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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