STEWARD'S NEW PATIENT by Dashiell Walraven Copyright © 2010
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A map with a highlighted, one-hour route to the Deever home lay on the seat next to him. Steward pulled out of the coffee shop with a double-shot latte in one hand, and desperately wanted a cigarette. Setting down the coffee at a stoplight, his eye caught a glint from the new name tag affixed to his neatly pressed shirt. "Steward Smith, R.N.," it read. Steward smiled to himself, and flicked a mote of lint from the tag and smoothed the shirt against his chest.
His first forays into private duty nursing had been a welcome change of pace from the hectic ICU and ER scenes. At first, he'd craved the action and adrenaline, but lately it didn't seem as much fun. Much of that had to do with a whirlwind affair with one of the residents that proved disastrous for both of them. Steward winced as he sipped the hot coffee, turned up the radio, and hit the highway. Even with the radio blaring, Steward was still able to focus and think about his new patient. A review of the file showed that Michael Deever, 18 years old with cerebral palsy, was pretty high maintenance. Michael's regular private-duty nurse was taking maternity leave and the office stuck him with the job. Being the new guy, Steward reasoned that he would catch all the scut work that nobody else wanted, and to date, that is mostly what happened. From the respiratory cases that required a lot of suctioning, or the colostomy and ileostomy patients that required changing of bags and wound care. Stinky stuff didn't bother Steward, his time in the ER innured him to just about every nasty and viscous fluid that might come from a human body. Steward mentally ticked off a quick checklist of the things he knew about cerebral palsy, its causes and sequelae, and the normal things one looks for and treats in chronic, bed or wheelchair bound patients. By the time he pulled into the driveway of the Deever home, he felt prepared.
The drive was long and lined with tall trees as it wound from the road up to the house. A large colonial, it perfectly suited its New England surroundings and looked like something out of an Eric Sloane painting. Stone walls criss-crossed the property, with white fences and several barns in the distance. Steward heard a horse whinny from one of them as he got out of the car and slung his backpack over a shoulder. The house was big enough that he had trouble figuring out just where the front entrance was, or even if he should use it if he found it. His eyes focused on a red door near the garage where other cars were parked, so he chose that one and rapped the large brass knocker.
"Jes?" a hispanic woman in a domestic uniform answered the door. Steward stuck out his hand and smiled.
"Hello, Steward Smith, I'm the replacement nurse for Michael Deevers?"
"Oh," she said smiling back and opening the door, "Please, please, come in." Steward stepped into the expansive mud-room and looked around. "My name is Carmen," she said politely, "you are new?"
"Yes," Steward said, "I've been working for the agency for about two months now."
"Okay," she said quietly, "Do djou have much esperience with ceepee?"
"I'm sorry, with what?"
"CeePee?"
"Uhm..." Steward stuttered, "CeePee? What is that?"
"I sorry," Carmen apologized sheepish, "djou know... Sara Brell... Pall... Pale..."
"Cerebral Palsy?"
"Jes!" Carmen said happily, "I sorry, my english is not so good."
"It's fine," Steward smiled warmly at her. He briefly entertained the notion of saying something flippant about having her teach him spanish, but he didn't think he be around that long. "Can you take me to him?"
"Yes," she said, her face suddenly cloudy, "I want you to know, I love Michael very much, and that last lady, I don't she take good care of him."
"Really?" Steward was surprised.
"She was the one, you know... enciente?" she made a motion in front of her indicating a large, pregnant belly.
"Yes," Steward nodded.
"She was a bitch to Michael, I no like her at all. I am happy she go." Carmen stamped her foot as if to put a period on the statement. Her cheeks had turned a little scarlet and she stood there, waiting for Steward to say something. Deep within the recesses of the house, an animal like shriek echoed. "He is awake," she said, "come."
Steward followed her into the house, passing museum-like rooms furnished with expensive looking furniture and fixtures. It all looked completely un-lived-in. Steward followed her into the home, climbing to the third floor suite for Michael. The noises Michael made grew quickly more frantic, Carmen picked up her pace. By the time she made the door to Michael's suite, she was nearly at a dead run. She swung the door wide and Michael's cries were suddenly louder and more piercing. Steward could see his bony limbs flailing in the bed as she reached over and starting clucking in soothing tones, caressing his face. Michael quickly calmed as Carmen smoothed his hair and rubbed his cheek.
"There baby boy, its good," she smiled at him, "I brought you somebody nice, you don't have to worry about that no good woman anymore." Carmen waved Stweard over and he walked in, taking a good look at the place.
Michael's suite was set up like one would imagine any private hospital would be. Fine cabinetry, gleaming clean and white, Carmen's handiwork no doubt, and fine appointments made the room look like a strange cross between an ICU bed and a superb hotel. Michael's bed was of a very expensive type designed to place no pressure on any one point of the body, thus avoiding bed sores. The linens were all very crisp and clean, and Michael had a flat panel display above the foot of his bed. Steward came around to look at Michael and was somewhat shocked by what he saw.
Michael looked at Steward with deep brown, gold flecked eyes, his black hair combed fairly neatly across his head, save for one stubborn cowlick toward the back. He did not look to Steward like an 18 year old boy at all. Even taking into account for Michael's somewhat contracted stature, he barely looked 5 feet long and couldn't have weighed much beyond 60 or 70 pounds. A wide, somewhat distorted smile split Michael's face and he waved his arms, his two useless looking hands flopping to and fro.
"Gah!" he exlaimed loudly. Carmen beamed at me.
"Michael is a very good judge of character Mr. Nurse," she said confidently, "and he likes you. Look, he is saying 'hello' to you."
"Please," he said modestly, "Call me Steward, that will be fine."
Carmen showed Steward around the room, they opened cabinets and drawers. Throughout, Carmen kept a running conversation with Michael, telling him what they were doing and being generally chatty. Michael's eyes followed them around the room, smiling and clapping his hands.
"Gah!" he shouted again.
"Does that mean anything in particular Carmen?" Steward asked.
"It is his word," she shrugged, "it is what he says for everything." Steward nodded in understanding. Carmen showed him the desk on the side of the room, near the window, where his predecessor had filed all of her notes and care journals. Steward scanned the documents and found her notes to be thorough, complete and professional. She certainly was competant, regardless of what Carmen may have thought. Steward looked for notes from the night nurse.
"Carmen?" he asked, "Who takes care of Michael at night?" Carmen looked into the air, as if checking some airborne calendar.
"Uhm, Saturday night it was his father Robert; last night was his mother Betty, and tonight will be his brother Marshall." Steward raised an eyebrow and gave himself a mental kick in the shins. He had completely misjudged the family assuming them to be rich snobs who couldn't be bothered to care for their severely disabled son and brother. From the records he saw before him, he'd been comletely unfair in his snap judgement.
Carmen excused herself to return to her duties; Steward set about getting started on the day with Michael.
"So Mr. Deevers," Steward said brightly, "Let's see about getting you bathed this morning so I can check you over while I'm at it, shall we?" Michael's eyes shone brightly as he watch Steward busy himself by warming the disposable, premoistened bath towels in a the microwave oven. Michael seemed to be always smiling when Steward looked at him, thoroughly engaged in whatever Steward was doing.
The microwave beeped and the bath towels emerged warm and steamy, Steward brought them to the bedside and set them on the small table there. Reaching over, whistling to himself, Steward unsnapped the buttons at Michaels shoulders, and pulled his night shirt from his body, tossing it to the laundry bin nearby. Steward pulled one towel from the plastic container, and testing it on his wrist, found it to be nicely warm and not too hot. The moment the towel touched Michael, his eyes rolled upwards in obvious pleasure as Steward gently scrubbed at the skin of his forehead and face. Steward took particular care with Michael's ears, gently scrubbing at the inner folds with a deft, yet careful finger; Michael seemed to particularly enjoy this. Steward looked up to see Carmen had paused by the door, watching him.
"Hi Carmen," Steward acknowledged, "how am I doing?" Carmen smiled approvingly, gave Steward a quick thumbs-up and moved on. Steward looked back down to grin at his patient and continue bathing him. Discarding the first cloth, Steward pulled a fresh one and scrubbed at Michael's black hair. With the tips of his fingers, he massaged the moist towel deeply through Michael's hair and scrubbed at the scalp. Michael gave a deep, throaty moan, and clapped his hands together in enjoyment.
"You like getting your hair washed, don't you?" Steward asked him.
"Gah!" came Michael's exuberant reply. Steward chuckled, brushing Michael's damp hair with a soft brush. Steward looked at Michael's hair; what had been a dark, coarse looking wet mop, transformed into a finely brushed head of hair that shone like obsidian in the bright sunlight of the morning. Each strand of hair, while deeply black, picked up the light and fairly sparkled like glass. It was then that Steward really started to look at his patient.
Michael's palsy had rendered its typical distortions to his features. His muscles lacked much tone, and his facial features were somewhat slackened. Michael generally breathed through is mouth, which was rarely closed. The upper mandible seemed prominent as the lower jaw fell away. Still, beyond that, Michael was still a handsome young man. Steward found himself wondering what the rest of the family looked like, and where he would see the resemblances. He continued on with Michael's bath.
With another fresh, warm towel, he rolled Michael over onto his side to scrub down his back. Michael responded by reaching over and grasping the rail on the opposite side, helping to steady himself. Steward stopped for a moment, watching Michael do this, surprised. Michael seemed to be able to pull up and hold almost his whole weight. Steward resolved to do a complete assessment of Michael's strength and muscle tone.
Steward moved the cloth in circles around Michael's back, noting how the muscles there rippled with pleasure as he did so. Steward hummed quietly to himself, busily scrubbing at a bit of scaly skin. Steward took the time to scan Michael's back for signs of bed sores. The special mattress of the bed had done its work well, as there not even any red marks where the weight of Michael's body had produced any pressure spots. Steward was impressed. So often he'd found patients in home and private-duty care, who had pressure sores from laying in the same position for hours on end. In Steward's mind, it showed that Michael was indeed, extremely well cared for, and surely very loved.
Steward rolled Michael back after wiping down the backs of his legs. As Michael returned to lay on his back, Steward observed the front of Michael's diaper was tented up. Steward professionally ignored the erection and continued to Michal's feet. Steward knew that by moving away from Michael's midsection, the erection would go away of its own accord. He looked up at Michael, who was looking back and watching him with a happy grin.
"Let's get those feet and toes clean shall we?" Steward said brightly, noticing Michael's "bump" was already subsiding. This confimed for Steward what he already suspected, which was that Michael's erection had less to do with physical stimulation, than the simple mechanics of his disease. General lack of muscle tone in a bed bound patient meant that when being moved and rolled around, blood tends to move towards the pull of gravity. When Michael was turned over, blood would have naturally flowed into the chambers of his penis, causing it to become engorged and partially erect. This effect can take several minutes to go away. If the patient is aware, it can be acutely embarassing, which is why nurses are trained to ignore it and move on to something else. Michael, didn't seem very aware, or the slightest bit bashful about it, so Steward simply went about cleaning his feet.
Michael giggled some as Steward scrubbed his feet and in between his toes. Working his way upward from the ankles, Steward made quick work of Michael's legs. Removing Michael's diaper, Steward balled it up around the small bit of stool he found there, and tossed it to the garbage bin. He rolled Michael once more and gently cleaned his anus and perineum. Steward noticed some rash to the skin there, and applied some Desitin ointment. Steward rolled Michael back onto a fresh, opened diaper, lifted his testicles and cleaned beneath them.
Steward looked at Michael's genitals and considered that they seemed proportional, but not entirely developed to the extent he would expect for a boy of 18 years. There was a downy patch of black pubic hair, but not much, and the scrotum and perineum were completely bare. Michael's penis lay to the side, and looked no longer than perhaps 4 inches even in it's slightly "chubbed" state. Overall, Michael could have easily passed for a 14 or 15 year old, maybe 16 at maximum. Steward shrugged, most likely Michael's puberty had been delayed by the effects of his cebral palsy. In his experience, he'd seen this before, so it didn't concern him.
Steward pulled a fresh cloth from the warm bin, took Michael's penis with one hand, and gently cleaned it with the other. Slowly, Steward retracted the foreskin, and wiped away the small amount of gathered smegma. Again, no surprises there, Steward was becoming accustomed to the fact that Michael's family and caregivers has seen well to his hygiene. As Steward cleaned, he noticed that Michael was once again becoming erect. By the time he was nearly done, Michael was fully hard and it bounced with each pulse of his heart.
Michael's breathing had become strangely quiet and Steward noticed that he was looking away and chewing on his lower lip anxiously. Steward understood the signs of Michael's embarassment, and finished cleaning him up. The one last swipe with the cloth however, proved to much for Michael. His abdominal muscles tensed and his hips gave a buck as his penis swelled and started to spasm. Hot jets of semen arced through the air, landing on his belly and across Steward's wrist. Michael moaned deeply and started sobbing quietly. Steward felt his heart break for the boy. Quickly wiping his arm, Steward went straight to Michael's face and smoothed his hair.
"Shhh Michael," he said soothingly, "it's fine, don't worry, it's a perfectly normal thing to have happen." Michael appeared lost and lonely as he sniffled and sobbed. Steward gently rubbed his fingers through Michael's soft hair and pressed them gently to the back of his neck. Steward quietly apologized to Michael and explained that sometimes these things happened, and to not be embarassed. Michael's crying eventually abated and Steward pulled a new cloth from the pack, and gently washed Michael's face again. He appeared comforted and gradually, his signature smile started to return. He seemed to sense Steward's care and concern and appeared relieved Steward was not angry. Steward wondered if this had happened before with the other nurse, and guessed her response might have been a bit harsher. Steward took the remaining towel, and cleaned up Michael's little explosion before taping the diaper snuggly into place. Michael's erection had gone its merry way and he was returning to his normal, ebullient self.
After attaching the feeding tube to Michael, Steward dressed him for the day. He picked out a nice button down shirt, some black pants and shoes, and lifted him to his customized chair.
The wheelchair, canted back at a slight angle, with special padding and rests to help him hold his head upright, looked comfortable enough for him. He moved his hand to the joystick and slowly moved the chair across the room and planted himself in front of the television. Steward held up several movie choices, and Michael pointed at one obviously well-worn favorite, and Steward left him to be transported off to the magical world of wizards and muggles while he took a break to go to the bathroom.
Upon Steward's return, he found Michael had dozed off. Checking his breathing quickly, Steward found nothing alarming, and set about changing the bags in the garbage and laundry bins. Taking them both downstairs, he bumped into Carmen.
"Can you tell me where to dump the garbage?" Steward asked. Carmen showed him the dumpster just beyond the kitchen door and then attempted to take the bag of laundry from him. "I'll be happy to do that Carmen," he said, "just show me where the machines are." Carmen paused for a moment and eyed him suspiciously.
"Are you sure Mr. Nurse?"
"I'm sure," Steward laughed, "why, did the other nurse not do this sort of thing?"
"Pssht!" she made a dismissive wave,"no way. She just tell me when the laundry full. I got a whole house to keep clean you know? I'm not her personal house maid," Carmen muttered darkly.
"Well, I'll be happy to share my part of the workload Carmen, don't worry about that."
"You know, you keep this up," she said, wagging a finger at Steward, "I never gonna let you go back, you gotta stay and watch after my Michael for good." Steward laughed out loud at that and wagged his finger back at her.
"Be careful what you wish for!" They both laughed lightly as Carmen waved at him to follow her through to the laundry room. As she showed Steward where to find the detergent, bleach and how to work the controls, they talked about the four years Carmen had worked for the Deevers.
Carmen found herself immediately warming to Steward. She fancied herself a very astute judge of character, and her instincts told her Steward could be entrusted with Michael's care. She had lost her own son to an aneurysm about a year before she came to work for the Deevers, and Michael apparently was about the same age when she started. She fully understood the reasons why she attached herself to Michael, but it didn't matter. Here was a boy that needed looking after, and she was a mother who needed to look after one. Carmen even confessed to thinking about going to nursing school to learn how to care for Michael. Steward smiled at that and told her she should do it.
"Nurses make better money than housekeepers," Steward said, immediately regretting it, "no offense of course."
"None taken," Carmen said in a mock snooty tone, "besides, the Deevers pay me good and I been saving my money so I gonna do it someday, you watch me." Steward did not doubt her, and wished her the best of luck.
While they were talking, Marshall Deevers' sneakers barked against the tiles, startling both of them. Marshall stopped at the hallway as he crossed into the kitchen, and waved to Carmen.
"Hey Carmen," he said cheerily. She waved him into the laundry.
"Marshall, come here and meet Michael's new nurse," she encouraged. Marshall dropped a backpack to the floor and walked in, coming face to face with Steward.
"Oh... hiya," Marshall said extending his hand. Steward shook his hand and looked at Marshall in shock.
"Uhm... hi," he said slowly to the boy, "Steward. Steward Smith."
"Steward Smith R.N." Marshall corrected, reading Steward's nametag.
"Uh..., yes..." Steward stumbled over his words, "I guess that's what it says..."
"Nobody told you about me, huh?" Marshall said, with the same sideways grin I'd seen on Michael.
"Well, I've only been here a short time, I haven't gotten the full skinny on everything I guess." Steward said, recovering quickly. He looked the boy over; the resemblance was stunning. If Michael could have walked, you would have been unable to very well distinguish him from his brother. "I didn't know you have CP too."
"Yup," Marshall nodded, "Michael and I are twins, Mom had eclampsia before we were born prematurely, Michael got the worst of the deal, I'm a bit more mobile." Marshall's speech was somewhat muffled by a speech impediment, but it was easily accommodated by the ear. Marshall wheeled around and retrieved his backpack, slinging it up to his shoulder and started walking toward's Michael's room with a peculiar, swinging gait. "Come walk with me, Steward Smith R.N., let's talk." Steward quickly sprinted to catch up and matched his pace.
"This is a beautiful place you folks have." Not knowing what else to say, Steward thought he might try some small talk.
"Thanks," Marshall said, shuffling along, "Michael and I bought it." That stopped Steward in his tracks.
"What?"
"Dunno all the details, but Mom was pretty sick during her pregnancy with us, and her doctor apparently never checked her blood pressure and told my parents her headaches and puffiness were normal, stuff like that."
"So, he missed the pre-eclampsia?"
"Pretty much," Marshal continued, "then Mom had a massive seizure at home one day. They took her to Yale, where they did a C-section, delivered us and basically saved all our lives."
"So, they think the seizure caused the cerebral palsy?"
"I'd say it's a fair guess, wouldn't you?
"So this," Steward said, widening his arms to indicate the house where they stood," is the result of a malpractice lawsuit then."
"Oh yes," Marshall nodded, "kept in trust for us until we are 21. The trustees of the fund saw to it that we would be housed rather comfortably and with plenty of help." Marshall resumed his shuffle up the stairs to Michael's room. "I'm going to Fairfield University, but during the weekends, I care for Michael on the overnights. Mom and Dad switch off during the week.
"Wow," Steward whistled, "That's what I call family togetherness."
"Gah!" Michael called from inside his room, he heard Marshall, became excited and started clapping his hands.
"Gah!" he repeated as Marshall rounded the corner and launched himself at Michael's chair.
"Hey dude!" Marshall exclaimed, wrapping his arms around Michael's neck and kissing him directly on the mouth.
"Ma-maarshaaaaalll," Michael drew his name out but it was clear as day.
"He can say other words too?" Steward asked, blinking..
"Of course," Marshall teased gently, "silly."
"SSSSSIIIILLY!" Michael chimed in. Steward shook his head, it appeared he was making a habit of undersestimating this family, he was going to have to stop that.
"How much can he understand?" Marshall stood up and looked back and forth between Michael and Steward.
"What do you think Michael?" Marshall asked. Michael looked back and forth between Marshal and Steward several times, and then finally held his limp hands in the air and shrugged. Marshall turned back to look at Steward.
"That has been the subject of some controversy," Marshall said quietly, "and frankly, the way we've worked it out, not to many people know. His last nurse, we never told her."
"Told her what?" Steward was getting confused. He looked back at Michael, who was grinning at him devilishly.
"Michael is completely and fully aware Mr. Smith," Marshall said quietly.
"Really?" Steward said, directing the question to Michael. Michael raised his eyebrows and nodded. Steward had to sit down, his bathtime adventure suddenly flashing through his mind. A pit grew in his belly.
"So, now that I'm here, I guess you can go Mr. Smith," Marshall started, but Steward interrupted him.
"Uh, I can't," Steward said, "I'm supposed to be here until 7:oo o'clock."
"Oh don't worry about that, I won't tell on ya!" Marshall waved dismissively at Steward.
"But, what if the agency calls," Steward asked, "They'll check up on me because this is a new assignment."
"I'll tell 'em you've gone out to get some stuff for me or something, I'll make it believable," Marshall assured him, "besides I want to give Michael a bath, he's probably due."
"I uh, did that already, first thing this morning after I got here." Marshall turned to look at Steward, his face dark.
"You did?"
"Yes, it's a good opportunity to get acquainted and to do a complete physical survey. I assure you it is standard..."\
"No worries," Marshall said quietly, "his last nurse probably wouldn't have bothered, so I guess that's why I didnt expect it. He stood there, quiet for a moment.
"Did I uh..." Steward stuttered, "... do something wrong?
"Oh no," Marshall said, snapping out of his brief reverie, "I just, you know, I usually do it for him, it's kinda like, our thing, I guess." Marshall appeared far less the confident college boy suddenly, and seemed nervous.
"Oh," Steward said, "then, if you want, I can leave that to you I suppose. It is just part of my normal routine, that's all, that's why I went ahead."
"Okay," Marshall muttered, "S'cool." Steward still couldn't shake the feeling that he upset the boy somehow.
"Mmaa-sh-shall," Michael said quietly to his brother, "sssaah-wee". Marshall's head snapped over to look at Michael.
"What Michael?"
"It sounded like he said 'Sorry'," Steward said.
"He did," Marshall said, turning his head to look directly into Steward's eyes, "did uh... anything happen during Michael's bath?"
"Hmm, no," Steward swallowed, "not that I can think of." Marshall narrowed his eyes at Steward and then turned to Michael, smoldering.
"Michael!" he barked, "did you do it again?" Steward felt suddenly sick, and looked up to the exchange between the boys. Michael's eyes were filling with tears as he nodded, his lower lip wobbling. Steward stood and rushed to Michael's side.
"Hey stop!" he exclaimed to Marshall, "it wasn't his fault, it was an accident, that stuff happens sometimes, he can't control it." Marshall's features softened.
"Oh I know he can't," he said quietly, "I've got the same sort of hair-trigger." Marshall hung his head.
"Really?" Steward asked.
"Oh yeah," Marshall said, nodding, "I get wood at the drop of a hat and if I'm not careful, I'll jizz my pants just from the fabric rubbing on it. It can be very embarassing." Steward nodded silently, allowing that it certainly would. "So..." Marshall continued, "you didn't mind?"
"Nope," Steward shrugged, "like I said, no big deal, happens all the time." Marshall appeared visibily relieved.
"Meh,." Marshall grunted devilishly, "I wish I could get my own personal nurse to take care of stuff like that." Steward looked the boy over, and before he could stop himself, he spoke.
"Since you both have CP, I could make this a dual trip, and see to your needs too."
"Really?" Marshall turned to him slowly, "do you mean that?"
"Sure," Steward shrugged, "I'm here, why not?" Marshall grinned at Steward once more, but this time, wih a far different look on his face.
"Alright then," Marshall said, "I guess now would be good..." Steward glanced down to see the front of Marshall's pants sticking out around 2 to 3 inches. Steward grinned and began to think about how this just might turn out to be a perfectly lovely assignment .