He was a She

I never meant to offend him. Oops, there I go again. He is now a She and I'm supposed to call him Miss. He's the first sex change patient I've ever looked after. I was supposed to check his surgical wound, or operation site is more like it, but I ended up asking one of the female staff to take a look.

He still looked like a man, he still needed to shave, although he did have long wavy blonde hair which most women would die for. I know as a nurse I'm supposed to be professional and not think the strange thoughts going through my head, but I can't help it. This man had 'IT' chopped off. I don't even know if they took his testicles off as well. If they did he must have to take hormone treatment or something. I wonder what sort of chromosones he has. I've heard of people with and extra X or extra Y chromosone, so I imagine that must be confusing.

He didn't talk to me much during the course of the day, in fact I would say he looked rather depressed. I hope he wasn't regretting his decision because it's way too late now. Unsurprisingly his voice didn't change, didn't become higher by an octave or two.

I don't mean to sound cruel or uncaring, and this may not seem like a big deal to most people, but what do I say to the guy. Maybe he's pissed off at me because I keep calling him Mr Jones instead of Mrs.

Curiousity is such a powerful force, and by the end of the shift I was almost regretting not having checked on the surgical site. Would it look normal, would it be convincing. Oh well, maybe I'll come across another patient like this one day, maybe in another twelve years.

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How hospitals kill and get away with it, all the time

Infections, drug resistant bacteria, patients lying in their waste for hours on end. Medications given at the wrong time, not at all, or even the wrong drug. Why is this becoming more of a problem. The answer is simple, even though management can't seem to grasp the idea that having enough staff saves lives.

Sixteen surgical patients is more than enough work for two registered nurses, let alone one. I couldn't keep up with any of the things that needed doing, as there were patients fresh from the operating room, patients ready to go into the operating room, as well as all the intravenous fluids to give plus all the intravenous drugs and other oral medicines. I didn't have time to do any of the remotely humane things, like help feed patients who can't help themselves. The number of times I've seen untouched dinner trays sitting beside, but just out of reach of helpless patients is countless. Also countless is the number of times I've seen patients lying in bed all day, or sunken into their lazy boy chair, with their chin resting on their chest, and their wound dressing sitting on the floor, while the wound itself leaks a straw colored liquid tinged with red.

But sometimes I am given an assistant, usually a student nurse trying to make some extra money, or someone who decided to give up packing groceries at Sainsbury's and after a few months of training is supposed to be able to make my job bearable.

No nurse that I know likes seeing these things happen, we try our best with what we have, but it is so often survival nursing, and not the caring nursing which we really want to be. Management seem to forget that it's the caring side of nursing that saves lives and reduces complications. A perfect example of this is the stroke patient.

Mr Jones was 65yrs old and had a mild stroke affecting the left side of his body. By mild I mean he could still move his arm and leg, although the finer movement of his fingers was lost. With rehab, physiotherapy and good basic nursing skills he could come out of this with most his parts working.

0700hrs I begin a quick ward round to get my patients ready for breakfast. I have to be quick because I have patients who need to be ready for theater by 0715hrs. This is one reason I hate it when medical patients are mixed with surgical patients, everyone has a tight schedule to keep. I sit Mr Jones up in bed and place his bedside table in front of him, ready for when the breakfast trolley comes around.

0715hrs The theater porter moans at me because Mrs Smith isn't ready to go to theater. "She's in the toilet. You're welcome to tell her to hurry up" I tell him. He shuts up. I take Mrs Smith to theater five minutes behind schedule. The nurses in theater are a vicious lot and kept me waiting another ten minutes when I got there. I eventually return to the ward.

0735hrs Mr Jones has slipped down his bed and fallen asleep with his head on his chest. I grab an assistant and together we sit him up again. He grabs the cup of tea that has been placed on his table, but it's cold. I offer to get a new one.

0745hr I still haven't got Mr Jones his tea because I ended up answering two call bells and helped two people use the commode.

0810hrs Not sure where the time has gone, but I'm due to give my patients their intravenous antibiotics. I remember about Mr Jones and his cup of tea, but have to put it aside as I spend the next half an hour injection medicines into veins.

0850hrs I finally get a chance to check on Mr Jones. He's slumped in his bed again, his breakfast untouched and the cold cup of tea still sitting there. I look for an assistant to help me get him up, fed and watered. I make a promise to myself to make sure this gets done. I search for five minutes until I find someone available to help me.

0900 I am back at Mr Jones' bedside and have him sitting out on a chair. The movement has obviously stirred him up as he begins to cough, a moist, infectious sounding cough. I make a mental note to make sure to tell the doctor about this. The last thing he needs is pneumonia.

0903hrs One of my patient's bells is ringing. In fact it won't stop ringing. It's probably an elderly patient who has sat on their bell, but I have to go and investigate, it could be urgent.

0904hrs It's not urgent, it is only Mrs Bailey sitting on her bell. She apologizes profusely. I'm about to go back to Mr Jones when Mrs McDonald, the woman sharing the four bedder room with Mrs Bailey, says she urgently needs a commode.

0915hrs I'm back at Mr Jones' bedside. I've warmed up his toast in the microwave, and have a fresh cup of tea. I begin to help him eat when Sharon, the charge nurse comes into the room. "Have you done your medications yet?" she asked me. "No, I've been too busy" I reply. She frowns at my remark. "What are you doing with Mr Jones?" I thought it was obvious, "Feeding him" I replied. She seemed to disapprove of what I was doing. "Your assistant can do that. You have more important things to do." With that she ushered me out of the room and I began to do my medication round.

1030hr Medication rounds for sixteen patients take forever. It doesn't help that there are always medicines missing from the trolley and half my time is spent tracking them down. I finally checked on Mr Jones and he's fallen asleep in his chair, his chin on his chest. His breakfast trolley has been removed, but I know for sure that he has had nothing.

1045hrs I was supposed to have a morning tea break, but instead I spent it feeding and watering Mr Jones. It's the only attention he's received all morning.

That was a typical morning in a London med/surgical ward. Conditions are often worse. Over the course of two weeks Mr Jones developed a nasty pneumonia. His breathing became so labored and his lungs so shattered from infection that he eventually stopped breathing. The doctors and nurses made quite a heroic effort to save him, but to no avail.

Mr Jones could have been saved. All he needed was a bit of proper care.

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Meddling Media

The media rarely get the whole story, and when they do, they even more rarely get it right. It wouldn't worry me so much if the media didn't get it right, but they've made things a lot more unpleaseant for me at work.

These headlines appeared in the local newspaper a couple of years ago in my home town "Child with meningitis waits four hours to see doctor." Needless to say, these headlines were on the front page, and the child in question was a child that I had looked after. If witholding the full story is to be considered a lie, then these guys were the biggest liars around.

I made sure the girl saw the emergency room doctor straight away. Of course we suspected she may have meningitis. The emergency room doc immediately consulted with his consultatant, who immediately began a course of the appropriate antibiotics. The girl was literally recieving antibiotic treatment for meningitis withing fifteen minutes of being admitted.

Unfortunately the children's ward was full, and the paediatric specialist was unable to see the girl for four hours, and so the child was left with us in the emergency room. When a bed was finally available in the children's ward, she was taken there and seen by the paediatrician, brining the total number of doctor's who had seen her now to three.

The family were not happy at having to wait four hours to see the paediatrician, and they made their displeasure obvious by writing to the paper. After saving this child's life, I would like to think that it was a miscommunication on the part of the family, that omitted to tell the newspaper that she had actually seen not just one, but two doctor's within minutes of arriving at hospital. I like to think it was an over-eager journalist desperate to make front page headlines. It doesn't matter who was to blame, because the result is the same. The day that story was printed, we ended up with a waiting room full of angry parents (children included) demanding to see the doctor, all convinced they had meningitis, and all certain that they needed to shout and be abusive as they were convinced we were not just useless, but neglegent.

The real story never got printed. The damage was done.

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Punch up in the ER

As I jumped onto the back of one of the biggest guys I've ever seen, I wondered if I was going to make it out alive. But the guy had my friend and colleague, Damien in a headlock and was going to ram him into the wall.

Forgotten was the fact that this was a hospital, that this was the emergency room where we are supposed to help people, save lives and all that other wonderful stuff. This was a damn brawl like you'd see in your average pub on a friday or saturday night.

The good news is that the giant released my friend, the bad news is that he went for me.

I'm not afraid to run, and so I did, straight behind the ranks of security guards. "Why the hell didn't you help me?" I shouted at them. "We're not supposed to use force" was the reply. Meanwhile, the giant could see that he was outnumbered and bolted for the door.

His timing couldn't have been better because he ran straight into half a dozen friendly police officers. Thank goodness the receptionist had phoned the police at the first sign of trouble.

And how did it begin, well it was the usual story. Alcohol. The giant that the police were escorting away had got in a fight, received some nasty laceration which would need some sutures, and called an ambulance. He was angry at the paramedics for taking so long, (they were there in seven minutes) and when he came into the emergency room he didn't like being told that he should stop using the F... word, even when I explained that we had young children here who could hear him.

Hopefully he'll spend some time in jail, and maybe even have to pay us some money.

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Tips for young, male adults in hospital

If you are a young male adult in an emergency room, then there is a good chance you're an idiot.

If you are a young male adult in an emergency room on a friday or saturday night, then you're most definitely likely to be an idiot.

But there are a few rules that young males can follow to make their stay easier:

1. Don't chat up the nurses, you are most likely drunk, or sick, and definitely not looking your best
2. Never grope, grab, fondle or otherwise get too close to a nurse as we can and will add an extra medication that totally kills your sex drive.
3. Do not invite your girlfriend to join you in bed for a quick romp, as this is gross and it is offensive to the other patients in the room.
4. Don't bother saying you are afraid of needles. Your body is covered in tattoos in some of the most sensitive areas, and besides, no one likes injections, so get over it.
5. Never threaten, or use bad language We will take you to court.
6. Act like a normal human being for once in your life and be nice. Being nice makes it easier for everyone, especially you.

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Somethings is not quite right on the operating table

I know secrets from both sides. The nurses side and the doctors' side. How do I manage this. I talk to my wife, who happens to be a doctor. I thought I knew all the secrets there are to know about what goes on in hospitals, but my wife proved me wrong.

There was too much laughter and hilarity going on in the surgeons common. It wasn't the usual banter between doc's, nor the normal flirting with the nurses or talk about what went on at the weekend. No, this jocularity had a barely perceptible inane quality. My wife said it had been like this for the whole year she had been there, although she steadfastly denies becoming involved.

Management must have been hearing rumors of the goings on of the surgeons common room because they decided to do something about it, and so in came the breathilizers. Yep, the doc's were drinking too much vodka between operations. My wife said that some of the guys got quite more than a touch of the merry side, then went off to slice people open. Fortunately this intervention worked and the hospital now has sober surgeons again.

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Surgery Shortcuts

The management won't be happy with me because I helped a patient beat the waiting list. Mr Jones is a only 45 and suffering from his first episode of heart pain, or in more technical terms, Angina. He had actually been suffering for at least a year, but instead of having pain, he found that he couldn't run so far. He was the coach for the local rowing club and a fit man.

The waiting list was 6 months at the earliest, even for a young man like him who didn't smoke, and led a healthy lifestyle. He was also the type of man who never wanted to be a burden, so when I told him he needs to come in to hospital if his pain wasn't settling with the medication we gave him, he refused. His wife was no problem, she was on my side and wanted him to come in as many times as needed, but still, how was I to convince Mr Jones to come in. The answer was simple.

"The more times you come in, the sooner you'll get your surgery" I explained. "They'll see that's in the long run it's cheaper to treat you now, rather than ten admissions later." There's also the humanity side, such as saving a relatively young man's life.

Mr Jones got his heart bypass graft within one month of his first presentation. He can now run again without getting short of breath and he's still coaching at the local rowing club.

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Dirty old place called Hospital

MRSA. That stands for drug resistant bacteria, the type that keeps on killing people again and again in our hospitals. Governments in all the industrialised world are spending countless millions trying to combat this problem, but are not having much success. Why are they having no luck? Let me tell you the story of ward thirteen, the 35 bed surgical ward I've spent the last few weeks in.

There's vomit on the floor. It's not unusual, it does happen. I'm used to cleaning up the occasional bit of vomit, but the cleaner is here with me. She just happened to be in the room when I noticed it. "Can you please clean it up?" I asked the woman. She shook her head "It's against the rules" she answered.

It seems rather strange to me, a cleaner with a mop, not cleaning up the vomit on the floor. I asked the silly question of "Why not?" "It's a body product, and we aren't allowed to touch that. We don't have the training." I don't actually have any training either, I must have missed the lesson in nursing school about how to clean up vomit, but I have to do something.

I asked her to give me her mop. "It's against the rules" she replied again, to which I asked again, "Why?" "You're not trained to use my equipment. If you injure yourself or anyone else I could lose my job." As yet I've never managed to harm anyone with a mop, although I was beginning to have some serious thoughts of how it could actually be done.

Next step is to go to the cleaning cupboard and get a mop and soap-like stuff. I should have guessed, the cupboard is locked. "You can't go in there" I was beginning to think the cleaning lady was stalking me. As it turns out the ward doesn't own any cleaning equipment. The equipment belongs to the cleaning company that is hired to clean our hospital. The cleaning company is terrified of being sued, so strictly enforces rules about body products and use of it's tools.

The result is that I clean up shit and all sorts of stuff with a towel which is pushed around by the sole of my shoe. Sometimes I put on gloves and get down on my hands and knees to clean crap up. It's impossible to keep my uniform clean, so I take it home and try to get it cleaned and dried for the next day as my other uniform is still in the washing machine, soaking wet. I never like taking my uniform home as I'm not really keen on spreading hospital germs to my wife and children, but hospitals no longer do staff laundry as it saves them quite a bit of money. In fact it's another outside agency that now does the laundry, so I guess they really need to save some money somehow. It would be so much easier if things were done the old way, with the hospital taking care of its own business, taking pride in doing a job properly, because none of the outside service people that I've seen seem to give a damn.

I wonder what new plans the government will come up with to combat hospital infection???

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The Brits don't wash

Everyone makes fun of the French, especially the Parisians, about their lack of bodily hygiene, but the British are pretty bad as well.

The ward has two bathrooms for 35 patients. The toilets are too small to manovour in a chair on wheels, have no handrails, and it's a bloody circus act trying to help any of the elderly patients a little less nimble. The damn showers are a nightmare as well, with a big step at the entrance which makes it impossible to wheel the chair in.

It's probably just as well as there is no room to move in there even if I did manage to get patient and chair in. Poor Mrs Knight, she hasn't had a shower in the three weeks she's been here. She keeps on washing herself with a facecloth at the bedside every morning. I don't have the heart to tell her she needs a better wash, so instead I said I would take her to the shower.

The pressure is now on. Mrs Knight has just half her foot amputated. The surgeons just cut it off, no stitching together, and every time I look at the foot, it's just a big gaping wound. Can't see it healing, but the doc's obviously know more than me. We made it to the shower, it was a tight squeeze, and even though she nearly tripped over the damn step at the entrance to the shower, she's very happy to be clean at last.

As I couldn't fit a seat in the cubicle, she spent the duration of the shower leaning on me while standing up, holding her foot off the ground. She wasn't even embarrassed to have a male standing there holding her up as she washed herself because she was so grateful to be clean at last. Back at the bedside she kept on thanking me over and over for taking the time to help her.

I didn't actually have the time to spare, it is a busy surgical ward after all, and I have 10 other patients to look after. They're all overdue for thier morning meds. Oh well, I may be late, but I did the right thing. I did the small things that show patients that I care.

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