LIFE IN LONDON #05

I scanned my list of names again and found her address. The number matched the rust-bitten silver digits screwed into the black door and I consulted my paper to find her flat letter. I leaned on the “A” doorbell and stepped back, waiting for the little box beside me to squawk into life with my patient’s voice asking who it was.

I locked eyes with a landscaper working in the neighbouring garden and flashed him a smile. He nodded, a recognition of a fellow community worker navigating the maze of London houses and apartments.

When the response finally came, it wasn’t from the direction I’d anticipated. The metal box remained silent and instead a wavering voice drifted down from above.

‘Hello. I’m up here.’

I glanced up to find a thin elderly woman in her nineties leaning out from an upstairs window, a bird-like hand waving at me, and a toothy smile grinning down at me. It was instinct: I waved back.

‘Hello,’ I said, remembering why I was there. ‘I’m Jonathan, the community phlebotomist. I’m just here for a blood test. You must be Catherine.’

‘Oh, right you are. I’m not good on my feet. I’ll have to throw the keys down.’

‘Oh.’ This was new. ‘Okay, sure,’ I said to an empty window, my patient already disappearing inside.

I rocked on my heels, waiting on a stranger to throw her door keys at me, and shared another look with the landscaper. I gave a weak smile and glanced away, repressing the urge to tell him this isn’t how it normally went.

After five minutes the frail face reappeared in the square of window frame. ‘Oh good, you’re still there. I’m throwing them down now.’

I raised my arms above my head and clapped my hands. ‘Go ahead,  I’m a good catch,’ I said, then felt an absurd surge of anxiety that I’d drop them with the landscaper watching. I couldn’t tell you why I wanted to impress a stranger with my key-catching abilities, but there it was.

Catherine gave a little flick of her claw of a hand and the keys hung in the air. I traced the arc of the descent with my eyes and my hand snaked out, snatching them from the sky with a contraction of my fist. I felt a flood of elation and sneaked a glance at the landscaper to see if he’d seen. He gave a raise of his brows and I shrugged like it was no big thing.

‘It’s just the one by the handle, and then the bigger one unlocks the lower lock.’

Catherine’s words snapped me from my victorious reverie and it occurred to me to put the keys I was still holding aloft like a trophy to use. I followed my patient’s instructions, unlocking deadbolts and locks with keys straight out of the Victoria era, big fat keys with the small square of teeth at the end. I stepped inside and into an apartment that could have been lifted from a Sherlock Homes’ novel. Sunlight filtered through the dusty air and a rug-lined staircase twisted up through the wooden foyer to the bedroom above.

I mounted the stairs and found my patient sitting in her nightie and dressing gown on a two-seater couch that looked as old as she was. She looked small in the big bedroom instead of the image I previously had of her hanging out a window.

‘Catherine, it’s nice to meet you,’ I said, handing the keys back, stupidly triumphant in this exchange of property, as if it was a challenge I had risen to and won.

I slipped into my role of health carer, providing the necessary small talk and questions while simultaneously preparing equipment and poking this sweet old lady with something sharp. If done well, you can have your patient more absorbed in the conversation than the act of taking blood, and they’ll swear afterwards that they didn’t feel a thing, even if in the moment they winced as the needle pierced flesh. This I treat as a real triumph — the ultimate victory.

I completed the necessary paperwork and Catherine fell silent as I worked. When finished, I looked up to find that she had a portable phone in her hand.

‘The council are always so hard to reach,’ she said.

‘Tell me about it,’ I replied while slipping on my backpack. While I’d never tried to reach my local council in London, I felt I’d waited on-hold long enough with equivalent organisational bodies to share an eye-roll at the ineptitude of Catherine’s local council.

‘I just ring the gas-leak number,’ she said with a wicked and satisfied little smirk I wouldn’t have believe this old dear to be capable of, and she pressed dial on her phone.

I laughed and gave her a silent tip of the hat, and as I waved her goodbye and turned to head down the stairs I heard this exchange:

‘Hello! No, no, there’s no gas leak. I just need more of those green compost bags…Oh, you could? Oh, well, thank you, dear.’

As I made my way down the stairs I couldn’t help shake the feeling that there was a lot Catherine could have taught me about navigating life in London.

LIFE IN LONDON #04

In the old days (by which I mean a few months ago when I lived in Australia) I used to work as a district nurse. This involved driving from patient’s home to patient’s home and providing nursing care in the person’s own environment. The work day would finish by heading back to the office and sitting around a table with my peers and having a serious discussion about our patient’s needs. It also involved having a not-so-serious discussion about the absurd things we’d come across that day, each of us trying to best each other’s latest edition of the bizarre things humans are capable of.

Working in the community opens you up to a plethora of (what’s the politically correct way of phrasing this?) “interesting” people. These are the people who treat social norms as more of loose guidelines than hard-and-fast rules. Normally, this is a good thing. Life would be boring if we all behaved the same, dressed the same, and said the same things. Unfortunately, some of these patients take it too far, and dismiss certain social norms that are norms for very good reasons. Let me give you an example to help clarify what I mean.

One day a friend of mine told me casually over the work table that she’d been met at the door by her patient, a middle-aged man, “windmilling” his penis at her. I think he was wearing an open robe, but it’s equally likely he was stark naked. This is one of those times where the social norm is beneficial for everybody — let’s stick to shaking hands instead of shaking alternative appendages.

For anyone wondering, I think the term “windmilling” was invented by my friend, and I find it brilliant because right now everyone reading this has an image in their head of exactly what took place. You lucky things.

This is the first example that came to mind, but rest assured there are many more. From a smoker with a chest wound that puffed out cigarette smoke every time he coughed, to a woman dressing in a garbage bag while having her catheter changed to preserve her dignity (mind you, a hole had to be created to get to her catheter, so I’m not really sure what this achieved).

A colleague who has worked as a nurse for over thirty years once said to me that she wished she’d written some of these stories down, that for all the ridiculous tales she could remember there were twice as many she’d forgotten.

Now that I’m in London and doing essentially the same sort of work, I thought I’d learn from my friend’s hindsight and pencil some of the stranger incidences down.


From the outside, the block of apartments looked dignified. Ancient trees drooped limp branches over the grass ringing the building, and the flats were constructed of old brick begging to be strewn with a lace-work of ivy. I read the name from my sheet — Patricia — and pictured the sweet old lady that belonged to this sweet old building, already looking forward to her proper accent and polite ways.

I walked around the apartment block and found the line of buzzers by the exterior door, checking her number on my list of patients and pushing the button. A few seconds later, there was a mechanical whirr and a click, and I pushed on the door and stepped into the stairway. It was dank, but it’s London, so that wasn’t particularly unusual. I climbed the creaking wooden stairs, scanning door numbers until a green door bearing the appropriate digits stood before me, and I rapped on the wood.

Footsteps sounded from inside the apartment and I straighten my coat, wanting to make a good first impression. Appearances can say a lot, after all. The door opened and I blinked, my introduction falling from my lips on instinct.

‘Good morning, I’m Jonathan, the community phlebotomist.’

An adult diaper covered her crotch and buttocks, but everything else from her flabby breasts to her varicose-veined legs were on show. She was younger than I’d anticipated, around sixty-five, although from what I could see, time had not been kind to her. She smiled at me, a toothless smile revealing gums as naked as the rest of her, and she asked, ‘Are you here for the blood?’

‘That’s me,’ I replied. She seemed completely comfortable with her attire, entirely unperturbed at being barely clad in front of a young male stranger. I felt the weird sensation that it would have been rude of me to make an issue of it.

She waddled down her dark hallway and into her cluttered living room, saying over her shoulder, ‘You’ve caught me in my nappy.’

‘I can see that,’ I said, moving into the room and inhaling the scent of years of cigarette smoke soaked into walls and floorboards. Her house was stifling from the warmth of her heater, and I pulled off my jacket before I began to sweat. A method of cutting down on her heating bill occurred to me, but I decided not to mention it. I reasoned that I had obviously interrupted her preparing for the shower, and wanted to give her an out. ‘I not bothered by it if you aren’t.’

‘No, I’m not bothered.’

‘I’m happy to wait,’ I said, sliding my backpack to the ground, letting the implication hang in the air that the time spent to put clothes on was no burden to me.

She plonked down onto the couch, plucking an already lit cigarette from an ashtray on a coffee table and took a drag. ‘Wait for what?’

That was when I realised she obviously wasn’t putting clothes on, and just as obviously hadn’t been preparing for any shower.

‘Never-mind,’ I said, smiling at her, and wondering exactly when it was this woman had last showered.

With an internal shrug, I went to work going through the routine of preparing my blood-letting equipment while keeping up a stream of small talk. For those of you who have never attempted to take blood from an elderly woman wearing nothing but a diaper, I can tell you, it’s a distracting process. It’s hard thing to carefully thread a needle into the twisted and constricted veins of an actively smoking patient while her breasts are bobbing in your periphery. I had to bite down the urge to ask “Are you sure you wouldn’t be more comfortable with clothes on?”, the subtext of the query being that I sure as hell would have been more comfortable if she’d put some clothes on.

Luckily for me, Patricia was as unbothered by the situation as she had stated, and merrily nattered away, as comfortable as a babe in her crib. Which is ironic, because that’s exactly what she looked like. Well, an ancient over-sized baby in a nicotine-stained couch, but it equates to the same thing.

Once I had pierced her vein and drained the required blood, I taped a cotton ball to the site and pressed the fingers from her opposite arm to the cotton ball, instructing her to apply pressure for at least a minute. She kept up her flow of conversation while I squatted on a stool and wrote her details in the microscopic space provided on the tubes. It wasn’t until I was done that I looked up and found that she was bleeding.

The minute I had asked for her to apply pressure had lasted for as long as it’d taken me to glance away, and blood had seeped out from the small hole I’d created in her vein.

‘Patricia, you’re bleeding.’

‘What?’

She lifted her arm and revealed a red puddle running down her arm and pooling on her thighs. I instructed her, again, to apply pressure to the cotton ball while pulling on another pair of gloves and got to work cleaning her up.

A bleed always looks worse than it is and it didn’t take long to mop up the spilled fluid from her arm and thighs and have her back in her not-so-clean state. She smiled at me, that naked-gum smile to match her outfit, and thanked me.

‘No problem, Patricia. It turns out it was a good thing you weren’t wearing any pants,’ I said, raising my brows and nodding at her recently blood-smeared thighs.

‘Yeah,’ she answered cheerfully, ‘it really was.’ She seemed proud of this, as if the decision to wear nothing but a nappy had been a genius stroke of forethought on her behalf, rather than the neglect of a very basic human desire to put on clothes. I let her have it — I figured an adult who spends their day walking around their home in an adult diaper didn’t get many wins.

‘Nicely played,’ I said, shrugging on my jacket and giving her a wink, and immediately reflecting that winking at an almost naked elderly patient probably wasn’t the smoothest thing I could do.

I said my farewells and waved goodbye to my new nudist friend, stepping back into the stairway and making my way out into the fresh air and away from the tropical heat and cigarette-perfumed environment I had just left with relief.

As I found the address of my next patient and begun trudging away, I looked back over my shoulder at the beautiful English building I had just left. It really did look quite dignified.

But looks can be deceiving, I suppose.

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.

FOR SCIENCE!

As my last post detailed, I made the decision to venture overseas and live in England this year. One of the integral components of this endeavour was to become registered as a nurse in the UK so that I could fund my travels, rather than end up broke and homeless somewhere along the banks of the River Thames.

I love the idea of continuing my work in another country, and can’t think of a better way to get to know the character of a place than to drop into the homes of the people who make it up. Being able to practice as a district nurse in London is as exciting for me as the prospect of travelling. However, the act of getting registered has not been as straight forward as I had hoped.

Despite growing up in an English-speaking country, attending an English-speaking school, and getting a degree from and English-speaking university, one of the hurdles I had to jump was passing an English exam to prove I could read, write, comprehend and speak English. I am thankful to say I passed. And the act of proving I had indeed mastered the English language only set me back five-hundred odd dollars.

After that, I had to prove I had all the required knowledge of a nurse. Again, I have a degree and have worked in the field for six years, but I could understand the necessity of proving this knowledge. After all, some people are very good at phoning in their jobs. So I sat a practical nursing exam, and again, thankfully passed, proving to myself and the world that I can nurse (Yes, it can be used as a verb, I’ve passed an English exam and have the certificate to prove it). And this evidence of my nursing knowledge, a compliment to my degree, let’s say, only set me back another five-hundred odd dollars.

What followed was a hurricane of paperwork that I had to obtain from multiple sources including my university, the Australian registration board, a doctor, my current employer, and the Victoria police force (all for a certain cost, of course). After weeks of gathering all the necessary documentation, I dropped the brick of paperwork into the mailbox and sat back, awaiting my registration with a grin.

Only, it wasn’t as straight forward as I had hoped.

The UK registration board left me waiting for a month and a half, after which they replied that the forms I completed, THAT THEY PROVIDED, weren’t detailed enough, and they required further information. For the past two months I’ve worked and waited, and enquired and waited, and collated and waited, and have now sent off another batch of paperwork that I hope will be acceptable. Although, given the nature of the process so far, I’m not booking any day trips around London quite yet.

But, the point of this long-winded story is that during this process I found myself very much stationary. From the fury of the initial idea of moving, of renting my house and relocating, of mentally ticking off to-do list items, I was suddenly stuck in limbo while I waited to hear back from university and registration boards. I found myself putting off beginning anything as I didn’t want to run the risk of committing to something I would have to drop once I had the green flag to head to the UK. I wasn’t making plans with family and friends, because I might not be in the country in two months time to complete those plans. In short, I began stagnating.

It was while waiting on the second instalment of paperwork that I realised I couldn’t keep my life on pause. These months, this time, was life still happening, and I was getting itchy with my self-enforced purgatory. Once I had this realisation, I started up again, deciding I’d deal with the potential conflict of clashing plans once that demon was on my doorstep.

One of the things I decided to do was apply to write for an online science magazine. Of which I now am.

The Australian Times is a grass-roots not-for-profit organisation that releases a collection of over forty magazines free for the community. In the latest edition of Science, I wrote an article about the creation and trial of a bionic pancreas.

You can read it here.

2014/15

2014 felt like a year of waiting for me. Maybe waiting isn’t the right word. A year of rest, perhaps. But not simply rest, more the relaxation between efforts. The moment of sitting down, stretching out legs and breathing deep, of letting muscles slacken and body sag, before slapping knees and standing to tackle the next job. 2014 was a year of repose.

But despite the sense of respite the year has left me with, things happened in 2014. The biggest and brightest that springs to mind was my trip through the United States. It was a trip that took me away from the comforts of home and family, and opened me up to new friendships and experiences. It wasn’t challenging in the way hiking up a mountain might be, or backpacking through a foreign country, instead it tested this introvert’s ability to participate and get involved without the safety net of heading home at the end of the night. I deliberately placed myself in a situation that didn’t include my normal supports in an effort to strengthen my rarely flexed social muscles.

The trip involved putting forty-two adults ranging between twenty-one and thirty-seven on a bus together, and driving that bus from one side of North America to the other. Not the usual past time of an introvert.

It took a while for me to ease into it, like lowering into a hot bath, my rigid and tense body sinking in small piece by small piece until, submerged and immersed, I relaxed. And a good thing I did too. Away from the stress and routine of work, I rediscovered the joy of impulsivity and spontaneity. I didn’t have to plan for things, to go to bed at certain times in order to be up at certain times, parceling my alertness to ensure I made it through the work day. I didn’t have to squeeze activities around an eight-hour shift, staggering to these events with the dregs of energy left to me.

Activities became my full-time job. Speaking to new people, sharing meals and experiences and drinks, was the sole expenditure of my vigour. Seeing new things, new environments, new communities, having new thoughts, was now the purpose of my day. And with that new purpose came new drive. I was surviving off five hours sleep at best each night and feeling more energetic than I ever had.

And by the time the trip wound to an end I knew this was what I’d been waiting for. This, this feeling, experience, frame of mind, was what I’d been inching towards the whole year without realising it. I was a hibernating bear sensing the first rays of spring, and that new season was kick starting my sluggish arteries. I decided I needed more of it; I was done hibernating.

 

Since before even leaving school, I knew what I had to do. I knew I had to be realistic, that once I left this complacent nest of learning and days dictated by ringing bells, I had to work towards supporting myself. I took two years to obtain a Diploma of Writing, an indulgence for myself I completed while working thirty-six hour weeks at Coles, but I knew in the real world people had to work, so I walked out of one tertiary building and straight into another, and began studying to become a nurse. Nursing meant job security.

I completed my three years of university, slogging through the trials of clinical placements, hours of lectures, and headache-inducing exams, without really giving any of it much consideration. I was being realistic, and on the right path. I completed the course, swapped the title of student for nurse, and started working. A lot of graduates entered the workforce doing only eight shifts a fortnight, an easing-in process. This I also didn’t give much thought to: I’d be working full-time. I knew this was what an adult did, had seen my father work endless hours, often weekends as well, and knew this was the lot of a grown-up. Of a provider. So I commenced full-time employment on forty-five hours a week.

I came out the other end of my graduate year almost burnt out, a withered black match with only a millimetre of unburnt wood left to me, pinched between shaking fingertips. I had gritted my teeth and clung to the resolution of adult work-ethic, and it had kicked my arse. I was ready to leave nursing — but not full-time employment, of course.

I found a job as a medical writer and worked in that position for three months until contracts dried up and I found myself unemployed. This felt very wrong to me. I was twenty-four and not working. This was not being very realistic. I found work as a district nurse, and discovered, much to my pleasure, that it was work I enjoyed. I was doing a forty-hour workweek again, and confident I was back on track.

I continued down the responsibility path and purchased a house with my girlfriend, and after a couple of years, garnered a promotion. My girlfriend and I split, but I bought her out of the house, my sense of adult responsibilities serving me well in still being able to make repayments. I was doing it, I was an adult, working full-time with a property to my name and succeeding in my job. And it wasn’t until this point, until I reached this peak of being a provider, this adulthood nirvana that I’d been slogging towards since leaving school, that I stopped to look around and question what the fuck I was doing.

Because I had overlooked a rather pertinent point. I had modelled my work ethic on a man who was providing for a family. A man who headed into work each day knowing he did so to feed and clothe his four children. I didn’t have four children. The only dependents I had were a lemon and lime tree that survived despite my months of neglect (Side note: Dad repositioned them to a sunnier location and probably saved their lives. You can see why he was an influential role model).

I had accepted the inevitable role of provider and the responsibilities that went with it without ever questioning if this was what I needed to do to survive. If, in fact, there were other patterns to self-sustainment, a plethora of varying patterns, that didn’t involve working forty-hour work weeks, particularly when the only one I had to provide for was myself.

This realisation opened up new avenues for me.

 

The combined insight that I was not a bear made for hibernating, nor a father providing for four, meant that the track I’d set myself on since before leaving school had played itself out. That track had given me incredible experiences and lessons, but they were lessons for a more black and white me. I was ready for a new path.

Which is why 2015 won’t be another year of repose, but a year of exploration. I have already moved out of my house and back into the comforting embrace of my previous residence in Brunswick West, and am once again enjoying the company of my brother and his girlfriend. But this is only a temporary lay-over. In March, I intend to fly to the United Kingdom which I will make my new home for at least twelve months. I will work, because I haven’t changed so much as to disregard the idea of a responsible income completely, but only casually, as a district nurse in Scotland, and later in London. My primary purpose will be to see. To experience. To explore. To engage. To discover. To act.

2014 was good for me in both the rest and insights it offered, but now it’s time to slap my knees, stand, and tackle the next adventure.

THE BAD ONES #03

The patient was an eighty-eight year old man who lived at home with his wife, both of whom were surrounded by a perpetual cloud of smoke despite our nurse’s continued requests that they butt it while we visit. He was a man just managing to stay at home by the skin of his teeth – or, more accurately, by a lot of effort from the support services put in place to keep him safe at home, services neither he nor his wife appreciated. They both had a diagnosis of dementia and shared a common lack of insight into their own failing health and poor living circumstances. Neither acknowledged the nicotine-stained walls or ceilings, the carpeting stained with old and fresh dog shit, or their own deteriorating bodies and minds stained with years of neglect and abuse. In their estimate, they were, ‘…doing fine, and we don’t need anyone barging in and taking over!’

But despite his shortcomings, this wasn’t enough to make him one of the bad ones. Once you got past the bluster and opened a window to air out the house, both he and his wife were pleasant in their own confused and belligerent way. The problem was the patient’s GP.

The patient had returned home from a short stay in hospital due to his yo-yoing health, and, as hospitals are prone to do in an effort to prove they did something to help the patient, they had played around with his medications. This slight tweak on their behalf often means a mountainous headache of work for us. Easily one of the most infuriating and frustrating aspects of my job is attempting to get a list of my patient’s medications, complete with the drug’s dose, route, and frequency, and topped off with a signature from the prescribing doctor, so that I may legally administer those medications.

Perhaps you’re reading this, thinking, “Surely, that’s not so hard a thing to obtain. A doctor would have on file the current medications his patient’s are taking.” This world of doctors keeping an up-to-date list of their patient’s medications is one that belongs in a medical utopia, a place where patients are keen to participate in their health and old stoma bags smell like vanilla essence. Unfortunately, I operate outside that sphere, and consider it lucky if the GP I’m corresponding with has a computer on which to type a list of medications. The stereotype of illegible doctor’s handwriting is very real.

The client’s GP was a doctor I was familiar with, and I knew him to be a man resentful of assisting in any way. His choking arrogance always seemed to get in the way. So, knowing this, I rang his office.

‘Hi, this is Jonathan the district nurse, I was just hoping to speak to the doctor regarding Mr X.’

‘Oh, sure,’ his secretary replied, ‘I’ll pop you through.’

*On-hold music* – wait time 30 seconds.

‘Yes.’

‘Hi, Doctor, this is Jonathan the district nurse. I’m just ringing because Mr X has returned home from hospital. He was diagnosed with GORD while in there and commenced on Nexium, and I was hoping you could add this to his medication authority and fax it through to us.’

*Click*

He had hung up.

I rang again.

‘Hello, Doctor’s office.’

‘Hi, this is Jonathan again. The Doctor just hung up on me. Could you put me through to him.’

‘Oh. Sure.’

*On-hold music* – wait time 1 minute.

‘Yes.’

‘Doctor, it’s Jonathan again. We got disconnected. So as I was saying, we just need a new medical authority so we can administer Mr X his new medication.’

‘What is all this?’ he grunted. ‘I’m sick of doing all this work for your company. Why don’t you have your own doctor on staff?’

‘You know how we operate, Doctor, how community health operates. You’ve worked with us for years. You know we don’t have our own doctor on staff.’

‘I’m sick of doing all this over the counter work, it’s ridiculous.’

‘Sorry, I’m not following you. What do you mean “over the counter?”’

‘Well, it’s not face-to-face, is it? I’m not billing for this.’

‘Oh, so you’re worried about your money?’ I chuckled.

In retrospect, laughing may have been the wrong tact to take.

*Click*

I squeezed my mobile phone, envisioning the pathetic old doctor’s neck, and rang a third time.

‘Hello,’ his secretary said.

‘Yeah, it’s Jonathan again.’

‘ I thought so, it’s why I didn’t answer with the spiel. Is it a connection issues or is he angry?’

‘Oh, he’s angry. Can you put me through again?’

‘I can try.’

*On-hold music* – wait time 3 minutes.

‘Are you still there?’

‘I’m still here,’ I replied.

‘The Doctor’s busy at the moment—’

‘Uh-huh.’

‘—but tell me what you need and I’ll see what I can do.’

I detailed what was required, explaining that my persistence was only to ensure the patient got his medications and remained out of hospital. I did my best to stay calm and jovial with the secretary, reminding myself that her employer’s childishness was no fault of hers, that she was the only one attempting to help, and that she had to put up with the megalomaniacal wanker for hours at a time. Once I had repeated what I needed and she wrote it down, she assured me that she would have it faxed to me by the end of the day. I thanked her, sincerely, and hung up.

It’s hard to work in an industry full of contradictive people claiming to be there to care for others whilst only caring about themselves. It’s hard to advocate for your patient against the very people who should be helping. It’s hard to remain professional while those you deal with act like children. And it’s too easy to think, ‘Why do I continue to work in this faulted system?’

The secretary was true to her word, and by the end of the day I had a medical authority with the patient’s new drug added to the list. Unfortunately, the previous authority had two medications that, due to the Doctor’s past laziness, had only been scrawled on by hand, and hadn’t come across with the new list. I would have to phone him the next day to have them added.

He was one of the bad ones.

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.