When you have worked in home care for as long as I have, you often have a sense of when there is going to be a difficult case that Challenges you. It’s not because your boss says “good luck to you” after she hands you the referral, or when the referral itself gives you the clue of a tough case by the type of medications that the patient takes.

It’s often when you arrive at the home itself that you know how bad it is going to be. You can be lost and unable to find the home (this happens more than you think) and all of a sudden you slam on your brakes and see this one lonely little house sitting all by itself and you just know that this must be the place you're looking for and sure enough it usually is. I would like to call it a sixth sense but all it really is is what the house looks like.

I pulled into “Steven’s” driveway and before I got out of the car, I took a deep breath and said to myself, “Let’s do this.” As I got out of my vehicle, I could see that he had been unable to maintain his home, the grass was knee-high, the paint on the house was chipping and dirty and the mailbox was attached to the iron railing with a coat hanger. “MMMmmm,” I said to myself, “I wonder what this is going to be like.”

I knocked on the door and heard a very quiet voice say “what do you want?” I identified myself as the visiting nurse and asked if I could please come in. The mystery voice behind the door yelled: “I don’t care.” I was a little startled after that but it was only the beginning. I opened the door to a smell that was unfamiliar, one I have never smelled before and have yet to smell again to this very day. The house was dark, all the curtains were pulled and the shades were down, there was a little light on; it sat on the floor next to the chair my new patient was sitting in.

There sitting in this dirty, torn, material hanging out of it chair was “Steven.” The VNA had received a referral straight from the doctor’s office, requesting that we see this patient for home safety evaluation and for what may be a possible case of cellulitis of the hand. I knew before I got there this was going to be one of those cases, most of the “Patient can’t come into the office to see our referrals,” from the doctor’s offices are usually like that. The patient had not seen the Doctor in over a year and would not leave his home to do so, so the doctor called in the VNA to do the assessment.

“Hi my name is Marilyn, I am the visiting nurse and I have come here today because the doctor wanted us to check you out.” “My name is "Steven,” he said it very quickly in a monotone voice. As I moved closer to him, I noticed that my feet were sticking to the floor as I walked; I looked down and saw that it was the carpet, I was sticking to the carpet “ewe” I thought.

“Steven, I need just a little more light in here, do you mind if I open a window shade?” He responded yes, I opened the shade to let in the light and when I turned around I saw him standing there right next to me, I was a little startled, to say the least. I backed up a little and I began to assess the situation. “Steven why don’t you sit back down so I can have a good look at you and your injured hand.” He did as I asked him but didn’t say a word.

I asked to see the hand that was hurting him and he shot it right up into my face, again I was a little startled. I assessed his hand, it was dirty and had fingernails about one inch long, with dirt caked under them. I asked him if there was somewhere where he could wash his hands; he jumped up out of the chair and went into the kitchen, without saying a word to me.

The Kitchen was dark as well and I knew where that odor was coming from. The sink was filled with dirty water with a thick layer of scum over it, about an inch thick. “Ewe not there,” I said, let’s try the bathroom” he walked past me and led me to the bathroom.

My eyes must have popped open wide when I saw this man’s bathroom because he looked at me and he looked as if he was going to cry. The sink was totally black with grime, slime, and dirt, the shower had no curtain and it too was black in color around the ring of it and at the bottom and his toilet didn’t look any better. This is one of those times I wish I could have taken a picture because no one is going to believe me about this home.

I swallowed hard and said, “Ok, Steven lets wash those hands with my soap, it doesn’t need water.” So I went to my bag, which I had hung on the door, the safest place to put it for now and grabbed my soap and showed him how to use it, “just rub it into your hands and let the soap do its job.”

Tune in Next week to see what Steven was wearing!