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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Nursing Nightmares

It was eight o'clock at night and I was reluctatnly preparing for my nightshift. I had been sold on the idea of working in one of Britain's newest hospitals, agreeing to a three month contract in a surgical ward. Without even working in the place, I'd moved out of my apartment in London and was currently boarding with a little old lady in a city called Downtown.

"You've got beds one to twelve again" Sharon told me. Sharon was the nurse in charge for the night. She was only one year post grad and I couldn't imagine myself in her position at that stage of my career. It was my third night on end and I knew the patients well so I began my first round for the night. The first two rooms were rooms were side rooms and nothing was amiss with the patients there, but that all changed when I went to my first six bedded room.

"Evening ladies" I said as I walked into the room. The ladies greeted me with warm replies, except there was one voice missing. I walked over to Mrs Smith's bed, the only patient apparently asleep in the room. "She's been asleep all day" Mrs Jones, the woman in the bed next to Mrs Smith, whispered to me. "Asleep all day, are you sure?" I replied. "The doctor seen her. She won't wake up" Mrs Jones didn't sound worried. Alarm bells began to ring in my head. "Mrs Smith" I called, gently giving her shoulder a shake. I called again, a little louder, giving her shoulder a much firmer squeeze. Still nothing. I tried the fingernail squeeze, and eventually a sternal rub, all to no avail. I went in search of Sharon.

"Sharon, I need your help" she seemed a little irritated that I had interrupted her during her medication round. "Get one of the assistants" she replied, without even giving me a chance to explain. "No, it's about Mrs Smith. She won't wake up" I felt sure that this news would shock her, but she shrugged her shoulders. "It's ok. The doctor has seen her, she's had a scan, even the consultant has seen her." She turned back to her medication trolley, obviously thinking the matter was over with. "But she's unconscious. You can't leave an unconscious woman unsupervised in the middle of a general ward. What about her airway? What if she vomits?" I was too stunned too be angry, yet.

Sharon was getting angry, "The consultant has seen her, and he's happy for her to be there. If you want, you can get an assistant to check in on her regularly." Sharon seemed unable to grasp the fact that Mrs Smith was a very high risk patient "Her airway is unprotected" I said again "It doesn't matter how often we check on her, it only takes a minute or two for her to die." Sharon was not going to give in "I can't change a thing. It's the doctor's responsibility." With that she grabbed her medication trolley and wheeled away from me.

Mrs Smith was only fifty seven years old and was recovering from a minor surgical procedure. She was normally fit and well and had no previous medical problems. I became angry, not just at the utter negligence of my colleagues, but at the position I was put in. What if she stopped breathing on my shift. What would a court say if they asked if I felt comfortable leaving her there? How would the court react when I said I didn't feel comfortable? They would then say why didn't I do anything.

I did the best I could. Every half an hour I went in to check on her, and every time I approached her bed I felt sick to my stomach, wondering if she would still be alive. I tried waking her each time, and got no result. It's not often you see a patient that is truly unresponsive, but Mrs Smith was up there with the worst of them.

At three in the morning when I tried to wake Mrs Smith, she opened her eyes. "Hello" she said, sitting up in bed, as casually as if she was waking from an afternoon nap. "What time is it?" she asked. "Ah, it's the middle of the night" I began to explain. A look of surprise crossed her face "Middle of the night. But it was just morning" she said.

I called the night doctor to tell him the wonderful news. "That's good" he said. "Um, don't you want to see her? Do an assessment? She's been unconscious nearly eighteen hours" There was a pause on the end of the line, "Ah, ok, I suppose so."

By morning Mrs Smith was back to her normal self. She was ravenously hungry and I made her an early breakfast.

Mrs Smith was unique because I had never seen a patient suddenly lose consciousness for no reason, all her tests normal, then suddenly wake as if from a relaxing deep sleep, with no side effects. What I have also never seen is the complete negligence from a medical team, from both the nurses and doctors'. Mrs Smith may not have recovered because she may have been dead, may have aspirated, or vomited, or her airway may have blocked some other way, well before she made such a miraculous recovery.

I lasted another two weeks at that hospital, then quit when things continued to get worse.

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