Critical Care Reflection & Research Written Assignment
In Critical Care: A New Nurse Faces, Death, Life and Everything in Between, by Theresa Brown, the following statement was offered: “Doctors don’t do poop, but nurses do poop up, down, and sideways.” Nurses provide essential care, including managing patients’ bodily waste, which highlights the demanding and often unacknowledged physical and emotional labor inherent in their role. Brown was emphasizing that nurses do the gross work, so that when the doctors arrive, they are not dealing with the mess.
Brown, while working as a nurse, recalled the day she spent cleaning up an incontinent patient. The patient, Mr. Barton, could not control his bowel movements and the doctors thought this was due to the chemotherapy. Alas, Brown, with the help from her Aide, spent every half hour cleaning Mr. Barton and the exam room. Luckily, Mr. Barton did not show anger or embarrassment and was very respectful given the situation. Brown recalls that the night shift nurses claimed that his bottom was so raw, that even a fart would hurt him. This forced the nurses to try to keep his bottom as dry as possible, another very difficult task with the constant cleaning of poop. They attempted to diaper Mr Barton, which made him feel infantilized, and he needed to be changed, so he wasn’t just sitting in his own poop. Mr. Barton pretending to be a baby helped break some of the tension.
Brown continued to provide exceptional human-centered support and displayed great compassion towards Mr. Barton. The intern doctor eventually requested Brown take a stool sample, which was easy given the situation, and after physically showing the doctor the stool sample, the intern displayed signs of disgust, like he was grossed out by the poop. It was at that moment she realized, doctors don’t do poop, but nurses definitely do. After the chemotherapy treatment resided, Mr Bartons GI problems diminished, and for a couple months he was doing well.
It makes practical sense that Brown said that doctors don’t do poop, and leaving it all up to the nurses. In general, we can see that nurses spend more time providing direct patient care so it it highly likely the doctors are much less experienced in the dirty aspects of the job. Doctors are typically busy dealing with a larger number of patients, dealing mostly with numbers and facts, whereas nurses provide the direct care like educating patients, prepping them for what’s to come, and even cleaning up their messes. Brown spent more time caring for Mr. Barton’s humanitarian needs compared to the intern.
Mr. Barton eventually left the hospital and was doing well for a while, but eventually Mr. Barton’s cancer came back and doctors had to weight the benefits of chemotherapy with the costs on Mr. Barton’s body. The doctors were not comfortable giving him another round of chemotherapy due to the negative effects on the GI tract. So the doctors offered 3 options. One, they keep him on light treatment and keep him comfortable, two, they only focus on keeping him comfortable with no treatment, or three, they give more chemotherapy, but it doesn’t fully cure the disease, and potentially hurts his body some more, with more GI discomfort.
According to the National Cancer Institute, some cancer treatments can cause urinary and or bladder problems. Some of the most common treatments that may cause gastrointestinal symptoms can include radiation therapy or chemotherapy to the pelvic region or treatments that target fast reproducing cells. (1) Many cancer therapies target these fast reproducing cells and as a result they may accidentally target and destroy the positive fast reproducing cells like those that line the stomach. The fact that Mr. Barton’s cancer treatment was targeting fast-reproducing cells meant that the treatment was also destroying some of the good gastrointestinal cells, which can lead to diarrhea and vomiting. This likely caused much of Mr. Barton’s incontinence.
Many other similar symptoms become present during chemotherapy. For instance, urinary problems that may arise include pain or a burning sensation while urinating, blood in your urine (hematuria), trouble starting to urinate, trouble emptying your bladder completely, frequent need to use the bathroom, leaking, or bladder cramps and discomfort. Treatments usually include drinking plenty of fluids, restricting caffeine and alcohol, as well as reducing spicy foods and tobacco products. Some medications may alleviate GI symptoms, but it’s very difficult to control the symptoms that come with chemotherapy, and this would be very difficult on Mr. Barton’s aging body.
Although Brown never found out the conclusion for the patient, she heard “through the grapevine” that he received some variation of all three options of treatment. She mentioned that she hadn’t heard he died, which was a positive, and that she prefer not to know ultimately what happens. After caring for someone, its better for her mental health to live in ignorance.
It’s significant that doctors don’t deal with poop and that nurses do. Because nurses experience the hard work and humility of cleaning up after someone, it takes a lot more compassion for the nurse to do her job compared to the doctor. The nurse doesn’t have time to get grossed out over the fecal sample, because she has already been elbow deep in poop all morning. While the doctor gets to stay clean and address the problem, the nurse gets in deep to help take care of the patient.
Even though it’s in the nurses job description to take care of situations like these, I can imagine myself in this situation. I am very bad with smelly bodily fluids, and I know that if I had to deal with this patient I would be very disgusted. However, even if it is disgusting, it is our duty to take care of the patients that cannot take care of themselves. It’s what we do as nurses. Brown was right to notice that nurses deal with the far dirtier side of healthcare, and it takes a lot of compassion and unit culture/support in order to safely deal with gross bodily functions like incontinence.
My personal discomfort with gross bodily fluids may lead me to a less, gross, jobs dealing with different populations. Even though every job has its “thing”, my typical as a nurse can be spent running ECGs in the cardiology department, or putting in stents, rather than dealing with poop. However, I do have a strong respect for those that can endure the grossness. Nursing needs compassionate and patient people like them.
It is extremely important for nurses to deal with these situations with respect, and humility as to not belittle or embarrass the patient, to maintain a sanitary workplace, and to offer the most support for their patients. Without proper practice management, and nurse compassion education, patients will not receive the respectful and proficient care that they expect and deserve, especially in vulnerable times like the one Brown experienced. According to a study by Sydney Malenfant (2), clinical and education interventions for compassion in healthcare appear to be limited. More intervention or training programs are required to ensure that healthcare professionals can provide adequate and compassionate care to all patients.
Although Brown’s situation is a common situation for nurses- occupational exposure to body fluids like blood, poop or urine remains a major risk for the transmission of disease and infections. (3) Diseases like hepatitis B and C and human immune-deficiency virus are common illnesses spread through contaminated bodily fluids. A systematic review by Dechasa Adare Mengistu et al determined a high prevalence in bodily fluid exposure, with the highest instances so far occurring from 2003 to 2008.
Likewise, the United Stated Department of Labor offers a statistics report covering occupational injuries and illnesses among registered nurses. What was phenomenal to read was that of all 100% of the non-fatal occupational injuries and illnesses, only about 3.3% of the injuries documented involved exposure to harmful substances or environments (4). They compared this to about 4.3% across all occupations recorded, meaning nurses were getting hurt or ill due to occupational exposure far less than other jobs. Another interesting statistic from this study was the age distribution of people getting injured or ill due to occupational hazards. The Department of Labor found that 15.4% of American workers age 20 to 24 experience injury or illness due to occupational hazards compared to 3.3% aged 25 to 34. This number keeps dropping as one ages.
The main takeaway from the occupation hazard statistics is that the more experience one has in dealing with occupational hazards like poop, the lower the risk of injury one has. This means that universities, hospitals, private practices and nurse management teams would benefit from furthering their team’s occupational hazard education. Providing clear educational resources, especially to younger or less experienced health professionals can help more nurses overcome gross situations, like the one Brown experienced with Mr. Barton in critical care.
The Department of Labor’s study was unfortunately flawed, or could have been better suited for health care professionals. Their occupational hazard study presented data from multiple industries comparing industry wide trends. This fails to share the intricacies of the nursing profession and how different types of nurses experience occupational hazards differently. Although more studies can be done on the types of hazards and the methods used when a nurse encounters a hazard, we can safely conclude that nurses require extra compassion, and extra occupational hazard training, or what I would refer to as “poop training.”1. “Urinary and Bladder Problems and Cancer Treatment – Side Effects.” And Cancer Treatment – Side Effects – NCI, www.cancer.gov/about-cancer/treatment/side-effects/urination-changes. Accessed 14 Apr. 2025.
2. Malenfant, S., Jaggi, P., Hayden, K. A., & Sinclair, S. (2022). Compassion in healthcare: an updated scoping review of the literature. BMC palliative care, 21(1), 80. https://doi.org/10.1186/s12904-022-00942-3
3. Mengistu, Dechasa Adare, et al. “Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis.” The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien Des Maladies Infectieuses et de La Microbiologie Medicale, U.S. National Library of Medicine, 3 June 2022, pmc.ncbi.nlm.nih.gov/articles/PMC9187485/.
4. “Occupational Injuries and Illnesses among Registered Nurses.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, www.bls.gov/opub/mlr/2018/article/occupational-injuries-and-illnesses-among-registered-nurses.htm. Accessed 14 Apr. 2025.
5. Brown, T. (2010). Critical care : a new nurse faces death, life, and everything in between (1st ed). HarperCollins Publishers.
