6. You’re on your own. You don’t get to know your fellow nurses, and you don’t form much of a bond with your colleagues. You can feel isolated, and miss being part of a team.
Mrs Olsen
Fortunately agencies also help provide long-term jobs. Often the rates are negotiated. I took my first steady job after my initial year temping.
Tracy had wasted no time in finding me a job for three months. It was on the outskirts of London, quiet, often described as a great place to raise a family. Apart from not being at the family stage of my life just yet, the thought of a quiet place appealed to me.
As part of the job, I would be provided cheap accommodation, only a ten-minute walk from work. I was sold. No more falling asleep on the tube. No more getting lost trying to find the right ward… or even the right hospital. No more being woken up at 5.30 a.m. because the agency desperately needed a position filled, even though I had said I wasn’t available for work. This job sounded just what I needed.
Alabaster Ward was like any other surgical ward I had worked in before, except for one minor difference…
‘You’ll be looking after beds 1 to 16,’ Bethany, the charge nurse explained to me.
‘Ah, 16 patients, isn’t that a bit much?’
Bethany looked amused at my comment. ‘You won’t be alone. You’ll have a nurse assistant to help you. Orla usually works on your side. She’s very good, and knows her job.’
I wasn’t reassured.
I didn’t like to complain, especially before even starting work, but I was seriously worried. ‘But only two registered nurses for 32 patients. It seems a lot of work.’
Bethany genuinely didn’t seem to see a problem. I could only assume that this must be all she had ever known. It was the afternoon shift, and this was a common staffing level. The morning shift was a bit easier as there were three registered nurses (RN), bringing the ratio down to about one RN per ten patients, with a nurse assistant each.
I did what every other nurse does when put in a difficult position: I got on with the job and survived, although things were far from perfect. Medication wasn’t always on time. Patients were occasionally not ready for theatre when the porter came searching for them, irritating the surgeon by forcing them to wait an extra ten minutes. Patient hygiene wasn’t always as good as it could be; having only two showers for the whole ward, neither of them accessible by a wheelchair, didn’t help. Wound dressings weren’t always dressed as often as they should’ve been, although I was fortunate to find that Orla was rather proficient at dressing wounds, even though she admitted to me that she wasn’t supposed to do them.
Things like feeding patients, walking them, sitting and talking to them were often left to Orla, as I would be busy doing the things that only registered nurses can do, by which I mean giving intravenous medicines and keeping on top of all the intravenous fluids. Or, if a patient was on a blood transfusion, 20-minute observations. Or, if someone was fresh back from theatre, then they required even closer monitoring. When I had the intravenous meds out the way, I had to dole out the oral meds for 16 patients. Often the drug trolley was lacking in several medicines and a drug round could easily be delayed for half an hour trying to track these down.
The list of things to do was endless, but as much as I suffered under the strain, it was always the patients that suffered the most.
Within my second week on the job I met Mrs Olsen. She was 45 years old, diabetic, and two weeks earlier had had half her right foot amputated because the circulation had died and the tips of her toes had begun to turn black. Poor circulation is very common in diabetics, often as a result of too many years of having high blood sugar levels, which causes damage to blood vessels.
Mrs Olsen had the most unusual foot surgery I had ever seen. It was as if she had placed her foot under a guillotine and had it amputated, about two inches back from where the base of the toes should have been. What surprised me was that there was no attempt to sew the ends together. I could only presume that this was normal procedure, but every time I dressed her foot it had hardly changed. There was a bloody, open stump of a foot staring at me.
‘I don’t suppose I could ask you a favour?’ Mrs Olsen didn’t often ask for much; she was still fairly independent.
‘Sure,’ I replied.
‘I would give anything for a shower. Do you think it’s possible?’
‘How long since you had one?’ I asked, curious to know if any of the other nurses had taken her to the shower when I wasn’t around.
‘A week,’ she replied. ‘I haven’t had a proper wash since the operation.’
If making Mrs Olsen happy meant taking the time for a shower, then that is what I was going to do.
I went in search of a chair that would fit in the shower.
Orla intercepted me before I had accomplished the first part of the mission: ‘Mr Davenport is back from theatre. The nurse needs to handover now, she’s really busy.’
Mr Davenport had just had some of his bowel removed, as well as a large cancerous growth. He had a pump full of morphine, with a cord and a button attached, which he could press to give himself a dose. It’s called patient controlled anaesthesia, or PCA.
His observation chart showed that his blood pressure was low and the doctor had ordered ten-minute checks for the next hour. But worst of all was his respiration rate, which was low, because of the morphine. A normal respiration rate is 16 to 18 breaths per minute in an adult. His were ten breaths a minute.
I responded to the low respiration rate by removing the button for the morphine pump from Mr Davenport’s hand. I called in my assistant to help as we got him washed, changed the bed, replaced his dressing, all the while keeping an eye on his breathing. By the end of the hour, his respiration rate was up to 12 breaths per minute. It was still on the low side, but high enough to be considered safe.
An hour later I returned to Mrs Olsen.
‘I can see you’re busy. We’ll try the shower another time.’
Mrs Olsen wasn’t angry, and didn’t seem surprised, although there was obvious disappointment.
‘We’ve still got time. We could even do it in the afternoon.’
I was determined not to let her down.
But I did let Mrs Olsen down that afternoon.
Fortunately, the next day none of my patients were scheduled for theatre.
‘Is lunchtime okay?’ I asked Mrs Olsen, already knowing what the answer would be.
Mrs Olsen agreed and when lunchtime came around, instead of taking my break, I began preparations for the shower.
I encountered my first obstacle.
‘I can’t find a chair that will fit in the shower,’ I said to Mrs Olsen. ‘Do you think you could stand?’ I asked.
Mrs Olsen was not deterred.
‘As long as you’re there to hold me, we’ll be fine.’
I wheeled her to the entrance to the shower. I briefly left her sitting there as I went in search of Orla. There was a six-inch step that Mrs Olsen would need to hop over, and I didn’t want to risk her falling.
‘I’ll go at the front, you at the back,’ Orla ordered me.
Once she had seen the task in front of us she eagerly joined in.
‘You’ll be sure to catch her if she falls.’ Orla was only half joking, but Mrs Olsen was in fine spirits and thought the whole situation amusing. In fact, this was the most energetic I’d seen her.
With Mrs Olsen squeezed between Orla and me, we got her over the next hurdle and into the cubicle.
‘I can’t get out,’ Orla said, her head peering at me from behind Mrs Olsen’s back.
‘We can all have a shower together,’ said Mrs Olsen, making us all laugh.
‘I’m going to squeeze behind you. Suck in,’ Orla said, as Mrs Olsen pressed herself against the wall, making just enough room for Orla to squeeze past.
With Orla out of the way, the shower began in earnest. Mrs Olsen rested one hand on my shoulder while she held a black, rubbish-bin bag off th
e floor. The clean rubbish bag was the most practical thing to use to keep her foot dry.
‘That’s bliss,’ Mrs Olsen crooned. ‘Turn it up a bit please.’
I turned the heat up a notch.
‘Perfect. I could stay in here all day.’
We stayed for ten minutes, before I wrapped her in towels and, with Orla’s help, eased her over the now wet, slippery step and wheeled her back to bed where she could get changed.
‘I feel like royalty.’
Mrs Olsen had not stopped at just having a shower. She hadn’t put on her old hospital gown and instead put on her own clothes from home. For the first time since I had met her she had make-up on, and perfume. From that moment, it seemed as if Mrs Olsen’s perspective had changed. She began focusing on the future, on getting out of this place.
I finally began to see a change in her wound. It did begin to heal. It dried out and slowly crusted over, although it still took a very long time.
Mrs Olsen continued to make an effort with the small things, like putting on some perfume, or her own clothes, a touch of make-up, or doing her hair nicely. She began to ask questions about how she would cope at home, and exactly what resources the hospital would put in place while she recovered. She also made more of an effort to get out of bed. And although she wasn’t exactly nimble, she eventually managed to take herself to the shower and wash herself, although I did, of course, make sure everything was set up.
She was a new woman.
A positive attitude can have a huge physical impact on healing. It may not be the happy, positive thoughts that do the healing, but in Mrs Olsen’s case, the right attitude helped motivate her to make an extra effort.
MRSA where?
Isabel had been working in Alabaster Ward since she had graduated from college two years earlier. As I had slightly more experience than her and had travelled a bit, she sometimes turned to me for help. I tried to support her whenever I could, but there are some things a man should never be asked to help with.
‘Can you please tell her I’m busy?’ Isabel begged of me.
She was referring to Mrs Livingstone, quarantined in room 12.
‘I don’t have time to listen to her stories.’
Mrs Livingstone was in a private room because she had Methicillin Resistant Staphylococcus Aureusor (MRSA). This is the hospital superbug, which is so often being discussed in the media and parliament. It was unknown whether she had the bacteria present before coming in, or if she had acquired it while in hospital, but it soon became apparent that something was wrong after her operation.
Mrs Livingstone had had her right lower leg amputated from below the knee and when it didn’t heal and began to ooze pus, swabs of the site came back positive for MRSA.
‘But you enjoy her stories,’ I said to Isabel, ‘and besides, you love the chance to talk French.’
Mrs Livingstone only spoke French with Isabel, because she believed it to be a more cultured language – a sign of class. Looking at Mrs Livingstone sitting in her wheelchair in a public hospital, it was hard to believe she was once a high society woman.
‘I must have heard each anecdote a dozen times by now,’ Isabel moaned. ‘She’s very interesting, especially when she talks about the numerous married men she has had. But once she starts, I can’t get out the room.’
I promised Isabel that I would share with her the burden of responding to Mrs Livingstone’s call bell.
‘Oh, it’s you,’ Mrs Livingstone always said this when I answered her bell. ‘Is my nurse available?’
In Mrs Livingstone’s mind, Isabel was her own personal nurse and nothing we could say or do would change her way of thinking.
‘She’s busy right now,’ I said. ‘Is there something I can help you with?’
‘Well, it’s not important. Well, maybe it is. I need to ask Isabel something.’
‘I can take her a message,’ I offered.
‘No, it’s not that important. Just tell her to come see me when she is finished.’ I was promptly dismissed.
‘What did she want?’ Isabel asked when I saw her next.
‘She wouldn’t say. Said she would only speak with you. When you’re free of course,’ I said with a wry smile.
‘Don’t laugh at me!’ Isabel exclaimed. ‘She treats me like a favoured servant. You don’t know how lucky you are.’
Isabel eventually made the effort to go and see Mrs Livingstone. She was in there for at least 15 minutes and when she came out, she looked flustered. She grabbed my arm and took me into the office.
‘What’s wrong?’ I asked.
Isabel began to laugh. She laughed so hard she had tears streaming down her face. It was a while before she was in a condition to answer me.
‘She’s worried about MRSA,’ Isabel began.
I nodded my head. ‘So? She’s had it for a while,’ I replied.
Isabel began laughing again.
‘She wants to know if it has spread. She wanted to show me…’
Isabel paused as the laughter became too much.
‘You’d better get to the funny part.’
‘I didn’t know how to answer her, so I said I would ask you to take a look,’ Isabel said, sitting down to catch her breath.
‘Where does she think it’s spread to? I’m happy to have a look.’
‘She wants to know if she has MRSA on her clitoris!’
‘What… ? Where… ? How?’ I asked, immediately regretting it, because it set Isabel off into another bout of hysterics.
I didn’t go and have a look at Mrs Livingstone’s MRSA, although Isabel eventually did.
She said that everything looked fine.
As bizarre as Mrs Livingstone’s request may sound, it’s very difficult for most people to talk about something so intimate, and so embarrassing. The fact that she made this request of Isabel only emphasised how worried she actually was. And as hilarious as the situation sounds, when your health is concerned, there is no such thing as a silly question.
Deep shit
At 28, I felt I knew a thing or two about nursing. None of the women in front of me looked older than 22 or 23; rather young (at least I thought) to be in charge of a surgical ward.
‘Let’s get started then, shall we?’ said the girl closest to me. She went on to introduce herself as Anna, before pushing a button on the tape recorder in front of her.
Well, this was certainly new.
‘Excuse me—’ I began.
‘Sshh… don’t interrupt handover,’ Anna said, as everyone else glared at me.
I kept quiet and began taking notes.
The tape recording wasn’t the most clear and I was struggling to keep up with the pace of things. I was still writing a patient’s name down, while the recording began spouting out important health information. I looked over at my neighbours’ notes and noticed that they had a printed sheet with everyone’s names.
‘Um… excuse…’ I began again, but was quickly silenced by four sets of eyes glaring at me.
I made do and got down as much information as I could.
‘It’s a bit different, but it works,’ Anna said to me, when the recording had stopped.
‘Um, yeah, sorry, but I’m missing quite a bit of information,’ I said.
‘Oh, you’re looking after rooms 1 to 12. Don’t worry, Beatrice has been looking after that end. She doesn’t like recorded handovers. She’ll be here shortly to tell you all you need to know.’
I breathed a sigh of relief.
Beatrice turned up a moment later and began her report, without as much as a glance in my direction.
‘Right, let’s get started. Won’t take long.’ She then pulled a slip of paper from a pocket, carefully rearranged the glasses perched on her nose, and began to read.
‘Mrs Dickinson, no change. Mrs Truss, no change. Mr Martin has had a good day…’
I cleared my throat.
‘Excuse me,’ I timidly called out.
Beatrice raised her eyes briefly in
my direction, then turned back to her slip of paper and continued reading in this manner for all of her 12 patients.
‘That’s my lot, hope you have a good night,’ Beatrice said. She carefully removed her glasses, stood up and left the room.
There was a moment of awkward silence. No one seemed willing to come to my aid. I knew exactly nothing about any of my patients. Anna eventually stood up.
‘All right, we’d better get started,’ she said. The others followed her out into the corridor. I tagged along as well, just in case I overheard something useful about any of my patients. I quickly caught up with Anna.
‘What was that?’ I asked.
To my surprise Anna’s face turned red.
‘Look, I’m sorry, but don’t worry’ – she actually sounded embarrassed – ‘we have a bedside handover next. She’ll tell you what you need to know then. Don’t worry. I need to get my handover now; you’d better go and get to yours.’
Back at the nurses’ station, Beatrice had collected her handbag, put on her cardigan and was about to head out the ward. I cut her off at the door.
‘Beatrice, aren’t you forgetting something?’ I asked.
She looked at me blankly.
‘What about the bedside handover?’ I added.
She was silent a moment.
‘It was all in my report. Said all I’ve got to say. Nothing further to add.’ She paused for a moment. ‘Oh, there’s a man in room 2, we’ve put his mattress on the floor. He’s been asleep for a while, so I haven’t been in to see him recently.’
And with that she stepped around me, out of the door and down the corridor.
I turned towards my colleagues, towards Anna, towards anyone who could help, but everyone had mysteriously disappeared. Either they were hiding, because they were so embarrassed, or at the bedside, getting a handover, which is what I was supposed to be doing.
I didn’t even have a complete list of my patients’ names. I thought of walking out. It was a dilemma that no nurse should have to be in, but one that happens sometimes: care for myself first, and leave, or care for my patients.
Confessions of a Male Nurse Page 10
