The Two Minute Catheterization!

Home care nurse, stuck in a potentially dangerous situation in a patient's home. Happens right in the middle of a procedure. Who will help her? Nurses Announcements Archive Article

The Two Minute Catheterization!

I saw the knife from the corner of my eye!

The knife was pretty long and wicked looking. The woman on my right holding it was mad and was barely two feet away. On my left, stood another woman holding up a weight used for traction. They cursed each other out as I flinched hoping this was just a bad dream, I would wake up from! I sat between them on a stool with my patient in front of me with her legs spread out. I was going to catheterize her in her house. Ms. Land was home bound, morbidly obese with a host of chronic conditions and a neurogenic bladder. I came almost every third day to catheterize her as she kept ripping the Foley out every time the bladder spasms got bad.

This all began 40 minutes before when my husband dropped me in front of the apartment complex where this patient lived in an unsafe neighborhood littered with drug dealers, gangs and graffiti ridden walls. I worked for a private agency that provided RN services to home bound patients. My husband waited in the car with my older two who then were 6 months and 2 years old. When I went upstairs and knocked on the door, Ms. Land my patient called out that the door was locked and her HHA had gone to get milk. So I sat on the steps and waited for her, wearing regular clothes as no uniform was required from this agency, my ID prominently displayed holding my Nursing supply bag. After 20 minutes the HHA Sherry Walters came.

"Good Morning Sherry! How are you?"

"I am fine Nurse Annie. How about you?

"I am good. I have been waiting for someone to open the door. Do you have the key?"

"No, Nurse Annie, I don't. Ms. Carpenter has the key!"

"Who is that Sherry?" Sherry rolled her eyes.

"Her partner. She left with me and took the key with her. She said she would be back in half hour."

I went on full alert as I had heard about this Ms. Carpenter from the agency. She used to be in a physical relationship with my patient. She did not live with her anymore but came every month to case the apartment and take my patient's money. She then went and gambled the money off. She had got into multiple fights with the agency staff. Her MO was to get everyone off the premises and then do what she had to without witnesses. The patient was afraid of her but would never press charges even though she had been advised multiple times. She was alert and capable of making decisions and was in no way cognitively impaired. The partner never physically abused her but took her money. I told Sherry to keep her cool and not get into any argument with Ms. Carpenter when she came.

Ms. Carpenter arrived around 10 minutes later and looked me up and down. "And who are you?"

"I am the Registered Nurse Annie." She ignored my ID.

"How do I know who you are? You don't look like an RN. For all I know you could be here to rob Debbie Land!" she sneered. I stayed calm as I knew she was trying to needle me into a fight.

"I don't know you either and can same the same about you! I am here for my prescheduled 10 am appointment with Debbie and have been waiting the last 40 minutes for you to come and open the door. Could you open the door please?" I replied calmly. She backed down and opened the door. I ignored her, greeted my patient and proceeded to do a quick assessment. I set up for the catheterization. In the background, I was aware of Ms. Carpenter taunting Sherry, the HHA and sherry getting more and more irritated and struggling to hold her temper in check. Sherry was very meticulous with her cooking and cleaning and took pride in her work. She also had a very soft fuse and very strong Jamaican accent when she was excited or upset. I made eyes at her not to respond to the needling but I could see that her temper was held by a frayed thread at this point. As I sat in front of the patient on a stool with the footboard out of the way, Ms. Carpenter made another rude comment about how the apartment was kept. Sherry snapped.

"That's it with your nonsense! Don't say another word!" Ms. Carpenter puffed out her chest and wagged her fingers with a smirk at Sherry.

"What are you going to do? Let me see!" She was delighted as her plan was working to perfection. Sherry grabbed the traction weights and stood by me.

"Sherry, please put that down."

"No, Nurse Annie me had it with her. She gonna get it you know. She is making me so mad!"

"Sherry don't let her play you. Put that down now." Ms. Carpenter laughed at us.

"You are a bunch of lilies. What losers!"

"I'll show you who is a lily!" Sherry grabbed the weights and made a move closer. Ms. Carpenter went to the kitchen and pulled out a knife from the drawer.

"You want a fight! I'll give you a fight!" Sweat trickled down my forehead as I sat between them trying to find the urethral opening amidst the jungle of hair, acutely aware of the knife and weights barely an arm length away on either side. Saying a prayer, I blindly went in, right under the privy parts and hey presto clear urine. My hands never moved so fast as I inflated the balloon and hooked her up to the bag in less than 2 minutes. I grabbed the stuff on the bed and dumped it in the plastic bag and then the trash. I turned around and looked Ms. Carpenter in the eye and said, "Put that knife down now." They both stared at me and slowly lowered down their weapons. Ms. Carpenter picked up the phone and dialed, still holding the knife in one hand!

"I am calling the cops on you as you threatened me with the weights!"

"Excuse me! You pulled a knife and you are calling the cops! That is rich! Let them come, because I am going to do some talking!" Sherry fumed as she put the weights down. I got my signature from the patient and got my stuff together. The cops were there in 5 minutes. Both Sherry and Ms. Carpenter started talking to the cops at the same time. One of the cops saw my badge and asked me to step outside the door and spoke to me in private. He asked me what happened and I told him what happened. After getting statements from both of them, they spoke to my patient who as usual did not want to press charges against her friend. Sherry however did and they booked Ms. Carpenter and took her for further questioning. I left the apartment and went downstairs to my unsuspecting husband. As we drove away, my husband informed me that he had seen 2 squad cars pull up in front of the building a little while back and wondered aloud where they went.

I calmly told him that it was to the same apartment that I was in! My husband was in shock and told me to quit that assignment as it was not worth my life. When I went home, I called the agency and told them and they pulled out their staff from that case. I am not sure who provided her services for her after that but since then I have never beat that record time of two minutes to insert a Foley catheter!

3 Votes
spotangel

About spotangel, DNP, RN, NP

Chronic Care Coordinator

Mother, Nurse, writer, friend! Loves God above all!

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Specializes in ICU; Telephone Triage Nurse.

This tale made me cringe, and recall several less than safe events from my past nursing career. Cathing a woman is never easy (and uttering a little prayer before hand never hurts) but doing so under pressure of a full on brawl while tempers escalate and potential hooks are imminent sounds like a living nightmare!

Luckily everyone walked away whole, and maybe this predatory "friend" of your patient got a dose of reality in the pokey. Maybe events even made this horrible woman leave your client and her possessions alone thereafter (one can hope).

You certainly have lived a colorful life my friend!

2 Votes
3ringnursing said:
This tale made me cringe, and recall several less than safe events from my past nursing career.

It made me cringe too, but probably for a different reason.

I saw OP's post earlier but it was back on page two so I decided to not reply as I didn't want to bump it. However now that it's back on page one, I will add my two cents.

3ringnursing said:
You certainly have lived a colorful life my friend!

To me, it's too colorful.

Quote
I saw the knife from the corner of my eye!

The knife was pretty long and wicked looking. The woman on my right holding it was mad and was barely two feet away. On my left, stood another woman holding up a weight used for traction. They cursed each other out as I flinched hoping this was just a bad dream, I would wake up from! I sat between them on a stool with my patient in front of me with her legs spread out. I was going to catheterize her in her house.

Spotangel, this is a serious question. Are you an aspiring mystery novel author? Your tales are usually full of dramatic flair; like the "wicked" looking knife in this story.

A mentally unstable person wielding a knife (even if that knife had been "kinder" looking), an arms length away from you, could have slit your throat several dozen times in the two minutes you in my opinion unwisely, decided to devote to that catherization.

It would be one thing if you were writing your stories solely for entertainment purposes. But when you present them as actually having happened as you describe them, I think they amount to poor advice on how to handle a situation that could have gotten real ugly, real fast.

Threats and volatile situations is something that most nurses might encounter during their careers. My advice to anyone reading this is that if they find themselves in a similar situation as the one OP described, is to prioritize your own and your patient's safety. The nursing task at hand will have to wait until the situation has stabilized. Yóu DO NOT attempt to catherize your patient when you have a mentally unstable and physically threatening individual with a knife less than two feet from your jugular & carotid! The knife was bad enough, but adding a second emotionally upset person with the weight makes for a situation with too many moving parts. A wholly unpredictable situation.

Exactly how you handle it depends on your experience and abilities, but one of the two following things need to happen. You either remove the threat or you remove yourself from the threat. You do not remain within striking range of a lethal weapon in the hands of an aggressive person. That's basic safety thinking. Also law enforcement should in my opinion have been contacted before the task was done, not afterwards. You and your patient are lucky that the situation didn't escalate further.

Please everyone; act smart, remain vigilant and stay safe at work.

1 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Macawake , just curious, which way would you have turned for your safety; towards the knife or the weight? The wall was behind me and the pt's legs in front. My stories are real and colorful! I make no apologies for them!

1 Votes
spotangel said:
Macawake , just curious, which way would you have turned for your safety; towards the knife or the weight? The wall was behind me and the pt's legs in front. My stories are real and colorful! I make no apologies for them!

It's difficult to give a detailed description of how I personally would have acted. This is in part due to the fact that I have incomplete information about the specifics of the situation. You've just now added information that wasn't included in your original post (your back being against the wall).

Even if I was in possession of all the pertinent information, my course of action might not have been the recommended course of action for you. As I've previously mentioned, it depends on your experience and abilities/physical capability. I am in all likelihood much more physically able to safely disarm a knife-wielding individual, than you are. I have literally spent thousands of hours in self-defense training and tactical policing as well as of course apprehending numerous violent/armed offenders.

Spotangel, according to this and some of your previous posts you have decades of nursing experience in various fields, including ER, ambulance and home health. You must be aware of the importance of situational awareness and scene safety! Despite that, your story suggests a surprising level of situational unawareness.

spotangel said:
As I sat in front of the patient on a stool with the footboard out of the way
spotangel said:
Sherry grabbed the traction weights and stood by me.
spotangel said:
No, Nurse Annie me had it with her. She gonna get it you know. She is making me so mad!

Sherry don't let her play you. Put that down now. Ms. Carpenter laughed at us.

You are a bunch of lilies. What losers!

I'll show you who is a lily! Sherry grabbed the weights and made a move closer. Ms. Carpenter went to the kitchen and pulled out a knife from the drawer.

You ask which way I would have turned for safety in the situation you described. The number one safety measure I would have taken, and that you should have taken, was to never end up boxed in/cornered in the first place. This part is important, and to anyone reading, please always have this simple self-defense strategy in mind. I've escaped harm on more than one occasion by always being aware of the layout of the locale I'm in, and the exit routes available to me.

The moment that Sherry grabbed a weight and uttered the threat towards Ms. Carpenter, was your cue (if you hadn't sensed it earlier), that the situation was about to get out of control. When Ms. Carpenter left was when you should have acted. I would have quickly stood up, covered my patient's exposed genitalia with a sheet or whatever was at hand, and rapidly moved to a position were I had more space around me and more options available to me. You had no idea why Ms. Carpenter left or what she might return with, but you did know that you had a volatile and possibly escalating situation brewing. Sitting down and three out of four possible escape routes more or less unavailable (the wall route of course being completely unavailable ;)), leaves you in a very disadvantageous position.

As I've explained, I wouldn't have allowed myself to get boxed in like you did. But if I for some reason ended up in a similar situation, I would never decide to perform a nursing task that would require that I take my eyes off the multiple threats close to me.

The scenario you've described is strange to me. I don't understand why Ms. Carpenter who seemed primarily angry at Sherry chose to press herself against the wall after she returned from the kitchen with the knife, positioning herself so that you sat like a buffer between her and the person she was attempting to intimidate?

spotangel said:
The patient was afraid of her but would never press charges even though she had been advised multiple times.

You saw Ms. Carpenter with her knife from the corner of your eye as you sat with your back against the wall, ready to catherize your patient. That means that the knife-wielding ex-partner that your patient was already afraid of, was in the patient's direct line of sight as she lay there spread-eagled.

What about the safety and dignity of your patient? This whole situation was in my opinion utterly undignified and unsafe. I can only imagine how exposed and vulnerable the patient must have felt. The scene that you've described is so absurd. You have two agitated, emotionally unstable and armed individuals, one a predatory ex-lover that you know the patient was afraid of, witnessing how you catherize your patient.

Does anyone really question why this story bothers me?

(This isn't really important, but the inquisitive legal mind in me, wonders how you knew that Ms.Carpenter got a knife from a kitchen drawer? How do you know that it wasn't from the sink, countertop, dishwasher or some other place? Could you see the kitchen from your position?? If you could you knew that she was arming herself with a lethal weapon).

1 Votes
Specializes in Pediatric Critical Care.
spotangel said:
Macawake , just curious, which way would you have turned for your safety; towards the knife or the weight? The wall was behind me and the pt's legs in front. My stories are real and colorful! I make no apologies for them!

Wait but then how did you get out after you had finished putting in the catheter?

1 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.
Julius Seizure said:
Wait but then how did you get out after you had finished putting in the catheter?

I turned around and looked Ms. Carpenter in the eye and said, Put that knife down now. They both stared at me and slowly lowered down their weapons.

Once she lowered the knife and turned to grab the phone, I moved away from the stool I was sitting.

Ms. Carpenter was in no way deranged or mentally unstable. She was a bully and like all bullies backed down when confronted. Her MO was always to get people out of the apartment and once the cops showed up, she put on another face. I have had situations with psychiatric pts when I always stand ready to take off at a moment's notice! She was not one of those.

1 Votes
spotangel said:
I turned around and looked Ms. Carpenter in the eye and said, Put that knife down now.� They both stared at me and slowly lowered down their weapons.

Once she lowered the knife and turned to grab the phone, I moved away from the stool I was sitting.

Ms. Carpenter was in no way deranged or mentally unstable. She was a bully and like all bullies backed down when confronted. Her MO was always to get people out of the apartment and once the cops showed up, she put on another face. I have had situations with psychiatric pts when I always stand ready to take off at a moment's notice! She was not one of those.

(my bold)

Oh, for crying out loud...

Your original post certainly conveyed a lot of drama with a liberal use of exclamation points and words and phrases designed to paint a picture of a situation fraught with peril and emotions running high.

Now you're saying that the mad, knife-wielding Ms. Carpenter wasn't at all unstable (I beg to differ, fetching a "wicked-looking" knife to threaten another human being with is neither stable nor remotely normal), and that you knew all along that all you needed to do was to confront her and she would back down.

This raises several questions. Why were you in such a hurry to complete the task and why did you flinch, hoping this was just a bad dream if you were so in control of the situation?

Why did you ask me in a previous post to explain which way I would have turned for safety, towards the knife or the weight?

spotangel said:
Macawake , just curious, which way would you have turned for your safety; towards the knife or the weight? The wall was behind me and the pt's legs in front.

I certainly interpreted your question as meaning that you felt you didn't have an obvious solution to this problem. Wasn't that what you were attempting to convey? Why ask me if you knew all along that you could have just told the "bully" to back down?

This latest addition to your story really begs the question; if you could easily have put a stop to this earlier, why on earth did you allow the procedure to continue? You chose to let an individual who had previously had an intimate relationship with your patient and who you knew your patient was afraid of witness a very personal procedure and stand a few feet from her exposed genitals, brandishing a knife. Why on earth would you make that choice? I honestly don't think you protected your patient the way we are expected to.

I'm curious, if the ex-lover had been male instead of female, would that have affected the way you chose to handle this situation? In my opinion it shouldn't, the gender of an abusive partner/ex-partner doesn't make a difference to the victim. They are both scary and capable of doing psychological and physical harm.

1 Votes
Specializes in Oncology.

Apparently a traction weight in her face wasn't enough confrontation to back down, just needed someone to tell her to after placing a foley.

1 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

That's right Blondy2061h!

I did not play into her drama like the HHA despite the sarcasm. Everyone walked away unhurt and the perp was arrested.

Macawake, You take the pleasure out of writing with your quotes, bolding texts and nonstop questions. When I attempt to clarify, you accuse me of planting "new information". When words create images in people's minds, I become a novelist! The pot is constantly stirred. So continue staying ruffled my friend! I will continue to write of my experiences in colorful narratives with exclamations! You can chose to read/skip, believe/disbelieve, argue/stay silent. Your choice.

Cheers!!!

1 Votes
Specializes in LTC and Pediatrics.

Wow, what a story, glad to hear everyone was not injured. Sounds like you definitely lead an interesting life with your job. I bet your husband was scared for you too.

1 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

True! I love being a nurse but some days can really get you! My husband was upset but calmed down later. He still insisted that I don't go back. Thankfully, the agency pulled all staff off that case. I was not complaining!

1 Votes