Nursing

THE FIRST TIME

/ jonathanrobb / 1 Comment

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.

HOSPITAL BED PERSPECTIVE

/ jonathanrobb / Leave a comment

My previous post detailed how I found myself turning twenty-six in a hospital ward. Happy birthday (Can you hear the slathered on bitterness and irony? You can? Good).

The experience was unanticipated and has been disorienting, but made even more surreal by that fact that I’m normally the one standing over the hospital bed rather than laying in it. I guess I should thank rhabdomyolysis for allowing me a patient’s perspective. I should, but I’m not going to.

When I chose nursing as a career I had only been inside a hospital three times: when I was pushed out into the world, visiting a sick cousin, and saying goodbye to my dying great-grandmother. Except for my birth, of which I oddly have little recollection, my other visits were short and superficial. I was there to be with family and largely ignored the hospital as a whole.

Therefore, when I came to nursing I came with virtually complete ignorance of the hospital system. This ignorance only became apparent during my first student placement; until this point I presumed the various television shows and movies I’d watched that had taken place in a hospital would have adequately prepared me. This was not the case. Apparently, liberties had been taken when writing those scripts.

My first placement consisted mostly of me learning where to stand so as not to be in the way. I soon mastered this skill. Eventually, I saw the overlapping cogs of the multidisciplinary health team and what my expected role was within them. A hospital can seem a chaos of doctors, nurses, pharmacists, physiotherapists, occupational therapists, cleaners, PCAs, patients, and visiting family members. But there is a pattern in the chaos and it wasn’t long until I knew where to go, what to do, and who to speak to; basically, how to be a nurse. Prior to this I had the skills – I could take blood, hang an IV, administer injections – but now I had the knowledge of how and when to apply them.

By the time I graduated and started working as a nurse the wards were a familiar place. I could recognise people by their roles, I knew what to do when a buzzer went off, how to placate a distressed patient, and the perfect place to stand so as not to be in the way (This skill still came in handy when a herd of doctors descended on one of my patients). Like any well worked in workplace, the hospital became commonplace and I could navigate its walkways with ease.

This did not prepare me to be a patient.

The first thing I noticed as I was lead into the emergency department with a patient name band around my wrist was the casual condescension of the staff. There was no intended insult in this; they’re used to speaking to people with little health knowledge, and often, with limited knowledge of the English language. However, with both medical knowledge and a strong grasp of the English language, the small and simple explanations I was given seemed only to patronise. I immediately scanned back to the multitude of conversations I’d had with patients, and prayed I didn’t come off so bad.

I received descriptions of my condition in language usually reserved for five-year olds. I itched to interrupt and explain that I knew all this, that I was a nurse and the equal of them. I didn’t, as I figured the intrusion into their well-meaning explanation would only serve to paint me as arrogant. However, when the natural segue presented itself, I quickly slipped in the fact that I was a nurse. The change was instantaneous. Suddenly, I was a person again, not a patient.

The next insight was of dependence. Even in my state of physical competence, I was dependent on the whims of the hospital. Food came when it came. If I wanted a shower I had to wait for towels. Doctors and answers appeared on their own schedule, not mine. And I waited.

Working as a nurse is a job of hectic tasks, a never-ending to-do-list that begins when you step onto the wards and ends when you handover with a breath of relief to the new nurse taking over. For a patient though, it’s one long day of boredom. You stare at the same four walls, bounce between the same time-wasting activities, and wait. You get excited when the food tray comes, not because the food tastes particularly good, but because it gives you something to do. You watch everyone rush, and you sit, and wait for the moment when they say you can go home.

In here I’ve seen how miscommunication between staff and patients serve to add to the cloud of confusion and unease. Patients don’t quite know how to phrase their questions and staff have no time to decipher their desires. Presumptions are made, things are missed, and the patient settles back and waits.

The other side of this coin however is how vital and appreciated the staff become. Whether the dependence is enforced or genuine, a helpful nurse is a godsend. A doctor who takes an extra minute to explain what the blood results mean gives a patient an afternoon free of anxiety. Simply having a friendly face and a quick laugh to break the tedium is a gift worthy of a bear hug.

What I hope to gain from this enforced role reversal is a better insight into what my patients are experiencing, and what I can do to ease their pain/anxiety/discomfort/boredom. I’ve been shown the other side of the looking-glass and the details reflected back have shown me the importance of small mercies and kind words.

Hopefully, being a patient will make me be a better nurse.

Thank you, rhabdomyolysis.

THAT WON’T HAPPEN TO ME

/ jonathanrobb / 7 Comments

This post comes to you from inside a hospital.

I turned twenty-six yesterday.

This was not how I foresaw my twenty-six birthday.

As a nurse I’ve come to terms with the fragility of health. When you see a patient die from a fractured hip, or a previously healthy twenty-eight year old women yellow with jaundice, you quickly realise sickness isn’t just for the old.

Most of us, understandably, fool ourselves into the mindset of, ‘That won’t happen to me.’ We watch documentaries of people just like ourselves come down with cancer, people of the same age, gender, socio-economic status, and race, and we still tell ourselves, ‘That won’t happen to me.’ We mentally scan our body for aches and pains, and when we find nothing we relax in the knowledge that we are, at least temporarily, invincible.

And despite my apparent insight into the illusion of health, I was still shocked when three days ago I stood over the toilet and watched as brown urine trickled out from me. I did the right thing and saw a doctor who took samples of my bloods, but I felt confident the results would be minor; that I would be fine.

Because that sort of thing wouldn’t happen to me.

And even when I got a call from the pathology clinic testing my bloods at eleven forty-five on a Sunday night telling me to go to emergency immediately, I still couldn’t shake the notion that it was no big thing. Sure, I’d go to hospital, and maybe they’d keep me for a few hours, but then they’ll send me home telling me to keep my fluids up and to take it easy.

Because that sort of thing wouldn’t happen to me.

This was three days ago and I’m still tucked away in my little corner of the hospital.

Let me back up and tell you how this happened.

A week ago I was talking with my brother who was telling me of an exercise boot camp he had enrolled into. Five weeks, three hours a week, improved fitness at the other end. It sounded good, and I signed on. Thursday afternoon found me grunting and swearing as I worked through push ups, sit ups, pull ups, planking, tyre lifting, squats, and a light jog. The workout was hard, my arms shook, my stomach tightened, and I felt a little sick. But you’re meant to, aren’t you? That’s how you know you’ve pushed yourself.

I wasn’t concerned despite the fact that for the next two days my upper arms and chest ached. I struggled to lift my arms higher than my head, groaned when I had to reposition myself in bed, and trembled when attempting to take off my jumper. I figured this was the repercussions of a very thorough workout.

Consternation came when urine the colour of cola-flavoured cordial streamed from my body. I opened my laptop and typed ‘brown urine, excessive exercise’, into Google, and quickly learnt a new term. Rhabdomyolysis.

Essentially what I had done was damaged the muscle fibres in my arms and chest to the point that the muscle cells died. Upon the destruction of these cells, proteins are released into the bloodstream. This is not where they’re supposed to go. What I was seeing when I looked down into the toilet bowl was the dead matter of my muscles.

The risk of rhabdomyolysis is that the kidneys are not used to filtering these proteins, and one, creatinine, can build up in the kidneys. Potential consequences: decreased urine output, kidney damage, renal failure.

Let me reassure you that at this point it doesn’t look like I will suffer from any of these afflictions. Although, for the record, the specialist told me he had never seen creatinine levels so high. I’m marking this as an accomplishment; you have to take wins where you find them.

So here I am, on the other side of the looking glass. From nurse to patient. From the lands of the invincible healthy to the wards of the acutely sick. From twenty-five to twenty-six.

And they say exercise is good for you.

DEALING IN DEATH

/ jonathanrobb / 2 Comments

I’ve been reflecting recently that a lot of my writing contains death. This is not a conscious decision. Death seems to worm its way into my stories like a recurring character in want of a cameo. And I’ve been trying to decide why I’m drawn to exploring this phenomenon. And I think I know.

The first reason is a rather simple one: I think about death a lot. This is not for any morbid reason. I don’t run fingertips over blades or stand on the edges of buildings rolling a foot over the corner. I’m a nurse. Death refuses to be ignored in my profession. Every time I interact with a patient who is wasting away I’m aware of death waiting in the background. Patients want to talk about it. Family members need to be consoled. Co-workers joke about it. This results in reflection on the nature of death, which in turn works its way into my writing.

The second reason is also rather simple: Death is dramatic. It’s an organic occurrence that shakes things up. It’s a way to test characters, to see their world view when confronted with loss. Death is a catalyst.

The reason I’m writing about death today is that I saw a patient recently who was thick in the absolute and utter realisation of her own mortality. This patient, let’s call her Pat, is a sixty-one year old woman with chronic leg ulcers. She has been in and out of hospitals for the past ten years of her life. She had been ill, recovered, and fallen ill again. And yet none of this was what triggered her sudden confrontation with the idea of death. It was seeing it in someone else that forced the truth of it into her mind.

Pat attended a doctor’s clinic for a regular review and saw another patient whom she had seen in the waiting room during previous appointments. At first she didn’t recognise the man. She though the woman with him was his daughter rather than his wife. It was when she went into the doctor’s room and found the doctor wiping away tears in an effort to compose herself that the connection clicked, and Pat realised that the healthy man from months ago had shrunk into the sickly old man she now saw in the waiting room.

Pat went home shocked. She sat in her empty house over the weekend chewing on the image of the man’s rapid decline. And when I arrived the following Monday she was scared, and desperate to talk to me about death.

So we talked. We discussed the obvious things first; the fate awaiting us all, the loss to ourselves and our families, and the misery of such a loss. And eventually we got to what really was bothering her: What was the point of it all? What surprised me most wasn’t the question, but that a woman almost thirty years my senior was looking to me for answers. And that I had something to say on the matter.

I told Pat that being aware of mortality isn’t a bad thing. It invigorates. It’s not a pleasurable notion to consider, but it forces you to acknowledge that you are alive now, and that that time is limited. It pushes you to make more of your time, and to appreciate the joys you get. I told Pat that I didn’t know what the point of it all was, or whether, in the face of death, our lives held a particular meaning at all. I told her what I knew: that in the face of no meaning, all you can work towards is contentment. That if you spend what time you have happy then you come away on top.

I had some form of an answer for Pat because I had thought about death. My profession meant that I couldn’t ignore the inevitable reality of it like most of us do, and I certainly did before nursing. We, as a race, are too skilled at pushing the knowledge that one day we won’t be on the earth anymore to the back of our minds. We cram it down into the crevasses of our brain and pile trivialities and day-to-day details on top until we can’t see it anymore. And we smile and think we’ve beaten it. But it doesn’t do any good down there. And for Pat, when the truth wiggled its way free and sprung to the forefront of her mind, she had no way to accept it.

Pat listened to my answers like an eager student. She smiled at my closing statement and seemed mollified. The haunted look wasn’t gone from her eyes, but she appeared to be in more control. She was contemplative rather than scared. And I felt shocked and proud that I had been the one to comfort her.

Thinking about death, and writing about it, had given me an answer. I don’t know if it was the right one, but it is better than staring into the void without a form of comprehension.

And reflecting on this, I think I’ll continue to write about death.

BE NICE TO YOUR NURSE

/ jonathanrobb / 8 Comments

It was International Nurses Day a week ago so I thought I’d use that neat segue to describe a scenario I’ve experienced when working on the wards, one I’m sure all nurses have faced at one point or another.

I had an elderly patient who’d recently had a hip replacement. The woman, let’s call her Ethel, was a delight. Patient, pleasant, cooperative. She smiled a lot and consequently I smiled a lot. A smiling patient can be a rare thing. Ethel, unfortunately, had to have a catheter post her surgery. More unfortunately, she developed a urinary tract infection.

A UTI is rather common, especially when you’re inserting foreign objects into someone’s bladder, and is treated with antibiotics. For most people it means a little pain and irritation. However, with elderly and frail people it can bring on delirium. Delirium is essentially a fast acting, short-term dementia. In other words, it sends the patient loopy.

Ethel transformed from the perfect patient into a terror.

Sunken deep in her delirium, Ethel held the belief that the hospital staff were holding her there against her will. In her eyes, we were her jailers. She let us know this with a rather impressive and expressive collection of profanity, as well as physical threats. While this made doing even the simplest thing for Ethel a great struggle, a part of me couldn’t help but admire Ethel’s fight. In her head we were the enemy; rather than laying back and taking her imprisonment, she chose to fight. And I mean fight.

Fists swung, feet kicked, and if you weren’t staying alert and got to close to her head, you ran the risk of being head-butted. Ethel was a warrior.

Because of Ethel’s UTI she had to have an intravenous infusion of antibiotics. Luckily she viewed her infusion favourably. Any attempt to touch her cannula was met with, “This is mine! You can’t have it. If you try and have it, it will poison you and you’ll die!” This was a much better reaction than distrusting her infusion and yanking out the cannula, which was the usual course of events in these situations.

One night we had hung her latest infusion. Any interaction left Ethel unsettled so we gave her fifteen minutes to calm down before checking her vital signs. When we returned we found Ethel asleep in her bed. This was brilliant. Her BP cuff was still circling her arm and all it took to measure her blood pressure was the push of a button. Checking her temperature, however, was a bit trickier.

We had a thermometer that had to be inserted into the ear and a button pushed. This sounds simple, but when a person is violent thrashing their head it’s hard to get an accurate reading. A sleeping Ethel was a blessing.

I tiptoed beside Ethel, carefully lowered the thermometer probe, and pushed the button. It beeps as you press it. Ethel woke instantly.

I jerked my hand away just in time to avoid the clacking of her teeth as she tried to bite me. Her eyes darted between me and the thermometer in my hands and understanding spread across her face. Her response was instantaneous.

“You little bitch,” she hissed.

I had to bite my lip to stop from laughing.

After three days of antibiotics, Ethel was back to her charming and lovely self. She had no memories of her delirium, which was for the best.

Despite her reversion back to the grandmotherly old dear, I couldn’t help but remember the warrior that lurked beneath. I was warily impressed.

The point of this story is that this scenario is just one of millions that combine to make what is a rather average day in a nurse’s work life. Threats, physical assault, stress over a patient’s health, juggling ten tasks as once, and trying to decipher medical orders are the hurdles a nurse is facing at any given point, be it day or night.

As you’re reading this there are nurses tending to wounds, bathing patients, administering injections, and stopping sweet old ladies from biting down on their wrists. It’s a strange job, a stressful one, and a rewarding one. And one that leaves you with a lot of stories.

Next time you’re in hospital, be nice to your nurse.

Please don’t bite them.