Monday, 31 March 2008

Pointless Lectures

This afternoon, I was taught many things I apparently didn't know after 2 placements and months of crappy University.

I was told prejudice was wrong. AGAIN.

I was told stereotypes were wrong. AGAIN.

I was told discrimination was wrong. AGAIN.

Am I supposed to forget these things, until they remind me? Or am I supposed to be a rational fucking human being?

Anyway, they sort of made the point that discrimination and prejudice happens (shock horror) but shouldn't. And that you, as a nurse, don't have the right to 'like' patients.

The lecturers were a pair of PC nodding heads who seem to live in a dreamland. They propose we treat everyone equally but individually. They argue that it's not right that religious members of staff aren't allowed to wear any garments which could add to cross infection.

My opinion is thus: Nurses are people. People aren't perfect. I'm a person. I like some other people, and I dislike some other people. I'm quite indifferent to some. Just because I don't like a patient, personally, doesn't mean I can't treat them perfectly well from a professional point of view. And what else could I do? Force myself to like them? Highly unethical, and impossible, to boot.

It's fundamental for nurses to be real people, deep down. To care. To emphasise. And real people don't love everyone they meet. Doesn't mean you cannot be professional.

Treating everyone equally but individually? Come on. In a perfect world, fine. But in a world were we don't have the staff to actually suitably care for patients, it's nothing more than Carl Rogers' wet dream. And if you start it, where do you stop? If someone wants to die, as an individual, we can't kill them. If someone's big on scat and wants to sit in their own bodily waste all day, can we? It's just not workable in the literal sense, but they continue to bang on about it.

And don't get me started on positive discrimination on grounds of ethnicity or religion. If one person is allowed to wear something other than sterilised surgical scrubs in theatre because they believe a little story quite strongly, why can't I wear a baseball cap? We don't live in a theocracy. It's a democracy. I love freedom. But positive discrimination is not the way in which to attain this.

< /rant >

Tuesday, 25 March 2008

Be The Best plc.

So, fucking teachers are fucking crying over the Army and 'false advertising'.

Apparently it's not all windsurfing and rescuing beautiful Slavs. No. It actually involves guns and not very nice things, like death. But that's not the angle the Army are showing.

So, apparently, advertisements stretch the truth. No shit, Mr. Sherlock?

Nursing isn't all Holby City and beautiful patients. No, honestly. It's true.

And apparently, when you become a teacher you don't get classes full of smiling kids who are ready to learn. Shocking, I know.

I wonder why they don't try and sell their profession using that angle?

The Army, as well as the other Armed Services, do a job that should be recognised, not pissed all over. They should be respected, especially by other public servants.

So, on behalf of one would-be pubic servant: fuck you, Teachers Conference.

Pick a lane...

Sounds sci-fi, I've always thought, but it's pretty understandable science. Science which could lead to major health benefits and lives saved.

Obviously, religious zealots don't want it done. They have their reasons which they're happen to bore anyone about, so I'm not going to concentrate on them here.

My issue is with the Supreme Leader* is that about this so-called 'free vote'. To give or not to give. He has decided to kop out, again, which is becoming an annoying characteristic.

Dr. Crippen brought up a good point: If the 'Iron' Chancellor gives a free vote, the act will pass. It won't pass as successfully, but there are enough sensible people in the House of Sauce to get it through. Ontop of that, over 60% of the population of the UK support the idea. So why not?

You can't please all of the people all of the time. It looks like GB is going to die trying.

* Mental note: Buy Private Eye for this fornight.

Sunday, 23 March 2008

Let Off Early

I was let off early today. Like, hours early. Which was actually reasonably amusing.

Firstly, I'm not excessively well. Secondly, it's a Bank Holiday and I dragged myself in through the snow on my bike. So, four hours later my mentor let me know she'd pull some strings and got me off today and made sure I don't have to work on tomorrow's bank holiday. Woohoo.

I felt reasonably guilty, actually. Not that I'm essential to the running of our ward, but doesn't help my ego to think it!

Anyway, this means, thanks to other factors, I only have two days left. I'll have to look forward to them, since once I finish it's back to boring University and essays. But I'm not going to tell my mentor as well as my boss "No, you've offered to let me off early but I'll stay and work...". I'd finished my duties, and I work hard on normal days.

Wednesday, 19 March 2008

A consultant that rocks my socks

There is a consultant surgeon at my current ward. She is a woman, which is important in this case as consultants are, still, generally rich old white guys. So, she holds her own. We were chatting, and she let me know about a very bizzare medical problem a patient had, admitting I'd shown quite a bit of insight*.

We talked about empathy. She said you can go too far with empathy, and made the case that if you felt for each patient as much as possible you wouldn't get out of bed in the morning for tears. A point which I agree it.

I have a little time off coming up, and we talked about that. She reflected how it's important to take time off and be surrounded by healthy people who you don't have to care for. And it made me smile, as I agree with it wholeheartedly.

She's a bit awesome, I've decided.

* Woop.

Tuesday, 18 March 2008


An excellent article by Dr. Crippen. Just why is the circumcision of little boys considered acceptable practice when we don't live in a theocracy? I'm pro-choice, and this includes a child's right to choose which parts of religion he might want to follow.


Since this blog is sort of reflective practice, does it count as work on a day after work?

I've decided the answer is a resounding yes! But I would say that, wouldn't I?

I finish placement at the end of next week, which will give me a week or two to write to essays and read for them, too. Piece of piss, compared to the stunts I pulled on my first degree.

Anyway, the aforementioned difficulties.

We have a long term patient on ward currently. The patient has a lot wrong with them, and has been bed bound for an extended period of time (+3 months). Due to a stroke, the patient is in dire need of neuro-rehab, but our ward won't take the patient due to the fact they are out of catchment area, and the closer to home ward won't take the patient with a wound*. So they are with us until a deep sacral wound heals.

Which is annoying, as it's not a gastrointestinal problem. Anyway.

Up until recently, there was another patient on ward who was also long term. This patient had neurotic problems, and it is suspected they were tampering with their drugs, treatment and documentation in order to stay in hospital. This had something to do with psychology, and something more to do with the fact that BUPA were paying them 250 squid every day they stayed in hospital. However, the psychological issues meant this patient would stir up trouble with the others. Rumours which turned into Chinese whispers.

It appears, even though the latter patient is gone, the patient in question is still being effected. This patient thinks the ward is talking about them, behind their backs. Stuff like that.

Onto of that, this patient is also suffering the effects of being looked after for so long. Noone is really innocent of being nice to the patient, and it is very hard to not do so. Being cruel to be kind is easier said than done, but that is what happened today.

Yesterday, the patient was in severe pain localised to the groin. Bed-bound, the patient had been catheterised for months. Now, it had begun to hurt. Usually, laying the patient on their side could take the pain away, but it didn't work this time. Neither did a hefty concoction of pain killers. Re-siting the catheter led to more pain when we tried to inflate the balloon. My mentor took a clinical decision, which I agreed with, to remove the catheter and use absorbent pads while we thought of something.

In the middle of this, the medical team were made aware of the problem. They said they'd come back to examine the area, but never did. Can you believe that? Doctors not doing what they say they will? Well, I never... < /sarcasm >

The only problem with removing a catheter after such a long time is that the muscles have sort of forgot what they're supposed to do. Quite promisingly, the patient began to urinate every hour. They insisted they didn't know when it was coming, and so couldn't call for a bedpan and assistance. Which essentially meant they were sitting in their own piss for a while, which is NOT good for the two wounds down there.

However, our hunch, mixed with clinical judgement, tells us this might be a cry for increased attention from the already high level the patient gets. And it doesn't stop there.

The patient should be competent when it comes to transferring from bed to a wheelchair using a funky piece of wood called a banana board**. Now, don't get wrong. The patient got a shit deal. They had originally been out of bed to go for an appointment in the hospital proper. I went with. We weren't seen as quickly as promised and we're screwed around before being told we couldn't be helped. So the patient had a right to be irritated, being stuck out of bed for a long time when it's not very pleasant and having nothing to show.

So, when we got back and tried to transfer, the something was wrong. The patient was not putting any effort in, and I - secretly, at the time - got the impression that they were trying to make it hard for us. Eventually, the move broke down and they cried for us to save them. However, my mentor is no weight lifter and neither am I. Even if we were, ad hoc moving and handling is dangerous, so my mentor took the quick and excellent clinical decision to guide the patient to the floor. The patient was now in tears, and stayed thus until we could hoist them back in.

Patients acting out for nurse attention is not a new problem, but it is a tough one. In this case, the patient needs more specialist care. We can't replace this need for specialist rehabilitation by being overly nice to her and possibly neglecting others. But the specialist care is nowhere on the horizon. In reality, to paraphrase Amy 'the Dickhead' Winehouse, this patient should go to re-hab. But the bosses, for now, have said 'No, no, no'.

* Apparently the nurses there can't dress a wound with gauze.

** I personally think it looks like a giant boomerang, but whatever.

Friday, 14 March 2008

A good day

Today was quite funny, really. For a early-after-a-late shift I was in a shockingly chirpy mood. This mood increased when it turned out that our Ward Manager, due to unreliable NHS Professional temps (who else?) asked me personally to help her out with a bay. This meant I wasn't working with my mentor, but I was working with the WM who (I think I've previously documented) is mint. She sort of throws me into situations that I'm slightly nervous about, but quite competent in once I get my hands dirty.

For example, my awesome moment of today centred around a V.A.C. system. Something I have mentioned before and have sort of helped with. Anyway, short staffed as we were I sort of volunteered to do a dressing all on my own. But not, as the patient in question is quite experienced with it, too.

Using a bit of nouse as well as skill and luck, we got it done between us. Which made me feel pleased. V.A.C. stuff is pretty new, and here's me educated in it.

The rest of the day was useful. I helped out with numerous tasks, as well as looking after the bay for most of the shift. To end the day I muscled my way into a surgeon's makeshift class with medical students, educating the sprogs on how to do a good abdo-exam. Free education! On top of that, when I asked and when I thanked him later he seemed pleasantly surprised. I'm fighting the corner of intellectual student nurses, you see.

My writing is getting better, which is worthy of comment. I can only fret that my essays are being neglected, but I'm sure I can blag something, soon enough.

Tomorrow is my first saturday in, which I'm not looking forward to, but after a good day like today I'll struggle on.

P.S. The girl from previous posts got back to me. It was a quite scorpion-woman 'no' to an offer of a drink, stating instead 'maybe we'll bump into each other in town sometime!'.

This could mean - in girl-code - that she wants me to go to the same place as we met last week, but I'm not playing those sort of code games. Besides, I have a job to do.

Tuesday, 11 March 2008

My first complaint.

Yes. I've caused an incident.

Back last week, when we had one patient on the way to death's door (they died, by the way), we had another who was not in a great way.


Already in a side room, due to the fact they were very open to infection, they started the week badly and got worse. They experienced a cerebral event on Tuesday night/Wednesday morning and a house officer on call (the same inept one from the day after) was little help. We think this may have been a TIA - transient ischemic attack, which is basically a small stroke. Still pretty nasty, mind you. The patient was placed on four hourly neurological observations, and was not completely coherent of their surroundings, asking where they were on more than one occasion.

The patient went from being reasonably self sufficient (i.e. able to get to their toilet alone) to relying on bedpans. After the cerebral event their use of bedpans was questionable, as they would often miss and urinate in the bed. The night of their event meant my mentor and I spent time in the patient's room, looking after them. The night after, however, was a lot heavier and we were dealing increasingly with another patient in another side room (the one who I have previously documented about and referenced above). The patient's urinating was still not under their total control, and they were complaining about some wetness. The first time, my mentor and I checked and it seemed to be just the top sheet that had become slightly damp, which we changed. Later, the patient urinated again and the entire bed was effected. Unfortunately, at the time, my mentor was busy, as was the only support assistant on duty. I informed the patient, as best I could, that I would get help and change them as soon as possible. It may have been twenty minutes before I came back with the support assistant to completely change the bed. This was between helping my mentor with the dying patient in the next room, and taking care of our other patients who did not have completely settled nights.

A complaint has been made against me by the patient (to their spouse, rather than the staff directly). I am accused of leaving the patient lying in their urine all night for no apparent reason, and making no effort to change this situation.

When the situation was first brought up, the Charge Nurse enquired what happened and what I remembered, to which I responded like above. This Charge Nurse suggested, with the backing of my mentor and themselves, speaking to the spouse to clear the air. During this discussion I learnt that the patient in question was now quite scared of me, and so whatever memory had been made was no ingrained. We explained the situation and apologised if it had seemed to have been a long time. The spouse (thankfully) was quite happy with this, and was glad to have 'put some faces' onto the problem.

In reflection, if a situation like this happened again, I would make sure the patient was certainly aware that I was aware of the issue, and reassure them (repeatedly, if need be) that it would be dealt with as soon as I found another member of staff to assist me.

(/report over)

Brackets aside, that is what will be going into my official reflective diary. I'll use this last paragraph to give the real skinny.

As previously noted, the night was more of a nightmare. My mentor who, especially at this part of my training, I "should" be training directly under, was busy trying to get the doctors to do their fucking jobs and contact next of kin. When she wasn't in the room with a dying patient, I would be there, doing observations and taking note of what the late arriving doctors had to say. In the meantime there were a fuckload of other patients around who were NOT fast asleep.

So, we were busy.

Additionally, the patient in question never used a nurse call bell. They would rely on shouting, which would be fine if I was within earshot of their side room, but otherwise, given my hearing is not akin to that of a bat, I might not be able to hear them.

The crux of my gripe is that this was not my fault. No matter how amazing I am as a student nurse, I'm not a nurse. Officially, I shouldn't be doing much on my own but A) I'm capable and B) I want to help, so I sometimes work on my own initiative. However, this patient was being looked after by the night staff as a whole, not just me. It's unfortunate he remembers me as this white coated monster, but - suffice to say - if this white coated monster wasn't on placement that night there would have been noone else and they might've been lying in their own waste for longer than 20 minutes.

It's hard to tell an upset spouse that their beloved isn't really with it. As stated in my official report, the Neuro Obs from the day before were seldom conclusive. The patient wasn't really sure where they were, or who the staff were, so it's not surprising that 20 minutes might seem like longer, and that events may have been warped from their point of view. Not surprising, but unfortunate all the same.

A bit of a fuss has been made over this. I'm not particularly bothered now it's over and done with, pretty much. Additionally, I have felt supported by both my mentor and the Charge Nurse who dealt with it today, so my confidence is unrocked. And as a student nurse, officially nothing is my fault, anyway, which is always a nice safety cushion. As mentioned, if I wasn't there the result could've been worse. However, I'm quite saddened that we can't make as big as a fuss over fucking doctors who can't get down to fucking see patients when we fucking bleep them. Ahem.

The result now is that I will not be nursing this patient again if we can help it. Personally, I think the patient is a disagreeable old so-and-so, thus I won't lose too much sleep over it. Professionally, I'm aware that the mental picture they have of me means it'd be counter-productive for me to nurse them again given the distress it would most likely cause. Despite my personal views on the patient, I'm sad it turned out the way it did. Before we cleared the air I was worried and anxious*, even more so because my mentor and the Charge Nurse didn't seem that worried. However, they backed me to the hilt and I now realise that it wasn't something to get overly worried about and is a part of modern nursing. Another piece of unique experience for me.

(* Often, patients ask me "Is it [working in healthcare] anything like Scrubs?" My standard answer is: Nurses mostly like their patients, like in the show. Doctors are sometimes annoying and arrogant, ditto. But there is no malicious janitor. The soul searching I did today made it feel a bit more like an angsty American emotional sit-com, for sure)

Saturday, 8 March 2008

More About Girls

Last night I met another fashion student, who made the last one look like an idiot. She was awesome, we got on perfectly and she was completely lovely.

We were, however, in a gay bar. And, until 30 seconds before she left, she thought I was gay. Once I told her otherwise, her friends were already moving on so I didn't even get her number. Idiot.

The wonders of the internet knows no bounds, however. We had a picture taken by one of these online galleries, and I have tracked it down. She was the one who wanted the picture taken before I'd even noticed the photographer and so I think - or hope - she might check the website. I've left a comment there asking her to add me. And god, I hope she does.

Or I'll be just the tiniest bit annoyed.

Friday, 7 March 2008

The Principle Problem

I, in all fariness, am a man of few actual principles. I believe in giving people a fair crack of the whip. If people have had a fair crack and are still fucking idiots, then they deserve all that they get.

I also believe in relative freedom. That is to say, as much freedom as can be achieved realistically in the current world we live in. For example, in the 'First World' (Great Britain, in this case) people are sort of free. Free to buy what they want (if they have the money), work what job they want (if they have the qualifications) and be friends with who they want (which isn't as easy as it sounds). I think even these relatively liberated people could do with being free from fear, though. It's a bit of a bastard, really. Not just the fear of being blown up by a deluded religious zealot, either. Fear of not having the prettiest hair, the most up to date clothes or the hippest music tastes. In this sense, I believe even the 'First World' isn't truly free. Neither can it be (I believe, whether you like it or not, everyone serves somebody or something), but it could be more free than it is right now.

Right. Mini-rant over. Major-rant pending.

So, I am quite bereft of principles in a political, proactive sense. Some people are not, and I think these people should actually respect what they believe in.

I recently became involved with a political female. Without going too deep into the politics, she's a socialist (justice for everyone, no concentrations of power) and a feminist (in the sense that she wants fairness between genders, not some kind of stereotypical 'man hater'). She's involved in an open relationship, therefore quite liberal and 'modern' about relations.

We spoke all night in a scene (albeit edited for time) that wouldn't have looked out of place in a sugary, Hollywood rom-com. We fell asleep in each other's arms, later, out of sight of her friends, and did a little bit of kissin'. All good. In the morning, and later via cellular communication, she told me she couldn't remember meeting anyone like me and really wanted to see me again. Somewhat hampered by the fact that we live 200 miles apart.

An opportunity came up a week later for us to see each other in my current city. I was caught in work but we agreed to catch up over at least a quick drink over a few hours. I text her, asking about it a day before. Nothing. The next day, I tried again. Nothing. One step away from stalking, I contacted her over the internet and got no reply.

The friend who introduced us sighed at these stories. She'd sort of warned me about her, early on, and admitted this was sort of her normal way of dealing with boys and girls.

The girl's principles are an integral part of her life. And yet she played the role of a 1950s adulterer, basically. Finding a piece of eye candy, telling them they're amazing and using them for a while before going back to their relationship.

If she, a revolutionary by her own admission, can sell out her principles by acting like the kind of man part of her political viewpoint is directly against, it sort of explains to me why cunts like Patsy Hewitt can leave the government to line their pockets in private companies (Boots, in this case). I wish I was disappointed, really.

Thursday, 6 March 2008

Nights and Death

I've on the end of my three day night stint, which has been difficult for me. This morning, one of my patients began to die. I think they were still on their way out when I left this morning.

At least, I think it was this morning. My body clock is all upside down. I woke up at 4pm yesterday and haven't been to sleep yet. And now I'm drinking. So forgive any ramblings.

The patient who died was old, with a list of comorbidities as long as my arm. And to be honest, I didn't much like the patient from a personal point of view. The idea that nurses are angels to everyone is either naive or stupid. So, this patient being removed from my life was not a huge, personal loss. The scenario surrounding his slip is what got to me more.

The patient was a step down from High Dependency Unit. I personally don't think this patient should've returned, but that's just me. Observations were at a sensible level and the patient hadn't been scoring any high factors on any of the vital sign fronts.

Then, he just slipped. So, my mentor beeps the on-call house officer. Nothing. Beeps again - nothing (like has happened earlier this week). Eventually, my mentor went over this HOs head and to a Registrar. Once that kick up the arse was applied, two hours later, she turned up with the Reg. By the time they'd farted around outside and had a looksee, it was far too late.

At the same time, my mentor was trying to get in touch with the next of kin of the patient. Not too easy at 5am, really. My mentor tried, and tried, and tried but could not. 'Best efforts' doesn't even cover it.

These two things - the inability to contact the next of kin and the sheer attitude problem possessed by the HO (who we later learned was sitting on the internet looking at wallpaper samples) upset my mentor and I tried to communicate how they had done everything humanly possible. But that's similar to what everyone else was saying, and it was not going to have an immediate effect. I just hope a few days off will improve their mood. And I hope the lazy fucking HO gets what's coming to her.

I'm not going to go on some tirade of how doctors are bastards. Generalisations don't work. But this particular human being needs some sorting out. Things could've turned out so different.

Tuesday, 4 March 2008

It's 5pm...

I've been up for an hour...

It is, of course, the aftermath of my first nightshift.

Unable to get any sleep beforehand, my night shift was something of a misfire. That's to say I was not my usual, amazing self. Of course, a half-decent OFMN is better than your run-of-the-mill Y1S2 student nurse, I know, but still...

I'd been up for 10 hours before my shift started, which didn't help things, obviously. And I didn't know many of the patients after coming back from a weekend off (Including an excessively hot one who is, alas, only in for one night. We can discuss the ethics of patient-based flirting later). And then, to make matters worse, once my writing was mostly done and I was looking at a compassionate early dart home to get some clearly needed sleep, one of our patients has a 'slight' stroke. Made all the more annoying by the fact that we'd called a medic earlier to check the patient out, and the medic hadn't even went in the room to see.

I left my mentor 15 minutes early, god bless her. She still had the unenviable task of calling the patient's next of kin and informing them of the possibility of a stroke. I'm willing to take on new challenges, but that one is perhaps a bit ahead of me. For now.