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A Piece of My Mind
December 11, 2013


Author Affiliations
  • 1Montefiore Medical Center, Bronx, New York; and Doctors for the 99%

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2013;310(22):2399-2400. doi:10.1001/jama.2013.282710

I want to talk about scut work, defined as trivial, unrewarding, tedious, dirty, and disagreeable work; in other words, I want to talk about being an intern and the physical, backbreaking, day-to-day work of taking care of another person. During my last floor month as a resident, we had a patient who had been in the hospital for 2½ months: she had end-stage renal disease, obesity, and advanced COPD, was trached and PEG-ed, had deep vein clots and various bleeding and infectious complications. In addition, she had an extensive unstageable sacral ulcer, and, because of her anatomy, feces regularly got into the ulcer. The nurse’s aide, because she was not trained in wound management, would clean the patient but would go nowhere near the ulcer; the nurse would change the dressing daily, as ordered in the computer, but it was not her job to clean up patients, and neither could she, with six other patients to take care of. It was an impossible situation and an intolerable one. Only one nurse, and I don’t know how she did it, was able to keep the ulcer clean; she also gently rubbed the wound with clean gauze to help it debride. Because it was a priority for her, maybe, or because she was who she was, she performed this act that required vigilance and attention to detail. She was one of those nurses who have a fearlessness and practicality when it comes to wounds, smells, poo, and blood—what we keep scrubbed and hidden from normal society—and you have to admire their matter-of-fact way of getting things done that normalizes the breaking down of the body and human waste. It is a superpower that some nurses have.

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