Useless Parents.

"Sir, sir, please help, it's urgent" begged Andy. The waiting room was full, but so far all I'd seen was kids with sniffly noses and scratchy throat. Andy seemed genuinely worried so I motioned for him to come to the front of the queue.

Andy strode into my office and stood hovering over me as I sat at my desk. "You can sit down Andy" I said. "I can't sir, I'm too worked up, I'm friggin scared sir." "It's ok Andy. Sit down and tell me what's wrong." Andy sat down and began to tell his story.

"It's my eyes sir, I keep seeing things" Andy explained. My ears perked up at this. This was a far cry from the usual complaints. "What exactly are you seeing? Describe as accurately as you can" I replied.

Andy's symptoms had began about a month ago. He started seeing jagged lines at the edge of his vision. At the start he only noticed the lines a couple of times a day, but now he was constantly seeing lines on the edge of his vision. There was no pain, and his vision was otherwise unimpaired. I asked the usual questions like: How often, How long, What makes it worse/better etc. But the biggest shock was still to come.

"Have you ever had problems with your eyes before? Problems of any kind?" asked. Andy seemed surprised by my question "Of course I have. I spent five days in an eye hospital in the states getting all sorts of things done. But you know this. Mum's told you before." It was my turn to be surprised "Ah, sorry Andy, but your mother has never said anything about this at all." I then produced his medical records to show him that his mother had never informed us of her son's medical history regarding the eyes.

Andy was taken to the local emergency eye hospital where he spent the next 16 hours getting every examination possible. The doctor eventually sent Andy and I home. He said there was no danger to Andy's vision, but he said he urgently wanted a copy of the records from when Andy had five days of testing at an American hospital.

"Hello, is the Andy's mum?" I asked. "Yes, how can I help" came the reply. "I'm calling about Andy, I'm the nurse who took him to the eye hospital. We urgently need his medical records, or reports, anything you have" I said. I then spent the next ten minutes explaining everything the eye doctor had told me. "All right, I'll see what I can do" said Andy's mum. The line went dead.

Two weeks later and nothing. No medical notes, no emails, no contact at all with Andy's parents. Andy was becoming angrier every day with his family. After receiving no reply to my emails I phoned Andy's mum for the tenth time and finally got through. "I've contacted the doctor and they'll fax the records through" explained Andy's mum after I'd politely berated her for doing nothing. "How long ago did you fax them" I asked. There was a pause, "Ah, an hour ago" again, another pause, "Ah, what's the fax number by the way." I hung up the phone.

Andy's mum was a liar and not dong a thing to help her son.

I eventually tracked down the records a got a copy sent from the American hospital and sent then to the eye hospital here in Europe. As soon as the doctor here got the report he requested to see Andy that same day.

Thankfully Andy's vision is going to be ok, although he will probably always see these lines.

No thanks have to go to Andy's mum.

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What you don't know

"He's such a quiet guy" were the words that people usually used to describe Pete. This was then followed by something like, "Yeah, he's a nice guy. Never bothers anyone." Even though I knew Pete on a 'friends of friends' kind of basis and knew his life style, even I never knew how sick he really was.

Pete got out of bed and wandered to the kitchen, lighting up a joint in the process. Smoking a joint wasn't anything special to Pete, at least in that it wasn't a special occasion. He never sat down with friends and smoked, there was no ceremony about it. Pete smoked marijuana as if he was smoking a regular cigarette.

Pete then went to work where he spent the day killing chickens. His day was broken down into morning tea break, where he smoked some pot, lunch break which meant more marijuana, then it was off home and dinner whereupon he smoked another joint. His evening was then spent in front of the television. He would then have one final toke then off to bed.

Whenever the boys' went out on the town Pete was always such help. "Who wants to be the sober driver tonight" someone would ask. No one would volunteer, then someone would say "Hey Pete, you haven't been drinking tonight. Will you drive for us?" In his typical monosyllabic way Pete always said "Yep"

In fact no matter what we did, where we went, or who we met, Pete was always there, somewhere. He rarely talked, was always helpful, and for someone who spent their life completely stoned to pieces, he seemed rather level headed. In fact we sometimes wondered if he had developed some natural resistance to the stuff as we never knew quite how he still managed to function.

I left that crowd, and I didn't see any of them for ten years. Then I bumped into Pete by accident.

The doorbell rang. "I'll get it" I offered and headed out to the security door. When I got to the door I stopped and stared in surprise at the person on the other side of the reinforced glass. Pete looked the same and behaved the same. He showed no surprise when I opened the door. "Gudday, it's been a while" was all Pete said. "Ah, Pete" I stammered, "It sure has...Ah, what can I do for you?" I asked. "I've come for my injection" he said. I was a bit slow catching on. "Ah injection for what?" I asked. In his usual calm, unhurried way, Pete said "My schizophrenia medication of course" Pete said with a knowing smile as he walked past me and down the corridor.

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The rich kids health

The rich kids behave differently from the poor kids. It was time to send them a message. All the kids got a message from their favorite, caring nurse:

"When you get sick, do you expect to be cured? How many of you think there's a medicine that will fix all your problems?
Unfortunately there's not a lot we can cure. We hope to find things to relieve the symptoms a little, but your body does all the work, it just takes a bit of time sometimes.

What's my point? A lot of you seem angry that you're not getting antibiotics from the health center. Guess what, antibiotics work for bacterial infections. 99% of you have viral infections, meaning antibiotics are useless.

There are certain things we look for to help us decide if an illness is bacterial or virus, we know what we're doing.

So, don't get angry, don't be obnoxious, and remember to say please and thank you.

If you're not happy about something, discuss it in a polite and calm way like a normal human being.

Some do's and don't when entering the health center

Don't say "I just need..." or "Give me some..." or "Only one minutes, that's all..."

Try "Can you please..." or "May I please have some..." or "What time suits you..."

Don't complain that we've made you wait till lunch clinic about your sore knee when it's been sore for the last week and you've not bothered to come to one single clinic in all that time.

Don't tell me that you mum said you need to rest, sleep, go on antibiotics or have surgery. Your mum isn't here, plus about one third of your parents never bothered to return your health information forms.

Don't put on make up. Confused. Well the last girl who came to see me with apparent horrendous diarrhoea and vomiting had immaculate make-up, lovely perfume, and smiled a bit too much. Real sick people don't do this.

Don't tell me you "Can't breathe" in long, rambling 20 word sentences.

Don't tell me you need to see a specialist doctor. You probably don't know what one is, and if you did want to see one, the waiting time is usually two weeks or more. Fortunately, due to the aide of our local doctor, we can usually get appointments much quicker.

If at any stage you think you can get better help, go ahead and do so. I'm sure there are plenty of over paid doctors in Geneva happy to take your parents money when any experienced general practitioner could have dealt with your problem.

Do tell us your health problem, especially your past history. I am shocked almost on a weekly basis when people complain to me that nothing is being done about their illness which they've had since birth, but never bothered to tell us about it in the first place.

Do use your common sense and be patient.

It is a fact that the poorer the patient, the poorer the family, the better manners they have, the more appreciative they are, and the better care they receive, and all because they not only know how to be nice, but they are nice. In fact the poorer people bring in the nicest chocolates, even though they can't afford it.

So, try being nice, try saying 'please' and 'thank-you' and you might find life in the health center a little easier.

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Racist not, just Culturally aware

"It's your job to tell the ones faking and the ones that are sick" moaned Marco, "So do your job" he added with a touch of venom. Poor Marco, he just doesn't know when to keep his trap shut. I was beginning to feel sympathetic towards him, but now he's turned me against him.

"Ah, Marco, when did I say you were faking your illness" I asked with forced politeness. "C'mon sir, you know I'm sick, just let me sleep. Don't send me back to class, please" he begged. Three years looking after teenagers and it still amazed me how the kids could be rude and obnoxious one moment and then pleading the next. But what amazed me more how they expected sympathy even after they insulted me. When I was their age I know I wasn't stupid enough to offend the person who I was hoping would help me.

There are two problems with Marco. The first is that he is Italian. I'm not being racist, just more culturally aware. All the Italian kids I look after insist on being sent to bed at the slightest sign of a sniffly nose or scratchy throat. They act like they are dying.

The second problem is that Marco is not used to being told what he can and can't do. All his parents have ever done is throw money at him, and sent him off to boarding school for someone else to raise.

"Marco, you're your own worst enemy, did you know that" I said. "What do you mean sir?" Marco replied sounding genuinely confused. "Well, you just don't know when to keep your mouth shut. I was going to let you have some time off school to rest, but now you've made me angry."

"I'm sorry sir, so sorry. You know me. I'm real sorry."

What to do. Well, I guess I'm just soft. I let the lad rest.

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Compassionate Triage

As Doctor Pru stood there reading the file her mouth turned down into a frown. "Who triaged this patient?" She called out across the room to anyone who would pay her attention. Everyone ignored her except me. I knew whose file she had and I knew she'd make a fuss, not because there was a problem, but because she loved to pick faults and seemed to relish making people squirm in front of her.

"A name would help Pru" I said, "Whose file you got there?"

Pru glanced at the file in her hand "Mrs Smith. Did you triage Mrs Smith?" She said accusingly. "Yeah, I did, what's the problem?" I asked.

"Could you tell me why she's in the triage 3 box. She's at most a four, or maybe even a five. For goodness sake why? why? why?"

"Well, she is 93yrs old Pru. She's from a resthome and it was a big deal getting here. They had to get an ambulance to get her here, then have to arrange one to take her back. She's got a carer sitting with her as well. I'd thought I'd sneak her in first. It just doesn't seem right to let a 93yr old lady wait for three or four hours" I explained.

Pru sighed and rolled her eyes, "We do not triage on age" she said as if this was the end of the argument and placed her file in the triage four box. "But Pru, it'll only take ten minutes to get her fixed. All we need is for you to take a look at her and I'll do the rest. C'mon Pru, I'm not going to leave a frail old lady sitting there for ages."

Pru grabbed Mrs Smith's file from the drawer. I felt hope. She then put it in the triage five box. She grabbed another triage three file and marched out to the room.

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Saving the patient, and my Friends

It began with a simple hello and went down hill from there.

“Ah. Hi,” I stammered, as my mind frantically went into overdrive trying to figure out where I’d seen this pretty blonde woman before. “Can I buy you a drink? It’s the least I can do,” she offered.

Something definitely was amiss because attractive young women didn’t generally offer to buy me drinks. I peered closer at her face. Recognition hit me like a sledge hammer. “Ah, I’m fine. I’m, ah, drinking water tonight--designated driver, you know? Thanks for the offer.”

She shrugged her shoulders. “Maybe another time,” she said, then turned to the barman. I made my escape.

“Hey, you gonna introduce us?”Jake said to me when I returned to our table. “Yeah, if you’re not interested, introduce her to me,” offered Simon. Both the boys had been behind me when Sophie (I’d remembered her name by now) had offered to buy me a drink.

“Ah, she’s not interested,” I said. The guys were angry. “What are you talking about? If you like her, that’s cool, but if not, don’t be selfish,” said Jake. “Yeah man, don’t be selfish,” echoed Simon.

What could I say? I couldn’t tell them who she was—that I had vivid memories of her foaming at the mouth and of her painting her room in feces. I couldn’t tell them that I’d looked after Sophie for two months in the psychiatric ward and that, even at her best, she would never be quite right.

So I suggested another bar, I bought a round of drinks, and Sophie was soon forgotten.

What do you think? Did I mistreat Sophie by not introducing my friends? Was I prejudiced? Well, probably, but for the right reasons. I was just using my common sense. I kept them safe, kept Sophie safe, and kept my mouth shut at the same time. We were all winners.

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Making a dreadful impression part II

I'm now a school nurse, left the ER behind, the stress, the shiftwork, the adrenaline behind. I work in a very exclusive private boarding school in the european alps. The kids naturally don't know how lucky they are.

When Anna told me the other day she wants to be a nurse. I asked her why and she said she thought myself and the other nurses really nice people. It's very flattering, but should I tell her the truth?

Should I tell her about the long hours, the poor pay, the shift work, abusive patients, abusive family, abusive colleagues, understaffed and dangerous wards.

I could do this, but then there is something else I should do...

I should tell her what it's like to receive a box of chocolates from the poorest patient in the ward. I should tell her what it's like to see a patient make the transition from deathly ill to walking out the front door, and all because of you.

I should tell her about the adrenalin rush as the paramedics race in with a critical trauma and the feeling of awe and pride as we all worked as a team to perform a life saving miracle. I should tell her what it's like to give someone a heart stopping medicine to revert their heart back to a normal rhythm (you always cross your fingers that the heart restarts).

But most of all I should tell her that if you like helping others because it's part of who you are, if it makes you smile when you help someone else, then go ahead and be nurse. You'll enjoy your job and always be in demand.

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Making a dreadful Impression part I

"I'm going to be a nurse" a voice called out. I stopped and turned around, glancing at the sea of faces in the hallway. "Who wants to be a nurse?" I replied. "Me sir" said the voice again. It took me a moment to see wee Anna struggling amongst all the kids desperate to get to class on time. "I do sir. I want to be a nurse, I want to be like you." I was flattered, but I had better set Anna straight. "Come see me at lunch time if you're serious" I replied then continued on my way to the health center.

Teenagers are always saying silly things, for a laugh, for a reaction, or often beacuse they didn't think before they spoke. Anna was a top student, in more ways than one. Her grades were good, she was the best player in the volleyball team, and she was well liked. But what made Anna stand out was the energy, the enthusiasm she put into everthing she did. This energy had a ripple effect and made those around her. She was the most popular girl in school for all the right reasons.

Please don't become a nurse Anna.

What a horrible thing to say. I'm a nurse. I must be making a good impression if students want to be 'Just like me'. But she could be so much more. She already has so many other advantages compared to the other 99% of children around the rest of the world. Her family is wealthy, she's getting a top education, and she's a well balanced, popular teengager.

She will never get rich being a nurse. Her skills will be useless outside of a medical clinic. She will end up working long hours, irregular shiftwork including the dreaded nightshift. She'll be putting herself in a position to be shouted at, pushed around, punched by angry patients and relatives. She'll be putting herself in job that is becoming more and more litigious every single day. She'll be dealing with death, trauma, gore, seeing humanity at it's worst.

Why does she want to become a nurse? What should I tell her?

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The Cost of Nursing

I'm reasonably ok at Math, but I can't figure out why hospitals are always so broke. Let's take my last emergency room in London. Eight nurses on a shift. Four nurses working for the hospital at 12 pound an hour for the 11 hour night shift, and four nurses like myself, working for the agency at 30 pound an hour. I usually clocked 44-55hours a week.

Now, if you think this is costing the hospital a small fortune, the agency I work for takes another seventy pound an hour. So the hospital is paying 100 British pound an hour for an average of four nurses a night. Let's add it up, 11 hours at 30 GBP/hour is 330 pound per agency nurse per shift, multiply this by 4 and you get 1330 GBP for the night. For any American readers, that's 1660 dollars for the night.

The hospital keeps on saying it can't attract new nurses and that there is a terrible shortage of nurses. They don't have a choice but to pay agency rates. Hell, even the regular staff work the odd shift for the agency as their pitiful 12pound an hour is pretty pathetic.

Here's an idea. Why doesn't the hospital agree to pay their own nurses twenty pound an hour, plus sickness benefits, annual leave, plus pay for ongoing education. I think they would have no problem attracting permanent nursing staff and save a small fortune. I mean I've worked in London for four years and there's always been enough nurses around to fill in, even if we're from the agency. But I know myself and many of my colleagues would happily work for the hospital if they just paid a half decent wage.

But I'm not a manager and I'm certainly no math wizz, so can someone tell me why we don't give my idea a go.

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We're all oppressors... at least I'm told so

The Kamatua ground his thumb on the table, his eyes locked onto mine "See that thumb, that's you white people, and all Maori are under it" his voice quavered as he said this, seeming to struggle to contain his righteous anger. Somehow dinner had turned into a confrontation between the head of the local Maori tribe and myself.

How exactly did I end up in a confrontation with the head of the local Maori tribe? Well, as part of our nursing training the graduating class had to spend a night on the local Marae. The goal of the visit was to discuss ways in which we could help Maori people feel more comfortable in the white world of modern medicine. We were learning how to make Maori patients feel more comfortable in such an alien envirnoment, how to meet their cultural needs.

The confrontation began innocently enough. The kamatua decided to sit with me at dinner, and as happens with a group of people sharing a table, sharing good food, a conversation soon ensued. "This is a special place" he began, glancing round at his surroundings, his eyes lingering on some of the Maori carvings. I nodded my head. "It effects everyone, even Pakeha people like you" he said, obviously referring to being on the Marae. Pakeha is the Maori word for people of European, or white decent. "What do you mean, people like me?" I had to ask as his wording almost seemed to border on insulting. It seemed as if this was just what the Kamatua had been waiting for he answered without hesitation "The people in charge, our oppressors."

I sat there in silence, too shocked to be angry. I briefly wondered what this had to do with nursing. I wondered how this would make me a more caring nurse, but came up blank. I didn't need this confrontation, not now at the end of my three years of training. I didn't need to be labelled as a stirrer, a trouble maker, or even a racist. I tried to be diplomatic "Well, I'm just here to help people, that's what nurses do. I'm not into all this politics and stuff" I replied. My response seemd to anger him as his eyes narrowed, his face deepend into a frown "Fighting for our land, our culture isn't politics" he then ground his thumb on the table "See that thumb, that's you white people, and all Maori are under it."

So that's how I ended up here, on the receving end of a Maori leader. But I wasn't going to do down without a fight.

"To be honest, I really don't think this has anything to do with nursing. I don't need to be told how to care for Maori patients, least of all by such an unpleasant host as yourself." By this time we had attracted a small crowd of onlookers, amongst them two frowning nurse tutors. But I hadn't finished.

"As I see it, I'll treat anyone, from anywhere, on an individual basis. If I have a Russian, Korean or even a bloody Martian, I'll base my care on their individual needs." The Kamatua's face was filled with rage, but I wasn't worth further time. He rose from the table and walked away without another word.

It was an interesting experience spending the night on the Marae. This part has now been stopped as too many students were complaining that it had nothing to do with nursing, and I happen to agree. The biggest shock of all was what I can only describe as hate from my hosts.

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Where's the racist?

My eyes practically bulged out of my head as I read that last phrase again "...nursing staff, medical staff and environment systemically racist." The letter was signed by Marore family which I had come to know very well over the last two weeks. Helen Clarke leant forward in her chair, her arms resting on her desk "You were Mr Marore's primary nurse, so we're talking to you first. Nothing much specific has been said, and no names mentioned, but perhaps you could explain why the Marore family has sent this letter."

I sat there in silence, my mind a complete blank. I want to be honest, but I don't think it will work. The family wouldn't send a letter like this for no reason, but that's just the problem, I couldn't think of a reason. I couldn't think of a single reason why the Marore family found the care of their recently deceased father racist. "Sorry Helen, I don't have a clue. I acutally liked Mr Marore, hell, he even requested me to be his nurse every time I was on. Maybe it's just the family grieving, I mean they knew he was eventually going to die, but still, that doesn't make it a whole lot easier. Perhaps it's grief talking." The words seemed to slip out of my mouth on their own, and it took me a few moments to digest just what I had said. The more I thought about it the more my suggestion sounded plausable.

Helen nodded her head thoughtfully, "Perhaps you're right, but are you sure you can't think of anything specific, any reason why they would send a letter like this?" I took another look at the letter, "Well, it does say here that they feel the hospital policy of allowing only two visitors in at a time prevents them from healing in a traditional family way" I noted. "And was that enforced?" asked Helen. "C'mon Helen, you know it's never followed, as well as the visiting hours that are never followed. We always make exceptions. Hell, the minimum visitors that Mr Marore had were two. I swear we've had all his immediate family plus every cousin in there sometimes." Helen managed a brief smile before her face turned somber "But these are very serious allegations, it still has to be dealt with." I shrugged my shoulders "Sorry, can't help anymore."

I read through the complaint letter again, but it didn't help anymore. "Look Helen, the only specific thing they've complained about is the offical numbers of visitors allowed, the rest vague, it doesn't acutally complain about a specific person, just everyone. Perhaps you should request something specific from them, perhaps word it in such a way that you want their input so to make the system better."

Helen was in agreement and let me head back to work.

Over the next several weeks everyone in the department was questioned, and everyone came up blank. It caused a lot of stress and left a sour taste in everyone's mouth. Helen was no further ahead and did send a letter as I had suggested.

We'll hear the reply to that letter in a future blog.

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An Unusual Argument/View on an old topic...

Cough, splutter, cough, "I..... need some more..... oxygen" gasped Mr Jones. He couldn't have any more oxygen because too much of the stuff would kill him. He knew this, it had been explained many times before, but it didn't stop him desperately desiring enough oxygen to stop his breathlessness. Instead he had another nebuliser with room air pumping though the mask.

It was Mr Jones' third admission in five months, which was not bad for him. He had a run the previous winter when he had come in once a month for five months on end. It almost seemed that Mr Jones spent as much time in hospital as out. We knew him, he knew us, he knew the respiratory ward better than his own back yard (he no longer could walk in his own back yard as he got short of breath and had to go back on his oxygen after the exertion).

Ten minutes later the nebuliser was finsihed. "Could you... wheel me outside for a fag" his gasping wasn't quite so bad as he mananaged a sentence with only one pause for breath. I shook my head, "Ah, no Mr Jones, oxygen and a lit cigarette really don't go that well together" I replied. He managed a brief chuckle "Got away with it... all these years". I knew better than to argue, and he knew better than to try asking again.

Mr Jones was eventaully admitted to his second home, the respiratory ward. I went home, but stopped off at the local for a quick drink and catch up with a couple of friends, but didn't stay long as the smoke in the bar was so thick.

It may seem my point has been made, but I'm not done yet...

Over the next week the news was filled with those against and for banning smoking in all public places. Anong the various arguments against the ban was that they were being discriminated against, human rights etc.

Let's jump to Mrs Smith

Mrs Smith was sent to hospital because her family doctor was concerned about a lump in her arm. He was pretty sure it was just a lipoma. It was her first time ever in hospital as she is normally a healthy person who doesn't happen to smoke. The doctor there said it looked like a harmless lipoma as well, but she would need a biopsy, just to make sure. He also said it wasn't urgent.

What he didn't say to Mrs Smith but to myself (the attending nurse) was that if he had the time, or the hospital had the money, we'd get it done now, instead of letting her wait another month or more before she had the biopsy. She ended up going to her family doctor again who did the biopsy as it was quicker this way. (It was a harmless lipoma)

You know where I'm going with this yet?

Mr Jones the smoker is an extreme example of a smoker using up thousands upon thousands of pounds of health care over and over again, every time he is admitted to hospital. Most smoker's will at some stage cost the health service money because of their habit.

Mrs Jones has been admitted only once, and in need of a rather minor procedure, her visit a rather cheap visit compared to most, but she didn't get the ideal treatment because of cost.

So, for those diehard smokers who complain about their right to smoke, their right to sit and relax over a pint and light up at their local, especially on a rainy day, I have no sympathy, even if they have are old enough to have fought for their home and country.

Mrs Smith has a right to healthcare. She's not a regular, she doesn't get her money's worth out of the health service, but she does pay for the Mr Jones' of this world to get the best healtcare available to prolong his sufferring.

Don't get me wrong. I'm not heartless and going to deny the Mr Jones' the right to healthcare. I like people like Mr Jones, there's almost something comforting seeing the familiar face of Mr Jones as he's wheeled through the hospital doors. Then there's the banter back and forth over a very serious subject to look forward to. I want to help. All I'm doing is supporting the ban of smoking in public places.

PS As of July 2008, there are 250,000 fewer smokers in the UK since the ban started. In the long term, that's a huge amount of money saved, although it isn't seen in the short term.

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Nurses... we're our own worst enemy

"Hey doc, could you prescribe me some fluids please" I asked, the bag of intravenous fluids already in my hands. "What's up with this one?" asked Dr Munro. "Twenty year old male, intoxicated, conscious, obnoxious" I replied. Dr Munro began to write up a bag of IV fluids for my patient.

"What do you think you're doing?" protested Sue. Unfortunately I hadn't noticed her presence and she had taken another opportunity to go on the offensive. Sue was the nurse in charge of the 'Major' injury department of the emergency room. It didn't matter to her that I was in the 'Minor' injuries department. I thought that I wouldn't have to see her this shift, but she seemed to be stalking me. I shrugged my shoulders, "Just being organised" I replied calmly.

Dr Munro was startled as Sue grabbed the chart from under his nose. "The doctor hasn't even seen your patient yet, give him a chance to do some work. Your patient will have to wait to be seen" Sue said. "Ah, I realise Dr Munro is busy, that's why I'm making things a bit easier for him. It'll be at least another hour, probably two, until he sees my patient, and if I get him sobered up and cleaned up now, then he'll be ready to go home instead of having to wait another hour or two" I explained. I wasn't trying to justify my acitons to Sue, I was trying to make an effort to be polite. I might as well have held my tongue.

"That is not how we do things here" Sue began. I cut her off, "Well maybe you want to tell Dr Munro that, he was happy to do it. In fact this is the way we've been working all night. Perhaps you should ask him if I'm making his job harder" I glanced at Dr Munro who was trying to shrink into his seat. Sue's mouth opened, about to spout out another protest, but I cut her off again "Sue, you saw how busy we were at the start of the shift, no beds free and an overflowing waiting room, and Dr Munro and I have cleared the place out. Just what is your problem Sue?" I realised a little too late that my voice had risen by an octave or two. Sue's face turned red and she stormed out of my department back to her own.

I started the fluids on my patient and had him discharged in two hours. There was no 'Thank you" from Sue, but Dr Munro promised to buy me a round or two for saving his ass that night.

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Going against the parents

At six pm my cell phone rang. I put down my dinner plate and answered my cell phone. "Can you come quickly, he's breathing funny" said the woman on the other end of the phone. "Hello, who is this?" I asked. "Is this the nurse on call?" asked the stranger on the end of the line. "Yes. Now calm down" I spoke calmly in the hope of getting the women on the other end of the line to follow my example. "Now, who are you, and who is having breathing problmes, and where are you?" I asked.

The caller was Mrs Anderson, a teacher on duty in the junior boys' dorm. She was with a boy called Mohammed who was breathing rapidly. The boy had no history of asthma, no medical problems, and according to Mrs Anderson, no sign of any injury. I told her I'd be there in five minutes.

My diagnosis was instant, although I still gave him a full check up. Mohammed was sitting outside on the steps because he said the 'Air was more fresh.' He was breating at a rate of 40-45 breaths per minute. At 85 beats per minute his pulse was fine, and his blood pressure was a healthy 125/75. His hands were beginning to cramp, looking like a bird's claws.

I sat down next to Mohammed. I moved slowly and calmly, every movement, every phrase aimed at creating a calm environment, my body language trying to say 'Don't worry, you'll be ok.'

Mohammed was having what is known as a 'Panic Attack'. With end of year exams about to begin he'd been getting more and more worried the closer exams came. As far as 'Panic Attacks' go this was definitely a good exmple of how nasty they can be.

I spent the next hour talking to him, trying to get him to slow his breathing, trying to have him blow into a paper bag, but it was all to no avail. I called the emergency doctor but he was busy with an emergency and couldn't come to see Mohammed, but he gave permission for me to give Mohammed a medicine to calm him down.

The medicine worked wonders and withing twenty minutes of taking the small tablet he was fast asleep in bed.

"I want the doctor to see him now" insisted Mohammed's dad. I had to hold the phone away from my head as he was nearly shouting down the line. "I'm sorry, but the doctor can't see him, and besides, Mohammed is fine now, he's fast asleep" I said. I had spent the last twenty minutes explaining very simply what had happened, but it wasn't getting through. "You're just a nurse, I want a doctor to physically see him and assess him. Take him to hospital, call an ambulance. I don't care, but do your job. He's my son and you will do as I say."

Nurses are generally understanding people and put up with a lot of abuse, but not when it comes to compromising their patients. "I'm sorry sir, but that would be the worst thing to do to Mohammed right now. It's taken a lone time to calm him down, and finally he is asleep, his breathing is fine. It really would be wrong to wake him, especially to drag him out of bed and take an half hour drive down the mountain. It could trigger another panic attack." I was determined not to wake Mohammed up at this stage, it would be the wrong thing to do, and may even make him worse. I had to stick to what I knew was right, regardless of what the parent said.

"You're telling me what I can and cannot do with my own son. I want a doctor, no, a I want a specialist to see him tonight or you won't have a job by the time I'm finished with you" screamed Mohammed's father. "I'm sorry you feel that way, but I'm doing what I know is right for your son. You left him in our care, you trusted us to make the right decision. That's the issue sir, you're not here to assess your son. I am. If it makes you feel any better I'll be checking on him during the night and will take him to the doctor in the morning. I'll call you then. Goodbye" I turned off the phone.

Mohammed woke the next morning back to his normal self. He was at breakfast with his friends, laughing, running, doing all the things a healthy teenager should. I had made the right decision, alhtough I did wonder if it could have been handled better.

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A Parent's right to know

"Ah, I'm sorry Mr Smith, but I can't tell you" I said. There was a brief silence on the line, then it exploded in my ear. "Who the hell do you think you are? You're just a bloody nurse. I pay your bloody wages. Tell me what I want to know or you won't have a job by the time I'm finished with you." I held the phone away from my ear so the other nurses assembled in my office for this historic confrontation could hear.

Mr Smith was unhappy because his eighteen year old daughter, who was a student at our school, had needed some medical assistance, and he wanted all the details. He felt that because he paid for her to be here then that gave him free licence to look at all her health records.

"I'm her father and I demand to know what she was in the health center for" Mr Smith was beginning to sound like a broken record. "Perhaps you could speak to your daughter. But I can't divulge her health records to you. Even though she's at school, she's legally an adult now. Legally I can't give you her records" I explained. "So parents don't have any rights over their children? Is that what you're telling me?"

It wasn't about parents rights, but the right of the patient to recieve confidential care. Even though the patient is a student at a private boarding school. In fact, confidential care is even more important to a student living away from home, who often feels they have no one to turn to. Sometimes the health center is the only refuge some of these kids feel they have. If they think we are going to tell parents every thing the confide in us, it could in fact work against us, maybe even put students more at risk. I could tell there was no reasoning with Mr Smith, so stuck with the legal argument.

"Mr Smith, legally I can't tell you anything. I understand your worried, but I can say your daughter is fine" I said. "It's damn well not fine. It was a pregnancy test wasn't it, that's what she had" The guessing game had begun. It was time to end this conversation. "This conversation is over Mr Smith" I said. "Well, can you at least pass on a message from me?" he asked. That seemed reasonable enough and I agreed to do so. "Sure, go ahead" I replied. "You can tell her that if we find out it was a pregnancy test, she won't be getting a car for graduation, and she'll be paying her own way to university. Tell her she can give me the records herself, and if her record is clean, everything is ok."

"I'll be documenting this conversation Mr Smith. Goodbye." I hung up the phone, fuming with rage.

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What is Euthanasia

Mrs X has anywhere from hours, days, or even weeks to live. We all know she is going to die. She's on a continuous infusion of morphine, anti-emetics and anti-anxiety drugs, plus having intermittent boluses of morphine. Some nurses are very generous with their extra boluses of morphine, and others not so, although it always depends on how much pain she seems to be in.

Mrs X has a large tumour in her bowel. The surgeon had tried to cut it out, but upon opening her up had quickly closed her back up as there was nothing he could do. The wound had since broken down, parts of her bowel had fused together and she had bowel motion coming out of her abdomen.

At eighty six years old Mrs X was a strong woman, and had lingered in this state for 120 days. Anyone else would have died. She wanted to die, she asked us to end it. We nurses took turns looking after her as it was too much for one person to cope with.

Mrs X hasn't woken in the last 24hrs, although her eyes did briefly open once as she cried out in pain, but I don't think that really counts.

Nurse Y gave Mrs X the maximum allowed bolus of morphine, which didn't seem to help with her pain. She was still crying out as another spasm of pain twisted her body, as the air was forced through her vocal chords.

Thirty minutes later nurse Y gave another maximum bolus of morphine, within the allowed limit of course. Her pain did seem to settle.

Later that afternoon Mrs X died. It may have been hours, days, or even weeks earlier than she was due.

It was legal, specifically it was not defined as euthanasia as it was prescribed by a whole team of doctors. It was right.

In reality it was euthanasia.

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Who's to Blame part II

The silence didn't last long, it was broken with an almost incoherent Mr Wright exploding down the phone line "Who the hell do you think you are? You're just a bloody nurse. Don't tell me how to raise my kids. I've never been spoken to like that before." Even though I hadn't been exactly diplomatic in my dealing with Mr Wright I was still surprised by his outburst. I guess that's what happens when you have a guilty conscience.

I kept my mouth shut about this last thought. The line went dead. The damage was done. But I wasn't worried. The big lie which Mr Wright and Jeremy were part of was a common one. The parent lies to the school, often thinking their child is responsible enough to go to a big city in the center of Europe with their school friends. Next the child lies to their parents, because of course they don't drink, don't party, don't have sex and love visiting museums.

The only person Mr Wright should be disappointed at is himself, and he should not be angry at anyone, least of all his son who never sees his father. The son should be angry that even in hospital his dad can't take the time to see him. I should be angry at having to deal with a child whose father won't take any responsibility for his son. Sadly it looks like Mr Wright will never see this, because he's too busy trying to find someone to blame.

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Who's to Blame part I

"You'll be speaking to my lawyer" said Mr Wright. His voice was so loud I held the receiver away from my ear. "I'm only a nurse, I don't want to speak to a lawyer. I'm the person trying to help your son, Mr Wright." I struggled not to rush my words, struggled to stay calm. "My son could have died, and you let this happen, you know what these kids get up to, and don't do anything to prevent it. It's a disgrace, no, it's criminal."

At the age of fifteen, Jeremy was already a veteran of boarding schools. The last eight years of his life had been spent in a boarding school because his father was an oil man, and went wherever the huge multinational corporation sent him. He was a good kid, but he, along with his father, was guilty of the most common crime here at this school. It just wasn't quite time to tell him this yet.

I tried to change topic a little, move away from confrontation. "Perhaps you should come and see your son, he'll be in hospital a few days. It would help..." I never got to finish the sentence. "Help who? My son or you. I'm a busy man, I can't get away from work. Just do your job. I hold you personally responsible for making sure my son gets well." I found it strange the way he threatens me with lawyers, then expects me to patch up his sick son and holds me responsible. It was time to play hardball.

"Mr Wright, it would be easier if you were here because the Police will probably like to speak to you. To clear up some details." It wasn't exactly the truth, but it wasn't far off. Jeremy had taken ecstasy and been found unconscious outside a night club. He seemed to be making a full recovery, but it could very easily have turned out fatal. The police had actually been the first people to find Jeremy lying on the sidewalk.

"No, no, no, you'll have to take care of that. They don't need me there. Why do they want to speak to me?" I could sense the worry, the doubt. "I'm not sure, but Jeremy is only fifteen, not old enough to book a hotel on his own. You did tell the school that he was staying with an Uncle" I replied. The school only let students leave the campus overnight if they had parental permission that they would be staying with family.

"We are helping how we can, but he was your responsibility. I understand you are worried about your son, but we can't look after children when you don't tell us the whole story. There wasn't any uncle, there wasn't any adult supervision." There was silence on the other end of the line.

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Parents to be...

"Get me a fag woman" snarled Sam. Jenny shrank even lower in her chair, pressing her back hard against the frame, even as she began searching her bag desperately for a cigarette. Even lying on a bed in a hospital gown Sam managed to instill fear in his woman.

"Sam, you can't smoke in here" I explained as I began to change Sam's bag of intravenous fluids."Yeah, just wanna hold it, no harm in me holding it" Sam said. Jenny had given up trying to look for a cigarette and now sat with arms crossed, resting on her distended belly. She looked to be nearing the end of her third trimester, which may have explained why she was in bare feet, even though they didn't look particularly swollen.

"Woman, where's me fag?" Sam demanded. Jenny shrugged her shoulders "Don't have any" she replied. Sam's face turned to me, looking me in the eye "What're they good for eh? Nothing, can't even get her man a fag" Sam said to me as if confiding to a friend. "Well go and get me some" Sam paused while Jenny sat there unmoving, "Now." Jenny got up off her seat, and wandered out into the rain, barefoot, without a coat, and pregnant.

Twenty minutes later Jenny returned, soaking wet, shivering, and handed her husband a pack of cigarettes which he promptly opened and began to light up. I promptly made him put it out. With much cursing and threatening he responded by making Jenny carry his bag of IV fluids while he stood outside the main door puffing away.

Sam was discharged later that day, his wife in tow, barefoot, wet, pregnant, and carrying Sam's bags.

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Never in Twenty Years

Where should the line be drawn? It's only a rehabilitation hospital, not much more than a rest home really. They're not my thoughts, but from what I've seen and heard, that is the impression I get from the staff working there. It just goes to show how much the staff, the nurses that is, can make or break a place.

The hospital looks nice. It looks modern, both on the inside and out. It looks clean and looks well stocked with all the equipment needed to help patients recover from a multitude of ailments. It even passed my bathroom inspection. One of my most important criteria when it comes to judging a suitable ward environment is if they have a big, open, wheelchair accessable shower and toilet. You may think there are other more pressing priorities, but when you've got ten patients to wash before lunch, an easy access shower is a big deal.

The staff looked experienced. They all had grey hair and over a cup of coffee would relish any chance to relive nursing stories, especially horror stories, from days long past. They remembered the days when doctors' were gods, nurses servants, and patients did as they were told. Unfortunately they nearly killed a patient due to complete ignorance.

Mr Jones' chest pain began at 8pm, but he only told the nurses at midnight about his pain as it had suddenly become worse.

"We don't do that here" said Rose. I ignored her remark and placed the oxygen mask on Mr Jones' face. "You can only use the nasal cannula, were' not permitted to give any more oxygen than that. You need to take that mask off now." Rose was standing at the end of the bed, where she had stood for the last ten minutes, not helping me in the slighest.

I had given the patient his GTN (angina medicine) with no effect. His ECG (heart tracing) showed ST depression in all leads (sign of heart not getting enough oxygen) and had called the doctor who was coming in from home and was twenty minutes away. The doctor had given me specific insturciton on what to do, and I followed them exactly. It wasn't hard to do as I was doing what I had done thousands of times before in all my previous years in many different wards, and often in the emergency room.

I had the oxygen up high and asked Rose where the intravenous equipment was. "We don't do that here, this is a rehabiliation hospital" Rose repeated. I realised that I had to do this on my own. I used the IV equipment from the emergency resuscitation trolley and quickly inserted the tubing into a vein. I then drew up some morphine, Rose very reluctantly consenting to sign the stuff out of the locked cabinet with me because "We don't do that here" she said again.

The oxygen helped get the pain from the an 8/10 to a five and his ECG showed some improvement, but it wasn't quite right yet. I administered the first of the morphine, 2mg to start. Within five minutes the pain was down to a 1/10 and the ECG looked almost normal. By this time Dr Gates arrived.

Dr Gates was also a new doctor, only in his second week on the job, so he was caught off guard by Rose. "I'm not at all happy about this. I'm going to have to speak to the head of department. You can't do that here. I know you're the doctor, but we've never done this. It's a rehabilitation hospital."

By the time Dr Gates had extricated himself from Rose Mr Jones was pain free. He had a look at my collection of ECG's and congratulated me on a job well done. Rose was there, arms crossed, face red in fury as Dr Gates said this. "In twenty years we've never done this" was all she could say. Twenty years and you've never saved a life?




I guess after twenty years in one place, with

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The Most Clever Gender

It doesn't seem to happen to women so much. I would even go as far to say that it may be a male genetic trait. If you are between the ages of sixteen and twenty-five, male and in hospital on a friday or saturday night, then there is a good chance you are an idiot.

Young Shaun had been having a good night out, until someone decided to smash a bottle over his head while he was walking home. "That's gonna need stitches" I said as I pulled the flap of skin back into place. I was examining the laceration on the back of his head and guessed three, maybe four sutures should do the trick. "Oh fuck, can't you just patch it, put a bandage on it. I gotta get going, I gotta get to bed." I shook my head. "Well, get on with it then, let's get it over with." Again I shook my head.

It was a busy Friday night and Shaun's wound would have to wait. Instead of suturing him up I placed some gauze over the wound and wrapped his head in a bandage. "I have some other jobs to do first. Shouldn't be too long" I said "What's your hurry. "I gotta go, I have to catch the last night bus home, I ain't got no money left" Shaun pleaded. He looked ready to cry. "I'll be back as soon as I can, don't worry, we'll sort you out" I promised and left to see my other patients.

Over the next half an hour I was approached four times by an increasingly impatient Shaun, desperate to get home. As drunk eighteen year old's go, Shaun wasn't too bad. He didn't swear too much, wasn't threatening, did as he was told, and wasn't bothering the other staff or patients and so I took sympathy on him. "Tell you what Shaun, if you wait until I can sort you out, I'll arrange for the hospital to pay for a taxi to take you home. We don't normally do this, but I can arrange it." Shaun didn't say antything, no `Thank you´ no sign of gratitude. He just shrugged his shoulders.

Half an hour later I returned to find Shaun's bed empty. The receptionist remembered seeing him leave out the main door, intent on walking home. Shaun was no longer my problem.

Half an hour later Shaun was brought in by Ambulance. "What the hell happened?" I asked Shaun as the paramedic wheeled him past me. "Got beaten up again" he said. That much was obvious as he now had two black eyes, swollen cut lips, and the bandage around his head was gone and his laceration was seeping fresh blood from under the paremedic's dressing.

Shaun waitied to be seen and treated this time. In fact he stayed with us the rest of the night and took up the offer of a taxi at seven in the morning, just as my shift finished.

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Nursing, what it's really like...

"Do you mind having him again?" Tracy asked. It was morning handover and my last day of a six day stretch. I didn't know how to look after Mr Jones, in fact none of us seemed to be doing to well when it came to dealing with Mr Jones. I shrugged my shoulders "Fine, no problem" I replied.

By 0715hrs the night staff had handed over their patients and the day was about to begin even though I didn't feel ready to face it quite yet. But that's not an unusual sensation around this place, especially this last week since a staff member had called in sick every day this week and we could only get a replacement nurse for three of those days. Today was one of those days that we couldn't get a replacement.

At the entrance to Mr Jones' room the smell of rot struck, my steps faltered briefly, but I continued on. Mr Jones was lying across the bed, his head pressed against the safety rail, the blankets on the floor and the dressings on his legs tangled somewhere amongst the blankets, leaving his stumps exposed.

Several years ago and multiple surgeries ago the surgeons had begun operating on his lower legs, but they refused to heal. A lifetime of neglecting his diabetes and heavy alcohol meant that the circulation to his legs worsened with each passing year and the ulcers became worse, became blackened dead areas.

Without fail the surgeons kept on cutting back his legs, starting at the toes and working their way up, until now he was just a torso with thighs... thighs that wouldn't heal.

Dealing with Mr Jones was a team event, but I had six other patients so with a guilty conscience I tore myself away from Mr Jones to do a very quick lap of the ward to see if any of my other patients were in a worse state. This ended up taking twenty minutes as my three female patients all needed assistance to get on the commode to relieve their bladders. On my way back to Mr Jones I grabbed my colleague and friend, Sarah, to help out. I promised myself to give Mr Jones the best wash, do all his dressings first, and take the time to sit and feed him myself to make up for leaving him in such a state.

"Get out of it" bellowed Mr Jones when Sarah and I straightened him up in his bed, "Get ya hands off me" Mr Jones was lay helpless between us "I'll call the Police, that's what I'll do." As I looked down at Mr Jones feelings of pity, sadness, and revulsion all mingled within my body. The revulsion came from the trail of slime his stumps had left on the bed as we had lifted him up.

Sarah was busy trying to calm him down while I prepared for the wash. One linen basket, one infections waste basket, one bowl of warm soapy water, fresh linen and blankets, multiple wipes, half a dozen towels (I sometimes get told off for using too many towels), stump dressings plus several other smaller dressing for the small bed sores he has on his elbows and sacrum.

It took half an hour to fully get Mr Jones cleaned, his bed changed, his dressings cleaned and drained. It didn't help that half way through the wash Mr Jones decided to move his bowels (hadn't moved for the last two days) without warning.

Once the hygiene cares were taken care of his blood sugar was checked and breakfast started. Of course his blood sugars were high and he had his usual morning insulin. His protests had eventually died down, but I knew it wouldn't last long, just hopefully long enough for me to take care of my other six patients.

Over the next hour I managed to get my other patients fed, watered and their medications done. I went back to Mr Jones, not in the least surprised to find him lying across the bed, his stumps exposed, his hands picking at his stumps. I had tried everything to try to keep him from being able to take his dressing off, I had even tried the soft boxing gloves which the ward sometimes uses for cases like Mr Jones, but no one had been able to get him to keep his stump dressings in place.

The shift eventually came to an end and I headed home for my two days off before the next six days of grueling care. I mean that's what care is, being willing to do the grueling, sometimes gross work while understaffed, underpaid and misunderstood.

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What's wrong with the NHS

I sometimes wonder if I simplify things too much. When people complain about the care (or lack of care) they receive while in the care of the British health system, I come up with an easy solution. I compare the health system I trained and worked with in New Zealand, to the conditions I usually find myself part of in a typical British ward.

In NZ we have five patients, six at most, per Registered Nurse, whereas in a busy surgical ward in Britain I've have often 12, sometimes fifteen patients, with a student nurse, or nurse aide to help out.

Fortunately British nurses are superb task managers as they can give all the oral medications, then all the intravenous meds, replace IV fluids and maintain them safely. They can also monitor all urnine outputs, make sure no one is consitpated, wash everyone who can't do so for themselves, change the beds, dress wounds, admit any acute admissions, plan discharges, turn bed bound patients every half hour/hour, observe closely any post-op patients, all the while keeping an eye our for any patients not conforming and becoming more ill instead of better.

But I'm merely a simple nurse and my solution is to employ more nurses. But I'm not clever like management as they keep on finding ways to cut staff and keep them at a minimum to save money, to stay in budget.

With all the money they save they will have extra money to pay for all the Agency nurses working at double the money, plus the extra 300% which the Agecny itself earns.

They will have spare money to pay for the complications patients receive from substandard care. Then there are the law suits, the increased staff sick leave due to stress. More money to spend on infection control as it spirals out of contaol. More money to spend on patients who are spending longer in hospital. More money to spend training new staff as everyone with any experience and sense has left for greener pastures.

The list is endless, but I'm just an Agency nurse earning my 30 pound an hour for 11 hours paid work. Although maybe I should start my own agency as they Agency I work work takes another 60 pound on top of what they pay me. That's 1000 pound a day per employee. (I do work night shifts in the ER I should add)

The hospital I work at the most in London is run by fellow Kiwis and Austrailians, all working for the same Agency. We usually outnumber the regular hospital staff. That's 1000 pound a day per nurse, that's a lot of money to be paying out.

There must be more to this management business than meets the eye. I'm just not clever enough to be a manager.

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To speak or not to speak

It began with a simple "Hello" and went downhill from there. "Ah, hi" I stammered, as my mind frantically went into overdrive trying to figure out where I'd seen this pretty blonde woman before. "Can I buy you a drink? It's the least I can do" she offered. Something definitely was amiss because attractive young women didn't generally didn't offer to buy me drinks. I peered closer at her face. Recognition hit me like a sledge hammer. "Ah, I'm fine. I'm ah, drinking water tonight, designated driver, you know. Thanks for the offer." She shrugged her shoulders "Maybe another time then" she said, then turned to the barman. I made my escape.

"Hey, you gonna introduce us?"Jake said to me when I returned to our table. "Yeah, if you're not interested, introduce her to me" offered Simon. Both the boys had been behind me when Sophie (I'd remembered he name by now) had offered to buy me a drink. "Ah, she's not interested" I said, the guys gave me angry looks "What you talking about. If you like her, that's cool, but if not, don't be selfish" said Jake. "Yeah man, don't be selfish" echoed Simon.

What do I say? I couldn't tell them that I hadn't recognized her because I had vivid memories of her foaming at the mouth, or of her painting her room in faecs. I couldn't tell them that I'd looked after Sophie for two months in the psychiatric ward and that even at her best, she would never be quite right.

So I suggested another bar, I bought a round of drinks, and Sophie was soon forgotten.

What do you think? Did I treat Sophie wrong by not introducing my friends? Was I being Prejudiced? Well probably, but for the right reasons. I was just using my common sense. I kept them safe, kept Sophie safe, and kept my mouth shut at the same time. We were all winners.

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Something's wrong, but is it you or me?

There's something wrong. I'm not sure what, but it's getting worse.

Scene 1.
"I've got a sore throat" said Marcello. "How long has it been sore?" I asked. "Since last night" answered Marcello. "Well, I can get you some pain killers" I offered. "I don't want no damned pain killers, I want it fixed" the quiet calm of the school health centre was torn apart as Marcello jumped off the chair and began walking out the clinic. "That's all you do, give me pain killers. I want it fixed." I sat still, refusing to chase after Marcello, and refusing to explain to him again how illnesses and viruses work. He left the health center, late again for class.

Scene 2.
"I've got a sore knee" Murray had rolled up his trouser leg and I was examining a very normal, healthy, strong looking knee. "How long has it been sore" I asked. Murray took a moment to think things through "Well, maybe a year, on and off. If a do a lot of sport it hurts, but if I rest it I'm fine" he explained. "Is it sore right now, right this minute" I asked. "Well no" he confessed. "Well, what do you want me to do with it?" Murray's brow creased in thought, but he couldn't come up with an answer. "I don't know, just curious what's wrong with it."

Scene 3.
"I need some antibiotic cream, and a band aid" said Michelle. I looked hard at her forearm, trying to see where she had cut herself. "Oh, you'll need more than that, I think I'll have to take you to see the doctor" I said. "Really... Thank goodness I came to see you then" Michelle sounded almost happy. My attempt at sarcasm had gone way over her head. "No Michelle. I can't even see your cut. I can't see any blood. I can't see any bruise. I can't see a thing, and if there was something that needed a bandaid, I wouldn't go putting any cream on it." Michelle argued with me for several more minutes before she finally left the health center.

Scene 4.
"I want an x-ray" demanded James. At six foot three he was the tallest fifteen year old in the school and as I sat there staring up at the full height of him, I felt almost threatened. "But you don't need an x-ray" I replied. "My back is sore, it's been sore for three days. I need an x-ray." I motioned for James to sit down, sick of craning my neck. James had been weight training three days ago, and he had been doing some heavy bench presses when he had felt a twinge under his left shoulder blade. The pain wasn't bad. "Are you in pain now?" I asked. "No, but it's sore when I work out. Mum said I need an x-ray. I'm insured, and I have the right to an
x-ray." I'm sure he must be mimicking his mother's words.

I had already explained that he needed to give the weights a rest, but he wanted something that could make him get back training straight away. "An x-ray won't show anything, and it won't stop you from being sore when working out. You need to rest" James' scowl deepened, it was like talking to a brick wall. "You don't have the right to an x-ray either. Your mum doesn't tell me what to do, and I'm not going to expose you to unnessary radiation." James ended up storming out of my office, talking furiously into his cellphone. I subsequently ignored his mother's vicious email and hung up on her when she began yelling down the phone.

Conclusion
I swear I wasn't this like this when I was a teenager. I wasn't soft. When I sprained an ankle, I acutally believed you had to walk on it straight away until the pain went away. It worked. Maybe I'm getting old, maybe I'm getting tired of handing out needless bandaids. Maybe I need a change of scene, some genuine sick people to make me feel better. I wonder if this is what every generation feels. Is this what those of my parents generation felt, frustration at the spoilt, pampered generation that came after them?

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Blame it on Mum

One tequila, two tequila, three tequila floor. As I picked Steve up off the bathroom tiles I used some toilet paper to wipe the trail of vomit from his face. "Can you hear me?" I asked him. There was no reply. "Give me a hand" I called out. Two of Steve's friends came forward and helped me drag him out to the car. "What're you going to do sir?" asked Dan. Dan had been with Steve the whole night, helping celebrate Steve's fifteenth birthday. "Hospital" was all I replied. Dan wisely didn't say anything more, he knew he would be facing the wrath of the headmaster once Steve was taken care of.

The emergency room staff didn't have any luck trying to rouse Steve and the discussion turned to whether or not he needed to be intubated. By this time I began to use my nursing skills as an administrator of medicinal pain to try and wake Steve up.

By squashing fingernails, rubbing my knuckles across his chest and a bit of pressure applied to the inside of the eye socket, I managed to rouse Steve up. He woke with a start, and even though "What the fuck?" were the first comprehensible sounds he'd made since losing consciousness, it was good to know he could be woken and wouldn't need intubation. With the help of some intravenous fluids and a lot of poking and prodding, by the end of an hour Steve was sitting up in bed talking to us.

I eventually took Steve back to the dorm where he lives. I had the help of the headmaster as well as head of his dorm. As I tucked Steve into bed he whispered to me,"Why aren't they yelling at me?" referring of course to the headmaster and the dorm head. "There's plenty of time for that later. Let's just get you better" I replied."I don't wanna go home, they'll kick me out, won't they." I didn't give him an answer, "We'll talk about it in the morning, you just need to sleep" I said instead. "Mum doesn't care, I'll drink more at home" he said, "She lets me drink." I turned out the light and walked out the room, pondering Steve's words.

To cut a long story short, Steve was asked to leave the school. It was his third drinking offense in two months, although this was by far the worst. His mother came to collect him, and this is when things became worrying.

"Did you smell it?" asked Shelley "Or am I just imagining it?" I shook my head, "No, you're not imagining it, I smelt it as well. Spirits, I think, strong spirits" I replied. "And that was no German accent, she was slurring her words. She was drunk. She drove here as well."

We never heard from Steve again, although I think he made it home alive, at least there were no reports of serious road accidents in the newspapers. A child had been sent home with his mother who was at least mildly intoxicated. So what did we do about this.

We looked into the legal issues of working in a school in Europe, whose child is from another country. We could have called child protection services, but as this is considered a non-urgent case, it would takes weeks to get dealt with, and even an urgent case could take days. By this time the parent and child has left the country, flown back to Germany, USA, Turkey, Saudi Arabia. The country is always different, but the outcome the same because we have no power. We lost another child, in all the ways that a child can be lost.

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The Drug Test

"Why me?" exclaimed Mike. I shrugged my shoulders, "Just doing my job, nothing personal." Mike handed me the an empty jar "Well, I can't pee, sorry. I need some water" Mike grabbed a cup out of the cupboard and began to pour himself some water. "Sorry Mike, no water. Might dilute the sample too much." Mike slammed the cup on the bench, water spilling everywhere. "You think I'm guilty, don't ya. You're out to get me" Mike stormed out of the room and headed for the front door. "You can't leave Mike, you gotta stay until you pee. School rules" I said.



Just like last year when Mike was drug tested, it took four hours for Mike to pee. When he finished he handed me the bottle, "Satisfied" he said, sloshing the bottle as he handed it to me, spilling urine over the top and dribbling down the side. Even with my gloved hands I could tell that there was a problem "It's not warm. It's cold" I said. You need to do it again, and this time keep the bathroom door open." Mike took a step towards me, his mouth open, his eyes wide in disbelief. I took a step back. "You've got to be kidding. This is bullshit." I went ahead and tested his sample, which came back clear, but made him sit until he gave us another sample.

An hour later Mike gave me the next sample. "Feel the difference" I said as Mike was holding his sample. "What are you talking about?" protested Mike. I took the sample from his grasp, it's warm, I can practically see the steam rising off it. Mike flung his arms in the air "Whatever" he said, again storming out the room.

"Good news" I said to Mike, "It's clear." "I told you I was clean. You've got it in for me. I'll be telling my parents about this. This ain't over." I made sure it was over "Mike, you seem to be forgetting that you were caught asking another student for their ritalin. You made yourself target. That's why you were drug tested in the first place. Perhaps I should talk to your parents again about this." Mike shut up and got out.

I don't want anyone to be positive for drugs, but it's part of the job. It's nothing personal, but the only students to protest as loudly as Mike have always turned out positive for drugs. Mike is guilty, but he's been very lucky, that's all.

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Psychotic Tales

"Are you the devil?" asked Michelle, peering at me intently. I shook my head "No" I replied. "Are you sure?" she asked again, her voice sounding suspicious. "I'm sure" I replied calmly. Obviously satisfied with my answer, Michelle shrugged her shoulders and wandered off down the corridor towards her room. I headed for the treatment room to get Michelle's dinner time medications, nonplussed by Michelle's question.

None of us nurses are pertubed by Michelle's bizarre questions or behavior because this is just who Michelle is. She is thirty five and has spent half of her adult life in and out of Psychiatric institutions. She rarely has a lucid moment, instead she drifts from one delusion to the next, and when she does have a lucid moment, any truth is so tangled up in a web of mass confusion and delusion it's impossible to tell what is real and what is only real to her. But even more rarely Michelle would surprise us, even shock us, with a very sharp, bitter comment that would bring the reality of being a psychiatric patient home to us. Today was going to be one of those very rare days.



I read the drug chart carefully even though I knew Michelle's meds by heart. A touch of clonazepam to keep things calm, a big shot of chlorpramazine to slow her down, a couple of fluoxetine to cheer her up, and a decent whack of cogentin to counter the side effects of all the medication she takes. I also checked her log book, but she wasn't due her monthly injection of antipsychotic.

I caught up with Michelle in her room sitting on her bead staring at the floor. "I don't want those" she said as I offered her the pills. "Why not?" I asked. "I just don't want them" she insisted "They're bad for you" she added. I sat down on the bed beside her. She still hadn't looked up fromthe floor. "C'mon Michelle, you take them every other day, why not today?" I asked. Michelle kept her head down "I just don't alright. Just go away. Leave me alone. Stop harassing me" Michelle got up off the bed and stormed out.

Michelle was generally a bright, cheerful person, but she did have moments like these when for no obvious reason she became agitated, angry, and sometimes verbally abusive. At times like these it was even more important for Michelle to take her meds to help calm her down. I found her sitting alone in the lounge.

"What do you want now? You following me? I suppose you want me to have your baby" she said. "No Michelle, I just want you to have your medication, that's all. You know it will calm you down, relax you" I said. "Yeah, you just want me to have my rape medication, like everyone else" she said. Michelle grabbed the pottle of tablets from me and swallowed them. "Satisfied. See you round" she left me standing in the lounge, speechless, but horrified, because she was probably right.

Those times when Michelle is not in the ward, but in the community, any bastard could ply Michelle with a touch of alcohol, and with the meds she's already taking, she'd be anybody's. Hell, with the meds she's taking they wouldn't even need to use alcohol as the doses she's on are very strong.

I mentioned Michelle's comments to the other nurses. "She's probably right" was the general consensus.

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Management vs Saving Lives

The crew thought he was going to die, and they didn't know what to do. They were literally thousands of miles from home, a world away from their families. The closest city was a week away. The Russian vessel was fishing in some of the worlds most dangerous waters, within spitting distance of the Antartic ice shelf. The nearest help was me...well, not just me, but me and the emergency room crew whom I worked with, at the southernmost hospital in the world.

"Got it" I called out as I hurriedly grabbed the red phone. The red phone meant that a helicopter was on its way in. Several other nurses gathered around, their heads close to mine as they tried to overhear the call. "Emergency recieving over" I said into the handpiece. "We have a forty year old male with severe abdominal pain, localized to right iliac fossa. ETA twenty minutes." "Message recieved, out" I hung up the phone. I related the message to the others. "Is that all?" said Cherie in dissapointment. Cherie was an adrenalin junkie and if she wasn't jumping up and down on someone's chest or up to her elbows in blood and gore, then it didn't interest her. "That's a bit harsh" I replied, but I found myself speaking to her back as she headed back into the resusciation room.


Twenty minutes later the chopper landed and another three minutes after that our patient was wheeled into our department. Cherie was the first to greet the crew and led them over to my area, the moderate illness area."Suka,pizdec bolit,pomogi blyad" the patient yelled out to us as we transferred him from the trolley onto a bed. He was a giant of a man, a stereotypical iron pumping, Bolshevik, American eating giant. "What did he just say?" I asked. The two men in flight suits shrugged their shoulders "Not a clue" offered Mark, the head paramedic, "But he's in agony, that's for sure. It's his appendix, and it must be due to burst." By this time Jason, the ER doctor was at my side, listening to the handover from the paramedics.

"Kto nibud', nu sdelaite je shto nibud' ebannyi v rot" Yelled the Russian as Jason gently pushed on his abdomen. "I'll get the morphine" I offered, but Jason had other plans for me. "Someone else can do that, get me a translator, now. If we don't get one soon, I'm gonna have to take him to theater, and I don't want to do it without consent." I was hoping someone else would get that job as the bottom of New Zealand is not the easiest place to find a Russian translator.We did have a list of translators, three Japanese, two German, two French, one Romanian, two Polish, one Dutch... there were at least twenty nationalities covered, but no Russian. There was a Russian name there, but it had a line through it. I called hospital management to get them on the case.

"You have a Russian?" said Jenny. Jenny was the day duty supervisor for the whole hospital. She was in charge of both nursing and medical staff. "Yeah, helicoptered in twenty minutes ago. He's not well and we need a translator urgently" I said. "Does he have insurance?" Jenny asked. "Haven't got that far yet, busy trying to save his life." I replied. There was a brief silence on the phone, just long enough to make make me nervous. "You've got the list there in the ER office. There's a Russian on that" Jenny eventually said. "It's crossed out, and there's no other Russian speakers" I said. "Well there's nothing more I can do, you'll have to sort it out yourself for now Don't forget that man's insurance details. I'll come down there in a while to sort things out." The phone went dead.

I would much rather have been at the bedside as it was much easier than trying to find a translator. I asked every nurse in the department but they too couldn't help. I became creative. I called the Polish translator in the hope that they might speak Russian, after-all, they were once under the Russian thumb, but they were no help. The Romanian didn't speak Russian either and sounded almost offended at my ignorance. I called the police, and they said they would get back to me. They never did. My last call was to the High School. "Yeah, we have a Russian teacher, "Vlad Prudchenko" said the headmaster "I'll get him right away." Five minutes later a translator was on his way.

"Skolko stoit?" called out our Russian patient. I looked towards Vlad, the translator. "He want's to know how much." I looked at the doctor for guidance, but our Russian patient had more to say. "U menya est dengi i ya mogu zaplatit'" We all looked at Vlad "He says he has money, five hundred roubles" said Vlad. "Prosto pomogite mne" said the patient. "He's begging us to take away the pain" said Vlad. Jason had heard all he needed to "Tell him not to worry about the money. We'll fix him up and get him back on his ship. No one will come after him for the money." Vlad translated and I kept my mouth shut. The less people that heard this converstation, the less complicated things could get.

Our patient was operated on within the hour. The surgeon said his appendix was only moments from rupturing. We had saved his life. Two days later his ship sailed into harbour and he was there to greet his shipmates, and leave with them as well.

"What's the name of the shipping company?" asked a furious Jenny "We'll get them to pay the bill." I glanced at Jason sitting next to me in Jenny's office. "Sorry, I never got it. I work in the ER, so I didn't see the Russian after he had his surgery" I explained. "I specifically asked you to find out about his insurance, and you did nothing." Before I could answer Jason interupted. "He did ask about insurance, and the man said he could pay. The man's life was in danger and we took him at his word. We didn't have time to chase up the man's paperwork." Jenny alternated between glaring at Jason then me. I tried to shrink into my seat, relieved that Jason had spoken up. "If that's all you're going to say, then the matter is up to the board, and maybe the lawyers. You'll here from me soon. You can go" Jenny waved her hand for us to leave.

I got up, but Jason sat still."Ah Jenny, before you take things further, you might want to think about your actions that night" said Jason. The air could have been cut with a knife. I thumped back down in my chair. "You were called in to help a situation, but you didn't help. You said you would come to the department, and you never did. We are not management, we are the people saving people's lives. You left us to make a decision without support, and we did what we thought was right. I'm more than happy to speak to the board, anytime you want."

We never met with the board. We never recieved a reprimand, and we never heard about the matter again. The only time the matter came up was over a pint of ale that I had bought Jason. I pint he well deserved.

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Breaking the C law,

I broke the C law, not on purpose. Never mind, too bad, he'll get over it. And what is the C law?

"Dear Nurse, thank you for your email, but we feel our son needs to see a doctor as his cough sounds terrible. He complains of being constantly tired, unable to sleep, and states that you do not let him sleep in the health center. As his parents we expect this request to be followed through. We hope to be able to avoid taking this matter further."

"Dear parents,
We will be happy to arrange for your son to see the doctor. We can arrange it for either tuesday or wednesday no problem. I do feel that he is not looking after himself, in particular regards to his smoking, especially as he has asthma. It's a very worrying combination. He has also been away this weekend, and I know he was at a big party and he was found very inebriated. He really needs to rest."

Later that evening, in the corridor...


"Hey Dave" I called out. Dave was only ten or so feet in front of me, walking with a group of friends. He turned at my call. "How's the cough?" I asked. His face hardened, "Fine. Thanks for sticking your nose in my business sir. Thanks a lot" he said, his voice dripping with sarcasm, a hostile glint in his eye. I stopped in my tracks, caught off guard. Dave had never spoken that way before to me or to anyone that I knew. I motioned for Dave to come forward, "Come here, please" I asked quietly. Dave did as I instructed. "What are you talking about?" I asked. "Thanks for telling my parents that I smoke. It's none of your business." I took a moment to collect my thoughts.

"You've got a short memory Dave. After all we've done for you. And now you're angry because your parents know you smoke. Are you going to stop smoking now?" Dave stood at arms length from me, his arms crossed across his chest, his feet in a wide stance. He looked ready to attack. "Yeah. Don't have a choice, or my parents will withdraw me. Who the hell are you to stick you nose in my business?" he repeated. I had heard all I needed.

"You want me to feel bad because you're going to stop smoking?" my voice rose a couple of octaves. "Who looked after you when you broke your collar bone? Who looked after you when you smashed your face on that rock and needed surgery? Who visited you in hospital every day? Who brought your friends in to visit you because you were bored? Who stitched you up when you sliced open your arm? Who drove you from classroom to classroom in the snow when you sprained your ankle?" Dave stood there, his mouth hanging open. His friends had taken a step back, in shock at seeing me tear Dave to pieces. It was a side of me very few had seen.

"Well, I have my rights, Confidentiality and all and I pay your wages" stammered Dave. As stunned as Dave and his friends already were, they were still unprepared for my next onslaught.

"Your parents practically ordered me to take you to the doctor. Your parents are providing for your healthcare, and they need to know the facts. You say you want to...sorry, have to give up smoking now, and you want me to feel guilty about that? Well I'm sorry for caring. You think I'm doing this for the money? You don't pay us to care. Caring people is what we are. Next time you come here, we'll do it without the caring. You can't pay for that. You need to go away and think things through. Oh, and one last thing, don't ever speak to me like that again, or you'll see a side of me you won't like." With that I strode past him without a backward glance.

The next morning

"Dear Nurse,
Thank you for your reply. This is a rather unpleasant information for us; it is the first time we've heard about this; we appreciate your frankness. It is extremely worrying that he smokes with his asthma. He was in hospital several times when he was younger because of his asthma. We will be dealing with this matter immediately.
Again, thank you for your honesty"

Later in the morning

"I'm very sorry sir" said Dave. He was sitting in the chair opposite me. His girlfriend had convinced him to come and seek me out. "Do you mean it?" I asked. "Yes" he replied, "I just never thought things through. I'm an idiot." I nodded my head "Yes, you are an idiot, but we still like you." Dave burst out laughing. "You're the only person that makes me laugh when I'm sick" he said. "It's just part of the job, although it's a shame they don't pay me more for the humor" I added. Dave blushed, got up from his chair, shook my hand and left the room.

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Fictional Scenario, Another Rich Parent

NB: Fictionional event, but this made up scenario is not unusual from parents I deal with.


I sometimes catch myself sounding just like my father, berating the younger generation for their softness, while describing in vivid detail what life was like when I used to bike to school in freezing rain, or minus ten degree frosts. But the kids here don't believe me. They've had life too easy. It's made them weak, both physically and mentally. Or perhaps I'm just having a bad day, but it seems the rich are ruining their kids.

"What's wrong" I asked Sally as she came into my office. Sally slumped down into the chair, let out a huge sigh as if she had the world on her shoulders. She should never take up acting as she was far from convincing. Like all the other students before her, she had not bothered to be so sad and sick looking while sitting in the waiting room. Thirty seconds earlier she had been happily gossiping, joking and laughing, literally the life of the party. She was the epitome of health.

"I can't go to class today, I'm too sick" she claimed "It's my stomach ulcer. It's playing up." She was clutching the middle area of her abdomen, now rocking back and forth. I played along for a while. "Is it a stabbing pain?" I asked. She nodded her head. "Does it come and go?" Again she nodded her head. "Is it lower down, near your belly button?" She nodded her head. "What about food. Does food make it better or worse?" She was silent a moment, thinking of the best answer. "It doesn't make any difference" she finally said. "Then it doesn't sound like an ulcer. In fact it doesn't sound too serious at all" I said. She didn't seem relieved by my answer. "My Dad has one, and thinks I may have one. You can call him if you like." I declined the offer to talk to her father.

When working in a boarding school, there are a few extra questions that are worth asking, as it is always important to get the whole picture. "Do you have any tests in class right now?" I asked. "No, and my grades are good." I then checked her blood pressure, pulse, temperature which were perfect. I listened to her abdomen, gently palpated it, all seeming fine. I then offered her some medication to ease her pain, but she refused, saying she wanted some lemon tea. I got her some lemon tea and over the next hour the tea seemed to ease her pain and she happily marched off to her next class.

The next day, at the same time, she had the same symptoms. "Do you have a test in class today?" I asked. She shook her head. "Well, that's not what your teacher said. I had a phone call from your English teacher, and you've missed yesterday's test. Plus you also have a presentation due today." Sally seemed to forget her symptoms, the stomach clutching, the rocking back and forth. "Are you calling me a liar?" The venom in her voice caught me by surprise. "No, but your symptoms have a strange coinicidence of coinciding with your English class. I'm not saying you're lying about your illness, but you did lie about your tests." Sally got up from her chair "My father will have your job. No one calls me a liar" she stormed out of the office. He's more than welcome to my job.

The next day, I recieved a less than flattering email. It went like this:

To whom it may concern,

This Friday, my daughter had yet another stomach pain, apparently stronger than before. This is not the first time that this has happened as she has constantly been feeling sick during the semester. I believe she might have an ulcer, or even pancreatitis, but I haven't been able to check with a specialist so far due to work commitments.

During Sally's math class, she started to feel a powerful pain in her stomach, more powerful than before, thus she was sent to the health center.

Not only did she have to wait thirty minutes, but when someone finally bothered to see her, the nurse yelled at her to hurry up, was threatening and demeaning.

This nurse, and nothing more, has put my daughters health at risk, both physical and emotional. My daughter was so upset she had to leave and spent the rest of the day sufferring tremendously.

It is unacceptable that a high school, for which I pay top dollar, to have nurses call students liars as they are still just nurses.

I have spoken with my lawyers, and unless I have a full investigation of events, plus a complete assessment by a specialist, and an apology from the nurse involved, things will be taken much further.

I keep thinking of how my parents would react. They would find out the facts, they would begin with polite, but firm enquiries. They would be fair, they would want to know the whole story, from both sides. But my parents are normal, regular everyday people. They don't have the power and money that Sally's father has, but they damn well know how to avoid making a fool of themselves.


With the above scenario, which is common, management tell us to be diplomatic, to apologise for any misunderstanding. That we should listen, understand, and be professional. I don't like it when non-medical people tell me how to do my job.

I couldn't help myself, and told Sally's dad a thing or two.
See my next post.

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My Drunken Ramblings

The ride home on the tube is so long, especially after a busy shift in one of London’s busiest emergency rooms. To help pass the time I usually read whatever I can lay my hands on. This particular evening it was The Evening Standard. There was one article which caught my eye, then made me rather angry.

The further I read the more amazed I became at how utterly stupid politicians can be, but this really is no surprise. The article was about the drinking laws in Britain and the drinking habits of the average Brit. They wanted to relax the drinking laws, that is, allow pubs to stay open longer.

As if the bloody laws aren't relaxed enough already, whoever the idiot politicians are who thought this up must be have made these proposed changes under the influence of a stiff whiskey or two.

“Where do you live? What is your phone number?” I asked. Justin was only twelve years old and been found by the police lying in a pool of vomit in a park. I noted that he was well dressed in good quality, moderately expensive clothing so assumed he had a place to call home. Justin mumbled something unintelligible and I leaned closer to hear more clearly. “Justin, wake up, you need to tell us where you live.” We were pouring fluids into him through a vein to help rehydrate him. “Regges place” he mumbled. Regges place? “Who’s Regge Justin? Is he your dad?” “Regens Bark” he mumbled again. I finally understood what he meant, Regents Park. Right, we were making some progress.

“Hello, is this Mr Cornett?” I said. “Yes, how can I help?” he replied. “I’m a staff nurse at the hospital and work in the emergency room. I don’t won’t you to worry but we have your son, Justin, here with us……Yes, yes, he’s alright, he’s had a bit much to drink.” “WHAT…where did he get drink from? He doesn’t drink? Oh hell, is he ok?” I could hear a woman’s voice in the background. “What’s wrong? Is Justin ok?”

“Mr Cornett, your son is ok, but could you please come down and we will talk about it more here.” Before I hung up I could hear a woman sobbing in the background. I’ve made calls like this far too often.

When intoxicated, legless teenagers are becoming a more regular site in the emergency room; doesn't this suggest that drinking laws are relaxed enough? When intoxicated legless adults are regularly seen in emergency rooms all around Britain and New Zealand doesn't this suggest that drinking laws are too relaxed? When men, women, children and even the elderly are picked up out of the gutter in ever increasing numbers doesn't this suggest that drinking laws are relaxed enough? Exactly how relaxed does the government want its citizens to be? How relaxed is relaxed enough? Is there someone out there that has been missed, someone that has not been seen in their local emergency room already that I need to see next?

The next idea proposed by politicians was to train frontline nurses in how to help binge drinkers address their problems at an early stage, specifically in the emergency room. I pictured myself sitting down beside an intoxicated patient and discussing the finer points of being a binge drinker. They would either be asleep or telling me where to go. Is it not enough that we are already dealing with blood and gore, with violence and death, with overcrowding and chronic lack of staff? More work for fewer nurses is just what we need.

I don’t suppose many politicians have had to deal with a severely intoxicated person? Have they ever had to clean up after them while screaming at security to get them out of the department, let alone tried to alter their drinking habits. You would have more luck trying to convince someone high on cocaine that they should stop; at least they would be able to listen and respond. I suppose we could wait for them to sober up and then educate them, but then I don't want to keep a drunk in my department any longer than necessary.

During my last month working in a London emergency room I saw some prime examples of relaxed drinking like Mr Smith who had fracture his wrist and was complaining about the time waiting to be seen, he had got drunk and wrapped his fist around his wife's head. He's really a nice guy; he only hits his wife on Fridays' after coming home from the pub. Mr Smith waited a long time to be seen.

Mr Brown was unconscious; he had drunk himself into a stupor, apparently the noise from his crying baby had driven him to drink, he just needed some peace and quiet. The baby was dehydrated, cold and covered in muck. He's normally a good father, but he was having such a good time at the pub he forgot all about his child.

Mrs White had a broken nose; her husband thought it looked better on the other side of her head. I didn't know whether to feel sorry for her or not because she had got drunk at home then gone to the pub. She had tripped on some steps and now her twelve month old baby has a fractured femur.

But surely normal people wouldn't be like this? Surely normal people don't beat their wives and neglect their children?

We see more "normal" people in the emergency room with alcohol related problems than we do wife beaters or child neglecters. But it's the real bad ones that stick in your memory, plus they make for a telling story. But each weekend I see more and more "normal" people in hospital with alcohol related problems than I do the real bad ones. Something needs to be done, I just don't know what, but I do know that more relaxed or less relaxed drinking hours is certainly not the way to go. Relaxing the drinking laws may not, in the end, make any difference to the above mentioned people, but do we really want to take a chance? Can any good come of it?

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Bought me a Doctor

Marie rolled her trouser leg to her knee, "Can't you see it?" she asked, looking at me expectantly. I peered hard at ankle, but there was nothing to see. No bruising, no swelling. I gently touched her ankle, moving it up and down, then left and right. She didn't flinch. "I can't see anything, and it doesn't seem sore" Marie let out a small sigh of exasperation. "It doesn't really matter if you can't see it. My doctor back home said I have fluid on my ankle and I shouldn't go skiing. You can't make me ski. I have a doctor's note" Marie put her sock back on and rolled her trouser leg back down.

This was Marie's second and senior year at St Mary's exclusive boarding school and with her long blonde hair, blue eyes, innocent smile and billionaire father, Marie was used to getting her own way, even when her father was several thousand miles away in another country. "Would you stop talking rubbish. You and I both know there's nothing wrong with your ankle. Why don't you want to ski?" I demanded. Marie's face broke into that innocent smile "Why I don't know what you're talking about" she even had the gall to flutter her eyelashes at me. "Fine, I'll just have to clarify things with your dad" I said as I picked up the phone. Marie made a grab for the phone "You wouldn't dare. That's against confidentiality" I put the phone out of her reach and began to dial. "Ok, ok, you're right. There's nothing wrong with my ankle, just please don't call my dad. He'd be so disappointed to hear I'm not skiing" she begged. "Well then just be honest for once and tell me why you don't want to ski."

Marie's smile faded and her expression turned serious "I don't look good in ski clothes." I waved her out of the office, disgust evident on my face. "Let's see what your doctor has to say."

Three days later an email arrived stating that Marie had internal bruising to her ankle and was not to ski. It didn't say which ankle, and it didn't say what she could or couldn't do. I was no longer annoyed at Maria, after-all, she's being clever to get what she wants. I became angry at the doctor she had bought.

"Dear Dr, I'm a little concerned about Marie's ankle. You seem to indicate there is a problem, which Marie has admitted is not true, and is in fact fabricated. Could you please clarify this matter. It would be also useful if you could tell me which ankle is affected as you didn't mention this, plus Marie seems to have forgotten as well. Also, as Marie has had no previous restriction on activity, could you please explain in detail exactly what she can and cannot do. So far this year she has been hiking, biking, ice-skating and climbing among other things.
I look forward to your reply and trust you will set things straight.
Sincerely
The Health Center."

Cherie is off the hook. I've found a new target, the Doctor for sale.

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