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.

Read more!

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?

Read more!

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.

Read more!

Ashtmatics Anonymous, part II

"Hold on a second, you come in here, two o'clock on a saturday morning, wheezing, coughing, smelling of booze, reeking of smoke and complaining that your asthma medicine doesn't work. And you say I'm judging you!" I only raised my voice a little. I could feel the adrenalin begin to surge in my veins, my haclkes beginning to rise, any thoughts of diplomacy evaporating. Darren began to protest, but I cut him off. "I then give you medicine, which you say doesn't work, and you say I've got an attitude." I turned my back on him, about to walk away.

"Hey, I'm sorry man" Darren called out. I turned around, looking at him expectantly. "I'm just so tired, sick of being sick" their was a note of desperation in his voiced. I softened my tone as I judged him ready to listen.

"How old are you?" I asked him. "Nineteen" he answered. "Do you live at home?" I asked. "Moved out six months ago. Living with some friends" he replied. "Were you always sick when you lived at home?" he shook his head. "How much and how long have you smoked?" I asked. He shrugged his shoulders, "Couple of years I guess, although only on weekends. That was when I was at home" he said. "And now?" I prompted. He shrugged his shoulders again, his body language trying to say, I don't care, but the incongruency between the visual and the spoken message was stark. "All the time, but it doesn' affect my asthma. The medicine just doesn't work anymore." I chose to avoid talking about the smoking for now.

"When did you last see your doctor. Maybe he could try you with some different medication?" I said. He looked at me in surprise "Two years, I think. What other medicine you talking about?" I went to the respiratory cupboard and took some of the various inhalers we had available and spread them out on the bed. "There's quite a few. Have you ever heard of a preventer?" He shook his head, "What exacatly do you mean by preventer?" I picked up the brown inhaler, "Just what it says, a medicine to help preventing you from having an asthma attack." He picked up the inhaler "It won't work on me. Nothing works" he moaned. It was time to get tough again.

"Darren, start acting like a bloody adult or move back home. Take some responsibility for yourself. Stop moaning and take some initiative. I'm not the person to tell you what you should do, and I'm not going to force you to see a doctor." Darren stared at me defiantly, "Fuck you. You can't speak to me like that?" I began to walk away again. "I just did. Get over it. Here comes the doc, don't be a stubborn idiot with him" I went over to the work bench and wrote down a number. "When you get out of here, this is the number for the asthma educator. It's up to you. Make the call. It may save your life. It's free as well" I handed him the slip of paper and left the room. I let the doctor know all that had happened.

Two weeks later, in a quiet moment in the emergency room, I made a quick phone call. "Who are you again?" Asked Sheila. "I'm calling from the emergency room. Just wondering if you've come across a guy called Darren Smith" I asked. "I'm not supposed to give out inforation" she said "Why do you want to know?" I briefly explained what had happened. "Yeah, I saw him, and I'll be seeing him again. He was a nice young man, he really seemed to appreciate all I did" there was a strange lilt in her voice, almost one of satisfaction, accomplishment, or maybe she even proud. "So you could do something for him?" I asked. "Of course. He was in a terrible way, but we've got him on the right track now." I thanked Sheila and hung up the phone.

Read more!

Asthmatics Anonymous part I

"It's always bad" Darren bent forward, hands braced on his knees, wheezed several breaths then continued, "The medicine never works." Not only was Darren's breathing wheezy and ragged, but
from the head down to his toes he looked unkempt, dirty, contagious even. His hair was greasy and uncombed, his face had at least a weeks growth. His clothes were covered with stains from at least several meals. Even his shoes had holes where his big toes were peering through.

"What medicine have you been taking?" I asked. He handed his ventolin (asthma) inhaler to me. "It's empty" he gasped "Ran out last week." I took a deep breath and sat down on his bed, a voice inside my head saying 'be patient, be patient' with the poor lad. "Ah, so your asthma has been bad for the last week?" I asked. He nodded his head. "And you haven't had any medicine in that time?" He nodded his head again. "Ah, can I ask why you didn't see someone sooner?" Darren kept his head bowed, unwilling to, or perhaps too exhausted to make eye contact "It's useless. Asthma medicine doesn't work for me." I placed a nebuliser mask over Darren's face, a mask containing the exact ingredients that he claimed didn't work.

Three nebulisers later and Darren's wheeze was much less audible and his breathing more relaxed. He was no longer sitting on the edge of the bed, hands on knees. He was able to sit back on the bed, although still in an upright position. A small victory, at least in the physical sense.

"I thought you said the medicine didn't work?" I kept my voice emotionless, as non-judgmental as possible. "The inhalers, they never work, I want what's in the nebuliser" he was able to look me when he spoke. "It's the same medicine" I replied "But you don't look like you've been looking after yourself. How much do you smoke a day?" His clothes reeked of smoke. "I didn't come here to be lectured. You don't know me, so don't judge me." Oh dear, to think I'm trying to be sympathetic, to think that this is his reaction to my nice side, how will he react when he sees my bad side?

Read more!

The Conflict

"Don't forget to note down any problems with the new health log" Cherie said enthusiastically "The computer guys want our input and are happy to make changes" Cherie waltzed out the room, her orders delivered. I turned back to the monitor, my brow creased in concentration. We had four hundred students at our boarding school and we still had three hundred and ninety still to put on the computer system.

The new computer record keeping system for the health center was good, but my fingers kept on tripping over the keyboard as I silently cursed the Americans. The problem was that when inputting patient entries for current events eg Simon has a headache, given paracetamol, the system accepted the regular system of date eg day, month, year. But when I went to put in the patients previous health information to update their overall health information eg vaccination records, it accepted the American date system ie month, day, then year.

I did as Cherie had instructed and noted the small fault with the system, feeling secure in the knowledge that my fumbling was serving a purpose, that is, to make the system better. Little did I know that a storm was brewing.

The next fault I spotted was when inputting the patients height and weight there was no place to put a date, an easy mistake to make and one easily rectified. I noted the glitch and got back to work.

"How's it going" without knocking Cherie barged into the room and stood over my shoulder, reading the information on my monitor. "Ah, fine Cherie" I stammered, "Taking a bit longer than I should, but slowly getting there" I swung round in my chair, coming face to breast with Cherie. A shudder passed through me and I looked up, our eyes making contact. "Why is it taking so long? I'm racing through them. Once you get going, it's quite easy" she sounded sympathetically disbelieving, but her eyes said 'You useless bastard'. "Well I have a couple of small things to improve upon" I suggested. "Oh, really, the system seems pretty fine to me. What's the matter?"

"Well, it's not really a big deal, but the system uses two different date systems. One part uses Amercian and the other uses the normal way" I then demonstrated on the computer exactly what I was talking about. "Oh, didn't notice that. Hasn't been a problem for me. Just be careful with the date and you'll be fine." The matter of the date was now dismissed.

"What's the other matter?" she asked. I turned back to the computer, "Oh, it's nothing" I said, don't worry about it" I said reluctantly. "No, I want to hear it, anything to make the job easier" Cherie's smile never faded, her false cheer more see through than ever. "Well, it would be good to have a date next to the height and weight" I tentatively suggested. "Oh, don't worry about that. We height and weight them on admission, so the date is the same for everyone" she said. "Ah, but the ones who have a completed physical, when we transfer that data into the computer, we need to put down what date the physical was done, it's sometimes months old." The smile faded at last "Yeah, but you can just write it at the top, where it says General Condition." "But everything else has a date, so why not this. I'm only trying to make our job easier" I said. "Don't interrupt me, I haven't finished speaking" Cherie brushed back her hair with a quick backhand movement then crossed her arms in a defensive posture. "There's no point. Just write it in the top. It's not that important" With that Cherie, my colleague, not my boss, left the room.

The fun and games had just begun.

Read more!

The basics of nursing...again

After four years temping in London, it's really hard to trust someone else to do a part of the care. This is mainly because of staff shortages and a corresponding lack of reliable aides to fill this shortage.

I've had aides that copied vital obs because they couldn't do a manual blood pressure. I've had aides who didn't know what was a good or bad blood pressure.

When working in london, with anywhere from 7-16 patients I have to rely on others to do the basics, but the fact is that the job is rarely done as good as I would like it. The result is that I'm not happy with the care patients are receiving, but I am helpless to do anything as the workload is too huge. I'm am not exaggerating when I say that in an afternoon shift I've been stuck with fourteen surgical patients, plus another that was admitted around dinner time. The Aide called in sick and the charge nurse got a second year student nurse to help me. Needless to say I soon left this job, in fact I walked out at around seven pm after an argument with the charge nurse.

Anyway, in my home hospital in New Zealand, we have maximum six patients per registered nurse. If you have a particularly heavy load, then you will have less. With this system you stay in touch with the absolute basics plus you have time to do the fancy stuff with all the new gadgets/technology etc. We have one nurse aide who circulates throughout the ward helping with bed making/washes etc.

On a more personal note, it is sad that we are too busy to do the simple jobs eg feeding patients. It is sometimes relaxing and therapeutic to sit with a patient, and spend some time talking, laughing, while performing a simple task. The more we move away from this contact, the more like a doctor we are becoming, eg assessing, diagnosing and treating. This is not what we are.

Read more!

Doctoritis... I was once guilty

Yes, once upon a time I suffered from Doctoritis, although at the time I was straight out of college, so I can blame it partly on my youth. But the rest of the blame lay with Dr Steele.

You see, I was an impressionable young man and Dr Steele had it all. He was a twenty nine, tall, handsome, worked out at the gym and had the muscles to prove it. He also had every women in the hospital in love with him. I pictured myself in his shoes. I thought that this is what being a doctor is like and that I wanted to be one. I was reluctant to tell strangers that I was a nurse, especially as a common assumption was that male nurses are usually gay. This is not the truth, although there are certainly a fair few represented.

Like all young nurses I was good at one thing, spending money on nights out on the town. Quite often Dr Steele would join us and it was always entertaining to watch Dr Steele in action. Out of the many nights that we spent on the town there was one moment which is still so vivid. It is so vivid because it when I first thought I had made a big mistake, I actually thought "Oh shit, I'm should have been a doctor, not a nurse."

That particular night a visiting women's netball team was visiting the city and we met up with them at the local pub. The bar was a U shaped bar and were on one end of the U and the visiting ladies were on the other end of the U. I watched as several attractive ladies kept glancing at Dr Steele, hoping to catch his eye. One of them succeeded and Dr Steele went into action.

He was drinking a cocktail and began stirring his drink with his straw. The woman whom he'd made contact with copied his motion and began stirring her drink with her straw. Dr Steele then gently began to poke his straw in and out of his drink, a motion which the woman copied. She then made her way over to us. After Dr Steele explained that he was a doctor, within minutes they had left the bar.

An hour later a grinning Dr Steele returned to the bar. The night was young and there was the rest of the netball team still to conquer.

I do not want to be a doctor and I am happy I am a nurse, but as I said, I was young and impressionable. I have been a nurse for thirteen years and you don't stay in this line of work that long if you're not in it for the right reason. And now, as an older nurse it is entertaining to watch the new, young, bright eyed students succumb to Doctoritis.

Read more!

Dress Code

So, the British Health Providers have been busy proving that they are a great big waste of space. They have printed out an 8,000 word publication telling staff how they should dress. Some of the recommendations included making sure staff had matching shoe laces as well as making sure that your hair is its natural colour. High heels should not be worn either. It then talks about safe clothing eg flat soled shoes, neckties and loose jewelery etc etc etc...

Anyone who has any experience dealing with patients, especially heavy patients requiring lifting, washing etc knows what is appropriate to wear and what is not. Considering that most nurses at some stage get sore backs no matter how careful they are, not once in thirteen years of nursing have I ever seen a nurse trying to lift, wash or transfer a patient while wearing high heels.

Thank goodness we have management that can take the time explain to us how to do our job, a job which many of them have never actually done. Obviously management have too much free time on their hands. They justify their actions by saying it will help reduce infection rates. I really don't see how matching shoelaces and hair colour affects this.

On a more personal note, I used to enjoy it when the nurses didn't wear a petticoat under their white uniform and they stood by the window with the morning sun shining through. I'm sure they did it on purpose.

I also love those who used to wear black or red sexy lingerie under their white dress. It really made it worth going to work.

On a more serious note, I think we look pretty good, and if someone was looking a bit scruffy, the charge nurse always sorted them out. No need for a 8000 word essay about it.

Read more!