Back to Basics

Some nurses recently said to me that nursing has changed so much and we do so much more, that we might as well be doctors. The two nurses who said this to me were both nurse anesthetists. They then went on to say that there a so many unskilled jobs that anyone could do, and that nurses should not have to do. In particular, they were referring to jobs such as showering/bed sponging, feeding, and dressing wounds. I found this rather sad. It seems that the fundamentals of nursing are being forgotten.

Confused? Well I'm referring to the days when RN's took care of the whole patient. Meeting hygiene needs, dressing wounds, and feeding patients eg stroke patients are not for the unskilled.

To me this feels wrong? It's these tasks which keep us in touch with the patient. For example, when we wash a patient we assess so much. When we log roll them onto their side we check their pressure areas, feel their skin under our hands: Are they hot, dry, cold and clammy. When we move them do they cough, does their chest rattle. When we feed a stroke victim we assess their ability to swallow. This is rather important as aspirating food into the lungs is never good. When we dress a wound, we observe each day its progress, it's shape, size, colour, odor, discharge. Is it pale red or angry red? There is so much that an experienced nurse automatically assesses when they look after the basic needs of a patient and it is not for the unskilled.

I realize that we do so much more, in some cases diagnose, treat/prescribe, or maybe we're nurse anaesthetists, but I feel that the absolute basics should always be a part of nursing. I am happy to delegate some basic jobs, but it should never be delegated because we feel it is a simple unskilled job for the unskilled health worker.

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No Chance

"I'm always scratching my head. Do you think it could be dandruff?" asked Louise. At twelve years old Louise was the youngest girl in the school. The high school sometimes took students a year early, they were called pre-nine's, referring of course to the ninth grade. Until I met Louise, I had never figured out why the high school sometimes took children one year earlier than normal.

"Well, I'd better have a closer look, it could be something else" I said as I put on some latex gloves. "Why are you putting gloves on? What could it be?" Louise asked nervously. "It's nothing to worry about, but you might have nits?" I explained. "Yuk, that's disgusting. That's so gross" Louise then pretended to vomit. I then began to search through her hair. I didn't have to search very hard as the nits were so big and there were so many, I could see them without having to sift through her hair.

"Yep, you've got nits" I said, "I'll get some treatment from the pharmacy today. Who's you're room mate? I'll have to get her checked as well" Louise again pretended to vomit, a big smile one her face the whole time. "How did I get them? Can I share them with my friends?" She really didn't seem too upset about the whole deal. She almost seemed to be enjoying the attention. "You could have caught them by direct contact from someone who already has them. You can even get them from using someone else's brush, or from their clothing" I explained "So it's really important I see you room mate." Louise went to her dorm and returned with her room mate, Nicole.

Nicole did have nits, although not as bad as Louise. Nicole acted the same as Louise, by expressing her disgust at having "creatures" in her hair, but she had a smile on her face and seeming to enjoy the attention. "Come back at lunch time and I'll have some medicine for you both. Oh, and I"ll call you parents, just so they know what's going on." Nicole nodded her head while Louise reacted differently. "They don't need to know" she said "Don't bother calling them" she said. "Why not? They need to know what's going on. It's part of my job" I explained. "There's no need, they won't care anyway. They'll say it was my fault" Louise pleaded. "Well, let's get the treatment started and we'll talk about this later" I suggested. As for the parents, I sent an email to both sets. Nicole's parents wrote back thanking the health center for helping their child, while I heard nothing from Louise's.

Nicole and Louise both received the treatment and after ten days were nit free, or in Nicole's words "creature free." Each day both girls came in laughing and joking about the "creatures" in their hair. They didn't need to come every day, but they enjoyed being in the health center. Between myself and the other two nurses who worked here, the girls probably received more positive attention than they were used to. At least in Louise's case, it was most likely the most positive attention she had received.

Over the next month Louise was involved in some rather serious incidents, all involving alcohol and boys. In fact she was even hospitalized because she had drunk so much and her 'friends' couldn't wake her. I had to pick her up from the hospital and had to call the mother. "She couldn't have drunk much, she's such a small thing. One tequila would be enough to make her very ill" said Louise's mum over the phone. "Well, she drunk enough to be unconscious. Her friends said she had a lot more than one shot of tequila" I said. "That can't be right. She's so small, she'd only need a few shots to be in such a state. Someone must have spiked her drunk. Can you do some blood test to check for that? I insist you do some blood tests."

During the drive back to the school campus I informed Louise that I had spoken to her parents. "She doesn't care. Mum's an alcoholic anyway. I'm just following in her footsteps." It's hard to know what to believe when kids talk about their parents, plus this wasn't the time to have a serious talk with her about her problems. I'd leave that up to the counselors. "What about your dad? He must be pretty upset" Louise kept silent.

Louise eventually left the school and was sent home. As I stated earlier, it was for an ongoing serious of problems. But I found out something so shocking that it made me worry just what sort of home she was returning to. It goes like this:

Two weeks before school was to begin for the school year, Louise's father had phoned the school and asked if he could drop his daughter off early, one whole week early. It was then explained to him that this was not possible as there were no staff at the school. The father then asked exactly what date school started, and he was told September twelve.

On the night of September 11th, at 2355hrs, Louise's father dropped his daughter off outside a dorm, unloaded her bags and drove off. No one knew she was here, she was left alone in a foreign speaking country, in the middle of the night.

By pure chance two staff members were walking home from a night out and found Louise and took care of her.

I got to say goodbye to Louise. "I don't want to go" she said to me. "I'm sorry, but it's not up to me. But you can't go on breaking the rules and doing so many dangerous things?" She nodded her head. "But you guys in the health center are the only people who've ever been nice to me, who've ever cared"

Five minutes later the driver arrived and took Louise to the airport.

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I don't mean to sound cruel but...

"What are you boys' doing?" I asked the boys' in front of me. "Ah, nothing" there was a pause as they thought of a suitable answer. They were standing in the dorm foyer dressed in ski jacket and pants. "Ah... just going for a hike. That's all." They must think I'm stupid. "Don't lie. If you lie to me, I'll just have to report this to the Dean." I was referring to Jim, the school Dean of discipline. "Well, we were just going up for a quick look. The snow looks so good. We were going to be back before lunch" said Justin.

Normally I encourage the kids to ski, but school exams began tomorrow (Sunday) and the headmaster specifically said no one can ski. He didn't want to risk anyone getting injured, in particular a broken bone, just before they were to start exams.

"Well, guys, I'm sorry but you know the rules" I tried to be sympathetic to their cause, but then I had a sudden thought. "Hey Justin, you're only a beginner skier. What the hell do you think you're doing going up? Do you want to break a bone?" Justin didn't even look guilty "I'm a natural athlete. I skied ten times last season. I am in the advanced ski lessons now." As a ski instructor of ten years, I knew that this was utter rubbish, but Justin probably genuinely believes he is good. "Well, whatever, but you can't go up today, the headmaster specifically said so. Is that clear?" Everyone nodded their head and headed back upstairs to their room to get changed out of their ski clothes.

As the nurse on call it was turning out to be a quiet Saturday morning and I was relieved that I had stopped a potential disaster from happening. Every weekend someone broke a bone. Ninety percent of the breaks were from kids going too fast and jumping. At this school any kid who could make it down a intermediate ski run thought they were good and could be found in the jump park. Some were even good at jumping, but rubbish at skiing. With the snow dumping down outside, I settled myself by the fire with a good book, expecting a quiet day.

At two o'clock the nurse mobile phone rang. "Hello, nurse on call" I answered. "It is doctor Munroe. We have one of your students here" he said. "Ah, you do?" I sounded surprised. Kids were supposed to call the nurse first, and then we took them to the doctor. Kids are not to go directly to a doctor. "We have a skier who has broken his collar bone. Can you come and pick him up?" said doctor Munroe. "Ah, the kids aren't supposed to be skiing doc, what's the kid's name?" "Justin. Do you know him?" said Dr Munroe. "I know him very well. I'll come and pick him up" I offered. "You don't need to worry, he just left in a taxi. It looks like he's trying to avoid someone" he said.

Justin isn't the first kid to try and hide an injury by sneaking to the doctor or even the hospital without contacting the school nurse. There was even one girl who, with two friends, sneaked out of the dorm at midnight and took a taxi to the hospital down in the valley. We never found out until the hospital sent us the bill. No matter how hard the kids try, we always catch them.

At two thirty I received a phone call from Justin. A very sombre Justin was asking for stronger pain relief. "Come to the health center and I'll see what I have for you" I instructed him. Ten minutes later we met in the health center. I couldn't help myself from saying "I told you so." Justin was still defiant "I'm a good skier, a natural athlete. I'm good at all sport" he said. It amazed me how Justin could still say this while his face was contorted with pain. Perhaps it's just as well he is in pain, maybe he'll learn a lesson. But that's just cruel of me...isn't it?

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Choosing to be blind

Before I begin, no names or places are real, but the situation is. It happened a couple of years ago, and the only reason it came to memory was that I have recently been giving some talks to the kids of drugs. I've also been recently dealing with some rather difficult parents. If the parent concerned in my next story did ever identify themselves, then it will be a mixed blessing. On one hand, the parent may be angry at me, but on the other hand it may just open their eyes, and by doing so, may just save a life.

"Do you think I should say something?" I asked the Sarah. Sarah was one of the other nurses whom I worked with. She had twenty years nursing experience behind her, twelve of those spent in boarding schools. "I don't see why not. It is a health issue. A very serious health issue. It would be wrong if we didn't say something" she said. "Yeah, but am I the right person to say something. The kid's already in trouble with Jim (dean of discipline) and he has already talked to the boy's parents. And you heard what Jim said, dad doesn't believe his kids would do such a thing."

Sarah was shaking her head in frustration, not at me, but at the father who wouldn't listen to what the school had to say. "Well maybe someone else needs to say something. Maybe he needs to hear it from someone else. We have to try." With that said I made the call to Mr Smith, father of Ian Smith.

"I've already talked about this with Jim, and the matter is settled. I don't appreciate you calling accusing my son of taking drugs" said Mr Smith. "I'm not calling to accuse anyone. I'm calling because I'm worried about Ian..." Mr Smith interrupted me before I could say anymore "Listen, I trust my kids. I know they wouldn't do anything. You cannot prove anything. They are good kids..." I decided it was my turn to interrupt him "I know they're good kids..." He interrupted me again. "Don't patronize me. You don't know my kids. I know they're good kids. Leave my kids alone or I'll sue you for harassment." I decided to give it one more try "Ok, but will you listen to me this once. If you don't agree with me, or want to speak to me after I've said my piece, then we'll leave it at that and the matter will be dealt with by Jim (Dean of discipline)." Mr Smith grudgingly agreed to listen.

I then explained the situation from our point of view, which was as follows:
Ian was found in his bathroom, with two other boys. They had a plastic bag filled with a dozen small, opened tins of varnish. A teacher walked in and found Ian sitting on the toilet, staring at the wall in a semi-conscious state. When spoken to he didn't respond. He was completely uncommunicative. The teacher hurried to get another teacher to come and help, and when he returned, Ian was still sitting there staring at the wall, looking pale, sickly, and still uncommunicative. The teacher's helped walk Ian to his bed where they lay him down and called the nurse. By the time the nurse got there (approx 15 minutes later) Ian was talking and almost back to normal.

"You've got no evidence. There were other children there. Ian was in the wrong place at the wrong time. This isn't the first time you've singled out Ian. You're out to get him. You have not right to accuse him of anything. Stay away or else."

I thought it best to end the conversation. Maybe with time he'll calm down and see reason. I wasn't accusing Ian, although I felt I had a justifiable right to. It's not politically correct or legally wise to go accusing, even when things are so damn obvious. I do wonder if anything I said would have made any difference. Jim, the dean of discipline didn't fare any better. It would be great if Mr Smith is right, but why can't Mr Smith at least accept that there is a remote chance he could be wrong. It's his son's life he is dealing with.

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Parents, Priorities and Kids

"I expect her to get better now" said the man on the end of the phone. I almost thought I could hear a hint of menace in his voice. The voice belonged Mr Smith, a naturally worried parent living thousands of miles away somewhere in South America. His daughter, Jennifer, was a student at the boarding school where I was working. "Well, we're doing the best we can. She's seen the doctor and is on her second course of antibiotics, so she should be fine" I replied, trying hard to keep my voice calm and neutral. "That's not good enough" he said "I want a real doctor. She needs a specialist. I want her to see a specialist today. Or do I have to come over there myself" when he said this, there was no doubt about the menacing tone in his voice.

I've heard it all before. Caring parents thousands of miles away accusing me of not taking care of their son/daughter. I've learned to have as little contact with parents as possible, as no matter what I do it will never be good enough, but sometimes I feel the urge to bite back.

"You're welcome to come over. I'm sure Jennifer will love it" I replied. "Shall I tell her that you're coming over then?" I added. "That won't...ah be necessary" my reply had caught Mr Smith off guard. Of course he wouldn't come over. He's just like many of the parents I deal with, too busy looking after their business instead of their children. "I'm sure you'll do what is needed." With that the phone went dead.

The problem was that one week ago Jennifer was diagnosed with a bad throat infection, commonly called Strep Throat. She had become sick one monday evening, about nine o'clock, whereupon I was called to see her. Her throat did look bad. It was an angry red and had a couple of small yellow spots. Her temperature was high and she looked dry. She was given the usual pain relievers, was given fluids and I instructed the dorm staff on how to care for her.

The following morning she was taken to the doctor where a Strep Throat test was performed, and following the positive result, she was commenced on the appropriate antibiotics.

After two days of antibiotics and analgesia, Jennifer felt much improved. So much improved that she wanted to go to class, which we allowed her to do. I did explain to her that even though she felt better, she still needed to take her antibiotics. It was a wednesday morning and everyone felt confident that Jennifer's illness would soon be cured.

Later that same day, around sixish, I caught up with Jennifer in her dorm because she hadn't come in to take her breakfast or lunchtime dose of antibiotics. "I feel so much better" she said when I asked her why she hadn't taken them. "Well, if you don't finish them you could get a lot worse. Do you understand?" She nodded her head. I then gave her a dinner time dose plus another to take around 10pm when she went to bed, that way she would only have missed one dose for the day. "Can I trust you to take them, or do I have to come and give them to you?" I asked. Jennifer promised to take the antibiotic. "You also need to rest this weekend. No going out. I want you resting in the dorm, staying warm, dry, no restaurants, no alcohol, and no partying." Jennifer again promised to do as asked.

I never saw Jennifer the next day (friday) or saturday. I saw her 6pm sunday evening after a phone call from the dorm staff which went like this: "She looks terrible. She's lying there not moving, please come quick." I made my way pretty quickly to the dorm.

As I walked into Jennifer's room I was almost knocked over by the smell of rot and bacteria. Jennifer was lying on her bed, staring at the ceiling, her lips parched, her breathing rapid and shallow and her bed soaked through with sweat.

It turns out that on Friday afternoon Jennifer's auntie had come and taken her away for the weekend. In that time, Jennifer said she had nothing to eat or drink because her throat was too painful, and she never took her antibiotics. On the sunday morning the auntie had taken her to hospital. She was discharged several hours later after being given a further course of antibiotics. The auntie never contacted any of us nursing staff or anyone else at the school. The auntie just dropped her off niece and left.

"Why was she so dehydrated? How could you let her get like that?" Mr Smith said accusingly. The phone conversation wasn't going well again. "Ah, Jennifer was under the care of her auntie. Jennifer never even told us she was going away. How can we look after someone when they are not here? Also, Jennifer insists she never had any food or fluids, and her friend who was with her confirms this. I don't want to blame anyone, but this is how she presented to us" As I said this I felt my ire rising. "You're calling my sister a liar?" Mr Smith fumed. "Ah, all I'm saying is she was away, when she was not supposed to be, and when she came back she was in this state. She came back at six pm, I was called at 1805hrs, and was with her by 1815hrs. We have done all we could for her, when she has been with us" I barely kept my voice calm. "Well your best is obviously not good enough" said Mr Smith. "Well, you did say you would come out here if you weren't happy with our care. Perhaps it would be best if you did, that way you can be assured your daughter is getting proper care." There was a brief pause on the line "Well, she's getting the care she needs now. So let's just leave it at that. I want a update every day on her progress. I want her to see the doctor every day and I want you to make sure she takes her antibiotics." I never got a chance to say goodbye as the phone went dead.

It is parents like Mr Smith that make me have as little contact with them as possible. Nothing we do is good enough. They rant and rave about specialists and threats of coming out here to deal with the matter personally, but generally they don't. Generally their board meeting is too important, or they send the family secretary out as they can't make some time for their own children.

Not all parents are like this, but many of these wealthy ones are. They have the money, the small or big fortune, but they don't have their priorities right. Their priorities are their business and making more money. It's a different sort of wealth from the one I'm used to.

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I'm not perfect. I'm far too human.

"I'm sorry" said the young man lying in front of me. "So you should be" I said and turned and walked away. The relatives of the man gave me hostile looks, but kept quiet. They may lay a complaint later, but I doubt it. Their son, brother, cousin, nephew, has caused enough grief already.

You're not going to like me for saying this. In fact it's the opposite of how nurses should be, but I can't be nice to that patient. I'm struggling to be civil, and for the most part, am managing it. How unprofessional of me, but he just killed his best friend. Fortunately the passengers of the car they crashed into survived.

He's not even a teenager anymore, so he can't use that as an excuse. He's twenty one and knows that drinking and driving kills. The guys weren't just a little drunk, they were roaringly drunk when they got into the car. His friend wasn't even wearing a seatbelt, but he, the driver, was. But it could just as easily have been the other way around, with the friend in the driver's seat and wearing the seatbelt.

My colleagues are treating him so gently, but I can't be gentle. My mum and dad were on the same stretch of road of the fatal crash only twenty minutes earlier. I keep thinking how easily it could have been them that they crashed into. The more I think the more angry it is making me, but I'll do my job, and give him the best medical care we can offer. Well, the best physical medical care, I'm not in the mood for the touchy feely stuff.

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The Sex Talk

"Hey, don't worry man. This is Switzerland" said Jason. I just hoped Jason was trying to be the 'Big man' in front of his friends and wasn't serious. I was having a discussion with a group of twelve 16-18yr old boys about sexually transmitted diseases. "What exactly do you mean by 'Hey, it's Switzerland?" I asked Jason. "You know, we're in the mountains man. It's not like a big city. No diseases here man." I stared hard at Jason for a moment. He sunk into his chair, a guilty smile on his face. "You really don't mean that do you?" I asked. "C'mon man, it's safe here. I'll be fine." I soon formed a plan on how to tackle this new found ignorance.

"Just for the record, this small village, used to be one of the biggest party places in Switzerland. It was also a hot-spot for intravenous drug users" I said. There was a chorus of protests at that statement. "You're bullshitting us. You're just trying to scare us...aren't you?" said Jason. I shrugged my shoulders, "Believe what you want. You seem to know this village better than me."

My plan wasn't to scare them, but to open their eyes, so I brought out my secret weapon. It was a chart that a teacher at another school had put together. This chart was a visual demonstration of all the students at a particular school of who had slept with whom. It linked all the people together ie If student A slept with student B, and student B had slept with student C, then in effect student A has slept with student C. The graph pretty quickly got way out of hand and in no time at all, every single sexually active kid was connected in some way to every other sexually active kid at the school.

The kids were horrified. If it wasn't such a serious subject, it would almost have been humorous to see the stunned expressions. I than made the matter even worse by suggesting that if student A visits another school for whatever reason, eg a sporting event, then student A is now connected with a whole new chart of every sexually active person from that other school. There were more gasps of horror. Even Jason was speechless.

Within one hour of that class, the health center was inundated with students requesting a STD check. It wasn't just from kids who had attended my little presentation. Word had spread throughout the school and everyone was worried. There was even a couple that were not sexually active, but just wanted a check, just to be sure. I did explain to this couple that they don't need to be tested, if they are not and never have been sexually active.

I never expected my talk to be so effective. Kids these days seem to think they know it all, but now I realize that I'm probably guilty of thinking they know it all. If I'm asked to have another talk with the kids, I suppose I could share with them some stories from my days working in a London walk in STD clinic. I can picture the kids faces now, and I can't help myself from smiling.

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Judging Success

I put a lot of effort into my work today. I did wonder if it was going to be worth it. By the end of the day I found that no only was it worth it, but that I want to do more.

I gave my first official drug education talk to the school kids. I have had 'unofficial' talks with the kids about drugs, but this was in front of a class of around 16 teenagers. I'm normally nervous when I talk to groups, but today was different. In fact today went real well. I didn't have a planned speech, just some keywords to trigger memories. Some of the memories that those keywords triggered were from my days dealing with teenagers in the psychiatric unit, some triggered memories of friends that have come undone by drugs, and some memories were from the good old emergency room.

I was asked to give a presentation by the social studies teacher, because the kids had just finished a week studying drugs. At the end of the week each kid had to give a presentation about a certain drug, eg Marijuana, Heroin, Cocaine etc. They had some great facts and figures, and the teacher thought that it would be a great way to finish this module with a drugs talk by the school nurse. The teacher said I had a whole free class to say anything I wanted. I decided to use my memories to give the kids a real life picture of what drugs can do.

The kids sat and listened attentively. No one fell asleep that class. No one made jokes. There was no chatter in the back of the classroom. I've never had a more attentive audience in my life. Time became meaningless as I delved into my memories about teenagers ruined by Marijuana. The kids were horrified to find out that Marijuana wasn't harmless after-all, especially to growing teenagers. They were even more shocked to find out that the person on the street selling cocaine is probably selling more battery acid than cocaine. They were disbelieving at first when I said you can't trust anyone, even your so called friends, because no one gives a shit when it comes to making a buck or getting fix.

I was a little surprised that the kids had no idea that heroin tends to stop people breathing. They didn't know what schizophrenia's was and they all cringed in their seats when I told them about a fourteen year old boy called Jake, who could see the spiders crawling on the floor, hear the rustle of their legs on the wooden floorboards, then feel the spiders as they crawled on his skin and then sank their fangs into him.

I wasn't there to scare the kids, although some probably were, but I talked about odds, or risk factors. Like a man asking his doctor what he can do to stop himself having a heart attack, I explained that everything in life comes down to increasing the risks or decreasing the risks. In the case of a heart attack, the risk factors are diet, exercise, weight, smoking. I explained that mental health is no different. It comes down to risk factors, several of which I discussed with the kids. You may be fine, and you may be ok, or perhaps your friends, but you increase your chances of things going wrong.

Never in my life have I talked for forty minutes so easily. I was incensed. I was a man on a mission. I ended up speaking to three classes that afternoon, three forty minutes sessions. And then I began to doubt. I'm not the expert. Maybe I've gone about this the wrong way. Who I am to educate about such things? I'm not qualified.

After the doubt came the belief that I had wasted my time, as well as the students time. No one really cared. They were quiet because my stories were entertaining, that was all. Then it happened.

I was back in my office when a 16yr old boy approached. "Excuse me Mr' asked the boy, "Do you have a minute?" he asked. I nodded my head, "Come in and grab a seat" I replied. The boy came in, shut the door behind him and grabbed a seat. "Can I ask you something?" he asked, "About your talk" he added. "Sure, ask anything you want" I replied.

I won't say anymore, as what the boy told me is of no importance to no one else but myself and the student. But what is important is that my talk made a difference, at least to one person. It was the best encouragement that I could ever have received. I realized then that even if I spoke to dozens of kids in a dozen different meetings, but I only made a difference in one life, then it is all worth it. Who knows, I may have even saved a life.

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This should never happen to a man

"Ah, I have a big bloody problem" said Mr Jones to nurse Brooke. Nurse Brooke was young, blonde, and just out of college. She had been accepted straight into the emergency room immediately post graduation. This was the hospital's new orientation policy and it was not too popular with some of the staff. The problem was that many nurses felt she should spend at least a year or two in the wards first. But Brooke's easy going personality and good looks, soon won over even the most hardened emergency room veteran. Especially the doctors.

"Well, that's what we're here for Mr Jones, fixing problems" Brooke explained. Mr Jones didn't look at all comfortable with Brooke. He wouldn't make eye contact and kept looking at the floor while grasping his privates. "I don't suppose there's any men around are there?" Mr Jones asked "I've got a problem down below, if you take my meaning, and it's fucking sore." Brooke felt the heat rise up her neck and turn her face bright red. "Ah, sure, I can get a male to have a look. But I really don't mind having a look. I'm a nurse, after-all." Mr Jones briefly made eye contact with Brooke "Trust me, it ain't pretty. But if you can help with the pain, go ahead." By now Brooke's cursiosity was well and truly aroused and she was almost eager to have a look 'down below.' "Well, ok then" Mr Jones began to unbutton his trousers.

I was seeing a patient in the bed next to Mr Jones and had heard everything. I was very curious myself as to what was going on 'down below' but kept out of the way as Brooke had everything under control.

"Oh my god" exclaimed Brooke. "Bloody hell. Be gentle woman" exclaimed Mr Jones. "I'm so sorry. Oh my god. What happened?" asked Brooke. "Don't touch a thing. Don't touch a bloody thing" said Mr Jones. "I'm sorry. I won't touch a thing. Here, let me just put a bit of gauze on it" offered Brooke. Brooke then emerged from behind the curtain and came over to me, her face pale in shock. "Ah, I think you'd better have a look" Brooke said. I wasted no time and went to look at Mr Jones' privates.

"How did you do that?" I asked Mr Jones. I was staring at a very bloody, mangled stump of penis. "Do you know what a Prince Albert is?" asked Mr Jones. I nodded my head, my face wincing in sypathy because I knew what he was going to say next. A Prince Albert is a chain that is threaded down the penis and is then pierced through the wall of the penis and the chain is then joined to form a loop. "Well, it fucking got caught didn't it. It damn near ripped the whole thing off" he said. It didn't really matter how he ripped it off, but I had to know "Ah, but how did you rip it off?" I asked. He lowered his voice so only I could hear "Ah, caught in some machinery, that's all." There was nothing more he would say and nothing more I could do, so went and got the doc.

Doctor Kassner was the senior doctor on duty that night and he was very talented with a needle and thread. Between Doctor Kassner, myself and nurse Brooke we spent the next hour suturing Mr Jones' penis back together. He was then admitted to the ward for overnight observation and sent home the next morning.

Two weeks later Brooke and I were working together again when Mr Jones came in to have his sutures removed. He certainly looked a lot livlier than his last visit although this was probably because his penis hadn't fallen off and he could pee normally. In fact he was in such good spirits that it was with tongue in cheek Brooke advised him that he should not get another Prince Albert. "You're bloody kidding right?" said Mr Jones.

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Moral vs Professional Nursing

Again, we have people complaining that if I can’t do something, a specific nursing task because of my beliefs, then don’t be a nurse. That sounds a little intolerant? The nurse who said this obviously hasn’t thought about all the good things that people can do, without going against their values/beliefs.

Nurses are supposed to be tolerant and caring, but so often we and intolerant to each other. Another important thing is compromise and working things out together. If you have a good team of nurses working together, then it is together that you can work with or around people’s weakness/strengths.

Why does everyone leap down my throat when I even mention about nurses not doing ’something’ I’m not talking about picking and choosing patients, I’m not talking about refusing vital care, I’m just getting people to think a bit about their own values and beliefs and how it blends in with their care, ie Does it affect you.

If you say it doesn’t then you either can’t see it, or you’re lying. It’s our beliefs/values that make us who and what we are, they influence us in every decision we make. Even if it means making the conscious decision to go against our beliefs/values to do what is needed for a patient. By making this decision, we are automatically incorporating our beliefs.

Everything is compromise. It would be nice if those people so willing to suggest I should end my nursing career, just because I dare mention that my own values/beliefs could influence my care, could be a little more caring towards another nurse as well as look at ways of compromising with their colleagues.

The question that needs to be asked is: “Where does professional responsibility end and Moral obligation begin?” For example, a doctor may believe in Euthanasia, while you don’t. The doctor asks you to administer a bolus of morphine. Or perhaps instead of administering morphine, they just withdraw care. What is your obligation? What helps you decide how to react and choose what to do?

What if you were working in a country as an aid worker and female circumcision is commonly practiced? What would you do? What if the patient is accepting of this, even wants this as in her culture this is expected? I’m pretty sure you would be in a moral and professional dilemma.

Overall I am disappointed at the reaction of my fellow nurses, to questions which are supposed to make you think.

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An Unexpected Hurt

I never thought I'd be a nurse. I had no great yearning to heal the sick and comfort the dying. I went into nursing because I thought "Why not?"

After twelve years I don't know what else I could be. I can't imagine not knowing what I do about looking after others. I've even forgotten what it must be like to not know about health and not have an understanding of illness.

What I have found is that I can deal with many sad and traumatic events, and even though it makes me unhappy, I often can keep myself separate from it. But there are times that really do get to me, and it's often the unexpected things. Let me explain...
I remember quite a number of years ago an elderly Scotsman called Mr Donaldson. All the time he was in hospital he never had a visitor. His wife had died several years earlier and his two children lived abroad. He hadn't seen a family member in three years. It wasn't that they weren't close, it was just that neither sons or father could afford to visit each other.
Mr Donaldson had a bowel resection and the formation of a colostomy. He went home two weeks after his surgery. When he went home he looked reasonably well, although understandably weary.

It was near christmas time, and in my part of the world Christmas means summer. This Christmas the whole town was on the street watching as the national pipe band competitions take place. For a whole two hours pipe band after pipe band filed by dressed in full Scottish regalia, kilt, dagger and all.

I was enjoying the parade, and then I saw Mr Donaldson, standing in a shadowed doorway at the back of the crowd. He looked even more pale than when he left. He looked even more thin and stooped. I was close enough to see what looked like moisture in his eyes. His eyes never left those of the pipers. He was wearing a kilt.

I found myself near tears. It felt like this parade was just for Mr Donaldson, as if it was some final farewell.

Another week later and Mr Donaldson was back in hospital. He was anemic, his colostomy wasn't working, and he was coughing up a lung. They took him to the operating room where he died.

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My Final Thoughts in regards to the male/female nursing issue. I've received a lot of grief from other nurses about genearlly not doing female catheterizaion.
I want to tell one more story, which I hope you read. It may really give you some food for thought.

As a student nurse, the school had problems finding a kindergarten placement for me. The kindergartens around the city didn't exactly have a problem with a male nurse, but the parents whose children went to the kindy did. When I finally found a placement, I was warned by the women who worked there that if certain parents come to see/collect their kids, that I should try not to be seen. Some of the parents only sent their children to that kindy because there were no male staff. What is my point?

The point is, we live in such a society where gender does matter. We live in a society where 99% of sexual assault victims are female. In an ideal world, a nurses gender shouldn't matter, but this is far from the case.

Now, when I began my first job, I received a letter in the mail saying I was accepted and was to spend 6months in ward 16. I had no interview, and I do wonder if the hospital management thought my name a female name. I was sent to the gynaecology ward. It was a job, I couldn't turn it down, plus after six months I would be transfered to another ward.

Now, every single patient in that ward was shocked when they realized they had a male nurse. Sometimes this was voiced to me, and other times the patient didn't say anything, but you could tell from their body language, the look in their eyes, their tone of voice, their general discomfort, that they didn't want a male nurse. Even when they said it was alright, most times they were still uncomfortable.

Now, as a new graduate with this extra hurdle, I had a problem. How did I get around this problem? I began by being far more sensitive to my patients privacy than the rest of the nurses in the ward. For example, when checking a surgical wound for a abdominal hysterectomy patient, I would put a towel over their genital area, and make sure I only saw the wound. When assessing PV bleeding, I had a brown paper bag at the bedside they could discreetly put the pads in and I could check them after. Of course I would ask them how much bleeding they had, but we all know how subjective this can be.

Patients did come to appreciate me and my efforts. I never once saw any of the other female nurses do the little extra things I did to make a patient comfortable. In fact, learning to do these things, was one of the best thing that came out of my time in the Gynae ward.

So, when nurses say we are nurses first, and men/women next, I find insensitive. I wonder if the nurses who say this have given thought to the way society is. I know as nurses we try to be above this, but it must be taken into consideration.

Now, as to my not catheterizing women. One nurse said "Why do you need a chaperone? Do you think you might do something bad?" The nurse who said this wasn't thinking about the world we live in. A chaperone is needed, even the male gynaecologists need one, at least in New Zealand.

This then brings up a practical issue. Why have two people to do a job that only one, needs to do. Why have a women standing watching me do a very invasive, intimate procedure on a woman, when I could be doing something useful to help her, while she does the catheterization.

Another scenario for those mothers out there with 16 year old daughters. In many countries 16 is the legal age of consent, and you are considered an adult. Imagine if your 16yr old daughter was approached by a male nurse. You, the mother is not there at the time. It is explained to her that she needs a catheter. She is nervous, but gives her consent. Is she nervous about the procedure, well probably, but I bet she's a damn sight more nervous about having a guy go down "there". She's probably so nervous that she doesn't realise she can say no, even if you say that you can get a female nurse. How would you, as the mother, feel about this?

Needless to say I would absolutely refuse to do this on a young, teenage girl, no matter what, even with a chaperone. It would not be right for the patient and it would not be right for me. I find it so strange to be called sexist because I care what my female patients think. I find it strange to be called sexist because I incorporate my values and beliefs in my care. Isn't that what makes us good nurses, using our values/beliefs to help provide great care.

For those who say that I shouldn't be a nurse because I "Don't do it all," I say to them, Is there anything you won't do because of your beliefs/values? And is all the good, the people that I have helped, the happiness and sadness that I have shared with patients in the last twelve years, is that now meaningless?

I'm sorry to hear that I shouldn't be a nurse because I don't "Do it all." I guess I'm just a failed nurse.

A caring nurse

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A Lesson in Life

"What are they doing here?" said Shannon, "They shouldn't be here. It's an emergency room for goodness sake" she added. I nodded my head in agreement, "Yeah, can't they see we're too busy" I added my two cents worth. At the time I had only been working in the emergency room for six months and I like all good junior staff, I was mimicking my seniors. You see, the problem was that we were ridiculously busy, with every bed full and the waiting time somewhere over four hours.

"I wish we could turn them away" Shannon said. Shannon was an incredibly skilled nurse. She had been working in the emergency room for over twelve years. Not only did staff turn to her when they needed help, but many junior, and not so junior doctors had even sought her advice. "Oh well, they'll just have to wait. Maybe they'll choose to go to their family doctor when I tell them that they will have to wait four hours" Shannon didn't sound hopeful.

What had Shannon so irked was that a mother had come in with her two children, aged four and six, both whom had diarrhoea, and both of whom could have been treated by their family doctor. There were always GP patients turning up to the emergency room and many, if not most of the nursing staff had at some stage vented their varying degrees of annoyance at this to one another. I genuinely felt this way myself at one time. But then that all changed.

A number of years ago one of my young nephews got sick with an ear infection. He ended up at the family doctor's clinic. One hundred dollars later he was sitting at home taking his antibiotics and analgesia. The doctor's fee was sixty five dollars, while the medicines took the other thirty five. My sister could afford it, but at the weekend he got worse and we had to see the emergency doctor. This time one hundred and fifty dollars was spent. Fortunately he got better. Unfortunately my other nephew developed an ear infection as well, and cost another one hundred dollars. We're not rich, we are just a normal family.

Now, when I see people in the emergency room who probably could have been dealt with by their own doctor, I am a different person. I'm a much more understanding person. It's not just about the money, it's about coming to the understanding that people often don't know where to turn to. They come to hospital for many reasons but they all have one thing in common. They are worried. For example: Why would you bring yourself to hospital in the middle of the night when all you have is diarrhoea. It's because you don't understand, maybe even you're scared. Sometimes people just need some simple reassurance and some education.

I do still look up to nurses like Shannon and I do still turn to my seniors for advice, but I no longer parrot their cries of despair at the inconsiderate GP patients. I haven't confronted them about their attitude, and it's too late now as I work elsewhere, but during my last several years in the emergency room I did my best to make those often less urgent patients feel at ease and feel important. I guess it's all about caring.

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I'm a Sexless Professional

I'm a professinal, at least that's what my colleagues say. But what does that exactly mean?
I recently had a discussion with some fellow nurses, all Amercican nurses, and told them that there are certain things that I am reluctant to do as a nurse. One of those things was the female catheterization.
"That's sexist" was one of the more polite remarks I recieved, while one of the more rational arguments was "We are professionals. As long as we behave in a professional way, then we should all have to do the same job." The group of women all agreed on this point. "So, does that mean we are nurses first, then man/woman second?" I recieved some confused looks, then eventually recieved a "Ah yes, well not exactly yes. No, ah Yes." I have asked this same question regarding catheterization of several male nuress, and they all agreed with the women.

Am I the only male who thinks that it is harder for a female patient as well as for a male nurse to do such an intimate procedure? Am I the only nurse who thinks that gender does matter? What harm does it cause if I choose not to do a procedure when there are capable people around who could do it just as well, plus make it easier for the patient.

And what does being a "Professional" mean? From what I'm hearing from others it sounds like I am a sexless machine capable of doing it all because that is what I am paid to do.

Instead I think of myself as a caring carer. I have my faults and biases. I make mistakes and I sometimes let my feelings help make my decisions. But I have a big heart and I do the job because I care first. I enjoy making people laugh when they're sick. I enjoy being able to make a difference in people's lives. I also do the job recognizing my faults, and if I ever think that my views/faults may jeopardize a patient, I know to get someone else to take over that patient's care.

I guess I'm not a very successful Sexless Professional. But I can live with being called sexist and unprofessional, just because I sometimes refuse to do female catheterization. I'm sure there's a lot worse things I could be.

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I think I'm an Elitist

Yeah, I'm quite comfortable saying that I tend to think less of people from wealthy backgrounds. It's this school that does it too me. More specifically, dealing with the parents of the kids whose health I'm trying to look after.

"I want a real doctor" a parent said to me today, "And then I'm going to sue the school." The woman was from Russia. She had begun the conversation by yelling and screaming, but after hanging up the phone on her several times she seemed to get the picture. "And why would you want to do that?" I asked innocently. It turns out that several Russian girls, along with forty other students, went on a school trip to France. The three Russian girls had shared a hotel room and it wasn't until the end of their three day stay that they noticed some itchy spots on random parts of their body. When they came back to school myself and the rest of the nursing staff concluded that they were bites, bed bug bites that is.

"How dare you send my daughter to a cheap hotel.." I interrupted her "Ah, I'm just the nurse, you need to talk to the headmaster" I explained. "Well, the medicine your school doctor prescribed didn't help at all. I want a real doctor. I'm going to take my daughter out of school to see a specialist." I can't imagine what good a specialist would do, except tell them to wash their clothes and bed linen, but I didn't argue. Wealthy parents, especially wealthy eastern European parents tend to like to throw their money around.

The above scenario is not unique. In fact many parents of the above mentioned ethnic group always begin a conversation by yelling, accusing and then threatening, although it does explain why the Russian Mafia do so well, if this is how the average Russian behaves.

But in reality these children and their parents aren't the average Russian. The average Russian/Eastern European I've met tends to be down to earth, honest and hard working, as well as rather poor. What I do know is that these wealthy parents made a lot of money very quickly over the last 10-20years. It's just a shame they've lost their values, although I suspect many of them had none to begin with. It's also a shame that money can't buy common class.

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Trust no one, part 2

I was woken early from my sleep by the phone. It was only nine o'clock and I had been asleep only a hour. "Were sorry to call, but it's urgent" said the woman on the line. It was Sheryl, one of the nurses from the agency. "What's wrong, what's happened?" I asked. I wasn't worried yet as I was couldn't think of anything that I had done wrong. "It's about last night. The hospital is furious" Sheryl said. "Can you give me some idea what it is all about?" I asked, still not too worried at this point. "You'd better come in, it'd be easier that way." It wasn't the answer I wanted. "Listen, give me some idea, or I'm not coming in. I should be asleep, and you want me to spend the next hour traveling to your office, worrying what on earth I have done." After several seconds of silence Sheryl spoke. "They said you prescribed and gave your own medicine, and the wrong dose as well." I felt my stomach lurch. "I'll be right there."
When I arrived at the office I was immediately taken to the manager, Miss Smith. She was very direct and didn't waste any time. "According to the charts you gave a patient voltaren 100mg. She was prescribed only 75mg twice daily. Plus you wrote on the chart that you gave 100mg. You're not supposed to write on the chart." I couldn't believe it. "I phoned the doctor, he prescribed it over the phone. I even phone the night nurse supervisor to make sure that it was ok to take a verbal order." Miss Smith nodded her head, "But what about the 100mg of voltaren? !00mg twice a day is too much." "But she missed out on her morning dose, and we had no 75mg suppositories, so we gave her the 100mg. The doctor did say it was ok." Miss Smith didn't look too happy at my words.
"And can you name this doctor involved, or the night supervisor?" asked Miss Smith. My mind was a blank. I'd had to phone three doctors as well as two night supervisors, none of whom would come to the ward. I shook my head. "Well then you're going to have to find out the doctors name. We've also contacted both night supervisors and both deny ever receiving your call and state that they do not allow verbal orders over the phone." I was struck speechless. My head was in a whirl. I felt that this wasn't really happening. Surely I would wake up in bed and find it was all a bad dream. "Well screw them, screw them all, this is bulshiit, utter lies" I was in a rage now. I have rarely felt so utterly full of wrath. For the first time since I had seen her, Miss Smith looked sympathetic. Perhaps she actually believed me. "Is this normal protocol? Am I supposed to carry out my own investigation? Am I supposed to ring around the hospital and interrogate the doctors and nurses. You've got to be kidding. It's my word against two senior nurses. I don't stand a chance. They are covering their own butt, that's what they are doing."
Miss Smith did believe me, and over the course of the next 24hrs the matter was dealt with. I was not to work in that ward again, or to be in charge again. I do find it ironic that I had never been asked to be in charge and was not only put in charge without my prior knowledge, but was left without another registered nurse to work with.
Eight years passed before I worked at that hospital again, this time in the emergency department, and guess what, they do take verbal orders, hospital policy does allow it. But I no longer take any verbal orders. I learned my lesson the hard way. When you're an agency nurse, you can't trust anyone, especially when the shiit hits the fan.

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Trust no one, part 1

Four years as an agency nurse in London means four years of trusting no one. My worst experience happened at one of London's most prestigious hospitals.
I turned up to work the night shift. The agency had said the hospital was desperate for another nurse. Not exactly encouraging words to hear, but I knew not to take offense. I took the job.
"Thank goodness you're here. It's very good of you to come at such short notice" said the nurse in charge of the afternoon shift. "Have you worked here before?" she asked. I shook my head. "Well I'll show you round then give you a handover." She then introduced me to Sheena and Irene, two nurse assistants that were on for the night with me. Sheena was from another ward and had only worked the occasional shift in the ward. She was only slightly familiar with the place, while Irene was an agency worker as well and had never even set foot in the hospital let alone the ward. "Ah, where's the other nurse?" I asked, naturally assuming that I had another registered nurse to work with. The charge nurse looked a little surprised, "Ah, didn't the agency tell you?" she said. I shook my head. "We couldn't get another nurse. You're our RN. You're inc charge tonight." I felt like I was in some kind of bad dream because this just couldn't be happening. I took the tour de farce with the charge nurse then began my shift.
Sister Grant in the side room was an seventy something nun in need of some pain medicine. According to her drug chart she had not been given her morning dose of voltaren. Voltaren is a analgesic similar to Ibuprofen. The drug was to administered as a suppository, or bullet up the backside. I was presented with several problems:
1. I was not going to near the private parts of a nun. She would be horrified.
2. She was prescribed 75mg of Voltaren twice daily. According to her chart she had missed the morning dose. The patient also said she had not had it.
3. We only had 100mg suppositories. I could give her the 100mg as she had missed her morning dose, but would need to get the prescription changed.

I tried to solve the problem by phoning a doctor. I called the medical doctor on duty that night to come and change the prescription. He said that I needed to call the surgical doctor as it was a surgical patient. I then called the surgical doctor who said it was a gynaecology patient. I called the gynae doctor who told me that because he was a private patient, originally under the care of a surgical consultant, I should call the surgical doctor. Needless to say I was rather confused.
After ten minutes I finally managed to get a doctor who agreed that she was his patient. He was the medical doctor. It turns out that Sister Grant began as a gynaecology patient, which unsurprisingly turned out to be a general surgical problem. The surgical problem was solved but she then developed a medical problem, and was then transferred to the medical team. The doctor then said that he couldn't come to the ward as he was too busy and offered to give me a verbal order to give the 100mg voltaren suppository. I said I'd call him back as I wasn't sure if I could take a verbal order.
I then tried to phone the night supervisor for some advice. I was put through to the first advisor, who advised me that she was responsible for the other side of the hospital and gave me another number to call. I finally got through to the correct nurse supervisor. I explained the situation with Sister Grant. "Can I take a verbal order?" I finally asked. "Yes" she said. I called back the medical doctor and said I would give the 100mg voltaren suppository.
I asked one of the assistants to give the suppository and the problem was solved. Or so I thought.
My real problems began the next day.

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Surely I was never this stubborn???

I first met Shaun at seven o'clock the morning after his surgery. It was a Saturday and the ward was quiet, it looked like it was going to be a nice shift. When I saw Shaun he looked to be in pretty good shape as he was nibbling at something light for breakfast and keen to get moving. He seemed to have had no lasting side affects from his anaesthetic, in particular any nausea, and his pain seemed under control. This was a good sign, it's always good to get patients moving early, but I did warn Shaun to take it easy.

“Take it easy? The sooner I get out of here the better.” Shaun was determined to get out this damn place because it was “full of depressing old people.” I couldn’t do much about the fact that he was sharing a room with three older men, but it wasn’t so bad. Sure one of them had a touch of night time dementia and kept getting up during the night calling out for his long dead wife, but at least he wasn’t in the women’s room. Any time anyone walked into the women’s room Mrs Stewart, the 85 year old nun on prescribed bed-rest because of leg ulcers, kept on calling for us to stop touching her in naughty places.

The first thing that Shaun wanted to do that morning was to have a shower. “No problem Shaun” I told him, “but are you sure you are up to it? Why don’t you wait until a bit later in the day, you’ve only just come out of theatre.” Shaun was not going to wait. I then suggested that he use the large shower room that has a chair in it that he can use, but he would have to wait half an hour as other patients were booked in first. Of course Shaun was not willing to wait; he was determined to use the normal size shower with no seat inside. I suggested to Shaun that this was perhaps not the best idea as the shower is hot, steamy, cramped and with no ventilation, he would probably pass out. Shaun seemed to think that he knew what was best for his body and ignored my advice, he was oblivious to reason.

From past experience I knew to wait outside Shaun's shower cubicle. Five minutes later I heard a ‘thump’ followed by a squealing sound that comes when skin rubs against wet plastic. These were the sounds of Shaun first hitting the wall and then sliding down the wall to lie in a tangled heap on the shower floor. As I helped bring him round I conveniently happened to have a bowl in my hand which Shaun promptly threw up into. I popped him in a shower chair and wheeled him back to bed. He was so pale that he would have made a ghost look tanned and he had broken out into a cold sweat.

As awful as Shaun looked it was nothing serious although I made sure he hadn’t done any damage to his would. Thankfully he hadn’t but he was in quite a bit of pain, what a surprise. I didn’t even pretend to feel sympathy for him but did give him some paracetamol.

Even though an appendectomy is quite a minor operation, it still takes a toll on the body. Not only have you been sliced open and had some innards taken out, the effects of a general anaesthetic can take its own toll on the body, even if you feel well. I have not had this problem with older men or woman of any age as they seem to listen to advice.

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Jobs that a male nurse shouldn't have to do part 2

So I avoided having to give Mrs Smith a catheter. Some nurses will be like Sharon and insist that a male nurse must do all that a female nurse does, and vice versa, but that is wrong. It wasn't an urgent situation, and in fact the only urgent situation that I can think of is the poor prostate patient with a bladder about to explode. I digress, back to Mrs Smith.

As I need a chaperone anyway, one that needs to be female, there is no need for me to do the job, and there is no need for the patient to have to go through having such an unpleasantly intimate job done by a male. As for all those poor men having a woman insert a catheter in their penis, well it just isn't the same, for the patient that is.

Some nurses will argue that we are professionals. They seem to think that by using the word 'professional' means we have open licence to do the most intimate procedures. I don't like the word professional as I sometimes feel it makes us sexless machines. We are carers first. It's not about what I can do for my patient because I have the knowledge, but about using that knowledge in an appropriate and caring way.

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Jobs that a male nurse shouldn't have to do

"You're are nurse, it's part of your job, so go and do it" Sharon ordered. She was of course talking about my patient, Mrs Smith. Mrs Smith was forty years old and was day two post an abdominal hyseterctomy. The catheter had come out and needed to be replaced because she was having trouble passing urine. "I can't go down there" up until now I had never had a disagreement with my preceptor. "I'm sorry, but you are going to have to do it. I have to catheterize men, so you have to do women." I could see Sharon's point, but it still didn't make it seem right. "Sharon, I've never done one before, this is crazy" Sharon then went on to give me some very detailed instructions.

I explained to Mrs Smith what was going to happen. "You're going to do it?" her face showed absolute horror. "Well I'm supposed to, but if you'd prefer, I can get one of the girls to do it." Mrs Smith's face instantly registered relief. "I'll got get someone now"

It was only my third week out of college, and as such I didn't really know what my options were in this situation, and that is why I had a preceptor, Sharon, but she wasn't giving me any options.

"She doesn't want me to do it" I said to Sharon. She shook her head in disgust "More likely you gave her the choice. You're a nurse, act like one. Tell her you're a professional and it's part of the job." I could see that I was not going to convince Sharon otherwise and went in search of another nurse.

"Ah, you can't go and give a catheter on your own" Leslie said. Leslie was another young nurse like myself, she had been one year ahead of me in nursing college, "You need a chaperone." I felt a shiver go down my spine as I thought at the potential trouble I could have got in if I had gone ahead and inserted the catheter. I even imagined my name making the front page of the local newspaper with the headline "Male nurse assaults female patient." I explained to Leslie what Sharon had ordered me to do and she couldn't understand why she would be so carelss. "Well, if I need a chaperone, then a female may as well do it" I reasoned. Leslie kindly offered to do the job for me.

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Drugs and Teenagers

I've never given a drug talk, but the school has asked myself along with the other nurses and counseling staff to give a talk about drugs to the kids. I know a number of kids who have admitted to taking drugs, "But only during the holidays, never at school. I wouldn't be that stupid" is the general confession I get. I've also received a lot of questions which I'm not sure is the best way to answer.

"Which is the safest drug to take?" I was surrounded by a group of boys, ranging from 15 to 18 years. The kids often came to the health center to get some time out of class. They would always ask an interesting question in the hope that I would get distracted and start rambling on. If they were then late for class, it was my fault and I had to give them a pass. But this was one question that I wanted to answer...well.

"Marijuana is harmless" said Dwayne. At 18 he was the oldest in the group. I shook my head "I don't know about any statistics, but nearly all the teenagers I dealt with in the psychiatric unit were there because of Marijuana." The boys' faces registered disbelief. "I've got friends who smoke it all the time, since they were young, and they're fine" Dwayne replied, although there was some uncertainty in his voice. "Let me put it this way, I don't know if Marijuana causes psych problems, or just brings them out, but I've heard that there may be a genetic link. Some gene, it's in about one in four of us. If you have this gene, then you've an increased chance of getting schizophrenia from drugs." I had heard this on documentary on BBC, but wasn't entirely sure of the facts and had never followed up the information, but I didn't want to mislead the kids. "I'm not completely sure of the whole gene thing, but if you spend any time in a psych ward, you cannot deny the obvious link between Marijuana and psychiatric problems."

"So you're saying I"m better off taking ecstasy, or coke then" it was Robert, the boy from California who asked this. After two years working in a boarding school, it no longer surprised me how much teenagers can read into a statement, justified or not. "I never said that, I'm just saying that Marijuana is not harmless." It was not often I had the kids hanging off my every word, and I wanted to use this chance to do some good. "I've seen a couple of deaths from ecstasy, and a teenager with coronary artery spasm that eventually led to a heart attack" I explained the fancy words and the kids were aghast. "They must have been heavy users" Dwayne said. "No, not always" I replied.

"So what would you do? Have you tried anything?" The kids had asked their chemistry teacher, in the guise of furthering their chemistry education, this question. They asked their social studies teacher, in the guise of better understanding society. They asked all their teachers, and now me. "No" I said. "Don't lie, you must have tried something" said Robert. "No, but I won't deny I've been tempted. But working in an emergency room and psychiatric ward soon cured me of any temptation." The kids seemed satisfied with my answer "But what would you recommend? Say we were going to do something, regardless, what would you recommend?"

And that was the dilemma I had. I couldn't say to them stay well away from methaphetamine, and that I'd rather you smoked a joint than take methaphetamine. I couldn't condone any drug taking whatsoever, but there definitely is a huge difference in lethality in some of the drugs. "Let me put it this way. If you decide to take something, then know what you're taking. Don't trust others to tell you that it's ok. Find out before hand what the dangers are. That guy on the street who's offering you cocaine, is probably selling you battery acid so he can make big money to support his own drug habit." There was a chorus of disgust at the mention of battery acid. "Battery acid, you've got to be kidding?" Robert asked. I shook my head. "No one out there is your friend. No one will tell you the truth. Don't take anything, but if you do take something, know what it is you're taking and what it can do to you."

"So which one do you think is the safest for us to take?" I was back to square one and sent the kids back to class, with a pass for being late.

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Embarrassing the kids

Everyone liked Greg. It wasn't because he was especially kind or especially generous, although that is not to say that he wasn't either of those. He was just a normal teenager who loved to laugh and loved to make those around him laugh. His favorite trick was to take out his false eye and scare the girls or impress the boys.

"Give it back" I overheard Greg say to the other boys at his table. I was sitting with my wife a few tables away and my ears perked up. "Come on guys, give me back my eyeball" I looked over at the table and saw Greg make a grab towards the kid on his left. It bothered me to think that Greg was being made fun of, especially since his false eye made him an easy target for vindictive teenagers. I had the feeling that Greg didn't really want to take his eyeball out, but he did it because by laughing along with others at himself, it helped him cope with all the attention he received. I thought I had better intervene.

"Hey guys" I called out to the lads, "Give Greg his eyeball back" Everyone at the table burst into laughter, Greg laughing the loudest. "What's so funny? Just give him his eyeball back" I said again. Greg finally managed to catch his breath "I said I-pod, not eyeball." I felt the blood rush to my face "You're awfully red" one of the kids remarked. The laughter continued, my wife laughing just as hard as the rest.

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The Reason I'm not a Doctor part 2

Scenario 1, part 1 I want you to imagine you are a young family doctor and you have a patient, a young man in his early twenties, who has been battling cancer for the last year. During that year he's tried every treatment that is available, often with awful side effects, but all to no effect. In fact he's been told that he will most likely die. Now, as the family doctor, you've just discovered a new treatment that only has a 50% chance of working. Regardless of whether the treatment works or not, it will have horrendous side effects, much worse than he has had yet. Now, what do you do? If you decide to tell him how do you go about this?

My answer was this:
1. Make sure that before you even talk to the patient you have all the facts and/or relevant people to refer to. Remember it's a new procedure and you don't want to get up any false hopes

2. Choose an appropriate time/place to tell him about the news. For example, a family meeting (if appropriate) or some other support person in attendance when you tell him about the new procedure.

3. Make sure he takes some time to make the decision, even if they say yes/no straight away.

The Interview Panel's Response:

1. " Could you please explain your answer?" I was at a complete loss at what to say as I thought my answer was complete and covered the issue of informed consent and providing a supportive environment ie family/friends.

2. After I told them that I had said all I had to say, their was a general shaking of heads and frowns. They then asked the next part of the question "Your patient chooses to take the treatment. He has horrendous side effects, but it fails. He comes into your office and blames you for all that has happened to him. What do you do/say?"

My Response

Don't take it personally, especially as anger is part of the grieving process. Be patient. Get the patient's support people involved.

The Panel's Response

"Is that all?" This was said in an almost disbelieving voice by the doctor with the knighthood. I was at a complete loss trying to figure out what more they could want, so I asked them. Their reply made me realize that I was never going to make the grade. "You haven't touched on any of the possible legal issues. You haven't protected yourself."

My Opinion

I felt disappointed that the panel didn't seem interested in the caring side of my answer, the bit about the family/support people, choosing the right time in place. I felt I had met my obligation by making sure my patient was informed.

As for the second part of the question, I still don't know what else I could have done except to understand where my patient was at.

I am well over any thoughts of becoming a doctor, their loss.

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Are you a Prejudiced Psycophobe?

When I quit my job in the gerneral med/surg ward to go and work in the psychiatric ward, everyone, including my charge nurse, said I must be crazy. Things like "They're all mad over there, and then there's the patients" or "You'll end up just like the patients" were common. No one I spoke to in the physical side of nursing could understand why I would want to do such a thing and discouraged me as much as possible.

I did make the change, and for two years had one of the most valuable experiences of my life. It was incredible, sad and even frightening to see people with no physical problems, yet because of the thoughts running through their heads, worse off than those with medical/physical illness. Sometimes I made a positive difference without even knowing it. For example, I became used to hearing people say things like "Sit with me" and when I asked why, a reply like "The voices want me to put my dinner fork in the electric socket" was not uncommon. My very presence seemed to help anchor them in our reality and stop them from making a fatal mistake.

Is anyone here willing to own up to being a little 'psychophobic?' The more my colleagues discouraged me from working in the psychiatric ward, the more I was determined to give it a go. Has anyone else had similar experiences from fellow staff? Has anyone else made the transition from regular medical nursing to the psychiatric ward?

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The Reason I'm not a Doctor part 1

A few years ago I thought I wanted to be a doctor. I wanted to do more for my patients and be the one to make the medical decisions, especially when I saw how awful some doctors were. I knew I could do a better job and I knew that I was committed enough, after-all I would be giving up six years of my working life when I could be earning, traveling, getting married, plus I would end up at least $100,000 in debt. But my dreams were shattered by my betters.

I had been told that it was difficult to even make it to the interview stage, so when I received an invite to attend such an interview, I began to get my hopes up. "I'm Professor Stickler" the owner of this voice was a tall, broad shouldered man with a head of silver. He looked the antithesis of your stereotypical diminutive, bespectacled professor. "This is Sir Edward Jones" he indicated the man to his left. "And on your right is Dame Catherine Smith" he said, indicating the woman on his right.

Needless to say, the introductions didn't put me at ease, instead they seemed to highlight the vast gulf between these privileged personages and my humble background. I didn't come from a medical background. Neither my father or mother were doctors, and until such things as taking government loans became commonplace to pay for university, we never had the money to pay for such an education.

The interview began and I answered the questions to the best of my ability. I even felt I answered them well, until about twenty minutes into the interview. They began a part of the interview that Sir Edward Jones described as a "Vital and Integral" part of the interview process. It was scenario time.

Scenario 1, part 1 I want you to imagine you are a young family doctor and you have a patient, a young man in his early twenties, who has been battling cancer for the last year. During that year he's tried every treatment that is available, often with awful side effects, but all to no effect. In fact he's been told that he will most likely die. Now, as the family doctor, you've just discovered a new treatment that only has a 50% chance of working. Regardless of whether the treatment works or not, it will have horrendous side effects, much worse than he has had yet. Now, what do you do? If you decide to tell him how do you go about this?

This was my questions. I won't give the answer I gave just yet as I'm curious as to how others' may answer. What I will say is that it was during the course of answering this scenario when I realized that I wouldn't succeed in being accepted into medical school.

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Advice for new Graduates

I'm not anyone special, and I don't want to tell people what they should do, but I strongly believe that there is one area that all nurses need to work in before specializing. Most experienced nurses I have spoken to agree.

Over the last few years I've seen many new graduate nurses get jobs in some pretty intensive areas of healthcare, such as theater/recovery, emergency room, intensive care, paediatrics, and neonatal to name but a few. The young graduates are all smiles and full of excitement at landing such an interesting job. Of course the units taking on new graduates realize they will need extra time to orientate to the job, but I can't help feel that in the long run they will miss out.

I don't want to go over old ground, but the best advice I would give to any new graduate who asks me where they should work, is to spend two years in a general medical ward. The reason I chose general medical over general surgical is often the medical wards run at a slower pace than the surgical. Having a bit of extra time allows nurses to spend time with patients, it allows new grads time to become comfortable in their environment, and become familiar with how a ward should be run.

Comments such as "It's boring" or "They're all old" or "It's not a challenge" are not uncommon amongst new graduated when asked if they would like to work in a medical ward. What they don't understand is that medical knowledge and skills applies to every other aspect of nursing. Confused??? How often does a medical patient develop a surgical problem? Not often, it certainly does happen, but consider how often a surgical patient develops a medical problem. I'm thinking about Pulmonary embolism, Myocardial Infarction, DVT, the list is endless. Often surgical patients already have medical problems before even going to theater.

The point I'm trying to make it that the skills you learn in general medicine apply everywhere and will set you in good stead wherever you go. It's not the only way to do things, but you'd certainly not be harming your prospects by doing a little good old fashioned groundwork.

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Someone to turn to, no matter what...

I struggle with the thought of not knowing what is happening to my children if they become sexually active at a young age.

At the boarding school I am at now, I've had to give the morning after pill to one thirteen year old and one fourteen year old. We went through the school doctor and I asked him for advice regarding parental consent. He said that we can't tell the parents as the kids really need someone they can trust. I have followed these rules, and it seems to be working, and a lot of kids have come to me just because they know I won't tell their parents. I realize now just how important it is for them to have someone to turn to that they can trust.

Last year we even had one kid who tried to take herself to hospital in the middle of the night because she thought we would tell her parents. She climbed out the window of a four storey chalet and was very lucky not to break her neck.

There was one pregnancy at the school last year and we convinced the girl (16yrs) that she should inform her parents. She was very surprised at how supportive her parents were. Children often think their parents will be furious, when this is not always the case.
It's also important to remember that I am a hospital based nurse and I am also learning from these experiences.

So when I deal with someone under 16yrs, I have learned to try and deal with the whole picture, not just treating the problem. What this means is talking about sexual habits/practices, finding out how much a person knows as often children think they know it all, but after questioning they really don't. I have also learned that just like in the hospital, there is no set rule to go by as every case is different and actions can be taken to suit the individuals needs.

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Nursing Nightmares

It was eight o'clock at night and I was reluctatnly preparing for my nightshift. I had been sold on the idea of working in one of Britain's newest hospitals, agreeing to a three month contract in a surgical ward. Without even working in the place, I'd moved out of my apartment in London and was currently boarding with a little old lady in a city called Downtown.

"You've got beds one to twelve again" Sharon told me. Sharon was the nurse in charge for the night. She was only one year post grad and I couldn't imagine myself in her position at that stage of my career. It was my third night on end and I knew the patients well so I began my first round for the night. The first two rooms were rooms were side rooms and nothing was amiss with the patients there, but that all changed when I went to my first six bedded room.

"Evening ladies" I said as I walked into the room. The ladies greeted me with warm replies, except there was one voice missing. I walked over to Mrs Smith's bed, the only patient apparently asleep in the room. "She's been asleep all day" Mrs Jones, the woman in the bed next to Mrs Smith, whispered to me. "Asleep all day, are you sure?" I replied. "The doctor seen her. She won't wake up" Mrs Jones didn't sound worried. Alarm bells began to ring in my head. "Mrs Smith" I called, gently giving her shoulder a shake. I called again, a little louder, giving her shoulder a much firmer squeeze. Still nothing. I tried the fingernail squeeze, and eventually a sternal rub, all to no avail. I went in search of Sharon.

"Sharon, I need your help" she seemed a little irritated that I had interrupted her during her medication round. "Get one of the assistants" she replied, without even giving me a chance to explain. "No, it's about Mrs Smith. She won't wake up" I felt sure that this news would shock her, but she shrugged her shoulders. "It's ok. The doctor has seen her, she's had a scan, even the consultant has seen her." She turned back to her medication trolley, obviously thinking the matter was over with. "But she's unconscious. You can't leave an unconscious woman unsupervised in the middle of a general ward. What about her airway? What if she vomits?" I was too stunned too be angry, yet.

Sharon was getting angry, "The consultant has seen her, and he's happy for her to be there. If you want, you can get an assistant to check in on her regularly." Sharon seemed unable to grasp the fact that Mrs Smith was a very high risk patient "Her airway is unprotected" I said again "It doesn't matter how often we check on her, it only takes a minute or two for her to die." Sharon was not going to give in "I can't change a thing. It's the doctor's responsibility." With that she grabbed her medication trolley and wheeled away from me.

Mrs Smith was only fifty seven years old and was recovering from a minor surgical procedure. She was normally fit and well and had no previous medical problems. I became angry, not just at the utter negligence of my colleagues, but at the position I was put in. What if she stopped breathing on my shift. What would a court say if they asked if I felt comfortable leaving her there? How would the court react when I said I didn't feel comfortable? They would then say why didn't I do anything.

I did the best I could. Every half an hour I went in to check on her, and every time I approached her bed I felt sick to my stomach, wondering if she would still be alive. I tried waking her each time, and got no result. It's not often you see a patient that is truly unresponsive, but Mrs Smith was up there with the worst of them.

At three in the morning when I tried to wake Mrs Smith, she opened her eyes. "Hello" she said, sitting up in bed, as casually as if she was waking from an afternoon nap. "What time is it?" she asked. "Ah, it's the middle of the night" I began to explain. A look of surprise crossed her face "Middle of the night. But it was just morning" she said.

I called the night doctor to tell him the wonderful news. "That's good" he said. "Um, don't you want to see her? Do an assessment? She's been unconscious nearly eighteen hours" There was a pause on the end of the line, "Ah, ok, I suppose so."

By morning Mrs Smith was back to her normal self. She was ravenously hungry and I made her an early breakfast.

Mrs Smith was unique because I had never seen a patient suddenly lose consciousness for no reason, all her tests normal, then suddenly wake as if from a relaxing deep sleep, with no side effects. What I have also never seen is the complete negligence from a medical team, from both the nurses and doctors'. Mrs Smith may not have recovered because she may have been dead, may have aspirated, or vomited, or her airway may have blocked some other way, well before she made such a miraculous recovery.

I lasted another two weeks at that hospital, then quit when things continued to get worse.

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Knowing too much

Sometimes I feel the phrase 'I know that I know nothing' just about sums up my nursing knowledge.Does anyone else feel this way? It seems that the more I learn, the more I realize how little I know. This is a good thing really, as over confident nurses can be dangerous. An example of an overconfident nurse happened last year, although I will add that we were in a difficult situation and I'm still undecided if what we did was right or wrong. I'm curious to hear what you think.

I'm currently working in a private boarding school in Europe, high up in the mountains. I work with two other nurses, one of whom was a very experienced emergency room nurse from the USA. Every time I had a question, she always knew the answer. She also kept herself up to date with the latest advances in medical procedures. Unlike me, she could name all the bones, muscles, and ligaments in the body. I felt rather inferior, even though I've had twelve years of work experience.

Anyway, it was a sunday night and one of the children (17yrs old) managed to dislocate his shoulder falling out of his bunk bed. By the time I managed to see him, 15 minutes after receiving the call, it was eleven o'clock at night. His left shoulder was definitely not where it should be, so with the help of a few of his dorm mates we hobbled along to the infirmary, which happens to be in the same building where the kids sleeps.

We lay him down on the examination table, the pain severe. He was pale, sweaty, understandably very vaso-vagalish. Unfortunately, our regular village doctor who we got on very well with, was away on holiday, and so we were left with a locum doctor.

Unfortunately we had had some run ins with the locum, especially as he had refused to come and see a patient of mine earlier on in the week, which resulted in me taking a one hour drive in the middle of the night down the mountain to the nearest hospital. The poor girl had the worst migraines I had ever seen. Nothing worked for her, and she is the only migraine patient that I have seen morphine used. She was in the back seat, supported by two of her friends as she vomited nonstop the entire trip. It was a harrowing experience for all, but we had no other option.

Back to my patient with the dislocated shoulder.

So before calling the doctor I called my colleague for advice as well as moral support. "It's defintely dislocated" she said to me after examining our patient. "Well, I'd better call the doctor" I said. She looked at me and smiled, "I can fix this. I've seen it done many times in the ER, it's easy." I began to protest "I'll call the doc first anyway, he'd better know what's going on." My colleague agreed, although I could see she wanted to have a go at the shoulder.

The doctor didn't answer his phone. I tried three times and no reply. The hospital was an hour away, it was night time and our patient was in agony. I watched as she put his shoulder back in place.

The relief was instantaneous. The lad was praising my colleague, as were his friends who watched the procedure. We placed him in brace and gave him some Ibuprofen, and sent him to bed. "Told ya it was easy, nothing to worry about" my colleague was in high spirits. "If we get another one, I'll let you have a go." I shook my head, "We're not supposed to do that" I mumbled, unable to look her in the eye. "I guess it's a bit out of our scope of practice, but did you really want have him suffer in the back of the car all the way down the valley?" She had a point and I kept quiet.

To this day the incident still upsets me. What if he had a fracture as well as a dislocation? What if some vasular damage had been done. The boy was x-rayed the next morning and everything was ok. But I guess what worries me the most the way in which she was so sure of her diagnosis, was so sure there was no fracture. She was skilled and knowledgeable, too confident, but lucky...this time.

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Medicinal Pain

There comes a time when things don't work quite as they should. It usually happens when we've had an ale or four too many. In the emergency room we get too see many people not working at there best. In fact every night from thursday to sunday I can guarantee that if you come to your local hospital, you will see many people not quite in control of things. Some people get so out of control that we are forced to take extreme measures to treat them.

"Will you take Mr Jones this time?" Elena asked me. None of the women wanted to look after Mr Jones. He was a regular, perhaps five or six times a year, and every time he always ended up being rude to the staff. "How bad is he this time?" I asked. "You'll know soon enough. The ambulance should be here in five." The emergency department where I was working was a little different than some places as the ambulance crews always radioed ahead to warn us that they were bringing in a patient, and how severe their illness.

I greeted the paramedics as they wheeled Mr Jones into the department. "How bad is he this time?" I asked. "We haven't been able to wake him, so we got the story from his neighbors." The only other thing that Mr Jones liked besides drinking was gardening. "His neighbors said there was a party last night. Said it went on all night and only got quiet around five. That was when Mr Jones decided to do a bit of gardening." "He couldn't have picked a more miserable day" I observed. The sky was gry and it had been pouring with rain the whole night. "Well, his neighbors know him pretty well, and kept an eye on him. They found him lying in the cabbage patch."

At sixty two years old, Mr Jones should was a fit looking man. He had no fat, his muscles were hard and wiry, although he did have the drinkers red, bulbous nose. "Can you hear me?" I said as I gently shook him by the shoulder. No response. I squeezed his hand hard while calling out. Not so much as a flinch. I grabbed a pen and squashed his fingernail hard against it and again no response, not even a reflexive flinch of the hand. Next I tried the sternal rub, performed using a fist and my knuckles. This is sure to work, it's hardly ever failed. Sure enough he moans and his eyes briefly open and he tried to push my hands away.

Twenty minutes later Mr Jones is awake and sitting in bed sipping on a cup of tea. It may seem like a miraculous recovery, but this is pretty normal for Mr Jones. Once the cup of tea was finished, the abuse began. "Where's my gumboots?" he demanded. "At the back door. They're too muddy to bring inside." My response seems to irritate him, "They're my property. You'd no right to take them. Give me my bloody gumboots." Again I tell him they're at the back door and they can wait. "I want them now, give me my f..king gumboots." The deterioration in his language means he's nearly ready to leave. "You're welcome to go get them" I said. Mr Jones got up, walked to the back door, put on his gumboots and without a thank-you or goodbye, began the walk home.

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Can't get enough of those basics

I think I'm quite lucky because I learned some very useful lessons withing my first year of training that have stayed with me. Unfortunately in most places I have worked since I left my home hospital, it seems that many people never learned the lessons I did. Confused? Well here's what I mean.

As a male I tend to be a touch on the messy and disorganized side. When I first started work my patients rooms were clean but not so tidy, with books/magazines left sitting on the cabinet or patients table. If a visitor had left a chair in the room, I would leave it there, thinking that they will use it tomorrow. Sometimes I would leave food/drinks on the bedside cabinet/table. Other times I would let the room become crowded with gifts that relatives had left behind, things like flowers, chocolates, wine etc. Then one day that all changed.

"You really need to keep things tidy" Jan explained to me one evening before I was due to go home. It had been a busy afternoon and I had done all the real big, important jobs, like take care of the blood transfusion, kept a close watch on my big post op patient, and felt quite confident that I was doing a good job. I was a touch offended by Jan's comment. "What's wrong?" I said a little too defensively. A comment like this from Jan, a nurse with nearly forty years experience hurt. "You can't leave the rooms cluttered at the end of a shift, especially the end of the afternoon shift" she began to explain, but I interrupted her "'I've been so busy, besides, it's only going to get untidy tomorrow. I've looked after my patients well." Jan made me sit down and told me an important lesson.

"It's not fair on the night staff, or the patient" she said. "It's a nightmare for the evening staff to have to wade through the room worrying about tripping over things and knocking things over" She had a point. I had not given any thought to the night staff. "And there is the safety issue as well" she explained "Imagine if something happens in the night and they have to rush in, with an arrest trolley and all. It makes it real difficult." It was a simple explanation and I promised to make an effort.

That night I had my rooms spotless. All chairs were removed. All food/drink put away, along with books/magazines. Extra things like vases of flowers etc were either placed in a safe part of the room, or removed for the night. The room looked spotless. I just wish I could make more effort on my own room.

It was as fate was watching me that night. When I turned up to work in the morning I found out that Mrs Jackson had suddenly and unexpectedly passed away. She had been one of my patients whose room I had made spotless. Jan was there with me as I heard the news. "Did they have any trouble getting in the room" I asked my charge nurse. "No problem at all" the charge nurse said, "The night girls even mentioned that your rooms were particularly spotless." Jan gave me a sly smile.

That lesson has stayed with me ever since.

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A Happy Memory

I find it too easy to remember the bad things that happen, while I often struggle to remember the good things that happen in the hospital environment. But the good does outweigh the bad, otherwise I wouldn't still be a nurse. One of the more memorable, feel good stories goes like this:

At 41 Mr Jones was very young to be needing vascular surgery, especially as he wasn't diabetic and as far as he was aware, he had no family history of circulation problems. But the supply of blood to his left leg was very poor and literally getting worse every day. "Will I be able to play gold again?" It was the night before Mr Jones' surgery and he had asked me this question several times over the shift. "If all goes well, I don't see why not" I replied. Only six months out of training but I knew never to give a definite answer. "Do you think it will go well?" It was the next logical question, but I chose my words very carefully. "Well, you're young, fit, no other health problems, don't smoke and hardly drink. You've got a better than many that I've known." He seemed to relax a bit at my words and let the matter drop. "See you sometime tomorrow afternoon" I said, making ready to leave the room. "If all goes well, I will" Mr Jones replied.

It's three thirty in the afternoon after Mr Jones' surgery and all seems to have gone well. He's still sleepy but he opened his eyes as I entered the room. "Think I'll be playing golf anytime soon" he smiled then drifted off back to sleep.

It was just as well that things had gone well with Mr Jones as I was so busy that I wouldn't have had time for things to go wrong. I had another patient due back from surgery sometimes after the evening meal, plus four other patients that were reasonable heavy. One was a stroke patients which was fully dependent, another was a prostate patient that was now 36hrs post surgery and still having reasonable heavy bleeding and in need of a blood transfusion. The other two patients were medical patients, one a male with congestive heart failure and the last patient, Mr Davis, with unstable angina. (heart pain)

At five o'clock I was seeing to Mr Davis as he had an episode of chest pain. At the same time the bell in Mr Jones' room began ringing, and didn't stop. "You'd better go answer that quick" Mr Davis said to me. He had been in and out of hospital so many times that he recognized a distress call. "He's probably sitting on the bell" I said, "But I better hurry and have a look. I'll be back in a second." I popped an oxygen mask on Mr Davis' face before leaving the room.

"What's wrong?" I asked Mr Jones as I walked in the room. Whatever it was it looked bad. His faced was screwed up in agony and he was clutching his leg. "Please do something, the pain, it's unbearable" he pleaded. His left leg was swollen, hot, and I couldn't feel a pulse in his foot. I called the doctor immediately.

Within five minutes the junior doc and the registrar were standing at Mr Jones' bed. "What' wrong doc?" Mr Jones managed between moans of pain. "We're going to have to take you back to theater" the registrar said, "It could be a clot, or the graft has failed. We'll know for sure when we open it up." The next hour passed in a blur. By the time I eventually saw Mr Jones off to theater, it was six thirty in the evening.

I wanted to rest, but I remembered Mr Davis and his chest pain. I had left him there with a mask on his face. I just hoped he was ok. I'd completely forgotten about him. I entered his room expecting the worst. "How you feeling?" I asked Mr Davis. He looked up from his paper, "Quite all right" he said. "And your pain?" I queried. "All taken care of" he said, then went back to reading his paper.

I went to check on my other patients, as one was overdue to start his blood transfusion and the others needed some other intravenous medication. I couldn't believe my eyes when I saw that the blood transfusion was started, and the medications given to all of my patients. I confronted the nurses in the office to ask who had done my work.

"We all did" Jan said to me. Jan had forty years of nursing behind her and was someone that anyone could turn to for sound advice. "But, no one has done that for me before" I stammered. My first six months of work since graduation had been spent in the gynaecology ward and I had been left to defend for myself. "That's how we do things here" Jan said matter of factly, "We look after each other." I was caught off guard by the rush of emotion that swept through me. I truly felt a part of this place.

-Years later I still vividly remember that moment and those words. To this day it still is the best run ward I have ever worked in and the patients received the best care in the world. We didn't always have the latest medical gadgets and medicines, but we had what mattered, people that care.

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