This was the same Rose who’d been with me during my first patient death. She was the acting charge nurse for the late shift. She had as much experience as most of us on the ward put together, but she would never be a full-time ward manager. For her, nursing was a hands-on profession. Hands on patients, not hands on pen and paper. Once you started to move up the nursing ranks to managing you lost a lot of that daily contact with your patients.
Thankfully, Rose approved the move.
What’s so great about room number 5? Just ask Mr Henderson.
‘I never get bored with the view,’ he told Colleen and I as we gave him his bed sponge.
It was early summer and the view from his window was pretty spectacular. It was on the top floor, and looked out over the local gardens and playground. From room 5 you could see mums and dads playing with their children; you could watch as young couples strolled through the rose garden; and, best of all, room 5 was at the end of the ward and had windows on both sides, so it was possible to watch both the sun rise and the sun set.
‘It sure is lovely,’ Colleen said. ‘I don’t think I would get bored either.’
Still, Mr Henderson had been in room 5 for over a week now, but had only slightly improved.
‘I guess it must be frustrating to be so close, yet so far,’ I added.
I don’t often make such shrewd observations, but I just knew that Mr Henderson would give anything to be outside in the fresh air. He didn’t reply, though; he had dozed off to sleep, but little did I know how much my comment had affected Colleen.
It was a gorgeous, early summer Sunday afternoon and now Mr Henderson’s fourth week in hospital. Unfortunately, he had taken another slight turn for the worse. It’s not uncommon for a patient’s health to have its ups and downs. The infection in his lungs had spread throughout his body. The doctors were using terms like sepsis and triple antibiotic therapy, but nothing we administered seemed to make any difference.
Colleen, however, had an idea that she felt sure would.
‘Come on guys, what harm can it do? We’re not exactly busy – we have the time.’
All the nurses in the office shook their heads. Colleen’s idea was to take Mr Henderson, bed and all, out into the garden. It was a hell of a risk to take. If anything happened while he was out there, out of the controlled environment of the ward, we could lose our jobs. If his breathing got worse suddenly, or he had a heart attack, he could die.
‘Look guys, you all think he’s going to die anyway, so why not do this? Who’s going to complain if something happens? He doesn’t have any family, at least none that have bothered to visit him. Imagine if it was your father or grandfather lying there.’
That clinched it – five minutes later we all gave the plan the go-ahead. We even managed to coerce the junior doctor on duty into keeping his mouth shut.
There were four of us in total: two porters to push the bed, one nurse to push the emergency equipment and one for good luck. ‘Don’t stop breathing on us, Mr Henderson, at least not until we get back,’ I said as we wheeled him along the corridor.
‘I’ll try my best,’ Mr Henderson replied.
It was the most upbeat I had seen him in over a week.
We wheeled Mr Henderson out of a side door, along a footpath and into the gardens. Unsurprisingly, people stopped and stared.
Others came over to say hello.
One boy came and asked, ‘What’s wrong, mister?’ and Mr Henderson responded with the happiest look – a look that I’ve not forgotten.
I don’t know if it was the feeling of wind on his face, the sensation of breathing in fresh summer air, the smell of the freshly cut grass and roses, or even the sound of children playing, but Mr Henderson came alive.
‘Mr Henderson’s white cell count has gone down and this morning’s chest X-ray shows less infection,’ said the junior doctor to his consultant. White cells in our blood fight infection – as a general rule, the higher their count, the worse the infection. The consultant just nodded his head as if he expected this, and why shouldn’t he? After all, Mr Henderson was receiving the best care that modern medicine had to offer.
Not only were Mr Henderson’s blood tests and X-rays looking better, but he was looking better himself. The grey pallor had left his skin. His breathing was also less strained. Somehow experiencing the outside world had made a huge difference, where medicine had failed. Perhaps by being so close to all that life and energy, some of it seeped in.
It was amazing to watch Mr Henderson progress: moving from lying in bed, to sitting on the edge of his bed. Before long he was taking his first few tentative steps, soon upgrading from walking with a frame and two nurses to one nurse and a walking stick.
He took his walking stick with him on the day of his discharge.
While the team of doctors quietly congratulated themselves on a job well done, we knew that it was Colleen who had made the difference. She had taken a risk, one that could have turned out very differently. Though, when I look back now, I don’t think Mr Henderson would ever have let us down. He would have stayed alive just to keep us out of trouble.
Helpless, but that’s okay
Sometimes it’s possible to have the best of intentions, but get things wrong; in some cases, there is a very fine balance between doing just enough to help a patient, and doing too much.
It was particularly hard seeing Mr Belford in hospital – he was such a physical, athletic sort of man, even in his eighties. You could tell he had spent a lifetime working outdoors – his body was lean, hard and tanned. He had never smoked and never been much of a drinker. But even being such a fine physical specimen, I still thought he was far too old to have been standing on the back of a truck, unloading cattle.
Mr Belford was with us after one of the cows had become restless and had knocked him from the back of the truck, causing him to hit his head on the ground very hard. The knock had been so severe he had developed symptoms akin to having a stroke.
‘I’ll get them to move,’ Mr Belford said, as he struggled to wiggle the fingers on his left arm.
Only 24 hours since his accident and the fingers were already looking like a set of claws.
‘I hope so,’ I replied – there are no certainties when dealing with head injuries.
Mr Belford had difficulty moving his left leg as well, but thankfully his speech was okay and although he was unsteady on his feet, he was still able to walk with a stick. Mr Belford lived alone, had never married, and had always done everything for himself. Aged bachelors like Mr Belford are generally pretty strong willed, even argumentative.
‘I’m not helpless,’ he said to me one morning, as I laid out his breakfast tray for him.
I had arranged extra-large eating utensils and made sure everything on the tray was in easy reach of his good hand.
‘Just doing my job,’ I replied, trying to make light of his comment.
‘That may be,’ he grumbled, ‘but there are more sick than me in this place. Go take care of someone who needs some caring. I can take care of myself.’
Having by then had numerous dealings with stroke patients, I wasn’t upset by Mr Belford’s words. I had learnt that anger is a natural reaction.
I left Mr Belford in peace – but not without making sure he had his call bell within easy reach.
I felt I knew all there was to know about dealing with Mr Belford’s situation. I was about to learn a simple, but important lesson.
‘Did you see that?’
It was Mr Belford’s ninth day with us, and small miracles had begun to happen.
‘I saw it,’ I replied, as I watched him slowly move his fingers.
The movement wasn’t perfect, it was awkward and uncontrolled, but it was a great sign. His walk had also become steadier, although he would always be left with a slight limp and in need of a walking stick. He would never be able to climb on trucks or herd cattle again. Despite all the progress, things were going to be different now in Mr Belford’s life; he could
never be completely independent again.
‘Can I help you with that?’ I asked, as he began to button up his shirt.
His affected fingers weren’t nimble enough, so he was struggling with his good hand.
‘I’m okay,’ he replied.
‘Are you sure?’ I asked again.
He was really struggling. I watched as it took him two minutes to do up one button.
‘Here, let me,’ I said, as I quickly stepped in.
‘Get ya hands off me,’ Mr Belford bellowed at me, as if I was one of his farm dogs.
I leapt back, stammering an apology, ‘I only wanted to help.’
Mr Belford stared at me in silence for a moment. The angry expression on his face began to fade.
‘I know you mean well, lad,’ he said.
Embarrassed, I felt my face redden.
‘But my life is different now. I can’t do the big things I used to do only a couple of weeks ago.’
His voice was hoarse. He’d always shown the tough, weathered old man-of-the-land exterior. This was a new side.
‘But the small things mean a lot now – like making it to the toilet on time, doing up my shirt, cooking my own dinner. It may take for-bloody-ever, but it’s important.’
Mr Belford was eventually sent to the rehabilitation unit, where he spent another three weeks. In that time, not only did he continue to do well physically, but everything was put in place to make sure that when he went home, he would be as independent as possible. Things like handrails being installed in the toilet and shower. A cleaner was arranged to help once a week, as well as a district nurse who would also be visiting him weekly. He was assessed to make sure he could cook his meals, and his neighbours were made aware of his situation and they promised to keep a close eye on him.
Thanks to Mr Belford, I started to think twice before rushing in to help right away. I learnt to be patient, and realised that the little things can mean a lot to a person, and make a big difference.
Golden years
During my time in Ward 13, the number of men I saw with prostate problems was extraordinary; it was almost as if they were an accepted part of ageing. Almost all of our urology patients were men needing some form of prostate treatment. (There were exceptions: the occasional female patient, who certainly wasn’t there to have their prostate checked – although it wouldn’t have surprised me to find someone looking for it.)
Some things get better with age; other things can only be appreciated with age. I am quite a long way from my golden years, but the more I dealt with the elderly, the more I found myself wondering if I would eventually suffer some of the ills that often come with growing old – and when. I started questioning whether my own water flow was as strong as it used to be. I’d never previously worried about how far I could pee or how easily I could make the colourful blocks of deodorant sitting in the bottom of the urinal move.
And, if I was worrying then, imagine how the patients with actual diagnosed prostate problems felt.
Mr Riley was desperate when he was brought into the ward. He had never had a problem with his waterworks before, although he had noticed that he was peeing smaller and more frequent amounts lately. He thought he could solve the problem by drinking more – and that is just what he did; he drank litre after litre of water. So, it was a bad time for his urethra to block off completely.
When we met him, Mr Riley was writhing on the bed in agony.
‘Please do something – please oh please – the pain is unbearable,’ he pleaded.
His looked to be a simple problem, hopefully easily fixed, so I didn’t waste any time getting Dr King, the junior doctor, to see him.
I didn’t want to palpate the bladder, especially as I could see it protruding up from his lower abdomen, so I left that part to the doctor…
‘What the hell was that for!? I could’ve told you it’s full.’
Mr Riley nearly went through the roof as Dr King gently pushed on his lower abdomen. It wasn’t really Dr King’s fault – he was just doing what he had been trained to do: a complete and thorough assessment. He was a bit shaken, but he was new and probably hadn’t seen someone in this much pain from a blocked urethra before.
‘Perhaps we could catheterise him now,’ I suggested.
The doctor readily agreed and we got started.
I don’t have words to describe the look of relief that swept over Mr Riley’s features as the catheter was inserted and the pressure finally released – but I’ll try anyway. Imagine spending a night out on the town drinking and waking up in the morning in urgent need of a pee. Now imagine that no matter how hard you tried, you could not pass a drop. Every minute, every hour the pressure keeps on building, the sensors in your bladder overloading with pressure, they’re screaming out at you to do something, but there is nothing you can do. Then suddenly…
‘I can’t believe it. It’s no wonder I was in agony,’ Mr Riley said, as two litres of urine drained from his bladder.
You might think it impossible for a bladder to hold two litres of fluid, but what happens in cases like Mr Riley’s is that over time the bladder slowly stretches… and stretches. It took ten minutes to completely empty.
Mr Riley was now on the prostate surgery list; he was entering his prostatic golden years.
Unfortunately, the waiting list for urological surgery is often long and there are many older men sitting at home with a tube of their own because their plumbing has blocked up. Some of these men have spent longer than twelve months like this. Mr Riley didn’t have private insurance and he now had to adapt to this new stage of his life.
It is unfortunate that we often have patients coming in to hospital because they have acquired an infection that has crept up this tubing and into their bladder, or patients whose catheters had blocked up because their urine was full of foul smelling lumps of dead tissue and bacteria. It seemed to me that more time and money was spent in the long run from these complications. And if anyone is going to get a complication it is most likely to be the elderly.
The veteran
Tom, Simon, Daryl and Joe were four patients who put a lot of trust in their urologist. At 75, Tom was the oldest of the men. He was a prostate veteran; this was going to be his second operation in three years. The rest of the men were virgins – all in their sixties and about to have a trim.
Being four men in the same room, all about to have the same operation, enabled the men to share notes and generally have a laugh (albeit a nervous one) at the situation.
‘You gotta drink lots of water, that’s the secret,’ Tom would repeatedly tell the others. He enjoyed being the expert – although this was almost all the advice that he could remember to give.
He was right though – plenty of water to flush the blood away. The prostate can bleed a lot when it is cut, and you don’t want it to clot and block off the urethra. Drinking plenty of water helps produce more urine, and reduce the risk of clotting.
I was just relieved that none of the men had heart failure. Heart failure means your heart is struggling to pump the blood around your body. If you add more fluid, you put more strain on the heart.
There was only one other piece of advice that Tom managed to remember – and it was a tip I wished he’d forgotten. Tom had the other men so in fear of me that they were distracted about their operations the following day.
As the men spoke about what I was going to do to them, I stood outside their room, hidden. Timing was everything: at the height of the discussion, I burst into the room.
‘Okay boys, who’s first?’
Silence.
It was six o’clock in the evening and it was time for the boys to have what they had been dreading. It was enema time. I didn’t want to give the boys a chance to get away, so I had given them no warning. I entered their room fully armed and ready for action.
The protests began immediately.
‘I’ve just been to the toilet; you don’t need to go waving that bloody thing round, you might poke a
n eye out,’ said Tom.
The others followed his example.
‘Yes, I’ve been to the toilet as well; I refuse to have one.’
‘You can’t force that on me, I have rights.’
The reason for the enema was simple. The doctor didn’t want to risk his patients becoming constipated, as this would put pressure on the prostate, and potentially increase post-operative bleeding. (Just for the record, they check your prostate by sticking a finger up your backside.)
When I explained to them that it was either have an enema or the surgeon wouldn’t operate, the men soon gave in.
But I still had the difficult job of choosing who to give the enema to first. I knew that if I picked the wrong man, he would kick up a fuss and exaggerate about how uncomfortable the procedure was. Since it was all Tom’s fault, I briefly considered doing him first; instead I picked Joe because he seemed the quietest, but sure enough, I picked the wrong man.
‘It’s blackmail, that’s what it is,’ he complained as I tried to pry his buttocks apart.
‘Stop fighting me and bend your knees up more,’ I ordered. ‘You’re making this much harder than it needs to be.’
I managed to see the target and tried to insert the tube.
‘Arrrgh…’
I began to squirt the water, hoping to get some inside.
‘Arrrgh…’
Joes butt cheeks were so tightly clenched, I was miles away from the bull’s eye and water was dripping down all over his backside and my gloved hands.
‘Joe, just relax and it will be over soon,’ I kept on saying.
‘Relax,’ he said with indignation, ‘relax? You lie here and let me stick things up your arse and try to relax. Arrrgh.’
He may have had a point, but I had a job to do. By the time I had finished, more enema fluid had spilt around Joe’s buttocks than up his rectum, but I had had enough and so a truce was called.
Confessions of a Male Nurse Page 6
