“Ready, steady, stand”

With the flat of my hand resting at the base of her spine, I gently push to encourage Corrine as she moves from sitting at the edge of her bed into a standing position. Holding on to her zimmer frame with arthritic hands, she begins the slow shuffle towards the ensuite bathroom of her private room. Corrine was moved to this room so that she could be isolated from other patients after testing positive for clostridium difficile or “c-diff”. Most commonly occurring is those taking broad-spectrum antibiotics, it is easily spread to others and can be life threatening, with profusive watery diarrhoea leading to dehydration, colon damage and even sepsis. Despite my best efforts to respond to her call bell, don the required PPE and assist her out of bed as fast as possible, I wasn’t quite quick enough. As we cross the room odorous brown-green liquid begins running down the inside of Corinnes legs, over her surgical stockings, and dripping across the floor. I look back at the bed she just got out of and see the trail leading from us to a small stain where she was just sitting.

Neither of us mention it. When we get into the bathroom, I silently pull her nappy down before helping her lower herself onto the toilet. I say I’ll give her a few minutes and leave to strip the bed and wipe up the mess. Despite her frailty, Corrine is fiercely independent. Recovering from a broken hip after a fall, she has worked doggedly with the physios to complete her rehab to get back home as soon as possible. This infection has really set her back. Not just delaying her discharge, but sapping the strength she has built up and the energy she needs to recover. This is the third time I’ve taken her to the bathroom since the start of my shift and her legs are now trembling with the effort of it. Although she has been managing her hygiene needs pretty much independently, when I return to the bathroom it’s to suggest I help her with a wash. Exhausted she agrees, and shyly asks if I can help her shower – no matter how much she wipes herself she just doesn’t feel clean.

Performing the required hand hygiene protocols on exit and entrance, and re-donning PPE, I return with pants, a nightdress, socks, towels and disposable flannels. I help her strip off and sit her in a plastic chair in the open shower area of the bathroom. The water runs hot and makes the air in the room feel cold. I have to stand holding the hose over her body to stop her from shivering as she lathers her hair. She leans her head back and I rinse out the suds. Proximity means the bottoms of my trousers, shoes and socks are quickly soaked. She manages to most of it herself, but I have to help her flannel her back and feet causing soapy water to run down my arms and fill the inside of my plastic gloves. Shakily she stands, holding on to a handrail, so that she can wash her bottom and between her legs. The effort of standing causes her bowels to open and the rising steam fills the room with the distinctive smell of clostridium difficile. The pooling water begins to discolour and I take a step back to avoid the spreading faecal matter from absorbing into my already soaked shoes.

Its a small while before Corrine leaves the bathroom. Once dry, dressed and wrapped in a blanket, she sits waiting for me to make her bed. Looking small and grey, her eyes are closed before I finished pulling the blanket and sheets over her. By the time I leave, carrying bags of laundry and pulling the door closed behind me, it’s been almost an hour since I first answered Corrine’s call bell. And despite the time, energy and coordinated effort it took from both of us, anyone looking in would barely be able to notice anything had changed in that time, seeing only a tired and sick, but clean and comfortable looking woman lying in a freshly made bed in a silent room. Nappies and socks have been binned, faeces wiped, washed, and flushed away, and all soiled textiles anonymously bagged and shipped to an industrial launderers. In the end, the only visible trace of our activities will be found on her electronic health record, under her “Fluid Input and Output” chart, where I have selected a box marked “Bowels Open – Type 7”.