Про интимное: как сохранить достоинство больного

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«Этот текст читать трудно и неловко. Так что простите. Но об этом никто не говорит, а боли за очередным и понятным табу очень много». Нюта Федермессер, президент фонда «Вера», о самых простых вещах, которые труднее всего заметить.

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Про интимное: как сохранить достоинство больного

Я была на конференции в Польше по долгосрочному уходу. Там была лекция, даже три лекции по инконтиненции. Не переживайте, я тоже узнала это слово только два года назад. Оно означает «недержание, проблемы с выведением». Мне казалось, что мы в хосписе очень даже думаем о достоинстве и личном пространстве пациентов, в том числе и в этой части. Но, похоже, я ошибалась.

Работая в хосписе столько лет, я неоднократно (как и многие другие сотрудники) представляла на хосписной койке себя и думала, с какой из медсестер мне было бы комфортно. И всегда в голове было одно: комфортно с той, которой не стыдно дать вытереть попу.

И вот я прослушала целых три лекции профессоров из разных стран про то, как много в нашей жизни связано со способностью контролировать процессы мочеиспускания и дефекации, и про то, как сделать жизнь зависимых от этого людей более комфортной. Это мегаважно. Ведь мы же многие имеем пожилых или лежачих родственников, а об этой стороне их жизни думаем мало, только в контексте наличия запаса памперсов дома и их цены. Ну и потом, проблема эта касается не только умирающих и лежачих.

Мы не задумываемся об этом совсем. А ведь это в какой-то момент практически в каждой семье произойдет

Вот представьте себе, что в силу болезни вам теперь всегда надо думать, когда по дороге следующий туалет. Какое место у вас будет в театре и на концерте. Надо с краю, и не близко к сцене, чтобы никого не потревожить. А какие у вас брюки, ремень, ведь надо их очень быстро снять. А цвет какой, чтобы если что, было бы не видно капель. А в магазине или в аптеке спрашивать прокладки мужские. Или женские, но не гигиенические, а при недержании. А жизнь супругов, если у одного из них в результате лечения начались эти сложности, а он еще вовсе даже и не лежачий больной…

А если наоборот. Если нельзя самостоятельно сходить в туалет. Если человеку никак не обойтись без регулярной клизмы или еще хуже, без так называемой мануальной эвакуации, которую самостоятельно не провести. Или без катетера не удается пописать никогда. Или если у человека, который вполне еще активен в повседневной жизни, стоит калостома или нефростома. И вот эти чудесные мешочки закреплены и спрятаны где-то на теле, под одеждой. Как тогда живется? А как с половой жизнью?

Мы не задумываемся об этом совсем. А ведь это в какой-то момент практически в каждой семье произойдет. Я имею в виду разнообразные проблемы инконтиненции. Это и при Альцгеймере, и при паркинсонизме, и при деменции, и после удаления матки у многих женщин, и просто от старости, и как результат лечения онкологии, или после травм и аварий, или при выпадении матки, или в силу мышечной атрофии, да даже во время беременности случаются такого рода проблемы… Да мало ли из-за чего еще…

Но я больше понимаю про это уже на нашем этапе, на хосписном. Это совсем получается ужасно. Большинство пациентов у нас в подгузниках. Подгузник меняет и подмывает пациента медсестра. А пациенты очень многие очень даже в себе и все понимают. Многие именно из-за этого стараются поменьше есть и пить. Представляете? Поменьше пить, даже если хочется, чтобы не обременять других…

А если это мама двух сыновей, и если это не в стационаре, а дома… И она хочет для них остаться мамой, безупречной леди… А если это муж у своей прекрасной много моложе себя жены… Еще недавно богатырь, заступник…. А если это свекровь и невестка… Еще неделю назад ссорились… Сколько в этом боли, неловкости, слез, зачастую унижения, обиды, хамства.

Самые простые вещи труднее всего заметить. Всегда надо смотреть на пациента с его перспективы, из положения лежа

Да даже если без них, вы просто попробуйте лежа в кровати расслабиться и пописать лежа. И как это будет, если вот это теплое под вами, и вы ощущаете, как это впитывается в памперс, или прилипает к попе, а медсестра еще не подошла… Или надо позвать мужа…

Вот именно поэтому большинство пожилых людей падают именно тогда, когда встают, чтобы потратить остатки сил на то, чтобы добрести до туалета. А в хосписе, когда совсем уже нет сил, все же стараются пересесть хотя бы на стульчак. И спина не держит, и тело падает вперед, и попу самостоятельно все равно уже не вытереть, но слабым голосом говорят медсестре: «Нет, я пересяду, я смогу, только подержите меня». А мы порой не закрываем дверь в палату или не ставим даже ширму у кровати… Или говорим — ну что вы, не надо пересаживаться, вот же у нас целая тележка памперсов…

А для пациента это гораздо больший признак конца, чем прием опиоидных анальгетиков или попадание в стационар хосписа. Мы так много времени уделяем подбору подгузника для ребенка: размер, вес, днем такой, на прогулку этот, на ночь японский, с резиночками, трусиками или на липучках, и ой-скорее-надо-менять-уже-на-другой-размер, он подрос, ему трет в промежности, или как-ты-не-поменял-еще-он-же-уже-минут-двадцать-как-покакал.

А дети ведь до определенного времени психологической составляющей этого процесса вообще не заморачиваются. При этом для взрослых у нас в магазинах выбор практически нулевой, размеров хорошо, если три, информации нет, разговаривать про это как-то неловко…

Интимная сфера остается интимной даже тогда, когда стареешь, болеешь, умираешь

Или вот еще момент. Практически у всех нас есть какие-то туалетные привычки. Кто-то в туалете курит, кто-то пьет кофе, кто-то читает газету или любимый детектив, кто-то лак с ногтей стирает, и уж точно все мы там наедине с собой и, значит, можем позволить себе спокойно и в носу поковырять, и всякие иные части своего тела придирчиво поразглядывать, и пукнуть, и… можно перечислять бесконечно.

Больной же человек в лучшем случае рассчитывать может на ширму около кровати, а если он все же доковылял до туалета, то он знает, что за дверью медсестра, родственник, сиделка, которая ждет, ну когда он там уже… и чашку кофе точно ему туда не подаст…

К чему я все это пишу. К тому, что самые простые вещи труднее всего заметить. Всегда надо смотреть на пациента с его перспективы, из положения лежа. Всегда надо поступать с другими так, как мы хотим, чтобы поступали с нами. (Боже, как я ненавидела эти слова в детстве, когда мама повторяла мне эту мантру по десять раз в день.)

Давайте постараемся понять, что интимная сфера остается интимной даже тогда, когда стареешь, болеешь, умираешь. Что соблюдать достоинство пациента в интимной сфере еще труднее, чем в области физического или духовного комфорта. А значит, как и со всеми другими интимными сферами жизни, надо уделять этой теме больше внимания и тратить на это больше своей души в процессе ухода за беспомощными людьми.

Источник: psychologies.ru

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