The Story of Matt Weddle, Madeline Notch, the Bedacheks, and the Botched Home Visit

Matt Weddle is a nursing student in his next to last year of professional education. He has enjoyed his professional training, especially being in the actual patient care environment. Today, however, he went to bed discouraged and wondering if he has made the correct career choice.

Matt is on a home health care rotation. He has an excellent supervisor, Madeline Notch, who has tried to provide him with a wide range of learning experiences and proper supervision during his time with her. This has not been an easy task; the census for the home care association is high, and with major cutbacks in professional staff, she has been busier than usual. He is sorry to learn that she is going on vacation tomorrow and that his supervision will be turned over to another nurse, Eugenia Cripke.

Today Ms. Notch asks Matt if he would stop by Mrs. Bedachek’s apartment to check on her son Tom and be sure his wound is healing well. “The wound may need debridement and a bandage change. You can make the judgment about whether to change the bandage, since I changed it myself yesterday on my way home from work.” He is somewhat uncomfortable about going alone to see a patient he has not seen before. He also remembers being told by his academic clinical coordinator at school that under no circumstances should he go into a patient’s home unsupervised. But he agrees to do so, not feeling free to question Ms. Notch about whether this is correct procedure. Instead, he assures her that he has done this procedure enough times under her supervision that he feels he should be able to do it. She agrees.

When he knocks at the Bedacheks’ door, a large woman in a filthy house dress peers through a crack in the door. At first, she does not want to let him in, but when he shows her his name tag as identification that he is “the nurse,” she admits him. He introduces himself with his name and says he is a student nurse. Mrs. Bedachek is already walking laboriously across the room toward the other occupant, an equally large man who appears unable to comprehend what is going on. The man strains to peer at Matt from a large armchair set up in the midst of the clutter in the small living room. Matt knows the man’s name is Tom, but he is unprepared for the greasy-skinned person drooling onto the front of a mucus-stained shirt.

When Matt tells the patient what he has come to do, the man grunts. The woman says, “I don’t want you to touch that bandage. It’s fine.” She draws up the man’s shirt for Matt to see. Matt is surprised at the size of it and concerned about the dark seepage around the bottom edge. Mrs. Bedachek says, suspiciously, “Who are you again?” Matt repeats his name. “At least you’re not a student,” she says. “They’re the worst.” Matt says nothing. He feels uncomfortable about this whole situation. He reaches toward the bandage to touch it, and she suddenly pulls the shirt back down over her son’s trunk. The stench is making Matt feel woozy.

“I said it’s fine,” she says firmly.

Matt replies, “Okay,” and leaves.

When he gets back to the office, Madeline Notch is there, clearing off her desk. “How did it go?” she asks. “Fine,” he says. “Oh good,” she replies. “I didn’t want to tell you, but most people can’t get through the front door. I went myself yesterday. I thought the wound looked really good except for that distal edge.”

Matt had meant to tell her immediately about the whole scene, but for some reason, her comments unnerve him and he feels like a failure. He says, “Yeah, I agree.”

She comes over to him. “Thanks so much for getting me through that squeeze. I knew you could handle that bandage change, and I was worried about letting it go.” She continues, “Sometimes I think it’s not worth trying to go on vacation!” She pauses and extends her hand, saying, “I have enjoyed working with you as a student. You will make a fine nurse. And you will enjoy working with Eugenia Cripke.”

She leaves hurriedly, saying she has to pick up her son at daycare and get packed. Matt takes Tom Bedachek’s record from the drawer and writes, “Wound debridement, bandage change. Purulent exudate around the distal rim of wound.”

Almost everyone would agree that both Ms. Notch and Matt Weddle exercised poor ethical judgment.