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Confessions of a Male Nurse
Michael Alexander
From the people who brought you the bestselling Confessions of a GP.From stampeding nudes to inebriated teenagers, young nurse Michael Alexander never really knew what he was getting himself into. But now, sixteen years since he was first launched into his nursing career – as the only man in a gynaecology ward – he’s pretty much dealt with everything: Body parts that come off in his hands; Teenagers with phantom pregnancies; Doctors unable to tell the difference between their left and right; Violent drunks; Singing relatives; Sexism; . . . and a whole lot of nudity.Confessions of a Male Nurse is a touching, shocking and frequently hilarious account of one man’s life in nursing.



MICHAEL ALEXANDER
Confessions of a Male Nurse



Copyright (#u99288368-c2dc-581b-8db8-b64de8fcf600)
The Friday Project
An imprint of HarperCollinsPublishers Ltd
1 London Bridge Street
London SE1 9GF
www.thefridayproject.co.uk (http://www.thefridayproject.co.uk)
www.harpercollins.co.uk (http://www.harpercollins.co.uk)
This edition published by The Friday Project in 2012
Text copyright © Michael Alexander
Michael Alexander asserts the moral right to be identified as the author and illustrator of this work.
All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this ebook on-screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins ebooks.
HarperCollinsPublishers has made every reasonable effort to ensure that any picture content and written content in this ebook has been included or removed in accordance with the contractual and technological constraints in operation at the time of publication
Source ISBN: 9780007469543
Ebook Edition © June 2012 ISBN: 9780007467044
Version: 2018-08-06
Disclaimer (#u99288368-c2dc-581b-8db8-b64de8fcf600)
The stories described in this book follow my progression from an inexperienced nurse to a relatively effective professional. To protect confidentiality, some parts are fictionalised, and all places and names are changed, but nonetheless they remain an honest reflection of my experience working as a male nurse over the past 16 years – surprising as that might come to be!
Dedication (#u99288368-c2dc-581b-8db8-b64de8fcf600)
For my wife and kids
Contents
Title Page (#ubf8ac6a5-25e7-59ac-a60c-0e3d8e494f63)
Copyright
Disclaimer
Dedication

Who am I?
Introduction
I
Slippery beginnings
Sharon’s law
The scapegoat
This little piggy
II
A glimmer of hope
Who’s to blame?
The meaning of teamwork
Big man, big heart
Beware of toilet
Heartless
Making a difference
Helpless, but that’s okay
Golden years
The veteran
Dr Baker
III
London calling
Filling in
The ego
Bad news, good porn
Magic medicine
A different world
Highs and lows of temp nursing
Mrs Olsen
MRSA where?
Deep shit
Tough love
How hospitals kill
Gotta get out of this place
IV
Reality check
Spotter
Mr Townsend
Dan’s demons
Mr Brown
Food for thought
Catherine, meet your new neighbours
V
Family man of steel
Dumb as they come
Don’t believe all you read
Confidential dilemmas
The perfect match
No chance
Saturday night shift
Full moon
Russell
All for a plate of sandwiches
VI
The nice drunk
The regular drunk
The unconscious drunk
The lucky drunk
The mean drunk
The changed drunk
The final draught
Epilogue: Reflections on a life of nursing
The dos and don’ts of being a patient
The big difference
How we do it
The best of the NHS
Where am I now?
Acknowledgements

About the Author
About the Publisher
Who am I? (#u99288368-c2dc-581b-8db8-b64de8fcf600)
I am just your everyday, run-of-the-mill nurse, with a unique story to tell. Okay, unique is not quite accurate; anyone that spends time working in healthcare has their own uniquely similar stories. Every day we come into contact with people from all walks of life, from the destitute to the wealthy, the young to the elderly, simple to genius, cruel to caring.
Though I never planned on being a nurse, caring for others was in my blood: my great-grandfather was a medic through two world wars, and my mother was also a nurse. Medicine provided them with a living, and so at the wholesome age of 17 I figured it would be good enough for me; nursing meant a guaranteed job. Little did I know that nursing would prove to be so much more than just a way to make a living.
Now, 16 years on, I’m still working in healthcare. I wouldn’t be if I didn’t like caring for others, but I’m only now realising that nursing isn’t just about what I can do for others; nursing is also good for me. Everyone likes that warm feeling they get when they help someone. Well, I really like it, and especially when I’ve done that little bit extra.
Looking after others is all I’ve ever known. I’ve seen people in all states of health, both mentally and physically, and I have come to the conclusion that our bodies themselves are the greatest equalising factors in our inglorious existence. Now, I want to show you what it’s like, what it takes, and what really goes on in the front line of the caring profession.
Why do I want to do this? On the positive side, I want to tell you just how amazing your average nurse really is; I want to prove that a good nurse can literally be the difference between life and death. On a more negative note, this is my chance to make up for the times when I should have spoken out about some of the horrendous goings-on in many hospitals, but didn’t; times when I kept quiet, because of fear, ignorance, or simply being at a loss about what to do.
Introduction (#u99288368-c2dc-581b-8db8-b64de8fcf600)
There is one thing almost all of us are going to be at some point, and that is a patient. One day, most of us are going to need to depend on someone when we are at our weakest. That someone is most likely going to be a stranger and that stranger is most likely to be a nurse.
I have worked with patients suffering from dreadful diseases, some of which I had never even imagined, let alone dealt with, like Guillain-Barré syndrome or motor neurone disease, or horrific cancers that spread through the body. Now, after 16 years, I’ve done pretty much everything – from keeping someone comfortable while their body is failing and the pain is getting too much to cope with, to chasing a confused (and very naked) patient down a corridor. I’ve learnt how to deal with a family who have been told their loved one is not going to make it (which never gets any easier, regardless of whether it is expected or not). I’ve experienced my fair share of emotions: frustration, impotence, despair, at the unfair ways disease and misfortune can strike those most deserving of life; at other times, relief when someone’s suffering ends.
But no matter how much I sympathise, I don’t really know what it is like to be a patient. I have only seen things from a nurse’s perspective, where you can’t afford to get too emotional or involved. I often wonder what it must be like to be on the other side, to be lying in bed, to see things through a patient’s eyes.
The only way I have of imagining is to use my experience of the way people in the past have reacted to being in my care.
What I have noticed, is that a person’s behaviour generally changes as soon as they become a patient. Some people become extremely nervous, which is understandable, and may explain why some pretty silly questions are asked. Does surgery mean I will have to have an operation? Then, there are the people who, during a ward round with their consultant, will nod as if in understanding, but when the doctor leaves they haven’t the faintest idea what is going on. I’ve heard many a patient, when asked by their consultant, ‘How do you feel?’ respond by saying that they feel fine, when in fact they’d spent the morning complaining about their ailments.
Some people suddenly find they are unable to do simple tasks for themselves, like pour their own water or fluff their own pillows, even if they are physically quite capable. Others become so used to being in hospital that they know how a ward runs better than some of the staff. Some become so demanding that no matter how many of their requests are satisfied, they will never be happy, while others are so grateful for any small service – even just spending five minutes listening to them – that they want to shake your hand or marry you off to one of their grandchildren. I’ve seen people too afraid to disturb the nurse, as they don’t want to be a burden, even though they are worried about the pain in their chest. I’ve seen others treating nurses like servants. Then there are people who lose all initiative, because they aren’t sure what they are supposed to do; they don’t know how to be a patient and they’re not sure what exactly a nurse’s role is.
When I picture myself sitting for hours in the waiting room, seeing patients who came after me being dealt with first, I wonder whether this would irritate me, or whether I’d be calm and rational, like all nurses want their patients to be. Then when I finally get called through to see the doctor, I imagine expecting the doctor to have all the answers to my problems as, ‘Doctor knows best.’
It must be frightening for patients who are admitted to be put on a drip, to have blood taken every day, or tubes stuck in some surprising places. For some having to share a room with a bunch of sick strangers might seem difficult.
But that’s why I’m here, your average nurse. It isn’t just about giving you your medicines and dressing your wounds. I’m here to explain things, including the foreign language the doctors use. I’m here to help you in and out of bed, to help you help yourself. I’m here to help calm you in the night when you wake up wondering where you are, or worrying about that pain in your chest. I’m here to help make your treatment as bearable as possible.

I (#u99288368-c2dc-581b-8db8-b64de8fcf600)
Slippery beginnings (#u99288368-c2dc-581b-8db8-b64de8fcf600)
Did I always know what I was doing? Of course not, but I couldn’t tell the patients that. A nurse must be confident and assertive, yet caring. The problem was I didn’t feel confident, nor the least bit assertive; I did care, though.
I will never forget my first day at Allswell, a hospital situated in the middle of nowhere – well, maybe more like everywhere. Allswell was a fairly typical example of all that is good, bad, outrageous and hilarious about hospitals across the civilised world. I remember vividly the reaction as I walked into the ward and explained I was the new nurse; mouths dropped open and there were mutterings of ‘there must be some mistake’ and even ‘this is a joke’. The nurse in charge of the ward even made a phone call to the head of personnel to explain the problem. You see, I was not just straight out of college; I was the only male in a gynaecology ward. The most important people I met that first day were Sharon and Cherie. Sharon was the nurse in charge of running the ward, similar to a traditional Matron. Cherie was the nurse whose job it was to familiarise me with the ward. It was a huge responsibility for her, although I didn’t realise it at the time. Over the next two months, Cherie’s task was to transform me from a naïve new graduate to an effective, safe and efficient member of the team. I don’t think either of us knew how difficult that was going to be.
My first day was spent following Cherie around. I was introduced to every patient and shown where everything was: the fire escape, cardiac arrest alarms, cardiac arrest trolley, treatment room, sluice room. I was handed a three-inch-thick folder of policies and instructed in the use of the computers, admission and discharge procedures.
All I really wanted to do was get my first patient and see if I could do the job. I went home that first day forgetting everything Cherie told me.
My third day on the job and I still didn’t feel the slightest bit at ease. In fact, I was feeling worse. Driving to work each morning, my mind was in overdrive thinking of the things that could go wrong, of all the ways that I could stuff up, and today I was getting my first patient.
‘I’m going to give you Mrs Stewart,’ Cherie said to me. ‘She’s day one post an abdominal hysterectomy. It will be good experience for you.’
Before starting on the ward the only time I had to think about a uterus was in the class studying anatomy books, and now here I was helping a patient recover from having one of the most intimate parts of her womanhood removed.
Forty-three seemed quite young to be having a hysterectomy, but at least Mrs Stewart already had three kids, so hopefully she wouldn’t feel too bad about her surgery.
‘Good morning, Mrs Stewart,’ I said, as I walked in the door. ‘I’m your nurse for the day. How are you feeling?’
Even hooked up to an infusion of narcotics, her shocked expression made it clear that the last person Mrs Stewart expected to see in a gynaecology ward was a male nurse.
She soon got over her shock. She had other things to worry about, such as the tubes sticking in her arm, the urinary catheter, and an abdomen that had been sliced open and sutured up.
‘I don’t know. How should I feel?’ she asked me. ‘I can’t feel anything. I’m numb from the stomach down. I had prepared myself for some pain.’ She sounded almost disbelieving.
‘It’s the miracle of the epidural,’ I replied, trying to sound knowledgeable, without actually having the faintest clue as to how effective epidurals normally are.
‘Well it’s amazing. I never thought I would feel this good. I wish I’d had this when I had my kids.’
I nodded my agreement and kept silent; there really wasn’t a lot I could say.
The shift seemed to go better than I’d expected, although this was probably due to the bright spirits of Mrs Stewart, as opposed to any particular skill on my part. Still, she didn’t seem completely at ease in my presence.
‘I can’t wait to tell my husband I’ve had a male nurse looking after me.’
Mrs Stewart had made this remark at least a dozen times over the course of the day and it seemed a bit forced, almost as if she was still trying to convince herself that it was okay to have a male nurse. Never mind, I was sure she would feel better about it by tomorrow; at least, I hoped so, because tomorrow was going to be a lot more challenging, for her as well as me.
The next morning, Cherie informed me that Mrs Stewart was to have her epidural removed.
‘It’s pretty straightforward,’ Cherie explained, ‘just pull.’
I was expecting something a little bit more detailed, but ‘just pull’ sounded easy enough.
‘Oh, and make sure you give her some analgesia straight after you take it out. You want to have something working before it wears off,’ Cherie added, before heading off on her own rounds.
Epidurals are not something nurses learn about in detail, although they’re pretty simple to follow. A needle is inserted between the vertebrae of the back, into the epidural space. The epidural space is a membrane that surrounds the spine. A plastic tube is threaded along the needle and into this space. The needle is removed, while the plastic tube is left in place and an infusion of analgesia is slowly pumped. This keeps the patient completely pain free from about the navel down.
All I had to do was ‘pull’ the tube out.
Thankfully, Mrs Stewart was philosophical about having the epidural removed.
‘I’m not looking forward to the pain, but I guess it means I’m making good progress,’ she said.
‘Oh, don’t worry, Mrs Stewart. We’ll give you some medicine before the epidural wears off. You’ll be fine,’ I said, as I picked up her drug chart.
She seemed comforted by my words. I looked at her drug chart to see exactly what sort of analgesic I could give, but decided it would be better to ask Cherie. As Cherie was the nurse guiding me, she was the person I was to go to with any problem, no matter how big or small.
‘We usually give a Voltaren suppository,’ Cherie answered when I asked her. ‘It’s long-lasting and tends to work really well. You’ve given one before, haven’t you?’
I had given one before, but only to a male patient. Somehow, during my student training I had managed to avoid having to go near women’s private parts. I explained this to Cherie, and her face brightened with a smile.
‘Well, there’s not much difference. You can’t go wrong.’
I wasn’t so sure.
The epidural was removed under Cherie’s supervision and it really was as simple as she had described, a slight ‘tug’ and it was out, no resistance, no trouble. A bit of iodine and a transparent dressing and everyone was happy. To make the most of a good opportunity (that is Mrs Stewart held on her side by Cherie and her bottom facing me) I prepared to give the suppository.
‘Stop,’ Cherie said, as I had one hand on Mrs Stewart’s upper cheek, while the other hand was ready to do the deed.
‘What’s wrong?’ I asked, frantically trying to think what I had done wrong.
‘Aren’t you forgetting something?’ Cherie asked me.
Under pressure my mind remained a blank.
‘The jelly – the lubricant – you forgot to put some on your finger,’ she said, in a slightly exasperated tone of voice.
‘Oh, yeah right, sorry,’ I replied, as I squeezed the tube of jelly a little too hard. So hard that I managed to lather up not just my finger but both of my hands as well. Cherie rolled her eyes but kept silent.
I hadn’t even begun to insert the suppository because with my rubber gloves soaking in lubricant I was struggling to hold up her cheek with one hand and the suppository in the other. The cheek kept slipping down and covering the target. I looked up to see an amused (and slightly bemused) looking Cherie.
‘Let me help,’ Cherie said as she grabbed hold of Mrs Stewart’s cheek and held it up.
‘Here we go, Mrs Stewart,’ I said as I went for gold.
I heard Cherie stifle a gasp. I suddenly felt nauseous.
With far too much lubricant on my hands, the suppository had missed and gone in the wrong hole. At least Mrs Stewart didn’t seem to notice anything because she was still numb from the remains of the epidural.
‘I’ve never seen that happen before,’ remarked Cherie.
I looked up into her face and gave her a ‘What now?’ sort of look.
She made a hooking gesture with her finger.
‘You must be kidding,’ I mouthed back at her. There was no way I was going searching in ‘there’ – it even crossed my mind that ‘searching’ in ‘there’ could be a form of abuse. My only hope was that it hadn’t gone too far. One thing I was sure of was that Voltaren was pretty rough on the stomach, and I began to worry what it could do if left in such a sensitive place.
I needed to move fast because this felt wrong. I looked up at Cherie again and shook my head. There were some things a man should not do and this was one of them. But Cherie motioned for me to hurry up and get on with it.
‘You’re a nurse now,’ Cherie whispered quietly, as if this meant I had an open licence to dig around in women’s private parts.
Eventually, I took a deep breath and with a quick flick of my index finger I managed to scoop out the offending suppository. Cherie gave me a ‘thumbs up’. I quickly popped the thing in the right spot, while Cherie rolled Mrs Stewart back on to her back.
‘All done, Mrs Stewart,’ I said. ‘How do you feel?’
Mrs Stewart took a moment to answer. She gave me a strange look.
‘Fine,’ she said eventually.
I left the room very quickly, without saying another word.
‘You won’t tell anyone, will you?’ I asked Cherie back in the nurses’ office. ‘I felt like a total pervert,’ I added.
Cherie didn’t answer, because she was bent double laughing – although she eventually recovered long enough to inform the whole ward.
Sharon’s law (#u99288368-c2dc-581b-8db8-b64de8fcf600)
A nurse is a nurse first, and a woman (or in my case, a man) second. At least, that was the thinking of my mentor, Cherie. One of Cherie’s favourite sayings was, ‘If a woman has to go down there, then so do you.’ Maybe that was why she made me go after that suppository. In Cherie’s world of nursing, there was no gender, just doing the job and doing it well. My problem was I never expected to be doing this particular job, in this particular area of nursing.
I had applied to work at the hospital as a general nurse on the new graduate programme. I expected to be offered a ‘normal’ nursing job in a surgical or medical ward. But I couldn’t turn down the offer of a full-time job. They didn’t even interview me for the position. Maybe the personnel manager was too embarrassed to admit that she had made a mistake. Maybe this was the reason no one seemed to like me, especially Sharon.
‘Stop daydreaming: pull your finger out your arse and do some work.’
The calm way in which Sharon said this left me speechless.
‘And close your mouth, you look stupid.’
Sharon seemed satisfied that she had made me look the fool and moved on down the corridor in search of her next victim. Only four weeks into my nursing career and I was learning to avoid my charge nurse at all costs. I looked over at Cherie.
‘I have to tell you something you won’t like’ – Cherie was never afraid to speak her mind – ‘Sharon doesn’t like you . . . a lot.’
With my self-esteem at an all-time low, I began to go about my rounds.
I knew that I knew nothing. It was a good thing really, as too much confidence can be harmful.
It won’t come as a surprise that I struggled with some parts of the job already. Things were unfamiliar, and it was usually vitally important that I got them right. The latest problem in front of me was called erythromycin. It’s an antibiotic, and in this case it needed to be injected straight into a vein.
‘What are you waiting for?’ Sharon asked me, as she entered the treatment room and saw me standing with a syringe full of intravenous antibiotic.
‘I’m waiting for Cherie,’ I replied cautiously.
Hospital policy stated that all intravenous medicines needed to be checked by a second person, but I felt a bit useless standing there doing nothing because mine had already been checked.
‘Let’s have a look. I’ll check them for you.’ Sharon began to look at the drug chart.
‘It’s already been checked,’ I replied. ‘I’m just waiting for Cherie, because she has to watch me administer it.’ Again this was hospital policy.
Sharon rolled her eyes and quietly cursed. I’d said the wrong thing.
There was an awkward silence; a silence which I hoped would last, because I knew when Sharon spoke it wouldn’t be to say how conscientious I was.
Sharon finally broke it with a calm voice, though I could sense the anger building:
‘Are you a registered nurse?’
I wasn’t sure whether to answer. Was it a rhetorical question? I knew there was more to come, so I just nodded my head.
‘Well, start acting like one,’ she added, her voice rising up an octave. ‘You can’t have someone holding your hand all the time. Take some initiative.’
I left the treatment room in a hurry and approached my patient.
Here I was standing at the patient’s bedside, with a syringe full of antibiotic that I’d never given before. Policy stated that I needed three months’ supervision before I could give these medicines on my own, and I was just nearing the end of my first month.
My mind was chaos turning over silly thoughts, crazy thoughts, even suspicious thoughts. Was Sharon trying to set me up to fail? What if something went wrong? I wasn’t even aware of all that could go wrong. If something did happen, no one would back me. Sharon would deny everything. What could I do? I knew what I should do . . . but I couldn’t risk facing the wrath of Sharon.
I slowly opened the intravenous valve and began to insert the syringe. In my nervousness I fumbled the syringe and it fell on to the bed. Was it still okay to use? I didn’t know, but Sharon would kill me if she saw me drawing up another antibiotic. I inserted the syringe and gave the antibiotic, because it was easier to do this than create a scene. I watched the patient’s chest to monitor her breathing. I felt her pulse . . . did it skip a beat? No, I was imagining things.
I waited anxiously those first few minutes, silently praying that nothing went wrong. Thank goodness my patient didn’t know how nervous I was, but even more importantly, thank goodness she didn’t have a clue that I wasn’t supposed to be doing this yet, even if my charge nurse had ordered me to. After five minutes, I figured that if anything was going to happen, it already would have. The one thing that even new nurses know is that with intravenous medicine when something goes wrong, it tends to happen pretty instantaneously.
I’d got away with it, this time, but would I always be so fortunate? One month in and life as a male nurse was already proving to be a minefield.
The scapegoat (#u99288368-c2dc-581b-8db8-b64de8fcf600)
The words looked all the same. The handwriting was horrendous: this could only be the writing of a doctor.
‘Can you make this out?’ I asked fellow nurse Jen, handing her the medical notes.
‘You’re hopeless,’ she responded in a tone of voice that seemed only half-joking. ‘You need to take some initiative. There won’t always be someone around to cover for you.’
Jen was yet to help me even once, and I would never ask her for help if there was anyone else around to ask.
‘I’m not asking for much,’ I replied, ’just some help interpreting the writing.’
As Jen tried to decipher the notes, I could see a frown forming. She was having as much trouble as I had been.
‘It says colonoscopy. You do know what that is, don’t you?’ she asked, with more than a hint of condescension in her voice.
‘If it’s the long, flexible tubey thing, with a bright light that goes a foot or two up your butt, then I guess I do.’
I was just as surprised as Jen that those words had come out of my mouth. I was just a graduate, while Jen had at least 20 years’ nursing experience behind her.
As I took the notes back, I avoided Jen’s gaze, worried that I had gone too far.
I took another look at the writing. I wasn’t 100 per cent convinced that it said colonoscopy. I knew she’d be pissed off if I asked her again, but I had to be certain.
‘Are you sure about that, Jen?’ I asked, increasingly regretting my earlier cheeky remark.
‘I’ve been doing this job since before you were born,’ she replied. I could see the veins begin to stand out on her forehead as she tried to control her anger. ‘You need to listen to your betters, or you’re going to mess up really bad one day.’
Now that I felt so positively reassured, I went ahead and got the patient ready for her colonoscopy.
‘Are you sure I need to drink all this?’ Mrs Knight asked me, after I had prepared the medicine for her to drink. At 79 years of age, Mrs Knight was quite a surprisingly sprightly little lady – a dedicated member of the local women’s walking club. Unfortunately she was having some women’s problems and had needed to be checked out.
‘I’m quite confident,’ I replied – trying not to put too much emphasis on the ‘quite’.
But Mrs Knight was still unsure about drinking two litres of salty water, and her hesitation was making me doubt my instructions as well.
After I poured the first glass, I stayed to watch as Mrs Knight took a mouthful of liquid.
‘Urrrgh.’
She almost choked. When her coughing fit passed, she looked me straight in the eye: ‘I can’t drink that stuff; there has to be another way. Besides, why do they want me to have an empty bowel? It’s not my bowel that’s causing the problem.’
She had a point and as I couldn’t come up with any answer other than the nurse in charge told me to, I thought I had better check again.
‘Mrs Knight’s refusing to take the drink,’ I began to explain to a very angry looking Jen, my voice tapering to a near whisper. ‘She doesn’t seem to think she needs it.’
Jen looked ready to hit someone. I held Mrs Knight’s medical file in front of me like a shield. She grabbed the file and looked at the notes again.
I didn’t see the look of shock that must have crossed her face, but I couldn’t miss her outburst.
‘You bloody idiot,’ she yelled at me. ‘What have you done? How much did you make her drink?’
Oh shit, what was wrong? All I’d done was what she’d told me to do.
‘Not much, not much at all, not even half a glass,’ I stammered. ‘I was only doing what you instructed.’
Obviously this was my screw-up; Jen certainly wasn’t going to take any of the blame.
‘I said colposcopy. You don’t know what a colposcopy is, do you?’
Thankfully, Mrs Knight didn’t drink her two litres of bowel-cleaning liquid and she was sent for her colposcopy, which was a look up the front side, not the back.
I kept silent – embarrassed and fuming at the same time. Jen had definitely said colonoscopy, but it was my word against hers, a new grad against an old hand. I would not win this argument.
Every ward needs to have senior, veteran staff members around that inexperienced people like me can turn to. I knew that Jen was a good nurse and could normally be relied upon to make the right decision, but sometimes impatience, being too busy, or even not liking a colleague can cloud a person’s judgement. Thankfully, this is not too common.
This little piggy (#ulink_ab4e9e2e-69b0-59b0-99fc-d737d14d570a)
After six months of putting up with a charge nurse that disliked me, and patients that looked at me as if I was from Mars, I had doubts about how much longer I could go on. But there were times when it all seemed worth it; times when I connected with a patient, and could physically see the difference I made.
‘You seem to know a lot about wounds,’ Sharon said to me one day.
Her comment caught me by surprise, because I really didn’t think that I had any particular skill or knowledge about wounds.
‘Not really,’ I replied, trying to figure out if she was thinking of a particular patient that I had done a good job on. With my mind still a blank I came up with a rather non-specific reply, ‘I just like to keep things simple; back to basics.’
She nodded her head as if I had said something wise. ‘I’ve heard some good things about what you’ve been doing with Mr Mannering’s feet. You’re not afraid to do what needs to be done and I like that.’
I thanked Sharon for the compliment and went about my business, surprised and confused. This was the first time Sharon had ever said anything nice to me.
Mr Mannering’s were by far the worst toes I’d ever had to dress. I couldn’t help but wonder what Sharon was thinking when she said I’d done a good job with his feet. His toes were black, completely and utterly rotten. The dressing was doing nothing useful, although the gauze between the toes was helping them from sticking to one another. I was simply keeping the rotten things covered until he got his foot, or even whole lower leg, amputated.
Due to a bed shortage, Mr Mannering was the only male patient in the gynaecology ward, and he sat upon his bed like a king upon his throne: he had everything at his fingertips and everyone at his beck and call. His room had a television, radio, electric bed, a great view of the hospital rose garden, and, of course, his nurse call bell within easy reach.
‘Has the newspaper arrived yet?’ This was Mr Mannering’s regular way of greeting me in the morning. I was never offended that he didn’t say good morning or good to see you. Mr Mannering spent all day on his bed; the only time he left was to be taken in a wheelchair to the toilet or the shower. For Mr Mannering, the morning newspaper was very important: it was a key part of his daily routine and his way of staying in touch with the outside world.
The newspaper also proved to be a convenient tool for me, providing a useful distraction from what I was about to do next.
‘Shall we get started?’ I asked.
Mr Mannering looked up from his paper and gave me a nod.
Whenever it came time to change the dressing on his toes he always made the same simple request: ‘I don’t want to see them. I don’t want to be put off my breakfast.’
As well as using the newspaper as a diversion, I put a couple of pillows on his shins to act as a barrier, in case he looked up at the wrong time and caught a glimpse of his feet.
I placed a piece of gauze between his big toe and the next.
Mr Mannering had had problems with his feet and the lower part of his legs for five years. He was diabetic, and over time the diabetes had affected his circulation. As a result, he had been battling with leg ulcers, but things had suddenly come to a climax when his toes had turned black.
‘Could you get us another cup of tea when you’re finished down there? Oh, and some biscuits as well?’
‘Yeah, just give me a moment, I should be finished soon,’ I replied. As I tried to pry apart his rotten toes, the thought of food didn’t seem quite right.
Mr Mannering chose this moment to inquire after his feet.
‘So how’s it looking down there?’ he asked, almost nonchalantly, just as if he was asking about the weather.
‘It’s not looking good,’ I replied. ‘But at least it doesn’t look any worse.’
There was no point being overly optimistic or pessimistic in my response, because no matter what I said, he responded the same way:
‘Well, you seem to know what you’re doing. I’ll leave everything in your capable hands.’
The little toe was the hardest to dress: it was too small, so the dressing wouldn’t stay in place.
I tried to pull his toes apart, so I could have another attempt at slipping in the piece of gauze.
Then . . . oops.
I could feel bile building up in the back of my throat. Somehow I managed to stop myself from vomiting, but I couldn’t completely hide the sound of air being brutally forced up through my throat and out my mouth, as my stomach clenched.
‘Everything all right down there?’ Mr Mannering had lowered his newspaper and was looking me in the eye.
‘You look awfully pale,’ he added. ‘Are you feeling okay?’
How did I feel? His little toe was resting between my fingers. I’d pulled it off. On the bright side, at least he wasn’t bleeding, although the smell from the foul, yellow-green-black pus seeping from the stump was making my stomach lurch again.
‘Well come on lad, speak up.’
For the first time in the two weeks that I had been doing Mr Mannering’s dressings, I heard a note of concern in his voice. I thought of the words he had said a moment earlier: ‘I’ll leave everything in your capable hands.’ I don’t think he meant it quite so literally.
As I crouched at the end of the bed, unable to think of anything to say or do, I had a vision of holding up his toe and offering it to him.
‘We have a slight problem,’ I finally said. ‘But it’s nothing to worry about – really.’
Mr Mannering leant forward. ‘What’s wrong?’
‘It’s your toe; your little toe,’ I began to explain. ‘It’s come off.’
‘Come off, what do you mean come off? Toes don’t just fall off.’
He had a point, toes don’t generally fall off.
‘Well, I pulled a bit too much and it just, well, came away in my hand,’ I said.
Mr Mannering took a minute to collect his thoughts, while I was still kneeling at the end of the bed with his toe between my fingers.
As the silence grew, I tried to justify my actions in my head: It really isn’t my fault. His feet are rotten. He’s going to get them chopped off anyway; surely he realises this.
I looked at Mr Mannering’s face to try to gauge his reaction. Then I heard a strange sound. It couldn’t be . . . but it was. Mr Mannering was laughing – a deep, throaty, contagious laugh. I found myself joining in.
‘They’re going to chop it off anyway, lad. You’ve just made their job a bit easier,’ he said to me.
‘Ever thought of being a surgeon?’ he added and broke into another round of laughter, as if this were a great joke.
‘Well, what do you want me to do with it?’ I asked – the discussion finally coming around to practicalities.
‘Well, I don’t want it,’ he said. ‘Throw it in the rubbish.’
It didn’t seem quite right throwing it in the bin – after all, it was a body part – but then again, a pretty gross part, so in it went.
Two days later, Mr Mannering went to surgery and had not just his toes, or even his foot, amputated, but his leg from just below the knee.
Mr Mannering had been the first male patient I had worked with as a registered nurse, and it was as if I had seen a light of hope at the end of a long tunnel. I found myself not only comfortable working with Mr Mannering, but actually enjoying it. This was just as well, because my time in the gynaecology ward was nearly up. I had received word from management that, as part of the graduate programme, I was to be rotated to a general surgical and medical ward. I just had to survive one more week.

II (#ulink_4406ecae-2bb8-5e10-8646-555156d591e3)
A glimmer of hope (#ulink_67add8db-2e94-54de-b24f-fb1a0456ecb9)
Six months after graduation, I was moved to Ward 13. I knew from the very start that it was going to be challenging, but hopefully in a good way. It was a small hospital and space was at a premium. The ward had surgical patients, medical patients, and urology patients.
The surgical cases often involved abdominal and vascular surgery, as well as urology surgery, which is anything to do with the kidneys and their associated plumbing. While the medical patients were a mix of everything. It was only in the years to come that I would learn that this set-up was not very common (although it happened often enough because of a shortage of bed space). It was certainly not ideal, but one huge benefit of the situation for me was that I gained a whole lot of experience in a relatively short space of time. I began to see things truly from the perspective of a caregiver.
Who’s to blame? (#ulink_7ac3cc71-75ae-5bd6-8197-da48f2becebd)
Horrendous, horrible things sometimes happen in my line of work. Things that make hospitals seem like a living nightmare. But good can come out of even the worst experiences, even if it is just a new way of looking at something – sometimes, perception is everything.
Interpretations of a situation can vary tremendously, especially when it comes to a patient’s perspective versus that of a nurse. It’s to be expected that the nursing staff will have a better understanding of health and illness and how the body deals with sickness. What is not always appreciated is a patient’s understanding, or lack thereof, of a particular problem.
‘Get ya hands off it; I don’t want ya breaking anything.’
I put Mr Kent’s leg back in the corner. It wasn’t a whole leg – just the lower part of his right leg.
‘I’ve been living without a leg since before you were born and I don’t need your help now.’
Mr Kent had lost his leg in a motorbike accident when he was 25. He had never married, always lived alone and never had to depend on anybody for anything – well, apart from the prosthesis manufacturer.
I was just trying to help him strap the thing on – speed things up a bit because he was taking so long to get ready. I know it sounds terribly impatient of me, but he looked helpless as he groped for his walking stick while struggling to sit up in bed.
Once Mr Kent had his leg strapped on and was on his feet he was a different person. He was mobile and, if not exactly nimble, he could move pretty quickly.
‘I don’t need to be here, it will pass,’ he kept saying.
And every time, I responded the same way: ‘It’s just a precaution, the doctors know what they’re doing; you’ll probably be home in no time at all.’
Mr Kent was a very strong willed man. He was so fiercely protective of his independence that he would not let any of the nurses help him in any way. The closest he had come to asking for assistance, was pointing his walking stick at the television and saying, ‘Be a good lad will you and change the channel for me.’
But for all his tough demeanour, I suspected he was more worried than he let on.
Mr Kent had been admitted to hospital because he had woken up one morning and found that the left side of his mouth was not quite working properly. When he had gone to look in his bathroom mirror, he noticed that this side of his mouth was drooping slightly.
The hospital doctors were concerned that Mr Kent might have had a small stroke, or even just a TIA (a Transient Ischaemic Attack – a mini-stroke).
‘A mini-stroke, now I’ve heard it all, next you’ll be trying to admit me,’ and of course they did.
Luckily none of Mr Kent’s limbs appeared to have been affected: there was no telltale weakness or paralysis in his arms or legs; and even though his mouth had a slight droop, his swallowing had not been affected.
On the third morning of Mr Kent’s stay with us the doctor decided to change his medicine slightly. For the last five years Mr Kent had been taking half an aspirin a day; the doctor now wanted to give him an enteric-coated aspirin, which has a protective outside layer so it’s less rough on the stomach. It was a good idea of the doctor; Mr Kent should have been on this medication years ago.
Aspirin is one of the most common drugs given to patients, but it can help prevent some serious problems. It thins the blood, thus reducing the risk of clots forming, lessening the likelihood of strokes (clots in the brain) and heart attacks (clots in the arteries that supply the heart).
The only problem was Mr Kent seemed a touch reluctant to take the new enteric-coated aspirin.
‘I’ve made it this far on my own with one leg and I will not be told what’s good for me by a boy.’
I could feel my face turning red as I sensed the eyes of the three other patients in the room on me. I had no reason to be embarrassed, and I certainly needn’t have felt stupid, but I did.
I suppose Mr Kent’s stubbornness was a way for him to stay in control of the situation, but I was resolute: I would make him see reason and win, especially as I had an audience. After all, it was for his own good.
‘If it makes you happier, I’ll have the doctor come in and explain things again,’ I offered, but Mr Kent just sat there with his arms crossed.
‘I don’t want to talk to him either,’ Mr Kent said, referring to the junior doctor. ‘I want to see someone old enough to know what they’re doing.’
‘Well, I can’t force you to take it,’ I said, changing tactics and making as if to exit the room.
‘Hold on a minute,’ Mr Kent piped up, ‘I never said I wouldn’t take the blasted thing.’
Why the sudden change of heart? Again, it was another way for Mr Kent to retain some control of his situation.
‘Get the doc. I’ll listen to what he has to say and then decide.’
I didn’t argue. Soon the doctor reassured Mr Kent that the change was in his best interest. Fifteen minutes later, the battle was over and I was the victor – although it didn’t really feel like a victory. As Mr Kent brought the aspirin to his lips he kept his eyes glued on mine; he wasn’t smiling and he certainly wasn’t happy. It wouldn’t have surprised me if he gave in just to have some peace and quiet.
With a sense of relief I left Mr Kent to his own devices and walked away down the corridor feeling at least content in the knowledge that I had done what was right, even if Mr Kent wasn’t 100 per cent convinced . . .
Beeeeeeepbeeeeeeeeeeep!
It was coming from Mr Kent’s room. Someone was probably sitting on their call bell – at least I hoped that was it – but as I turned around and hurried back to his room, I had a sinking feeling in my stomach.
I entered Mr Kent’s room and his eyes locked on to mine. He was struggling to sit up and reach his walking stick, but the right side of his body didn’t seem to be working very well. He kept on falling back on to his pillows. His right arm wasn’t doing what he wanted; it seemed to be determined to lie there like a lump of lead. His droop had worsened and his mouth was hanging slightly open. Mr Kent was having a stroke right in front of me.
I watched, with mouth agape and a sickening feeling in my stomach. The stroke didn’t stop him from being able to talk. ‘You’ve done this to me; you’ve killed me.’
I’m sure his voice must have been slurred, but I heard every word very clearly.
My skin broke out in goosebumps. I tried to help Mr Kent sit up but he waved his good arm in my face.
‘Get away. You’ve done enough damage already.’
I could feel the eyes of all the other patients in the room on me: disbelieving, shocked, accusing. I was to blame; it was my fault – I had forced him to take the new aspirin. At least, that was how they must all have seen this. I was responsible for setting this man on the path to death.
I couldn’t think rationally. I tried to help Mr Kent again; this time he didn’t speak to me, instead he made a loud moaning noise, a noise that spoke volumes. His stroke was progressing rapidly.
It felt like forever before the other nurses rushed in to find me standing there doing nothing – immobilised by shock; racked with guilt. The doctor was called and I left the room on the verge of tears. I was in no state to see any of my other patients. I knew if I went in to see one, I would no longer be able to hold back the flood.
Worst of all is that part of what Mr Kent said was true: the stroke probably was the end of him. Even if he survived, the effect the stroke would have on his mobility would be a huge blow, especially with a prosthetic leg. Once mobility is gone it’s never good; it’s a very slippery slope, especially in the aged.
Looking back now, I realise that Mr Kent’s stroke had nothing to do with either me or with the new aspirin. However, in Mr Kent’s mind, I was to blame. If he is still alive today, he probably still blames me, probably genuinely believes it was my fault. That is not a nice feeling, but I have come to understand that there are some things you cannot change and I can live with it.
I left work that day feeling as miserable as I ever had felt in my life. I was still battling with tears. I was only 21 years old, and just like Mr Kent had said only a short time ago, still a boy really.
The meaning of teamwork (#ulink_33f39977-72d5-55c3-aa4d-509f0b0998f4)
Mr Simpson was 45, fit, and an avid golfer. His biggest worry was whether he would still be able to play after the surgery he was having the next day. I explained that if all went well in the operating theatre, there should be no reason why he couldn’t continue to play golf.
Mr Simpson was by no means my first surgical patient, but he was the first patient that I had prepared for his type of operation. He was going to have a femoral popliteal bypass graft. Basically, the circulation to one of his legs was rubbish, and the surgeon was going to put in some new plumbing that would fix the problem. If the surgery wasn’t performed, Mr Simpson could eventually lose the leg.
As horrendous as my recent experience with Mr Kent had been, I felt happier in my new environment. It certainly helped that I wasn’t dealing exclusively with sensitive matters pertaining to female health, but the main reason things felt better was because of the team I was working with.
Katie was the nurse in charge for the shift, and she was great. Katie was always there to lend me a hand. Whenever I needed help with a wash, a lift, a wound dressing, advice of any kind, she was the person I turned to. Katie had already asked me several times if I was going to be okay looking after Mr Simpson on my own, and after reassuring her that I felt I could cope, she made it clear that I could come to her for help or advice, no matter how trivial. Knowing I had some support gave me a rare feeling of confidence.
Everything went smoothly and Mr Simpson was wheeled to the operating theatre at 7.30 in the morning. I didn’t see him again until one o’clock that afternoon.
‘How was it?’ he asked me for the third time in the last hour. With leftover anaesthetic in his system and a pump infusing him with intermittent morphine, that sort of thing was to be expected. I reassured him all went well.
The next day Mr Simpson was a bit livelier, and asking about when he would be able to play golf, but I still would not give him a definite answer.
By the second day post-surgery, Mr Simpson was in fine spirits, mainly because there was live golf on the television. I left him in peace and reminded him to call if he needed anything.
Thirty minutes later Mr Simpson’s bell went off.
‘My leg feels worse; it’s more painful than normal.’
Up until now his pain had been well controlled, so it was a bit of a surprise that it should start being a problem now.
I began to examine his leg, worried at what this could mean. I checked the pulses in his foot, to make sure the blood was still getting through. I examined his calf and his thigh. Thankfully there was no swelling. As a precaution I went to search for Katie and get her opinion.
I never got a chance to chat with Katie as I was distracted by the call bell of another of my patients.
Mr Dexter was one of my medical patients. He had pain in his chest, caused by angina. Simply put, the arteries supplying the heart were not letting enough blood through, resulting in poor oxygenation of the heart muscle. It’s the lack of oxygen that causes the pain.
Mr Dexter had a small bottle of spray which he was supposed to squirt under his tongue whenever he had chest pain. The medicine dilated his blood vessels, including the ones that supply the heart. Hopefully this would allow more blood and, therefore, more oxygen to the heart muscle.
He explained that he had given himself a dose five minutes ago. I instructed him to give himself some more spray. It works very quickly, within moments of taking it. I waited the recommended five minutes to reassess.
‘How bad is the pain now?’
I didn’t get a chance to hear how the pain was, because the call bell in Mr Simpson’s room went off, and continued to go off. It wasn’t stopping. I ran to his room.
‘Oh shit, it’s agony,’ Mr Simpson said as soon as he saw me.
I looked at his thigh and knee and placed my hands on them. I could feel something hard in his thigh. It wasn’t swollen to the naked eye, but I could definitely feel a lump that wasn’t there before. It was also hot. By the time I went to feel for a pulse in his foot, the other nurses on duty that shift were in the room.
Katie took charge, and within minutes had the doctor at the bedside. Katie told a terrified Mr Simpson that his graft wasn’t working, and that he needed to go back to theatre.
The head surgeon was urgently called back into hospital. During the next hour, myself, the junior doctor and the registrar made what preparations we could to get him to theatre. That hour was probably the most terrifying in Mr Simpson’s life. There was a chance that he would not only never play golf again, but possibly lose the leg altogether.
When he finally left for the operating room, the last of the adrenaline left my body and I felt physically and emotionally drained. It was also at that moment that I remembered Mr Dexter and his chest pain, as well as my other four patients that I hadn’t seen in all that time. I ran to Mr Dexter’s room, expecting to find him either clutching his chest in agony or dead.
He was sitting up reading his book. ‘Are you okay?’
‘Why shouldn’t I be?’ he replied.
I briefly felt relieved, but I rushed to check on my other four patients. Their medications were late . . .
. . . but they’d all had their meds. They were comfortable. All their needs had been taken care of.
Katie and the other nurses had seen to every one of my other patients.
This kind of generosity was not to be unique. Over the next two years I learnt that, in this ward at least, it was normal; the nurses worked as a team, and always watched out for each other.
Big man, big heart (#ulink_885fccf1-a764-5718-80f7-58712f2297c9)
Part 1: Who is Mr Groom?
Feeling part of a team was what made nursing truly enjoyable for me. I no longer dreaded going to work each day. I didn’t have that nauseous feeling in my stomach whenever I had to approach a senior member of staff. The biggest improvement was in the confidence I felt about looking after more challenging types of patients, which was fortunate because I was about to encounter one of my biggest challenges yet.
‘Are you okay having Mr Groom again?’ asked Carol, the nurse in charge.
What could I say? No, I’m worn out, he’s too heavy, too much work?
I had been looking after Mr Groom for what felt like forever and was hoping for a bit of a break, but whenever it came time to allocate his nurse there was always a silence in the office.
My adventures with Mr Groom had begun four days ago. I had just returned from my days off. The problem with coming back from time off is that you are at the bottom of the priority list when it comes to picking and choosing patients. To be fair, everyone is generally pretty reasonable when allocating patients, everyone takes their share of the demanding ones, but every now and then there comes along one patient whom no one really wants to be responsible for.
The first time I had met Mr Groom, I couldn’t believe my eyes; before me lay a sweating, rippling, heaving mass of flesh, covered almost head to toe in traditional Maori tattoos. He was one of the most obese men that I have ever had to look after. He must have been at least 180 kilograms.
Carol tried to be encouraging. ‘He needs someone strong and you’ve done so much for him; you’re good for him.’
I didn’t see exactly how I was good for him. We were too different. I come from an average white family, from an average white part of town. Mr Groom is an ex-member of Black Power, a gang with offices throughout New Zealand. Not a group to cross – even an ex-member – they eat boys like me for lunch.
‘Good morning, how are you?’ I asked Mr Groom.
At the sound of my voice he rolled over towards me, the bed springs protesting beneath him, and greeted me with a huge, gap-toothed grin.
‘Morning,’ he replied, then, after pausing to catch his breath, ‘Could be better, bro.’
Poor Mr Groom, he was only 35 years old, but he looked ten years older and had all the problems you would expect in someone twice his age. I could tell just from looking at his swollen legs, that it wasn’t all fat – there was fluid in them, a sure sign of a failing heart. Just to prove myself right, I poked my index finger into his ankle and left an indentation that faded away very slowly. Mr Groom’s joints also looked swollen and I wondered how much longer they would put up with being abused, before giving out completely.
Mr Groom had never been in hospital before, but he’d developed a bad case of pneumonia. In most 35-year-old men, a case of pneumonia would probably not need hospitalisation, but because of his weight he needed to be with us, especially now, because it looked like his condition was deteriorating.
With someone as big as Mr Groom, it’s never really just a simple case of pneumonia. He already had a diagnosis of heart failure. His joints always ached, and it was an effort to walk, even when well.
Mr Groom was drenched in a cold sweat, his hands were shaking, and as I clasped his wrist, I could feel his pulse racing. His eyes had a glazed look about them, as if he was in a world of his own. But it was his laboured breathing that caused me most concern.
‘How long has your breathing been this bad?’ I asked him.
Surely he hadn’t been struggling for breath all night? I knew the night staff would have done something.
‘It just got bad in the last hour’ – he paused to get his breath – ‘started about six this morning’ – pause – ‘came on really quick.’
He smiled again at me.
‘Why didn’t you call the nurse sooner?’
A rather pointless question, it wasn’t going to help, but I just had to know.
‘They had a busy night’ – pause – ‘didn’t want to bother them.’
Not the answer I was expecting.
There was no time to waste; I grabbed Carol who took one look at Mr Groom and immediately came to the same conclusion as I did. We went into the corridor to discuss our plan of action.
‘We need to get Dr Grey down here right away,’ Carol said.
‘Are you sure?’ I replied. ‘Why don’t we get the registrar instead?’
Dr Grey was the new junior doctor and had only qualified in the last few months. It’s an unfortunate truth that some junior doctors don’t listen to the nursing staff, and it looked like Dr Grey was turning into one of them. Just the other day we’d pointed out to him that one of his patients normally took his blood pressure medications in the evening before bed, because the patient said if he took them in the morning, he fainted. Dr Grey had disagreed and prescribed them for the morning, and sure enough the patient collapsed because of low blood pressure. The nurses were there to catch him. They also suggested perhaps reducing his dose, but this never happened either.
Carol thought over my suggestion for a moment or two.
‘You may be right, but we’ve got to give Dr Grey a chance.’
Fortunately, today Dr Grey surprised us all. He too took one look at our patient and did the wisest thing I had seen him do in three months. He called his registrar. Registrars usually have a minimum of four or five years of experience, and can usually be relied upon when complications arise.
The registrar took Mr Groom’s pulse. It was weak, but pumping along at 110 beats per minute. His breathing was rapid and shallow; he also had a high fever. Mr Groom had developed a sepsis – meaning the infection had got into his bloodstream – and a sudden worsening of his heart failure on top of his pneumonia.
With these added complications, Mr Groom was in a very serious condition. The doctors contemplated transferring him to the intensive care unit, but due to a shortage of beds he stayed with us. He was so weak that he was unable to stand, or even sit himself up in bed; the most he could do was roll from side to side.
‘It’s pretty bad, isn’t it?’ Mr Groom asked me.
It was. He could potentially die, but all he did was smile at me. It seemed I was more worried than he was.
‘Don’t worry,’ he said, ‘I know you’ll be able to fix me up.’
Was he trying to put me at ease, by putting on a brave front? If I were in his position I would be terrified. But his cool calm didn’t seem to be an act. Did he, by some chance, have that much faith in us, a complete belief that the doctors and nurses will be able to do just that? I wish I had that much faith in myself.
Let the battle commence.
Part 2: Mission impossible
To give his medicines, Mr Groom had a tube stuck into the side of his neck and threaded towards the heart, because all the veins in his arms kept on collapsing.
He also had a tube put up his penis to accurately measure the fluids passing through his kidneys – especially important since his blood tests had shown that his kidneys were struggling. It was quite the balancing act, because too much fluid and his heart would struggle even more, while too little and his kidneys might deteriorate further.
Mr Groom had the girls from the physiotherapy department visiting twice a day, pounding on his chest, trying to help move the build-up of mucus in his lungs.
He had multiple blood tests alongside multiple antibiotics.
But for all the poking, prodding and discomfort that Mr Groom endured, he only had one small wish.
‘I tell ya something, doc’ – he’d developed the habit of calling me doc because I was male – ‘get me in the shower and I will feel a new man. I can’t take another bed sponge, mate.’
Imagine spending 24 hours in bed; I guarantee by the end of it you will be desperate for a shower. Mr Groom spent a total of 170 hours in bed.
The job of washing Mr Groom was a team event, with nearly all the staff involved. It took five people in total: three to roll him, one person to hold the bed still, because the brakes were not strong enough, and a fifth nurse to actually do the washing. But for all the sponge baths and changing of bed linen, I could never clean him as well as I wanted, or he wanted. It was understandable that Mr Groom’s greatest wish was to have a shower, but he wasn’t ready for a shower yet, he just wasn’t well enough.
Thankfully, life slowly crept back into Mr Groom and it looked like we were going to win the fight. As his breathing settled down, his legs began to shrink, and he started asking when he would be able to get out of bed and joking about feeling like a beached whale. I laughed along with him, though it didn’t feel quite right, because it was the response he was hoping for.
‘Not long now, maybe tomorrow,’ I always replied – never giving him an exact answer, but we were certainly beginning to make progress. I watched as Mr Groom went from bed to bedside, from there to reclining chair, from that to standing with a frame, then unassisted. It was at this stage that I decided he was well enough to have a shower.
‘Um, I think it’s a bit small,’ said Mr Groom, looking down at the chair.
He was right, too. Even if we could have fitted him in the shower chair, I doubt it would have held his weight. I should have thought of this, and felt a touch stupid. I tried a normal wheelchair, but this was too small as well. I eventually managed to get hold of a chair used by the porters, which was half-again the size of an average wheelchair. These chairs are so big because they’re used to take patients between various departments around the hospital, and the extra space is often used for things like oxygen bottles, notes and IV poles.
‘Oh, that’s pure fucking heaven,’ were Mr Groom’s first words as I turned the shower head on to him.
The water streaming off him was a dirty looking grey colour from the build-up of the sweat and dirt that I had never been able to completely get rid of.
‘Harder. It won’t hurt,’ he told me as I scrubbed his back. ‘I want it red and raw . . . Oh fuck that’s good. I don’t want another fucking bed sponge again, no offence intended, doc.’
I wasn’t offended, just pleased to see him happy. Mr Groom seemed to like having me around and I was discovering that I also enjoyed working with him, even though he was heavy work. I didn’t see before me an intimidating ex-gang member, but a man in need of our help, a man who tried not to be a burden, a man now fighting for his life.
Any preconceptions I had had about Mr Groom had by now been turned on their head.
‘Here, let me stand up and you can give my bum a good rub.’
He grabbed hold of the rail while I prepared to pull the chair away.
‘On the count of three,’ I said. ‘Ready? One, two, three, heave.’
Something unexpected happened.
‘Let’s try again . . . and heave.’
I couldn’t remove the chair.
He turned his head towards me; his face had an almost apologetic look.
‘Guess I need to lose a few pounds.’
‘What do you think?’ I asked the nurses assembled in Mr Groom’s room. ‘All suggestions are welcome.’
I was greeted with silence and shrugged shoulders. Obviously, no one else had had this problem before, and as no one was coming up with a clever solution, I took the lead and tried the direct approach.
I positioned two nurses so they were holding Mr Groom’s arms; another nurse and I held the chair steady, and the last nurse grabbed hold of the bed.
On the count of three everyone began heaving – biceps flexed; thighs braced.
‘It’s not going to work,’ Carol grunted, as she pulled.
‘It has to work,’ I said through gritted teeth. ‘Pull harder.’
Suddenly the chair released its victim and Mr Groom was catapulted on to his bed. The poor nurse whose job it had been to brace the bed was squashed as the bed crashed against the wall. The towels that were being used to cover Mr Groom’s nakedness landed on the floor, and there was a moment of shocked silence as everyone stared at the bare, quivering backside of Mr Groom as he lay straddled across the bed. I grabbed a towel off the floor and tried to cover him.
He began making a strange sound, his whole body convulsing. What had we done?
But I soon recognised the noise, and realised the convulsing wasn’t a seizure, it was laughter. And not just a polite laugh to try to hide embarrassment, but a true, full-bodied, incapacitating, belly laugh; the contagious type.
Part 3: Missing parts
Mr Groom’s sense of humour saved us all from feeling like absolute crap. In my short time as a nurse, I felt that nothing could top it.
Enter Dr Grey.
Dr Grey decided that as Mr Groom was getting better, it was time to have his urinary catheter removed.
‘Surely not yet, doc, he’s only just managed to stand on his own. Shouldn’t we leave it at least another couple of days?’ I asked.
‘Absolutely not, it’s been in there far longer than necessary, he’s at risk of infection.’
The catheter is the plastic tube I mentioned earlier; it goes up the penis and straight into the bladder. It is an infection risk, as bugs can creep up it, but sometimes you have to weigh up the benefits against the risks. In Mr Groom’s case, the risk was of him being incontinent in bed as he might not get a urine bottle in place in time. Urine is very good at breaking down skin, and Mr Groom did not need sores around his inner thighs, buttocks or scrotum. I tried to make this case.
I wasn’t alone in thinking that it should be left in; all the nursing staff agreed. But the doctor didn’t even budge when the charge nurse stepped in, and so the catheter was taken out.
The next day Mr Groom began to have some problems.
As predicted, he was not managing with a urine bottle.
Even after the previous day’s shower, the smell coming from Mr Groom’s lower regions was getting bad again.
Michelle was the nurse assigned to Mr Groom this shift, so it was up to her to deal with Dr Grey, but I was by her side when she confronted him.
‘Can we put another catheter in?’ Michelle asked. The doctor hesitated a moment, then looked at me, almost for confirmation. I nodded my head, and Dr Grey consented.
Of course, Dr Grey was not going to replace the catheter, because that was the nurse’s job, and so that fell upon my friend Michelle.
I have known Michelle from my training days; she is a pretty blonde with a ready smile, a quick wit and a habit of over-dramatising things. Off she went with catheter in hand and the faithful rubber gloves. She came back from Mr Groom’s room 15 minutes later.
‘Can you lend a hand?’ she asked me, a blush touching her cheeks. ‘I’m having a bit of trouble.’
Trouble? There shouldn’t be any trouble; he’d already had a catheter so there shouldn’t be any obstruction.
‘Sure, but what sort of trouble are you having?’ I replied.
‘I can’t find it,’ she told me.
‘Find what exactly? The right equipment or the right size catheter?’
Michelle’s face went red.
‘No . . . I can’t find his penis.’
With this statement, Michelle began to giggle. I walked back with her to Mr Groom’s room to see if I could sort things out.
‘What’s the matter, doc?’ Mr Groom asked me as I walked in the room.
Mr Groom couldn’t see what was going on because he was lying almost flat and his stomach was in the way.
I didn’t know what to say. I couldn’t tell him that Michelle was unable to find his penis.
‘Nothing’s wrong,’ I lied. ‘Michelle just needs an extra pair of hands.’
I quickly put on some gloves and got down to business.
The penis wasn’t there – there was absolutely no sign of it. Mr Groom was so overweight his penis seemed to have been sucked up into his belly. There wasn’t even any sign of a scrotum. I glanced at Michelle who was redder than a beetroot and refusing to make eye contact with either me or the patient.
‘Can you try pushing a bit over here?’ I instructed Michelle, as we tried to coerce the thing out, by pushing on his bladder while I dug my fingers into the crevice where his penis should be.
‘Hold this bit for me,’ I instructed Michelle, as she used one hand to hold back his stomach.
No matter how hard we tried we couldn’t find the penis.
‘What’s the problem, doc?’ Mr Groom asked me again.
He didn’t sound worried, just curious. It’s just as well he couldn’t see past the roundness of his belly because he couldn’t see either my or Michelle’s face. Michelle looked like she was having a spasm – her shoulders were shaking from trying to repress a dose of the giggles. I felt like slapping her, not just because it was so inappropriate, but because it was infectious. Nothing in my training had prepared me for this. But I was not going to let Michelle contaminate me.
I had to answer Mr Groom, but my mind struggled to come up with an answer that would not take away any last remaining shreds of dignity that we had not already stripped. I finally settled on a reply.
‘How do you usually pee?’ I asked as casually as I could.
‘I just feel around for it a bit,’ Mr Groom said, ‘but I can’t find it lying down, and when I need to pee, I can’t stand up quickly enough.’
It all sounded very reasonable but his answer made me think.
‘When you say you feel around for it, does that mean that you don’t actually see your penis?’
There, I’ve just humiliated the man completely, but it might make our job easier if I know what we’re up against.
‘Haven’t seen it in a few years,’ he admitted, then fell silent.
Not wanting to admit defeat I went in again, while Michelle pushed down on his bladder with one hand while holding up his stomach with the other.
The conversation and situation were too much for Michelle and she began to cough, a cough which sounded suspiciously like a chuckle to me. She raced from the room, saying she had to go to the bathroom urgently. I told Mr Groom I was going to get the doctor and walked into the office to find Michelle red faced and worried. ‘Do you think he noticed?’ Michelle asked me. I could see Michelle was feeling guilty for not being able to keep away the giggles, so I reassured her she’d done the right thing by leaving the room, and that I was sure he hadn’t noticed.
Eventually, we called the doctor and between the three of us we managed to find his penis and insert the catheter. The doctor was subdued and to his credit looked guilty while Michelle and I were just relieved we could keep a straight face.
Mr Groom was eventually discharged home; he weighed 30 kilograms less and felt like a new man.
‘You’ve done good for me, doc, and don’t be too hard on yourself, it was pretty fucking funny.’
Beware of toilet (#ulink_c9121400-5c78-54f8-89dc-ad9e67dbd9c4)
One of the challenges of nursing is that you are constantly encountering new things. As a young nurse in my first year of work, everything was new. But there is one particular first experience that I will never forget.
Mr Smith was 82 years old. If he could have had it his way, he’d still have been living independently in his three-bedroom house with his quarter acre of land. His children and grandchildren, however, had convinced him that the best and safest option was for him to move into a small apartment that was part of a rest home – a nice balance between independence and supervision. But, after forgetting to turn off his stove several times in two weeks, Mr Smith’s meals were now cooked for him, and after a fall getting out of the shower, he had an aide who helped him with his bathing. Still, other than that, Mr Smith looked after himself, which is pretty independent for an 82-year-old man.
Mr Smith was brought into the ward at eight o’clock on a Sunday evening. His chest was heaving as he strained to pull air into his lungs; you could hear him wheezing, coughing and spluttering from outside his room. Mr Smith had been a bit off-colour for nearly a week. What had started out as a mild cough had gradually stained his handkerchief with white, then yellow, then green and now red speckled sputum. The infection had crept insidiously into his lungs, spreading lower and lower like a cancer. The nurses from the rest home had advised him to come to hospital earlier, but like many men in his position, he was stubborn and refused to move. By the time he agreed to go to hospital, he didn’t really have a choice: it was go to hospital, or die.
I liked Mr Smith instantly.
‘I’m only being a burden; just put me out of my misery,’ he said between gasps.
He even managed a brief smile. It says a lot about a person’s character when they can joke at a time like this.
I told him to stop talking rubbish; that once the medicines kicked in he would be feeling much better.
Forty-eight hours of intravenous antibiotics later, and Mr Smith was rapidly improving. He could speak whole sentences without getting out of breath. He was not coughing up so much sputum. He even managed to get himself up out of bed and into the reclining chair.
Watching your patient get better, knowing that you are one of the people responsible for making the difference, is one of the greatest feelings in the world. Though, while I’d love to be the one to take the credit for his progress, it’s always a team effort. It wasn’t only a matter of antibiotics fighting an infection: nurses cleaned, dressed, toileted, exercised and talked to the patient; the physiotherapist came in twice a day to exercise his chest; the laboratory and X-ray people visited daily to draw his blood and irradiate him.
Between us all, I was sure we would get Mr Smith back home.
It was Wednesday, Mr Smith’s fourth night in hospital, and he and I were discussing the merits of a commode versus a regular toilet.
Like most patients, Mr Smith had never liked using the commode, but up until now he had been too sick to risk taking too far from the bed. ‘I won’t sit on that disgusting thing again. There are other people in here and it is embarrassing.’
He had a point: there’s no way to completely hide the smells and sounds that go with taking a dump in a shared room.
‘I’m not using it and that is final.’ Mr Smith was adamant, and began to get out of bed. ‘You could try making yourself useful by handing me my walking stick.’
I had a vision of Mr Smith collapsing in the middle of the corridor: ‘Please, wait a moment and I’ll grab you a wheelchair.’
To make things easier, I used a portable shower chair, so that once I had him seated I could just roll it straight over the toilet and he wouldn’t have to move one bit. As I wheeled him down the corridor I noticed he was still wheezing, not nearly as badly as he had been on admission, but I still set him up with some portable oxygen to help things out.
Naturally, I wasn’t keen to leave Mr Smith alone, so I waited discreetly outside the partially open bathroom door, calling out every 30 seconds, ‘Are you okay in there?’
To which he responded, ‘Can’t a man take a crap in peace?’
But on my fourth call, Mr Smith was silent, and then I heard a thump. My heart leapt into my throat as I rushed in.
Mr Smith was still sitting in the chair, but he had slumped against the wall with his eyes staring sightlessly ahead. His nose and lips were a bluish purple, and darkening before my eyes.
This was it: my first arrest.
I’d actually felt a little envious of fellow student nurses who had been involved in an arrest during their training. I’d also heard experienced nurses casually talking over lunch break, ‘Oh yeah, Mr Brown, he was in VF and we shocked him a number of times; we got lucky – he pulled through.’
But this wasn’t exciting like I’d imagined. I couldn’t ever envisage casually discussing this over a sandwich. This was a nice old man whom I liked and who seemed to like me. A man who had been getting better.
An arrest can refer to arrested breathing, or an arrested heart. In Mr Smith’s case, he definitely wasn’t breathing, and if his heart hadn’t already stopped, it would very soon.
I called out for help, shouting down the corridor, and kept my finger on the call bell, until the doctor and another nurse came running.
The bathroom is not the easiest place to begin CPR and neither is a shower chair.
‘Grab his shoulders and don’t let him fall,’ Dr Jackson instructed as we wheeled him back to his room.
Between the three of us we literally threw him on to his bed and the doctor barked at me to push the arrest alarm.
The alarm was in the corridor. I walked past it dozens of times each day – in fact, I’d often wondered if I would ever get to push it – but suddenly it had disappeared. It should have been right in front of me, but the wall seemed so damned big at that moment.
It could have only been about ten seconds before I found it, but each of those seconds was one more in which the life was draining out of my patient. I jammed my finger on the button – which, of course, had been in front of me the whole time – and raced back into the room.
The doctor yelled at me to begin compressions. Holy shit, compressions. I jumped on Mr Smith’s chest and began pumping up and down at a furious rate, while the other nurse used an Ambubag to pump air into his lungs. The doctor was trying to get some intravenous access, because Mr Smith’s old line wasn’t working – what a horrendous time for a line to pack up. I hoped they wouldn’t blame me for that; he was my patient after all. I could see the swelling around the old IV site where the doctor had tried to inject some medicine.
‘Not so hard,’ the other nurse said to me, as I felt a sickening crunch as a rib or two cracked under my hands.
Within a minute, the arrest team arrived and the professionals took over. They asked me to stand back while they did their work, and in my hurry to get out of their way I knocked over the drinks bottle that was sitting on the bedside. It’s a strange thing to remember at a time like this, but it was a glass bottle full of black-currant concentrate, and when it hit the floor it splattered bright red everywhere, like fresh arterial blood.
As the arrest team got underway, I was amazed at how calm, quiet and confident they all were whereas I was shaking from all the adrenaline pumping through me. I watched as they hooked Mr Smith up to a monitor and wondered if they were going to shock him with the defibrillator, but it was too late for that. He had no electrical activity left in his heart.
In a lot of TV shows, someone yells ‘Stand clear’, and they shock the patient with some paddles, but Mr Smith didn’t need this. In fact, most TV shows get it wrong. Those shocks don’t start the heart, they actually stop the heart. When a heart arrests, the electrical activity which once made the heart beat doesn’t stop immediately: it goes haywire, shooting in all directions. It makes the heart a quivering jelly, shaking with all that uncontrolled current. When we shock someone, we’re trying to briefly stop this craziness, in the hope that the patient’s own heart will start again in a healthy rhythm. Another way to think of it is a lifeguard who swims out to rescue a drowning swimmer, but the swimmer is so panicked, the rescuer can’t do his job, so the rescuer slaps them really hard, to shock them into calming down.
Sadly, Mr Smith died that night and it was not a nice way to die; he was sitting on the toilet for goodness’ sake. The nurse with me during the arrest was Rose. She was in her early fifties, and had been a nurse all her life. She could see how shaken I was and took me aside for a quiet word.
‘There’s nothing you could have done,’ Rose said to me, ‘it’s quite common for people to die on the toilet.’
Registering my surprise Rose told me that it’s not unusual for people to want to empty their bowels before having a heart attack. She then explained that the effort to try to pass a bowel motion was often the trigger that set it off. She even said she’d lost a few in the toilet over the years.
But, instead of feeling better, I began to feel guilty. I shouldn’t have let him go. I knew he should have stayed in his room and used the commode.
‘It’s not your fault,’ Rose repeated, then let out a brief chuckle. ‘There’s no use feeling guilty. When it’s your time, there’s nothing we can do.’
Rose’s words helped a bit but there was still a sense of guilt. I was determined never to let any of my elderly patients use the toilet again; they could wait for the next shift to come on.
Rose offered to help me prepare Mr Smith for his family, who would arrive shortly. This was another new experience for me.
As we began to wash Mr Smith, Rose did something unexpected. Every time she did something to Mr Smith’s body, she would use his name and explain what she was doing, just as you would with a living patient. She was gentle, and spoke softly. You could tell she still cared.
Heartless (#ulink_77341e2e-10b8-506a-a56f-907939b5998b)
‘I’ve learnt my lesson,’ Mr Holdsworth said, pausing to look me in the eye for emphasis, before continuing. ‘I’ve learnt it the hard way.’
I nodded my head in sympathy, even though I’d heard the story at least three times. He seemed to think of himself as some self-sacrificing guru of wisdom; wisdom gained through pain and suffering. Well, I guess he was at least part right.
‘Don’t make the same mistakes I . . . arrrgh—’ He never finished his sentence because he was clutching his chest.
Having looked after Mr Holdsworth during his last two admissions, I was quite used to his frequent attacks of chest pain.
I placed an oxygen mask on Mr Holdsworth’s face, told him I’d be back shortly, and left the room. When I returned I was armed with morphine. ‘This should do the trick,’ I said as I injected the narcotic directly into his vein.
Often providing oxygen can be enough to relieve a patient’s angina, but if this isn’t enough, then morphine is another option. It not only relieves pain, but helps reduce the workload of the heart.
I watched Mr Holdsworth’s expression as the pain slowly eased from his chest and an almost calm, albeit glazed, look came over his face. It’s sometimes hard to believe that medicine can have such an amazing effect.
‘How much that time?’ Mr Holdsworth asked.
He always asked this and every time I was reluctant to answer. It’s not as if he didn’t need the medicine. People rarely ask how much. Maybe it was his background that made me reluctant, or maybe it was because I was giving him more each time, which meant his heart was getting worse.
‘Thirty milligrams,’ I reluctantly replied, avoiding his gaze.
‘Hell, I’ve never had that much in one go.’
Mr Holdsworth didn’t sound upset, more intrigued, as if curious about how much his body could take. You see, Mr Holdsworth used to be an intravenous drug user. Over the years that he had injected morphine into his veins, he had built up a resistance to the drug. This was also how he damaged his heart. Most of the damage occurred on the occasions he took so much that his breathing stopped (one of the primary risks of morphine). Once his breathing stopped, it wasn’t long before his heart stopped. Fortunately paramedics were able to revive him. Each time, he survived, but the damage to his heart was permanent.
‘Not a good sign is it?’ he added.
Sometimes it pays to tell the truth, even when it can hurt, but it’s still hard. Should I tell him that I’ve never given such a high dose of morphine in one push, or given it as frequently to one patient, in my entire career? Should I tell him that I’m even a little nervous giving 20 to 30 milligrams pushes of morphine every half an hour? He probably already knows this, especially given his background. He probably already knows that for most people one to two milligrams is a sufficient amount.
‘You’re probably just having a bad day,’ I replied with false bravado and an equally false smile.
‘Now I know you’re trying to be nice, but stop the bullshit. You know as well as I that I probably won’t make it to Christmas.’
Mr Holdsworth tried to say this as casually as if he was talking about the weather, but I could tell his efforts were as forced as mine.
‘You’re still young, there is a chance. Something could happen any day.’
Unfortunately, Mr Holdsworth had had his first heart attack at the relatively young age of 36. It had been his first wake-up call, but now after four heart attacks, and four subsequent areas of dead, scarred heart muscle, there was very little that either drugs or a healthy lifestyle could do to help him. Christmas was one month away and unless a miracle happened Mr Holdsworth was probably not going to see it.
Still, we had to hope, sometimes it’s all that keeps us going, and there was one chance, one possibility, that we could help Mr Holdsworth. At the age of 47, the only thing that could save him was a new heart, but after five years on the waiting list already, it seemed a very small chance indeed.
With Mr Holdsworth’s rapidly declining health, the topic of conversation was often how much longer he would last, and whether a miracle would happen.
‘I feel sorry for him . . . sometimes,’ Jenny said to all the other nurses in the office, ‘but at other times, I think he doesn’t deserve our compassion, or a new heart.’
‘I know we’re supposed to be caring, but we’re only human,’ I said to Jenny. ‘Today I felt sorry for the poor guy, but I’m like you. I don’t always have much sympathy for him.’
As I looked around at the other nurses in the office I could tell, by the nodding heads, that we all seemed to have similarly mixed feelings. ‘I guess it doesn’t really matter what we think now,’ Jenny continued, ‘he’s paying for his mistakes.’
Four weeks passed. It was now only a few days until Christmas Day. The girls had been busy decorating the ward, and I nearly broke my neck balancing precariously on a patient’s bedside cabinet to put the finishing touches to the tree. I love this time of year – everyone is in such great spirits – even the patients don’t seem so sick.
With half the ward empty we had time to sit around gossiping and reminiscing about who was the drunkest at the Christmas party – until it came time for me to check on Mr Holdsworth.
‘How much that time?’ he asked.
‘Forty milligrams,’ I replied. ‘Is it enough?’ I added.
He had stopped clutching his chest but his face was still creased with pain.
‘Could you try a little more, just another ten? That should do the trick.’
The instructions given to us by the consultant were to give Mr Holdsworth whatever it took to keep him comfortable, so I administered a further ten. With the additional dosage the last vestiges of pain left his face.
‘You’ve been good to an old fool like me,’ Mr Holdsworth said.
‘We all make mistakes,’ I replied.
‘It won’t be long now and I’ll pay the ultimate price.’
My mind was blank. There was no suitable response. I chose that moment to leave the room, my Christmas spirit well and truly dampened.
The next morning something strange happened; as I headed towards the nurses’ station I found myself taking a detour until I was standing outside Mr Holdsworth’s room. The first thing I noticed was that his name had been removed from the door; the second was the deathly silence in the room.
I felt strangely depleted. I think that deep down, I had been believing that a Christmas miracle might happen. I quietly opened the door and there, staring me in the face, was an empty room. I headed to the office, where the nurses seemed to have gone mad.
Jenny greeted me with a big smile. ‘Have you heard the news?’
I didn’t know what news she was thinking. I know we all had mixed feelings about Mr Holdsworth, but it didn’t seem quite right to be so damn happy first thing in the morning when a patient has just passed away.
‘It’s Mr Holdsworth,’ she was almost exuberant. ‘They came for him last night. They found a donor. He’s getting a new heart.’
Everyone in the office was so genuinely happy that he was going to have a chance at life – regardless of whatever past mistakes he had made. Without a doubt that had to be the best Christmas present ever.
Mr Holdsworth’s transplant operation had taken place far away in a big city hospital, so Jenny had to phone the hospital every few days to get an update on how our patient was doing.
‘He could be discharged soon,’ Jenny informed us, three weeks after he had been taken away. ‘The doctors say he is doing really well. No sign of rejection.’
Three months later and Mr Holdsworth was back at home and living a normal life – although, we assumed, a much more careful, healthy life. It makes sense that a near death experience makes a person wiser.
During the two and a half years I had spent with patients in the medical/surgical ward, I thought I’d seen it all. I had seen how high the human spirit can soar, and then how low and selfish humanity can be. But then, along would come someone new, who would set up new boundaries, whether high or low.
One April morning I was greeted by Jenny, who had news to share: ‘Mr Holdsworth is in the emergency room.’
‘Organ rejection,’ I blurted out.
‘Oh no, it’s much worse than that’ – What could be worse than your body rejecting your new heart? – ‘He’s back to his old habits. He’s overdosed on morphine.’
Jenny didn’t attempt to hide the scorn in her voice.
‘But that’s not even the worst part. When he gets out of here, he’s got an interview with the police. It seems he’s been selling it as well.’
I guess not everyone learns from their mistakes. As I look back at some of the ambivalent feelings I had had while looking after Mr Holdsworth, I wonder if deep down I doubted that he really had changed. That heart could have gone to someone else less likely to waste it. I try not to judge, but the fact is we’re all human and we do have opinions. I just hope that as a nurse, I can always accept people for who they are and give them the best care that I can.
Making a difference (#ulink_0bb3f951-cdba-5407-8b3a-2e19690d2cc5)
‘Mr Henderson has taken a turn for the worse,’ Colleen read to the assembled nurses. ‘He wouldn’t get out of bed today and his chest is sounding bad.’
Colleen looked pretty upset about this; moisture was pooling in the corners of her eyes. Colleen was straight out of training and hadn’t lost a patient yet; everyone was wondering if Mr Henderson was going to be her first.
All of the nurses liked Mr Henderson; he was a truly genuine, down-to-earth sort of man, with a heart of gold. At the age of 69 he should still have had some good years in front of him, but he had a bad case of pneumonia that the antibiotics couldn’t seem to get rid of.
‘The doc requested another chest X-ray. The infection hasn’t improved at all,’ she continued. ‘He even thought it was a bit worse. Every breath Mr Henderson takes is an effort. It’s horrible to listen to.’
The sound of a rattling, bubbling, straining set of lungs is never nice.
Everyone kept quiet – we had all had our first lost patient, and though Colleen might shed a few tears if Mr Henderson passed away, she would eventually recover.
With the report over, we filed quietly out of the office, talking with muted voices about the patient, as if he had already passed.
I was helping Colleen with Mr Henderson that day. As I entered his room, I took in his sickly grey skin. ‘Good afternoon, Mr Henderson, I hear you’ve been giving the girls a bit of trouble.’
This brought a smile to his face. ‘Could be better, son,’ he rasped.
That was Mr Henderson, having a joke in the face of death. I grabbed a passing nurse and together we heaved him upright in his bed to help his breathing.
‘I don’t think I have much time,’ Mr Henderson said to me when his coughing passed. ‘I’ve had a good life. I’m not ashamed of the life I’ve led.’
I felt a lump in my throat.
‘It’s not over yet, Mr Henderson’ – I had to at least try to be optimistic – ‘The doc has just started you on a new antibiotic; you might feel like a new man tomorrow. Besides, you can’t go letting young Colleen down after all her hard work.’
Mr Henderson managed a wry chuckle before bursting into another round of coughing.
‘You’re a bad liar, but you and the wee lass have done a lot for me – it would be a shame to disappoint you.’
Still, I wished there was something more I could do. Often it’s just a case of being there for a patient, and willing to listen. Every so often, though, there’s the option of doing something extra. Later that evening I had a chat with the other nurses about how we could make Mr Henderson more comfortable.
‘Room 5 is free. What do you say to that?’ I asked Rose.
‘The poor fella is in a four-bedded room. It’s not nice for him, or for the others in the room. Let’s move him,’ Colleen added.
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.

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