So, if ever you find yourself in the emergency room, or even admitted to a ward, here are some simple things to remember:
1. Listen to our advice. If we say ‘Don’t have a shower because you’ve just had your appendix out’, then don’t have a shower. I’ve lost count of the times I’ve waited outside the cubicle and caught a collapsed young adult.
2. Be sober. It’s rarely just a matter of being intoxicated, there’s nearly always some other complicating factor, like being found unconscious, so we can’t find out the history. This may mean spending the night in the emergency room, which neither of us wants.
3. Have a sense of humour. Sometimes there is no point in getting angry. Laughter really can be the best medicine.
4. Be nice and be patient. I don’t really have time to serve you tea and biscuits. However, I have done it before, and I will probably do it again. But if you’re not nice, I won’t do those extra things that aren’t really part of my job, but can make your stay much more pleasant.
5. No matter what hospital you find yourself in, never start a conversation with ‘I demand…’ The triage nurse has all the power, and it is she (or he) who decides who will see the doctor next. If your problem really isn’t urgent, you’re liable to find yourself waiting a very long time.
6. Don’t withhold medicine. It’s surprising how many patients come to hospital for some minor ache or pain, without having taken any pain killers. The common assumption is that the doctor will want to see just how bad things are. But you’re likely to find the doctor prescribes simple paracetamol.
7. Be honest. We’re not policemen. If you’ve taken drugs, we won’t report you. We won’t even tell your parents. Being honest may also save your life.
8. Remember Murphy’s Law. Don’t be difficult, picky, demanding or ungrateful. The bad luck experienced by unpleasant patients and families is uncanny. If equipment is going to malfunction, or an unexplainable complication is going to occur, or we are going to run out of a particular medication, it almost always happens to the patients already making a fuss.
The big difference
I’ve learnt a lot about being a nurse over the past 16 years, but what have I learnt about being a male nurse? Actually, that Cherie, my first mentor, was right: nurses are nurses first, and women or men second.
But it can’t be denied, there are some differences that are too big to avoid. Most importantly, there is a big difference between a male and a female nurse when it comes to private parts. Hold on a moment, you’re probably thinking something rather basic, but what I’m referring to isn’t quite so simple. It’s when dealing with the private parts of patients that things become a bit complicated.
I’ve known of male patients asking female nurses to help them put their penises in a urine bottle. The experienced nurse happily grabs a sharp-toothed pair of forceps to seize the helpless man’s member and insert it into the bottle. Unsurprisingly, there is never a repeat show. This, however, has never happened to me.
Some would say that makes me lucky, but then again, I’ve got some unique problems that not all of my female colleagues, or even some of my fellow male nurses, appreciate. In fact, I’ve even been told that I’m unprofessional, even that I should not be a nurse, because there are some things I won’t do.
Actually, there’s only one thing I won’t do, and that is female catheterisation.
Yes, females do this procedure on men, so why shouldn’t I do it on women? In most places I’ve worked in, I’ve helped the women out by doing their men, while they do my women. It works for me, and the staff, but most importantly it works for the patient.
I’ve been called a hypocrite and a sexist for having this attitude, but then I sometimes wonder who the biggest hypocrite is. If gender does not matter to a nursing professional, then why am I always allowed to shower little old ladies (a safe age seeming to be 60 plus) but never allowed to shower a 20-something woman.
Just for the record, I’m not trying to suggest I should be allowed to bathe attractive young patients, but if I’m sexist for feeling a bit old fashioned about some things, then those nurses who think I should do it all, and that gender does not matter, could be called ageist.
To further my defence, to perform certain procedures on a woman, requires a female chaperone anyway, so that chaperone might as well go ahead and do the procedure herself, and I can do her a favour another time.
With most procedures, though, it’s just a case of accounting for the fact that I’m a guy, and considering what I can do to make myself and my patients as comfortable as possible, whether that be a strategically placed towel, or simply knocking on a door before walking into a patient’s room.
If this is to be considered a weakness on my part, so be it, but I had to learn very early how to deal with sensitive issues. I was, after all, a new graduate accidentally placed in a gynaecology ward.
However you look at it, gender does matter, but not always in a negative way.
Often just by being what we are, a woman or a man, we can bring out the different sides of a patient. The company of your own gender is not to be underestimated. Older male patients often love to be treated as ‘one of the boys’, it helps them to open up, and I’ve heard some pretty amusing stories bringing laughter into difficult situations that I don’t believe they’d have relayed to a female nurse. After all, isn’t this what the job is about – making a patient’s stay a bit more comfortable, a bit more bearable and a bit more humane?
So yes, there is a difference between the private parts of the male and female nursing staff, but I do believe we can make them work together… to, er, bring out the best in everyone, of course.
How we do it
Nurses aren’t made of stone, although patients might think so. The secret is to learn to mouth breathe. Not sure what on earth I’m on about? Let me be explicit.
From bowel motions and contaminated wounds, to flesh eating infections, I’ve smelt a lot of horrible things during my career. I used to gag, but you have to rise above it, for your sake and the patient’s. Mouth breathing really does help, but then sometimes the thought of breathing in freely what your nose would naturally filter is enough to make you retch itself. In these cases, all you can do is try holding your breath. But, more likely, you have to grin and bear it.
Sometimes when a nurse knows what to expect, there’s an opportunity to bring in air freshener. The stuff hospitals use actually eats the odour (or so I’ve been told). The only problem with this is trying to be discreet; it doesn’t look good if you enter the room spraying every square inch of space from doorway to a patient’s backside. (I admit I may have been guilty of this, but only in the most extreme of cases.)
It’s not always a smell but a sight which is offensive. It’s pretty common for elderly men to put their dentures in a glass of water for the night. What is not so ordinary a sight is for them to drink the glass of water once they’ve put their teeth back in for breakfast. You’d think the prospect of so many floating things in the glass really would be a turn-off.
More often than anything, it’s the thought of the substances themselves that’s the worst. One of my most distressful moments as a nurse came about when emptying a particularly unpleasant bedpan into the sluice. A drop bounced up and landed on my lower lip. While pulling my lower lip down to my navel, I rinsed it with every caustic substance I could find – I think I probably caused more harm to myself from the acerbic cleaners than if I’d actually swallowed the damn thing. Fortunately my vaccinations were all up to date, and that ward has since put in splash guards.
On another occasion, one of my patients, a poor confused old lady, was having a terrible time with her piles. Her problem was exacerbated by a bad case of diarrhoea. The discomfort caused her to wander around the ward. She usually left a trail wherever she went. It wasn’t pleasant having to constantly chase after her and clean up the mess, but sometimes you just have to get on with the job. Fortunately, I solved the problem (temporarily at least) by usin
g some lignocaine gel. This is an anaesthetic gel we usually use when catheterising patients. It worked wonders for her. The poor soul couldn’t stop thanking me. I was just relieved she felt better, and I could get on with more savoury tasks.
Unsurprisingly, many patients are embarrassed by these side effects of their illnesses. The variety of wounds a patient can present with is endless, as are the types of bowel movements that can be passed. What many people don’t realise is that an experienced nurse can actually sometimes make a diagnosis just from seeing, or smelling, a patient’s excreta. Things like gastric bleeds, sweet smelling wound infections and cloudy urine can be the key to an important treatment.
As I said before, I’m not made of stone, but like most nurses I know, after some practice, I’ve developed the willpower to overcome almost anything.
The best of the NHS
I’m not unique, but I have done what many of my colleagues never have, which is to not only work in different countries, but also in dozens of different hospitals, in a vast variety of fields. I’m a classic example of the saying Jack of all trades, master of none.
I believe that what I’ve experienced has changed me for the better. I try not to make rash judgements, because I’ve seen many different ways of looking at and doing things. I’ve been through all of the bad and ugly stuff that your average nurse goes through during the course of their career. Yet for every negative experience, there have been so many more positive ones, and for every sad occasion, there were just as many happy and inspiring moments. I hope I’ve managed to balance this out, and given you an insight into my world. I would love to think that maybe something positive can come from sharing my highs and lows.
Over the course of my 16 years as a practising nurse, I’ve come to realise that often the truly meaningful and life changing moments of this job happen when we, as nurses, have the time to do what we know we are capable of. On those occasions when we have enough staff, who are not burdened by excessive workloads, we have the opportunity to truly look after the whole person. When this happens, it’s all good.
Day 1
‘Who’s going to look after me dog? I’m not sick. I don’t need to be here.’
Mr Blake was partially right. Medically, he was pretty healthy for an 80-year-old man. But the thing about public healthcare and the people that work within the system is that we don’t just look at the physical symptoms and diagnosis. We look at the complete picture, and try to do what we can for the whole person.
‘Is there anyone we can call to check on your house? Feed your dog?’ I asked.
‘Me and Rascal only got each other. He’ll be worried if I’m not home.’
Aside from Rascal, Mr Blake had been living alone for the last 15 years since his wife died, and like many aged men living on their own, he was stubborn when it came to accepting any help, or even to admitting that he needed any.
‘Are there any family members we can contact; maybe they can come and help.’
‘Now don’t go calling any of my kids. They’re busy enough with their own families.’
‘I’m sure they’d want to know you’re in hospital.’
Mr Blake scowled, his pleasant demeanour rapidly evaporating.
‘What about your neighbour, the one that called the ambulance? Perhaps I can give him a call. I’m sure he’ll be more than happy to feed your dog.’
‘How many times do I have to tell you? I’m not staying. Rascal needs me.’
Mr Blake had fallen over on the ice outside his house and received a few grazes to his hands and face. The neighbour had witnessed the fall and made a call to the paramedics. When the paramedics had arrived, they’d had a chance to see inside Mr Blake’s home, and it had been a worrying sight.
Everything they’d seen inside the house pointed towards a man not coping on his own: piles of unwashed dishes in the kitchen; no food in the cupboards except for some stale bread and baked beans. The clothes in his room, as well as those he wore and had packed in his suitcase, were in desperate need of a clean. Worst of all, the house was like a fridge. Mr Blake had a small plug-in heater by an armchair piled with blankets. They thought this was probably where he slept each night.
Then of course there was the dog. He was nice enough (at least the paramedics had said he was) but the place reeked of faeces, the furniture covered in animal hair, and like his master, the poor creature looked underfed and filthy.
Mr Blake needed to stay with us for his own good, but technically we could not stop him discharging himself if he really wanted to. With no obvious solution in sight, we decided to go that little bit further.
It turned out that Jackie, one of the nurses working with me the day that Mr Blake was admitted, only lived a short drive from his home. With assurance from Jackie that she would check on the dog and report back, our reluctant patient agreed to stay.
Day 2
It took a moment to figure out why Mr Blake was taking so long to get dressed – he’d pick up each item of clothing from his suitcase, hold it several inches from his face, examine it closely, and frown – but it ultimately came as no surprise when I realised that Mr Blake’s eyesight was failing, and he was trying to find the least dirty shirt to put on. Everything he had was pretty bad. I distracted him with the offer of a wash, and swapped his filthy clothes for a set of hospital pyjamas.
After a steaming hot bath, a shave and a fresh set of bedclothes, Mr Blake was beginning to look a lot better. He also hadn’t insisted on going home in a while. I wondered when he had last had a bath. I suspected he was starting to appreciate what he’d probably been missing for several years, maybe even for as long as his wife had been gone: a bit of TLC.
‘How’d it go last night at his house?’ I asked Jackie when I spotted her in the office with the charge nurse, Thabbeth. They were discussing what to do with Mr Blake.
‘Well, the place really is a mess. I managed to avoid touching the dog. I’m pretty sure it has fleas. I’ll go there again tonight if I have to, but we need to get something sorted out soon. I also met the neighbour, well, neighbours actually, a nice couple, young family, seemed really nice. They said they’ve tried to keep an eye on Mr Blake, but he generally keeps to himself.’
When I explained that Mr Blake didn’t want to bother his family, Thabbeth suggested that we should try him again. ‘See if you can get his approval. I’d rather not go against his wishes.’
Technically, if a patient doesn’t want his relatives to know they’re in hospital, we can’t do a lot, but that rule has been broken in the past, when it turns out to be the right thing to do in that instance.
Upon further questioning, it turned out that he had four children, and a decent smattering of grandchildren, some of whom he’d never even seen. But Mr Blake remained adamant that his family didn’t need to know he was in hospital.
Jackie and I were not prepared to let the matter drop.
‘Would you agree that your children would want to know you’re here?’ Jackie asked.
Mr Blake reluctantly nodded his head.
‘Would they want to help you out?’
Another nod.
‘Then you need to let us call them.’
Mr Blake sighed. ‘You bloody well don’t give up, do you, woman? But the answer is still no. No one can see me like this.’ Mr Blake seemed surprised by his own words and promptly shut up, but it was too late. Everything became crystal clear; Mr Blake was too ashamed to let his family see the state he was in.
‘This bloody woman knows what she’s saying, Mr Blake,’ I stepped in. ‘They’re probably going to find out at some stage anyway. You’re going to be seeing some social workers, some district nurses, maybe even a cleaner to help keep the house tidy. You’re going to have a whole lot of people helping you out, whether you like it or not.’
This wasn’t exactly true, as we can’t force help on anybody, but sometimes a little bit of exaggeration is in order.
‘I’ll make the call,’ Mr Blake finally said.
The events of the following day were beyond our control. Mr Blake’s three daughters, two sons-in-law and a litter of grandchildren descended upon our ward. The eldest daughter introduced herself as Cathy, and told us she lived just an hour out of the city. Mr Blake’s two other daughters lived about four hours away.
Cathy was horrified to find out her father had not been coping. She felt ashamed that she had no idea he was in such a state.
‘It’s all my fault. I do call him, every week. He tells me he’s fine. I knew I should’ve come to see him. I’m so sorry, so sorry. He’s too proud.’ It was heart-wrenching – and warming – to see her love for her father. Her sentiments were echoed by everyone else in the family.
The greatest moment came when Mr Blake was introduced to his youngest grandson, Michael, for the first time. The poor man laughed and cried at once, taking the child, who must have been about five years old, in his skinny arms.
Mr Blake’s family eventually left, but not before a plan of action was put in place.
Day 4
Meetings took place between Thabbeth, Cathy, social services, and, of course, with Mr Blake. Cathy decided to move into Mr Blake’s house for the next two months, while the services were put into place that Mr Blake desperately needed.
After which, a district nurse would visit once a week and a cleaner would come every few days. Someone was arranged to do Mr Blake’s laundry. Meals on wheels would be provided for his main meal of the day. Most importantly, his children promised never to listen to anything he said on the phone. Instead, they settled to take turns visiting him once a week.
As for Rascal, he wouldn’t leave his best friend’s side, except when the family took him to get cleaned up and had him bathed, de-flead, de-wormed, and fed a proper meal.
People in Mr Blake’s situation are extremely common. They are not necessarily in need of a tablet or medical treatment, but when we take care of a patient, we look at the whole person, and try to provide complete (holistic) care.
Confessions of a Male Nurse Page 22
