(Photo by Joe Howell)
A couple of years ago, Ellen Williams, R.N., had her first colonoscopy. She had assisted on thousands of the procedures in her career as a nurse, but had never had one herself because, well, it wasn’t time yet.
“It was when I turned 50,” she explains, which is the age at which such screenings, which can detect colon cancer at early and more treatable stages, begin for most patients. “I’m all about prevention. And I had it done here—it was a great experience.”
By “here,” Williams means at the place where she works, the GI Endoscopy Lab at VUMC.
And by “great experience,” well, that might not be the way you would describe a colonoscopy, but what Williams means is that she received excellent care in a friendly and efficient atmosphere—what she and her co-workers strive to do for every patient they see.
“We have great synergy in our department,” Williams says. “Our group is a well-oiled machine. It’s an amazing place to work.”
Having been a patient herself, she says, helped her to understand even more, the vulnerable position patients are in. They have had to undergo several hours—often overnight—of colon prep, which is about as pleasant as it sounds. Some are fearful of the procedure itself—even though it’s painless and most patients are anesthetized and don’t remember it anyway—and some are fearful of hearing bad news.
“We deal with a lot of high anxiety,” Williams says. “I think about how I would want to be treated in that situation.”
That extends even to little things. Because patients are wearing hospital gowns, the room can feel chilly. “We give patients as many blankets as they need—and they’re kept in a warmer, so they’re like a mother’s hug,” she says.
One of the side effects of having a colonoscopy is air in the colon, which many patients, not wanting to be impolite, are reluctant to pass. Williams has a way to put people at ease about that, too: “That’s the music of our day—don’t hold back for us,” she tells one patient with a smile.
Williams grew up in Smith County, east of Nashville near the Cumberland Plateau, attended Middle Tennessee State University and received an associate’s degree in nursing from Motlow State Community College. She worked for a time at Middle Tennessee Medical Center in Murfreesboro, and, when her husband’s job was transferred to Ohio for five years, worked in that state as a nurse manager for a private practice.
The pride and confidence Williams has in her co-workers and herself is evident in her interaction with patients.
“One day I saw some pictures on a patient’s chart,” she recalls. They were images from a colonoscopy—“A blood vessel the size of a human hair, but you see it the size of a television screen,” and she knew the place she wanted to be.
Now she spends her workdays surrounded by monitors displaying the kind of images that fascinated her in that patient’s chart years ago.
The GI Endoscopy Lab sees between 60 and 100 patients a day. It is on the first floor of The Vanderbilt Clinic, and consists largely of a long room with patients awaiting procedures on one side, and the other side is occupied by patients who are waking up from anesthesia following a procedure (that’s the Post Anesthesia Care Unit, or PACU). The patients are in rolling hospital beds and are in individual areas behind privacy curtains.
At the point between the two sides is a long desk where the nurses, physicians, techs and others can write notes. Above the desk is a video screen with a running scroll of that day’s patients, who is responsible for their care, and where they are in the process of their procedure—green letters mean a patient is in one of the eight procedure rooms, blue means the patient is in the pre-op area, and purple means the patient has checked in, but is still in the waiting room.
On the area near the monitor, a stuffed toy sits on a shelf looking down at the goings-on with a big smile. It is a cartoon emoji of—well, of poop. When it’s pointed out to Williams, she shows a big smile of her own.
“That’s what we do here,” she says.
The GI Lab is the work home to 34 RNs; one LPN; seven PRN RNs; 19 techs, (a combination of surgical technologists, endoscopic technologists and radiology technologists); and seven transporters.
The physician staff who may be working there on a given day is drawn from a group of 30 gastroenterologists with different specialties, as well as a dozen or so surgeons representing Trauma, Colorectal and Bariatric services. Three anesthesiologists and six certified registered nurse anesthetists also work in the GI Lab.
“We have great synergy in our department,” Williams says. “Our group is a well-oiled machine. It’s an amazing place to work.”
The nurses who work in the lab typically take one of three positions in the process of caring for patients—the pre-op position, which is taking vital signs, assessing patients generally, and starting IV lines; working in one of the procedure rooms; or working in the PACU, monitoring patients as they awake and recover. Typically, a given nurse will work the same position for a day, but rotate to different positions on different days. On this day, Williams is working in the procedure room with gastroenterologist Reid Ness, M.D., MPH, assistant professor of Medicine.
The pride and confidence Williams has in her co-workers and herself is evident in her interaction with patients.
“Dr. Ness is your doctor today. You’re in good hands,” she assures Rose, a morning colonoscopy patient, and as Williams returns a few minutes later to roll Rose’s bed from the pre-procedure area to the procedure room, she steps through the curtain with the cheery line, “Guess whose turn it is?” and adds the time-tested morning-patient crowd-pleaser, “You’re closer to breakfast!”
As Williams guides Rose’s bed down the short hall, she makes the most of the time, giving Rose a briefing about what to expect.
On the area near the monitor, a stuffed toy sits on a shelf looking down at the goings-on with a big smile. It is a cartoon emoji of—well, of poop. When it’s pointed out to Williams, she shows a big smile of her own. “That’s what we do here,” she says.
The moment the bed is in the procedure room, Williams introduces Rose to Ness and to Danielle Finney, the surgical tech working the room: “That’s Danielle—she’ll be helping take care of you.”
While that’s going on, she also expertly attaches monitors for cardiac and respiratory functioning and threads a nasal canula for oxygen. All this is to the musical accompaniment of Creedence Clearwater Revival’s “Fortunate Son,” playing through speakers connected to Ness’s phone on a corner shelf.
Williams carefully monitors Rose through the introduction of three sedation medications via IV line: Benadryl, which enhances sedation, Fentanyl, a narcotic, and Versed, a benzodiazapine. Rose starts off drowsy but able to respond when she’s spoken to, but soon slips into what is called conscious sedation—she is arousable, but basically asleep and patients usually have no memory of the procedure.
The last step before the procedure begins is a quick safety check, in which everyone in the room stops to, as a group, verify the patient’s name, date of birth and allergies.
The colonoscopy itself takes about 20 minutes. Ness uses a flexible lighted tube to examine the colon for polyps or others signs of colon cancer, the images on video monitors in the room showing the twists and turns of the light pink tunnel of the large intestine.
Probably the most challenging patient this day is having two procedures, an upper GI examination to look for possible causes of acid reflux, followed by a colonoscopy. The early-50s-aged woman seems nervous, so Williams spends a little more time with her.
Ness and Finney are focused on the image on the monitors; Williams occasionally glances at the video screen, but for the most part is watching Rose, handling nursing documentation and watching the monitors displaying Rose’s vital signs. She notes what medications Rose is given, what amounts, and when. She notes what time the procedure started and is completed.
Even before Rose’s procedure is finished, Williams is on the phone to the PACU to find out which curtained bay she will use for recovery, and then rolls the bed back to that bay, turns her care over to the nurse working in that area today, and immediately checks the screen to see who among the patients in the pre-procedure area is scheduled for the next procedure with Ness.
Through the course of the morning, Williams adjusts her interaction to suit the mood of the patient. A Vanderbilt professor is perfectly happy to quietly read that day’s New York Times as he waits. Another patient is having a colonoscopy at an earlier age than most people because she has had a heart transplant and the anti-rejection medications that she takes may make colon problems more likely—she is very accustomed to the medical system and cheerfully helps Williams understand her medical situation.
Probably the most challenging patient this day is having two procedures, an upper GI examination to look for possible causes of acid reflux, followed by a colonoscopy. The early-50s-aged woman seems nervous, so Williams spends a little more time with her.
During the procedure, Williams works alongside Kate Swan, R.N., who is completing an orientation to work in GI following a 15-year career at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Swan is an experienced nurse, but, as she puts it, “That was babies—this is totally different.”
The upper GI exam, in which a lighted scope with a camera is used to examine the esophagus to the gastro-esophageal junction, the point at which it meets the stomach, is completed first, with Williams and Swan not only handling the charting and documentation, but also making sure that the patient’s airway is clear and to be alert in case there is a risk for aspiration.
When that is completed, while the patient is still sedated, a carefully choreographed turning of the bed within the examining room repositions her for the colonoscopy. Both go well, and soon Williams is reuniting the patient, still awaking from sedation, with her husband in the PACU.
Williams returns to the main desk to check the monitor for her next patient.
She says that one aspect of her work that she likes is that the entire team in the GI Lab works together to make sure that the day’s patients are taken care of, and at the end of the day, the work is done. Everybody finishes up, the patients go home to their families (and, for the colonoscopy patients, to the first good meal in 24 hours or so), and the physicians, nurses, techs and others will be back to do it again the next workday.
For Williams, the end of the day is still several hours away. It has already been a busy morning—not hectic, but well organized and busy—and she has several more patients to care for today.
The organization, expertise and enthusiasm that she brings to her job is noticed and appreciated by both her patients and co-workers.
“Ellen has to juggle the demands that the patient flow may need to be orderly—but each patient has unique needs that need to be met,” Ness says. “There is a lot of balancing to do. Ellen is very good at her job.”
