REGISTRATION ROAD – PART 1

About eighteen months ago I had the idea to move to England and work as a nurse. I thought it’d be fun to go and explore the world, and to pay my way with the skills I’ve earned. I knew that to work as a nurse in the United Kingdom, I’d first have to register. I figured I’d fill out a few forms, send a few documents over, and before I knew it I’d be cleaning out wounds and sticking people with needles while they said charming things like, “Are you having a laugh?” and offering me copious amounts of tea. This was a delusional and naive presumption. (Not the charming things British people say, more the few documents thing. I’ve already genuinely been called “Poppet.” Twice).

It didn’t seem like a naive presumption at the time. The facts are these: I went to university for three years to train as a nurse. During that time I sat many exams and went through months of placement to prove my skills and knowledge were sufficient. After university, I completed a graduate year at Austin Hospital, one of Melbourne’s major metropolitan hospitals. I then worked for five years for the Royal District Nursing Service, becoming a team manager after the first year. I’m skilled up to my eyeballs, dammit.

I figured another first-world country, a country that is the mother of the commonwealth, the international collective to which Australia is a part of, would recognise these skills. I was wrong. I had to prove myself.

And over the last eighteen months I have learnt one thing: The process to register in the United Kingdom is a cold and unflinching bitch.

I’m now going to detail the arduous requirements that all Australian and New Zealand nurses have to go through in order to do the job they’re already trained for. I had to live through it, people, you only have to read about it…


To begin the process, I went online and punched my details into the registration website. This created an account for me with the various stages of registration mapped out — although all I had access to was the first stage. They put me firmly in my place; they didn’t want me getting ahead of myself. Looking back, this could be their catch-phrase:

“Don’t get ahead of yourself.”

The first stage was asking for the scores and ID number of an exam. As yet, I had not sat that exam, so I went about booking myself in. The exam cost somewhere in the vicinity of $400, and I was strongly encouraged to study and prepare for the day. I felt I had been studying and preparing for the exam my whole life — the exam was an English exam. I had to prove I had the necessary English skills to work as a nurse. This is despite the fact that English is the only language I know, a language I’ve spoken since the age of two, a language I completed school and five years of tertiary education in, two years of that tertiary education being in an English diploma. None of this mattered; I had to sit the exam.

So I did. I filed into a classroom with a collection of people for whom English was a second language, showed my passport (it was all very official), took my seat, and spent five hours writing, reading, interpreting, listening and speaking in English. The speaking component was a one-on-one interview, and when I met my interviewer and sat down, and it was obvious I was Australian-born, she looked at me and asked: “So why do you have to do this?”

I wanted to ask her the same question.

You’ll all be relieved to know I passed the exam. Shocking, right? In fact, I got full marks except for the listening component where I drifted off for a second and missed something the pre-recorded voice read out, and lost half a mark. So I’m officially a bad listener.

Exam done, I excitedly logged back in and put in my results details, and was rewarded by being able to access the next stage in the process. The next stage was an exam. Another one. Once again I went about booking myself in. This exam was to test my nursing theory, and cost somewhere in the vicinity of $350.

I wasn’t sure what to expect for this exam. The body of medical knowledge is a rather large one, and I didn’t know how to prepare for such a general topic, given that any aspect of health theory could technically be tested. Luckily, I was sent a document of what to study. This document was a forty-four page table consisting of minute areas to be tested, broken in to headings, sub-headings and sub-sub-headings. Most of it was entirely useless.

The table gave vague one-line wanky descriptions of what would be covered, saying very little of actual substance. Things like: “The ability to express the desires of the patient.” What? How do I study for the ability to express the desires of the patient? What sort of multiple choice question summarises something as subjective and variable as the ability to express the desires of the patient?

The document followed this up with links to various sites to which I gathered were places where I could get my answers. I would estimate that ninety percent of the links were dead, taking me down pathways to websites that no longer existed, and the ones that did work took me to journal articles with obscure titles such as: “Interpreting body language – A case study.”

None of this was helpful, and there were no questions in the exam relating to body language.

I did my own independent study on what I reasoned were the fundamentals of nursing theory and I passed.

At this point, I thought I was through the crucible. I knew once I got to London I’d have to sit a third and final practical exam, but this didn’t worry me greatly. I had passed two exams and was ready to be on my way. I was drafting my letter of resignation in my head. Thankfully, I never put the words to paper. It was a further ten months before I resigned.

I logged back on to see what was next expected of me and discovered that a mountain of paperwork was needed before anything further could be done. So, one by one, I went about obtaining, scanning in, and sending off the required documents.

I had to order a birth certificate, providing verified copies of various forms of identification to prove I was me and entitled to a record of my birth, I needed police checks, one for both Australia and the UK (although how I was supposed to have a criminal record in a country I’d never been to I have no idea), I contacted my registration board in Australia and for a $80 fee they agreed to send a single piece of paper to England proving I was a registered nurse in Australia. I had a multitude of blood test and booster shots, provided bank statements, and obtained declarations of good health from GPs stating I was mentally and physically fit for work.

And, hardest of all, I got in contact with my old university, a different campus from the one I attended as the one I attended no longer existed, and cajoled them into producing an eight-page document detailing down to the exact hour the subjects and placements I completed six years ago during university.

After months of administration and paying more money for these documents, I sent off a packet to the UK, and sat back and waited for my paperwork to be approved. This was it. The final hurdle before jumping on a plane and dropping into the rest of the world.

My documents were rejected…

(To be continued in Part 2…you lucky things)


Recently I created a Patreon page as a way to share some of my creative fiction, as well as a means to fund my writing.

I’ve recently put up a new short story called “Thermodynamics and Reincarnation.”

If you want to give it a read and become a patron, head here: https://www.patreon.com/jonathanrobb?ty=c

You can pay whatever you like – $1, $5, or nothing at all. The important thing is that you read it.

 

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LIFE IN LONDON #03

My last few weeks in London have revolved around obtaining employment. This has been a series of opening bank accounts, getting blood test, sitting interviews which turned out to be secret examinations, providing endless documents, proving I have a clean criminal record in both Australia and the UK (there’s no record if you’ve never been caught…wink. Or, in my case, if you’ve never committed a crime), and getting a national insurance number to ensure the government gets a cut of my money once I do start earning an income. God bless the queen.

But I’m happy to jump through all these hoops for two reasons.

One: I like money. Money means buying food and shelter, and food and shelter means staying alive. There’s no getting around it, really.

And, two: I’ve decided that without working, without being a contributing member of society, I can’t really claim to be living in London. And given these posts are all listed under the title of “Life in London,” it seems contradictory to claim to detail life in London when I’m not adding to the life of London. Don’t get me wrong, I am technically alive, and my physical body is technically in London, but without delving into that world of employment that makes up the cogs of a community, I’m stuck on the sidelines. I’m an observer. No, worse than that. I’m a tourist. And nobody likes a tourist.

I’ve been unemployed now for exactly three months and one day, which is the longest I have been out of a job since I was fifteen and got shown to my first register, and told to memorise the fruit and vegetable codes. Iceberg lettuce is 4016 for anybody who’s wondering.

I’m now twenty-eight years and ten months old, which means I’ve been working for almost exactly half of my life. And after working half my life and now being unemployed for three months and one day, I have learned something.

Being unemployed is amazing.

But I should really qualify that statement: Being unemployed, and having money, is amazing.

These last three months and one day have been so relaxing and liberating, and full of new experiences and sights, that I know I’ve changed as a person. Not changed as in shedding my old self, but just in letting my old self put down the weight of stress for a while, stretch out the muscles, maybe have a bath, catch up on some sleep, and see how I feel in the morning.

And how I feel is incredible. Working as a nurse, it’s inevitable that you take on the stress and anxiety of the people you care for. Their health is your responsibility, and when their health drops, so does your mood. They look at you and ask questions that have answers they don’t want to hear. Family members rain comments and queries at you, as if trying to catch you out. I know why they do it — they do it because they feel helpless, and this is the only thing they can think of to feel like they’re contributing to the care of their loved one. But as the person under the firing line of questions, all it does is drain you.

And, of course, you really are responsible for their health. How you place their catheter directly affects their wellbeing. The care you take with a wound dressing alters the healing of the wound.  How you speak to them and the empathy you show impacts on their outlook. And any mistakes you make directly impinges on your patient’s health. This means when you wake up feeling tired and unmotivated, you can’t console yourself by thinking you’ll just phone-it-in that day and play solitaire on the computer when the boss isn’t looking. Every day, regardless of energy levels, you have to give everything. Because they’re sick and they need you.

Being able to put that stress down, to be able to be selfish and think only of my own wants, felt like the lifetime equivalent of getting a solid eight hours of sleep. That sort of sleep where you don’t move all night and wake up in a pool of your own saliva, but you don’t care because you feel so damn rested. It was good to be unemployed. It was rejuvenating.

But, life isn’t about being stress-free. In fact, it could be argued that life is stress, and how we deal with it and turn it in to good things is living. And the point of this rejuvenation isn’t to put the stress of work behind me, but to stop, flush out the muck building up in my subconscious’s nooks and crannies, and feel ready to pick it up again. After all, as incredible as it is to lay around doing nothing but eating and drinking, and being studiously idle, no one wants to live in a resort forever.

And now I’m not. After my three months and one day, I am now once again employed. Which means I am officially living in London.

While I intend to eventually work as a nurse, until the UK nursing registration board decides to stop choking me with red tape, that’s not going to happen. So for now I am working as a community phlebotomist. While this sounds like a noise you might make clearing your throat, or maybe a procedure where they remove part of your brain, it’s actually just what would be referred to in Australia as a pathologist. Basically, I take blood for a living.

My day begins with me catching the tube up north into London and alighting in Camden. This trip takes about an hour, but I don’t mind as it’s time spent reading or writing, and as far as I’m concerned, that’s a good investment of time. I wear a backpack, the same trusty backpack that was my staunch ally through the deserted streets of East Croydon at two o’clock in the morning, which I’ve packed the day before full of tubes, needles, tourniquets, cotton balls, and tape. Basically, an IV drug-users goldmine. Luckily, I am a fine upstanding member of society, and don’t use these items to take drugs. I just drain strangers of their blood.

I then walk to people’s homes. I have a list of patients I need to visit throughout the day, and with the power of my own legs, I navigate the streets of Camden and the surrounding areas, knocking on doors and introducing myself before wrapping a tourniquet around my host’s arm and sticking them with something sharp. Most are surprising gracious about it.

So far, the hardest aspect of my job isn’t persuading people to let me have some of their bodily fluids, but the walking. Using google maps and a bit of guessing, I’d say I walk over twenty kilometres a day. I’ve just finished working four days, which means I walked in excess of eighty kilometres this week. That’s a lot. I know this because my feet ache, and my legs ache, and, weirdly, my bum aches. Just the sides, over the hips. Apparently these underused muscles get a workout when walking excessively. So the upside is, if I keep doing this work, I may eventually develop a bum. At the moment I’m mostly just back and legs.

But the real upside (besides a bum a black woman would be jealous of) is that I get to see London on foot. It’s a surreal image when I stop and picture myself, backpack on back, umbrella in hand, crisscrossing through London streets, navigating my way through the biggest and most famous of English cities. This is so far removed from my life of only six months ago that sometimes it’s hard to hold the reality of it in my head.

If I’m honest, though, the real surreality is in how much it’s the same. Once I find my next patient’s home amongst the stacked apartments and units A, B, C and Ds, knock on their door and disappear inside, leaving behind the big red buses and black taxi cabs, I could be forgiven for thinking I’m back in Melbourne, making my rounds as a district nurse. The formula remains the same, except in the introduction of: “Good morning, I’m Jonathan, the district nurse,” where I replace “district nurse” with “community phlebotomist.” I use the same small talk as I pick my way to the kitchen or living room, say the same jokes to break the ice, get the same responses to the same jokes, bluff my way through a sports conversation with the same generic ambiguous statements (it turns out saying: “It’s hard to say who’ll have a win, but it should be a good match,” can be applied to almost any sport), and thank my patient in the some way once I’m done. The only difference is instead of dressing wounds or changing stoma bags or administering medication, I’m only doing the one task — taking blood.

Even with the vertigo I sometimes get when I remember I’m half way around the world from a life I once knew, it turns out human beings just simply aren’t that different.

The final upside (besides becoming bootylicious and seeing London on foot) is that I am once again part of the community. I truly am living in London. I like being a member of society, I like dropping in amongst the people and sweating beside them as we work, and knowing I’m now one of them. I first had this sensation when working at the supermarket and recognising my customers down the street. They’d give me a nod and a smile, and I’d give a nod and wink, which was our secret little code saying, “I know you. You belong here.” Like the new kid at school invited to play foursquare, I had been accepted. And I killed it on the foursquare court. (For those unfamiliar with the game, it involves drawing four aligning squares in chalk on concrete and then slapping a tennis ball between them. It’s the closest you can get to exercising without actually exercising — it was right up my alley).

There is something to having someone acknowledge that you’re contributing to the social cause on some level, a shift that occurs in the brain when you transition from “me and them” to “us.”

I have assimilated into London culture through the avenue of work and been accepted.

The Brits want to play foursquare with me.

It feels good.

THE BAD ONES #02

I was visiting to admit him, a skinny Indian man recently returned from hospital. He was sixty, and previous to his recent surgery had been completely independent. He’d had years of back pain and recently gone in for a surgery designed to relieve pressure in his lower vertebrae. Unfortunately, during the operation, damage had been done to his nerves resulting in a neurogenic bladder. He had lost the ability to consciously relax the sphincter between his bladder and urethra, thereby releasing urine. In other words, he could no longer piss on command.

I was there to educate him on the catheter that had been inserted to ensure his bladder could still empty. I went through the usual process of introduction and listening to his recount of events before beginning to detail how to properly care for his new urinary system. He stopped me, and asked instead if I could remove his catheter.

After digesting his request I explained that couldn’t do as he asked, that without a catheter his bladder would continue to fill, that the pressure in his renal system would build and he’d be in extreme discomfort, and, if left unrelieved, could damage his kidneys.

Again, he stopped me, shaking his head and waving his hands, dismissing what I’d said. He told me that if I removed the catheter he would urinate. He assured me that if he could just relax, he could get a flow going.

I begun explaining about his neurogenic bladder, and again he cut me off, eyes closed and head shaking. ‘They have told me this in the hospital,’ he said. ‘But I know my body. If you take it out, I will be able to pee.’

I empathised with his difficulty in coming to terms with his new disability, but felt a bloom of frustration open in my gut. I tried again.

I explained, patiently, that in fact he’d had the opportunity while in hospital to do exactly that, that the hospital staff had removed his catheter and after an hour had scanned his bladder and found a litre of urine inside his body and not a drop out. I reminded him that they done this on two separate occasions, a week apart, and each time he’d been unable to void.

He was frowning now, jaws clenched as he waved his hands in front of my face. ‘I couldn’t do it there!’ he said. ‘There was too much pressure, with their machines, and their waiting. I am home now. I can do it now.’

I bit down my exasperation while requesting he not interrupt me, and to lower his hands, and explained that anyone with conscious control of their bladder would be able to pee if they had a litre of urine pushing down on their sphincter. He interrupted me.

‘No! Take it out and I will show you. I don’t want it anymore.’

This conversation continued for an hour. Despite my argument that it was in his best interest to keep the catheter in, he continued to command me to take it out. I told him that once the catheter was out, and he failed to urinate, he would be in agony. That his bladder would feel like it was ready to rupture and there would be no one around to insert a new catheter to relieve it. That he’d have to return to the hospital, something he insisted he wouldn’t do.

I explained that I wasn’t saying this to antagonise him, only that it was the truth. He rebutted with threatening to pull the catheter out.

By this point, over the hill of vexation and down again, I couldn’t repress a chuckle. A catheter has a balloon in the tip with a diameter of about four centimetres to hold it in place in the bladder. A male urethra has the diameter of about one centimetre. Pulling out a catheter without the balloon deflated is a painful process.

I detailed this, using the simile of pulling an apricot through a straw, and recommend that he not try it. He told me he would do as he liked.

In the end I slumped back in my seat and said I wouldn’t do what he wanted. He told me to leave.

When I got back to the office I contacted the hospital and informed them of the outcome of my visit, and they madly scrambled to have an ambulance and a bed ready if he did remove his catheter. I hung up the phone annoyed that they had to work harder to compensate for this man’s idiocy.

It’s hard to fight to save someone from themselves. It’s hard when their voice is raised and respect is gone, and you’re debating reason while they’re debating stubborn ignorance. It’s hard to keep caring about their wellbeing when they don’t care about your professional knowledge. And it’s easy to think, ‘Why don’t I just leave them to the consequences of their actions?’

He was one of the bad ones.

ENCOMIUM – PART 2

My last post detailed a typical visit to a patient named Ted, an eighty-four year old man I saw twice a day for over a year. Ted lived alone in a run-down unit, due for demolition, and had such severe short-term memory loss that within the course of a visit he could tell the same story multiple times. Luckily Ted retained his long-term memories, and, even luckier for me, the stories he told were so interesting it was no burden to hear them repeated.

As nurses we assisted Ted by administering his medications, ensuring he was having something to eat, moisturising his legs, and occasionally dressing any wounds he developed. We also gave the solitary man company, and, uniquely, Ted gave back. Some days it was hard to tell who was accompanying whom.

Ted was a joy. Normally seeing a client this often, particularly one who offers up the same conversation like a meal repeated until you’re sick of the sight of it, would become wearisome, but Ted was so genuinely happy, and so sharing in his happiness, that visiting him felt like recharging. Each rendition he gave of his stories was animated and energetic. His jokes, which after a few months I could mouth along with him, were always delivered with such sincere amusement and enjoyment that it was impossible not to laugh with him.

I was moved from the area where Ted lived and began nursing further north, and my visits with Ted were cut off. It was a different nurse who got to hear about the time his car broke down on a set of train tracks and was hit, with Ted still in the car, by a train. Ted walked away from the accident, went to get a beer at a nearby pub to steady his nerves, and decided the car was probably a wreck, and so hitchhiked his way home. True story. I heard it at least seventy-eight times.

A few months ago I found out Ted was no longer on our books. Ted has chronic obstructive pulmonary disease, which is a fancy way of saying his lungs are shot. He spent his early adulthood chewing on cigars, sucking on cigarettes, and even having the odd puff of a pipe. His later adulthood was spent working in a pottery factory at a time when OH & S didn’t include face masks, and so, even though he had quit smoking, the deterioration of his respiratory system continued with lungful after lungful of ceramic dust. Because of his COPD, Ted was particularly prone to chest infections, which made him particularly prone to hospital admissions. And so the decision was made by his case manager that Ted wasn’t safe to be living alone and a nursing home was arranged. This meant district nurses were no longer required.

The abrupt departure of a patient is an aspect of my job I find disorientating. Let me set the stage: we go into the intimate confines of a person’s home, are welcomed and offered tea. We administer care, which by its nature creates a bond between patient and nurse. We talk as we work, and learn about out patient’s lives and families. Then, as inevitably happens, one day they’re gone.

Sometimes it’s due to death, but more often it’s that they’ve been put into a nursing home. Or gone to live with family. Or are in hospital. The latter is the hardest because they disappear into the hospital system and it’s not until months later that you realise they haven’t returned and are left wondering what happened to them.

District nurses are, at best, a band-aid. We are a temporary fix, and the best we can hope to achieve is to maintain the status quo for a while longer until health deterioration catches up with our patients. Please don’t let this observation cheapen the profession. Those extra few years we buy our clients at home are years of comfort in a familiar environment, but it’s still frustrating to know we are a quick, and non-lasting, solution.

So Ted had disappeared into that world of post-district nursing, but because of where he had lived I still found myself driving past his unit most days. (Despite his absence, the demolition has yet to commence). And each day I was reminded of the man and what an incredible life he had led. I would remember the story of how, on an impulse, he quit his job in New South Wales and travelled to Melbourne with a friend to visit his friend’s aunty. And how, six months later, he married his friend’s aunty. She was twenty years his senior and initially refused to marry him, stating that he could stay until he was bored with her. Ted was outraged at the suggestion that he wouldn’t make an honest woman of her and slept on the couch until their marriage day.

And I remembered how, twenty years on, his wife had a stroke and, mentally, reverted back to an infant. And how Ted fed her, and washed her, and cared for her whilst she called him “Mum,” until the day she died.

An encomium is a tribute, either spoken or in text, to a person and their accomplishments. My previous post set out to capture just a slice of what it was like to know Ted. To immortalise a fraction of a fraction of his life, but one that demonstrated his humour, and his vitality, and his kindness. To protect and praise a man who had done some incredible things but who had been largely forgotten by the community he lived in.

Ted will undoubtedly have no memory of me and the small part I played in his story, but hopefully these posts will preserve my memories of Ted and the part he played in mine.

THE FIRST TIME

One of the most common things my patients say to me, excluding those unfortunate few who have lived with a chronic condition most of their lives, is “This is the first time I’ve ever been sick.” They say it as if daring me to believe it, because they themselves are having a hard time believing it. Their run of perfect health has inexplicably come to an end. They quote at me their perfect medical history, taking pride in their previous resilience:

“I broke my arm when I was seven, but beyond that I’ve never even seen a doctor!”

They are always surprised that their bodies have let them down. But why? Why are we taken by surprise by the fact that we are mortal, that our imperfect bodies, which until this point have been fighting like a Spartan to maintain homeostasis, have finally, inevitably, let us down?

The evidence is all around us. We watch a plethora of television shows set in a hospital that week-in and week-out cash in on the drama that is a healthy person falling sick. And the reason this is such a successful emotional hook is because we all know that such a thing is possible, even probable, when you consider the multitude of infinitesimal processes that can go wrong within our bodies. We swap stories about the health of our families and sigh in all the right places when hearing of another’s health decline. Yet we fail to, or refuse to, make the connection that we will all eventually have an occasion where we will be, for the first time, admitted into a hospital because something has gone wrong.

The irony is these same people who proudly boast about never having their blood-pressure checked in fifty years are the same people who have been walking around with increasingly high blood-pressure for the past forty years. One morning they pass out while attempting to move a couch, end up in emergency with a stroke, and later state to their nurse with complete surprise, “I’ve never even been sick before, and now all this happens!”

My favourite patient, and by favourite I mean in a sarcastic, eye-rolling sort of way, are the ones who blame accidents or hospitals for the chronic disease they have due to a lifetime of poor lifestyle decisions. One of the best examples I have of this was when a sixty-year old man told me the tale of how he procured type two diabetes. This is a man with a gut that preceded him by at least thirty centimetres, a man who thought a six-pack of sugar-covered doughnuts to be an appropriate between meal snack, and who hadn’t done regular exercise since playing football in high-school.

Out of the two of us, I thought I could give a more accurate rendition of how he procured type two diabetes.

The story went that one day in his fifties he had decided to try riding a bike again. He pumped the tyres of his old bicycle and headed out onto the streets, flushed with the joy of being back on the road with the wind in his thinning hair. Unfortunately a neighbouring dog found the image of an overweight middle-aged man on a bike to be greatly entertaining and decided to join him. While attempting to shake the dog off his tail with a mixture of swerving handlebars, wobbling wheels and wildly kicking feet, our man lost control of his bike, fractured his hip and ended up in hospital. Where, as is common procedure, they took a blood sample and discovered he had previously undiagnosed type two diabetes.

Or, as my patient put it, “Fracturing my hip gave me diabetes.”

Despite my tactful attempt to suggest that it was simply the series of events that resulted in the discovery of his disease, that it was more likely down to the fact that he has three sugars in his tea and has eight cups of tea a day that led to his diabetes, he remained resolute that the act of fracturing a bone in his pelvis gave him high blood sugar. In the end, after half an hour of discussion, I sighed, nodded, and said with complete sincerity that I hope he never fractures his other hip or else he could end up with high blood pressure. To which he responded that he already has high blood pressure, but that he got it from his mum.

We all, every one of us, will eventually find ourselves in a hospital ward due to something that has gone wrong with us physically. It may be our fault, it may be an accident, or it may be a genetic condition that has reared its ugly head in later life, but something will happen someday.

The best we can do is accept this, and in the mean time work towards being as healthy as possible, enjoying and appreciating our health while we have it, and exploring ways we can improve ourselves when a health condition becomes known.

And for god’s sake, try to look after your hips.

They may be the only things standing between you and diabetes.