Friday, April 8, 2016

Look Out Below

Florence Nightingale  envisioned hospitals as one story structures that had large windows for both lighting and ventilation. The fresh air was thought to have a healing benefit. Old hospitals had windows that easily opened and closed. There was no mechanical ventilation with a HVAC system and positive pressure rooms were in the distant future. Rooms were heated with radiators and windows were usually wide open in the Spring and Summer.

There were no high altitude flying insects in Chicago, so the windows above about the 4th floor lacked screens. There was nothing between the hospital interior and the good old outdoors.

This direct connection to the outside world presented a temptation too great for some nurses to resist. After working a harried evening shift with normal inhibitions dulled by being too tired and seeing too much misery the unthinkable suddenly seemed like a good idea.

The thought process went like this; "Hmm.... there are 8 Foley bags on this ward that need emptied.. I'm already behind schedule and it's 10:50PM...Over in the corner is a janitorial bucket with impressive capacity...Now lickety split I'll drain the urine bags into the bucket.. Now for the real stepsaver, DUMP THE BUCKET OUT THE WINDOW."

Now, I'm not saying that I've ever done this, but I know for a fact that it was practiced. One old nurse said the hospital planners even allowed for this practice. "Why do you think the sidewalks are located a good 40 feet from the building?" she asked. I don't know if this was true, but I made a mental note to keep a safe distance from any hospital building.

I noticed another tell-tale sign of the window urine dumping syndrome; the grass below selected ward windows was a dead brown color. The high nitrogen content of the urine had effectively killed the turf. I also noticed that upon venturing off the sidewalk (not a prudent thing to do without a raincoat) the unmistakable odor of urine was present. This smell could have wafted out the open windows, but it seemed to always be there which was further testimony of urine dumping.

Miss Bruiser, my favorite nursing school instructor, once asked the class for an explanation of gastric dumping syndrome which often occurred after a gastrectomy. One eager student quickly replied, "The dumping syndrome occurs on the detox wards when a patient vomits out a window." Miss Bruiser seemed puzzled by the student's response, but vomiting out an open window did indeed occur on the 6 bed detox ward.

I think it was a conditioned response with seasoned alcoholics to hurl their gastric contents out a window. The detox ward had that peculiar blend of olfactory insults as a result of the paraldehyde, stool, and emesis coexisting in a small area, so the windows were always open.
It is much easier to vomit out an open window than
trying to hit one of those tiny emesis basins. "When I
open the window, let it rip."
To a detoxing alcoholic the window looked like a perfect place to vomit.  The bed placement also encouraged this tactic. Two of the beds had the head of the bed aligned perfectly with the open windows.    As one old booze hound explained, "I've pucked out my car window many times, it's a lot easier to drive drunk, than clean vomit off the interior." I guess it's called projectile vomiting for a reason. This provided an added incentive to keep your distance from the hospital exterior. I don't know which would be worse to have dumped on someone, urine or emesis. They were both nasty.

There was no positive pressure ventilation in our old operating rooms and with our positioning on the 7th floor the windows were frequently open. Old time anesthesia machines were rather crude and sometimes leaked anesthetic agents. Even on cold days, Dr. Oddo would start hollering, "I'm getting sleepy, open the window."

Not much refuse was ever thrown out the OR windows as there were plenty of witnesses. Hospital window tossing of garbage or effluent  was usually a solitary act. The one exception would be an orthopedic case done in a regular general surgery room. This occasionally happened with a trauma patient and left the circulating nurse with a cleanup dilemma. The only sanctioned disposal location for casting plaster was way down the hall in the ortho room. The stuff could not be poured down a sink as it totally gummed up the plumbing.  After a long trauma case, the window could be a tempting place for plaster dumping. I always wondered what that stalagmite looking mass was on the ground below the general surgery OR. Now I knew, it was casting plaster, that stuff lasts forever.

With Lady Bird Johnson's keep America beautiful campaign in the late 1960's littering and dumping really had a pejorative connotation attached to it. I think most of this unsavory activity ceased. Of course if a nurse was working late at the close of a stressful shift, who knows what might happen. It's always prudent to maintain a safe distance from open hospital windows.


  1. Eeeeuuuuuw!

    And those little emesis basins are for the birds... I quickly learned to just go ahead and grab the bath basin in the first place!

  2. An open window provides an even bigger target than a bath basin :-)... To this day I am nervous about effluent from the sky when walking past a hospital. Old fears die hard!