I have thought long and hard before writing this blog.  How much do I tell?  Do I even broach the subject?  I have consulted with other people.  I have made rough drafts.  So it is the most difficult blog yet.  I was on the ethics committee at the hospital where I worked, but we talked about ventilators and open heart surgeries and more acute things, since that is the setting that a hospital presents.  Things like this never came up.  And if you are not involved in the medical field at all, you may be as horrified as our kids were when they found out what was going on.  But it is serious enough to cause death, and it had caused death in 2 of my friends the week before it happened to Bob.  So maybe that is why it was so much on my mind.  It is a most indelicate subject, so if you are at all queasy, you might not want to continue.  But if I have made you at all curious, plunge right ahead!  I finally decided that if my blog is to help others, they need to know that this can and does happen.  It is embarrassing, but would have saved some of my friends a lot of grief if they had known.  And since the purpose of all my blogs is to tell the true story, I need to be transparent, and not just pick the sweet topics.  I have no doubt that Bob would not be alive today if I hadn't intervened.  Not that I am so smart, but I have just had experience.  And the other patients are more mobile than Bob, so maybe this isn't your usual problem where Bob is.  He had never had a problem with this before, so it was a shock, and came out of the blue.
I will not accuse anyone, as some of the nurses didn't know this could happen because they had not had experience with it.  But if you have worked in a nursing home setting, you cannot help but know about it.  I took nurses training where part of the facility was acute care, and the other half was more like a nursing home, where we got basic nursing skills.  So though it had been more than 60 years, I had not forgotten the signs and symptoms of a bowel impaction.  Every evening the laxative tray was passed.  We called it black and white (or brown cow)---milk of magnesia and cascara cocktails, if you please.  Then the next morning it that hadn't worked, the patient was either given an enema or the stool that was impacted in the colon was manually removed.  And of course the students got to do that! So when I was notified that Bob was having runny stools, a bell went off in my head.  When a stool impaction occurs in the lower colon and isn't emptied, the more liquid stool from the upper colon just runs around it and the stool is continually running out.  So I asked if Bob had been checked for an impaction.  I was told "no."  I asked both hospice and the facility to please do it, but it wasn't done.  They said they had to have a doctor's order and then WHO on earth was going to do it?  I finally said that well, I didn't have to have a doctor's order, and this little red hen was going to do it herself.  I told them that I knew Bob was going to die, but I didn't want him to die of constipation.  Everyone was quite taken aback by that proclamation!  So I asked them to put Bob in bed, and took another old time nursing friend (who had also done the procedure many times) along with me for support.  But with both of us, it had been over 60 years ago!  Just as I expected, I found a huge impaction.  Now, this makes the term "full of shit" become quite a literal thing.  I couldn't reach it all, so then I knew it had to be moved down from the top.  I got some prune juice (which doesn't need a doctor's order)  and milk of magnesia (which they did get a doctor's order for.)
Thank goodness, I remembered the story a  friend told the support group.  She was caring for her husband at home, when the very same thing happened.  The doctor didn't recognize the classic symptom of the runny stools, and ordered a colonoscopy.  The prep from the colonoscopy wasn't enough to move it down, and she was up all night trying to keep things cleaned up.  When he went for the colonoscopy the problem of the massive impaction was found.  It took 3 weeks of laxatives to get the problem resolved, and then of course they didn't do another colonoscopy!
Let's go back to the aforementioned friends who had died the week before this happened with Bob.  I had just been to one of the funerals the week before and her husband told me what happened.  His wife's colon had become so full of stool that it had perforated (torn) and although she was taken to surgery, it was too late.
So I was quite frustrated, and 5 days after I had removed the initial impaction, the facility was still talking in a committee meeting about how to solve the problem.  To make a long story short, (Ha!) I worked with the med aide on the unit and we developed a program of daily milk of magnesia and prune juice (which works even better when heated) and then every other day remove manually what had moved down.  The stool was very hard, but fortunately there was still enough bowel motility to move it.  So he is back to being able to do it himself, but as with my friend's husband, it took 3 weeks to accomplish.  And we have developed better documentation with a paper chart kept in his room.  Formerly  they were just charted on the computer where they are out of sight and out of mind.  With the other residents it is more difficult to keep track of, as they are more mobile, and if you asked them if they had had a stool today, they wouldn't remember! 
I have checked with people that work in nursing homes, and impactions are still removed manually.  So the practice is not a prehistoric dinosaur of my day!  Eliminating waste is a basic body function along with all the others.  I have no doubt Florence Nightingale would have addressed it, but she was busy on the battlefield. 
I guess my message and the moral of this story would be to be persistent and don't be afraid to speak up for yourself, or be an advocate for your loved one about any medical problem.  I wish the doctor's would listen more, but they have so little time with their patients that they are looking for the quick fix and are not experienced in elder care.  There are no quick fixes there!  It takes time and patience which Santa does not bring!
And now it is the New Year.  My wish for all of you is a very happy, healthy, and regular 2020.
Betty