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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Nurses should never rise above it all

More and more, nurses are doing things that traditionally were the role of doctors. From taking blood, setting bones, prescribing medication, the list is endless. Our role has changed, but not always for the better.

In British hospitals I've often found nurses either too busy to do the basics, such as washing a patient, turning patients in bed, toileting, or even doing patient dressings. Often I found a nurse assistant doing a wound dressing and I wouldn't even get to see how the wound was progressing. Often these assistants are only doing as they have been instructed, which is understandable as six months ago many of these helpers were working in the supermarket.

Nursing means taking care of a whole patient. It's not taking blood, giving antibiotics, changing infusions, prescribing medication. All of these jobs are a part of what we do now, but they are useless if the basics are not performed properly. It's no good giving a patient the latest antibiotic if he hasn't been turned for two hours and his pressure sore has broken down and become infected.

In the very act of performing a bedsponge, you automatically do an assessment of a patient. You look at the heels, elbows, buttocks and other pressure points. You feel the skin under your hands, is it soft, brittle, dry, hardened. You talk to the patient, are they confused? You see how well they move as you roll them around the bed. You listen to their breathing, are they coughing when you turn them. Do they feel warm? Does he or she open their eyes?

Some nurses don't have time to do this, while many other nurses think they are above these jobs. More than one charge nurse, or even just a senior nurse, has refused to help me lift a patient up the bed, even though they were they only staff around at the time. "I'm too busy" or "Find an assistant" are the usual responses.

We can't afford to be too high and mighty to do the grunt work. It's an integral part of the job. I guess I'm just a modern old fashioned nurse, and always will be.

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Young men and other idiots

It is not too often that you come across young men or teenagers in a general medical or general surgical ward, but it does happen, and it usually happens for quite different reasons than those of a more mature age.

If you are between the age of sixteen and twenty eight, male and in hospital, then there is a good chance that you're an idiot. If you are between the age of sixteen and twenty eight, male and in hospital on a Saturday night, then you are definitely an idiot. It wouldn't surprise me that one day scientists discovered a gene for male stupidity in the hospital environment. Most times this seeming inborn idiocy is a great source of humour for hospital staff, but unfortunately these outbursts of idocitic behaviour are not always humorous because sometimes they cause harm.

As a general rule most people don’t really know exactly what to expect when they end up in hospital, and teenagers, and slightly older but still young males, are no exception. The lads don't really have a clue what to think as they sit in their bed surrounded by veterans from world war two. They even look slightly out of place. But it is sometimes nice to have a young patient in your care, as they do tend to be much more independent and mobile, and do not have the often heavy needs of an elderly patient. But they still need to be watched carefully, as they pose their own unique hazards.

Shaun was eighteen years old and had presented to the emergency room with generalised abdominal pain. He had a fever and as time went by the pain gradually became more severe and it also done something rather strange; it moved to the lower right side of his abdomen. At this stage a diagnosis was pretty easy to make and anyone with even a little medical knowledge should know what was wrong. At ten-o'clock that same night Shaun was taken to surgery where the surgeon opened him up and snipped out snipped out some innards. The surgeon said he was a very lucky young man as his appendix was very close to rupturing.

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 terrible as Shaun looked it was nothing serious although I made sure he hadn’t done any damage to his wound. 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.

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MRSA in the strangest of places

Isabel made life bearable for poor Mrs Stewart. The woman hadn't been outside the ward in over six weeks. The problem was that her wound would never quite heal. It wasn't any old wound either. It wasn't some minor surgical cut to the abdomen. Mrs Stewart had her left leg amputated from the just below the knee.

One day the wound would seem better, and the yellowish ooze which would occasionally discharge from the stump would slow down, or cease altogether, then suddenly the would open up again and a flood of pus would pour out. She had been to theater twice to get the wound debrided and cleaned out.

"Where's my Isabel? " Mrs Stewart would ask when anyone but Isabel answered her call bell "I need her now." Mrs Stewart's tone of voice spoke of someone who was used to authority, someone used to giving orders to servants. We were not offended. We would have been offended if Mrs Stewart meant to be rude and demanding, but making demands and giving orders was all she knew. We even felt pity for the poor woman, for it must be such a fall from grace to be in a public hospital.

Mrs Stewart was a high society woman from the 1960's. She would regale Isabel with stories about lords and ladies, wealth and debauchery. Mrs Stewart also only spoke to Isabel in her favorite language, the romance language of the French. "She's busy right now" I replied, "Is there something I can do for you?" I replied to Mrs Stewart, knowing full well that she would wait for Isabel only. "No, I don't think so" she paused and looked at me thoughtfully, "No I definitely need my Isabel. Only Isabel can help. I need to speak to her woman to woman." I left her room to inform Isabel that her unique services were required.

"What does she want?" Isabel asked when I told her that only she can solve Mrs Stewart's problem. "She wouldn't say, only it's a 'woman to woman' thing" I added. Isabel rolled her eyes "You've got to be kidding" she said. I found myself smiling, my mind going into overdrive wondering what crazy idea Mrs Stewart had come up with now. Isabel punched me on the arm. "Don't laugh, it's not funny. She asks the most embarrassing questions" Isabel continued, "Just the other day she asked me what position I thought would be the safest position to have six with only one leg." Isabel had asked all the nursing staff what they thought best, and had received some rather descriptive answers. "Just go in there and find out. I'll help any way I can" I promised.

With a nervous, backward glance, Isabel entered Mrs Stewart's room. Three minutes later I found a very flustered Isabel in the treatment room. "You won't believe what she asked me" Isabel said to me. I had never seen her quite so red faced, it must have been good. "Is it worse than the sex question" I asked. She nodded her head "Much worse." My curiosity was piqued. "Out with it then. What's so shocking?" I ordered. Isabel took a moment to compose herself. "She's worried that she has MRSA" Isabel began. MRSA is one of the hospital superbugs that are resistant to antibiotics. "We know she has MRSA" I interrupted. Isabel motioned for me to be quiet. "She's worried that it may have spread. She asked me to have a look."

"Have a look?"I exclaimed. "Look where?" Isabel took a deep breath, "She thinks she MRSA on her clitoris. She asked me to take a look." My mouth dropped and I stood there stunned speechless. So caught of guard was I that I wasn't even laughing. After a considerable pause I asked the next logical question "Well did you?" I asked. Isabel nodded her head "What else could I do? She could have it there, so I had to look."

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Wandering Hands

It's the only fun Mr Smith ever has. He spends all his time on bed because he was ordered to by the doctor. He was leg ulcers that he has just had grafted, so he'll be in bed for quite a while. The last time he was admitted, he didn't get off his bed for one whole month.

When we need to roll Mr Smith, for a bedpan or to wash his back, Sheryl usually makes me take the top half. Mr Smith says I'm not as good at Sheryl when rolling him, but that's because I'm a man and my buttocks isn't as soft as Sheryl's. I guess that's why his hands only ever wander to Sheryl's butt, and not mine.

Sheryl handles him well. "Stop being a dirty old man" she says only half playfully as she shifts his hands a little higher. "I've got parkinson's you know" Mr Smith says this every time in response to Sheryl. The tremor in his hands always suddenly gets worse when he says this. Sheryl isn't bothered by his actions, she is amused. I haven't had any patients try to grope me, and I hope it stays that way.

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Like Mother like Daughter

I am occasionally guilty of making the situation worse. But sometimes it's worth it. My good friend and colleague Michelle had put up with some horrific language from a sixteen year old girl. This wasn't unusual in itself, but the girls mother was sitting by the bedside the whole time while her daughter told Michelle to "F!@king hurry up," "F@!k off" or "Get the f@!k away from me." Michelle eventually decided that she had had enough. "Can you take her blood test" Michelle practically begged me, "I can't handle her that snarly piece of trash anymore." I was in the mood for mischief "Gladly" I replied.

What a surprise, the girl is refusing the blood test, so I tried to reason with her. "Sometimes you have to put up with a little bit of pain, for the greater good" I said. The girl never had a chance to reply because mum interrupted. "What did you just say?" she asked me. My mind briefly went blank, trying to think how exactly I had offended her. "Sometimes a little bit of pain is necessary, for the greater good" I repeated.

Mum face twisted into one of anger "I don't that's very appropriate" she told me. What the hell is she talking about. I was at a complete loss trying to figure out what I had said. "You know what I mean. About having to put up with pain." I really was at a loss trying to figure out her line of reasoning, "But blood tests do hurt" I protested, "And sometimes the tests are necessary." The woman looked furious. I could see that she was beyond reasoning, or perhaps I just wasn't communicating on her level. Maybe if I used a few more F... words she would understand, as that is the language her daughter uses.

"Who's in charge?' She asked, getting up from her bedside seat. I decided to diffuse the situation by being helping. "If you're going to lay a complaint, my name is ...." I said my name slowly, "Could you please get the spelling right as everyone gets it wrong." I then proceeded to spell out my name.

I've never seen someone so close to exploding. She had pen and paper and was writing the names of the nurses on the duty board down furiously. Stabbing her i's and slashing her t's.
Withing five minutes she was dragging her daughter out of the hospital and into a waiting taxi.
Michelle congratulated me on a job well done. My charge nurse told me that I could have been a bit more diplomatic, but gave me a thumbs up.

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Hanging out in the STD Clinic

I spent three months working at one of London's finest hospitals, asking men to drop their trousers. "It will only hurt a little" I said as I would grab hold of the shaft and prepare to insert the swab into the tip of the penis. At first I couldn't bring myself to grab hold of infected penis', even with gloves, but whenever I let the patient hold it, they would always flinch and pull away when I brought the swab near. In the end it was less embarrassing and over more quickly if I just got on with the job and done the deed.

It was never an enjoyable part of the job, although I never did ask my female colleague what she thought of having to grab men's dicks all day. I do know that she often was surprised as me when a certain member was stood out from the rest. Some were bent, hooked, multi-coloured. Then there was the size. I never thought someone would actually have a one inch penis, but I did meet such a man. He wouldn't let me near him with the swab when he saw that the tip was twice the width of his urethra. Then there are the big ones. It is true, and I'm not ashamed to admit it, but men of a certain darker skin tone do have bigger members. In fact some of them looked almost debilitatingly big. I swear the blood required to get some of those giants up must have drained a good pint of blood from the rest of his body. I'm talking about knee length with the width to got with it.

Thankfully the job had other interesting things to distract me, such as learning how to do the microscopy work to identify certain infections, namely gonorrhea. Quite often a microscopic exam was not really needed, even though we still did one. When the patient would go to give a urine sample and pee pus and blood, it sort of spoke for itself.

It's been quite a few years since I was in the STD clinic, but I'm sure I'll remember some more interesting stories.

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Emergency Room Antics

This is a typical Saturday night in the Emergency Room:

2000hrs: Two drunks, one of whom is 14yrs old and was found unconscious in the gutter, while the other was very well dressed, 41yrs old and celebrating his birthday with some work colleagues. He is a lawyer, and had just finished work.

2010hrs: Fortunately the 14yr old was able to be woken up. We managed to get hold of the girl's mother who was naturally hysterical and is on her way down. Unfortunately, we couldn't wake the lawyer, even after we tried everything in the book. We tried the sternal chest rub, squashing his fingernails with a hard object, and pushing the pressure points in the eye sockets. It looks like he may end up being intubated.

2020hrs: A drunk 16yr old boy presented with a broken collar bone. He's very subdued. It's probably because he has ruined his parents car. While he is sent to get x-rayed the doc has decided that the drunk lawyer needs to be intubated and has called the anaesthetist.

2025hrs: The 14yr old girl's mother has arrived. I feel so sorry for the poor woman. The moment she saw her precious child lying there in a hospital gown with a drip in her arm she broke down in tears. The girl broke into tears as well and now they are hugging. It's so good to see a family that seems to care. It could have turned out so different.

2040hrs: The lawyer has been intubated and taken to intensive care. Meanwhile an elderly lady has been wheeled in a chair complaining of a sore upper thigh. She had a fall getting off the toilet. I was a bit worried that she may have broken something so put her on a bed and saw straight away the signs of a fractured hip, or NOF (neck of femur). Her affected leg was shorter than the other one and rotated inwards.

2045hrs: A 61yr old man was brought in after falling off a bar stool. He was very intoxicated and had some superficial lacerations to his face and hands. He needed some sutures. He did fall nearly three feet onto his hip, but he showed no sings of a fractured hip. It is almost unfair that he doesn't break a hip when the woman on the toilet did, but it's not uncommon. Drunk people often avoid serious injury because they are so relaxed. When people are sober and fall, they tense up, helping to cause a break.

2100hrs: That's my first hour of work over and it feels like forever.

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GDGAPW Syndrome

GDGAPW ??? Well it's a very common syndrome affecting young males, especially those in their teenage years. I've seen so many teenagers with this syndrome that I'm beginning to wonder if it is genetic, although I must say that I must be missing this gene. So what does GDGAPW stand for?

Get drunk, get angry and punch wall syndrome. The W can also stand for window. We had an eighteen year old boy come in one Friday evening after punching a window. You would think that the window would come off second best, but you'd be wrong. He suffered a very small laceration to the inside of his wrist. It was such a small cut that he wasn't going to come to hospital, except the sensation in his hand had changed. Little did he know that his budding career as a rugby professional would come to an end.

The thing about rugby is that you need to be able to catch the ball and this young man was left with little-no sensation in a large part of his right hand. He will still be able to play rugby, but probably not at the top level.

The hardest part about this whole episode was watching as this realization came to him. As hardened as we nurses often come to alcohol related injuries and the stupidity of the average male, I couldn't help but feel deeply sorry for this young man. We've all made mistakes, and most of us are lucky. This young man said he had never done something like this before, and that he never would again.

It hurts when we don't get a second chance.

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Wealth and buying Health

The kid had a tiny laceration to his forearm. Three stitches should do the job. The problem was that dad was not happy. "I want a second opinion" he said to myself as well as the junior doctor working with me. The doctor's name was Russell.

"What do you think Russ? Where we gonna get a second opinion on a Sunday night?" I managed to stop myself from smiling as I said this.

Russ looked ready to let loose on the man making such ridiculous demands. Russ was a big Scotsman known to have a fiery side. "There is no need for a second opinion" Russ was losing control of his temper and the volume of his voice rose an octave or two. "It's a plain, simple laceration which any doctor could treat. I'm not going to call my consultant out of bed at ten o'clock on a Sunday night."

I might as well go and get the patient complaint form for dad to fill out, because Russ wasn't going to back down. But instead of getting angry in the usual way, like threatening to lay a complaint, yelling, or even getting physical, Mr Trite did something quite unique. "I'm willing to pay for a private consult. I don't care how much. I don't want my son to have any scarring. Get me a plastic surgeon."

Russ and I were speechless for a moment. "Alright" Russ finally said. The fight seemed to have gone out of him.

An hour later the hospital's head of plastics waltzed into the department. He was in fine form, chatting with Dad about almost everything but the kids arm. Subjects touched upon included golf, yachting and which was their favorite place to ski in Switzerland. It took less than five minutes to suture the laceration and another twenty minutes for Dad and the consultant to finish their conversation.

"I need a pen" Mr Trite said as he fished out his cheque book, making sure everyone knew he was about to hand over a bunch of money. Russ handed the man a pen. "How much was it again?" he asked the surgeon, to which he replied "three thousand."

Three thousand pounds for five minutes work.

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