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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