Nursing

FOR SCIENCE!

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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

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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

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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

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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.

THE BAD ONES #01

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My brother pointed out to me the other day that I don’t tell the stories of the bad ones, that on my site I’ve shared many stories of the good patients I’ve met, but have failed to document the more sour interactions. He, of course, has heard countless stories of exasperating patients, of those people I visit who have deemed themselves free of the need to conform to the social norms of politeness, respect, and quiet often, hygiene. His observation was accurate — it was with deliberate intent that I excluded those episodes from this site.

But after the discussion I realised that by focusing only on the uplifting exchanges, I’m not accurately portraying my profession, and in a larger sense, my community. Laborious and infuriating personalities make up the web of society as much as, and sometimes more than, the pleasant. By ignoring this branch of humanity I’m also ignoring the insights and experiences that come with them, as distasteful as those insights and experience can be.

So here we go…

 

The inside of her house was lined with a layer of dust and cat hair, an accumulation of years. It was something I couldn’t just see and smell, but could taste, to the point that simply breathing in the air felt like a fouling act. It was as if each breath was coating the insides of my lungs with its own layer of dried skin flakes and moulted cat fur.

I was there to attend to wounds on her lower legs. She was forty-five years old; young, given the average age of our clientele. She had wounds due to years of uncontrolled diabetes — the consistent high level of sugar in her blood had killed the micro-vessels in her legs, reducing the amount of oxygenated blood delivered to her skin. Without proper circulation, her skin integrity weakened and ulcers developed, which then failed to heal due to the same poor quality circulation that caused them.

It’s importance to stress that in her case “uncontrolled diabetes” isn’t a reference to undiagnosed diabetes. The patient had known of her condition and had had years of doctors and medical specialists educating her on the necessary exercise and dietary requirements needed to manage her disease. She weighed one-hundred and fifteen kilograms and her blood sugar results were perpetually high.

This was not a picture of a woman who had heeded medical advice.

She scooped four cats from her single bed, throwing them out the door, before falling face first onto the mattress so I could attend to her wound care. Her bulk filled the bed, her affected legs sticking out like twin wrapped hams. I peeled away the soaked and soiled dressings while she complained about how her wounds wouldn’t heal. Her limbs were stretched tight with oedema and yellow slimy pockets of broken skin rung her calves, the angry red edges like bruised and swollen lips.

I looked around her house, breathing shallow breaths, focusing on the decade worth of dirt that coated her home. Dirt that a half-an-hour vacuum once a week could have avoided. That a thirty-second swipe of a cloth could have wiped away at the time, but instead, years of voluntary neglect had accumulated into a stain that could only really be cleansed with fire. I took in these details and wondered if it was worth explaining for the hundredth time ways in which she could aid her own wound healing. Ways such as losing weight, eating a well-balanced diet, exercise, and stopping the consumption of soft drinks.

I began, knowing the words would be wasted, but she cut me off.

‘Yeah, yeah, I know all that. Every nurse goes on about it. I’m just sick of it.’

I fought to resist asking why then does she still spend her days eating chips on a couch that has moulded into the shape of her body.

A colleague of mine once decided she would wear this patient down with positive enthusiasm. She went in offering support and encouragement. She sat and talked to her about how we would help her heal her wounds if she would only help us. That we would aid her every day to bring her weight down and correct her diet. That it didn’t have to be a monumental thing, but just small acts done daily. Acts like walking to the letterbox.

Her letter box was ten meters from her door, and my colleague suggested that when she had finished tending her wounds, she walk with her to the letterbox on the way out as a form of exercise. The patient agreed.

Once she had dressed the patent’s wounds and hoisted her work bag, my co-worker said,

‘Come on, then. Walk me to the letterbox.’

The patient sat on the couch, looking at the nurse as she thought about it, then responded with a shrug,

‘Nah.’

It’s hard to care about another person’s health when they don’t care about it themselves. It’s hard to squat and lift heavy legs, to scrap muck away from weeping wounds, to walk into a home that makes you feel ill when the other party isn’t doing their fair share. And it’s too easy to think, ‘Why am I bothering when they aren’t?’

She was one of the bad ones.