill’s care, I got it down to a fine art.
Unfortunately, Bill’s bowel trouble didn’t stop then. One day a month later, Bill had trouble peeing again. At four in the afternoon, when he hadn’t urinated in twelve hours, I was concerned, but for once, he wasn’t. “Don’t worry, honey,” he said as I kissed him while he lay on the bed. ‘I’ll pee eventually.”
I went next door to give the local newspaper to John and Diane after I finished reading it. Since John had been a pharmacist, I asked him what to do. He suggested sitting Bill up for a while to see if a change in position would get his bladder to cooperate. Since he could no longer do his business while sitting on the commode, I would have to put him in his wheelchair or the recliner and then lay him back down again if he suddenly felt the urge. Since my singing group was practicing that night, I had little time and a million things to do. I needed to do something, though. He couldn’t go on like this. Much to my relief, when I walked into the bedroom with John’s suggestion on my lips, he held out the urinal and said, “I’ve got something for you.” I was never more glad to empty a full urinal.
However, he hadn‘t moved his bowels in three days which wasn’t unusual. That night before we went to sleep, he peed again, and I offered him a suppository. “No, it can wait till morning,” he said. Because I didn’t want to get up in the middle of the night to wipe him, I didn’t push it, but later, I wished I had.
At two o’clock the next morning, Bill said, “Honey, I need to go to the emergency room.”
“I can’t pee. I can’t poop.”
“Why don’t I give you a suppository? Maybe that will help.”
“No, I have to go to the emergency room. I could die otherwise.”
Since the paratransit service didn’t run in the middle of the night, the only way to get him to the hospital was by ambulance. This was crazy, I thought, as I picked up the phone and called 911. I contacted them many times before when Bill was on the floor, and I couldn’t lift him, and the operators and paramedics knew us. When I explained the situation, the operator on duty assured me the ambulance would be there shortly.
I then realized that if he was going to the hospital, they would need a list of his medications. Still half awake, I stumbled into my office with the intent to print the list on my computer, but when I saw the lights of the ambulance turning into the driveway, I knew there wouldn’t be time. After showing the paramedics into the bedroom, I dashed into Bill’s bathroom with a zip lock bag and tossed all his pill bottles into it. Since then, I kept a printed list in my fanny pack, back pack, and gym bag.
The paramedics discovered that Bill had a fever. This was serious, I thought, as they loaded him into the ambulance. Since I was still in my pajamas after the paramedics left, I quickly dressed and called John, waking him up of course, and he drove me to the hospital. When I was shown into Bill’s cubicle in the emergency room, the stench of fecal matter assailed my nostrils, and I
was relieved. “They dug it out with a chisel,” he said. “It hurt like hell.”
My relief was replaced by anger. “If you’d only listened to me when I suggested giving you a suppository at bedtime, we wouldn’t be here now at this ungodly hour,” I said, as I flopped into a chair near his bed. I knew I sounded like one of those nagging wives of hen-pecked husbands, but I didn’t care. John left, telling me to call if I needed him.
For the next four hours, I waited while Bill was given a laxative and two enemas. At six in the morning, Bill was finally ready to go home. The nurse had apparently overheard my earlier outburst because she said, “Okay Bill, it says here on your discharge instructions that you need to listen to your wife.”
Bill and I both laughed. We were both in better moods now that he was empty of waste. Since the doctor explained that Bill’s fever was caused by the stress his body underwent as a result of the blockage, I didn’t have to worry about that.
We were sent home with a tube of butt cream and a prescription for a laxative. Because the paratransit service still wasn’t running, the local ambulance service was again called, and the same two paramedics who took him to the hospital arrived to bring him home. I hated to call John again at such an early hour so I asked if I could ride with them, and they agreed. As we pulled out of the hospital parking lot, Bill said from the stretcher in the back, ‘Let’s go to the Rainbow Bar.”
”I don’t think it’s open yet,” I said, relieved that he still had his sense of humor despite what he’d been through in the past few hours.
At home, we settled back into our usual routine. To my relief, Bill liked the taste of the liquid laxative that was prescribed, and I gave it to him twice daily with his meals. The nurse at the emergency room said I could add it to his drink, but since Bill didn’t always finish his beverages, I decided against that. He also took an interest in eating fresh fruit: oranges, strawberries, and watermelons when they were in season. Eventually, he no longer needed the laxative and didn’t require suppositories as often.
Because the strokes somewhat effected his ability to communicate, he had a hard time thinking of the word “suppository” when he needed one. He often said he needed an enema, but I knew what he meant. One morning however, he threw me completely off guard. I’d just finished showering and dressing and was about to get him up when he said, “Honey, give me a butt fuck.”
“Oh, I mean an enema,” he said, laughing.
“You silly goofball,” I said, and we embraced and kissed.