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Tuesday, January 5, 2010

Code Brown ("Subjects relating to defecation are socially unacceptable...")

Medical Facts Mural
Originally uploaded by Regina Holliday
Have you ever potty trained a child or a puppy? It can be a long and drawn out process. You might have a sticker chart or prizes for every time your little one succeeds. You might use shame for every time they do not. I never understood that phrase "rubbing your nose in it" until I saw a friend potty training her dog. The shame of incontinence is instilled at a very young age.

And the shame does not stop there. Children grow up aware of society's aversion to talking about bowel problems or urinary mistakes. I still remember "pee" boy from third grade. This unfortunate child had told the teacher he really needed to go the restroom. She did not let him go. He finally could not hold it anymore and urinated all over himself and his seat. For the rest of the year he lost his name; he became "pee" boy. And so the shame goes on.

While I was in Navy boot camp in the summer of 1993, I heard a very important lecture. It was a week and a half into Boot camp and the CPO wanted to talk to us girls about our bowels. We sat in silence. She said, "I know a lot of you have changed your diet and are frightened. You may not have had many bowel movements or have had none. This is dangerous. If you do not have a bowel movement you will become impacted, and could end up needing surgery. If you have not had a bowel movement in several days, please report to the doctor." I was so glad she spoke to us. I had not had a bowel movement in two weeks. I was embarrassed and did not know what to do.

When Fred was ill last spring I remembered the CPO's lecture. Fred was in a lot of pain and the Doctor prescribed pain medication. He kept taking the pain medication and became constipated. He was very embarrassed. I urged him to go back to the doctor about the constipation. By the time he went back to the doctor he was more concerned about the constipation than the pain. She gave him a laxative, then more pain medication then more laxative... By the time Fred was in the hospital he was on four kinds of pain meds. and four laxatives. We had managed to get him regular again prior to going to the hospital. When the nurse took his medication history she was only interested in the prescription drugs. She said they would handle laxatives if needed. Fred had been stable on the four laxatives. They stopped them all. He became constipated.

Next came incontinence. If you read the entry about incontinence from Wikipedia it states,"Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation. " Fred indeed suffered "shame and humiliation" with this new condition. I would even say he worried more about this element of his condition that he worried about the cancer itself... No therapist ever comes to your side to talk about this shame no one explains the process of why this is happening to your body. No one wants to talk about it.

When I was with Fred I did his bedding changes when he had a movement. When I was not there, I had to depend on medical techs. and nurses to do this duty. I would sometimes arrive and find him sitting in filth. In one case a nurse had just been by. I asked her why hadn't she cleaned him up. She said she had asked him if he was all right and he had said he was fine. "So," I said to the nurse, "'Are you all right?' means "Do you need a bedding change because you have had a movement?" She said yes. I told her the patient doesn't understand this. You need to be more clear.

Recently, I had the opportunity to read Lisa Lindell's book 108 Days. It was a very fast read about the 108 days she took of care of her husband in a hospital after he was severely burned. She went into detail about infection control, lack of communication and incontinence. She called the situation Code Brown. She expressed her outrage at how long her husband would have to sit in his own waste before someone would come. On pages 200 and 201 she recounts two hours of suctioning blood from his mouth while trying to clean up diarrhea. She sums it up pretty well in this sentence directed at a Doctor, "Why do you people do this to him? I want the CEO of this hospital to lie helpless in burning diarrhea for two hours, and I want to pinch his cheek and tell him he's getting the best f---ing care!"

And so the shame goes on. When Fred came home to hospice care I had four industrial bedding chucks. One would be under him, one in the wash, one in the dryer and one ready to go. I would spend all day running down the hall to do get laundry and come back as quick as I could to take care of Fred. The day before Fred died the hospice nurse and I spent most of her visit just trying to do a bedding change. Fred worried so. He asked me, "Reggie, how do we keep doing this? I hurt so bad. I can barely roll over to help you." He hurt so much, yet he worried about me.

When I was painting the Mural in August, a woman came up to me and showed me pictures of the sores her Mother got from lying in filth while hospitalized. The pictures were horrible. It is shameful to be left in a pool of your own waste and it is dangerous as well. This poor mother spent her last days with massive bedsores and lost part of her foot, due to the ravages of laying in fecal matter. But no one wants to talk about it.

If I have done anything with this post, I hope I opened a few eyes. I hope you are more willing to talk about such a socially unacceptable topic with your family. I hope we can help deal with the shame together.

One day back in third grade, the gym teacher had the students choose a partner for dancing. I choose 'pee' boy. I got made fun of for it, but it was more important to help him in his shame.


  1. You are opening eyes.
    And every one of these posts is a reminder not to forget those who are suffering because we did not take time to think through about how we improve services that we might all find ourselves needing.

  2. Straightforward and illuminating post. Thank you.

  3. Regina-you see clearly many painful things that professionals choose to evade and you bravely share. A true leader and heroine. Thank you.