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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