Wednesday, 14 May 2008

The Long Day that wasn't

Yes, I was indeed half planning on doing a long day and taking tomorrow off to sun myself and do fuck all. But some strenuous nursing took it's toll.

There has been a patient in my zone for a while now who I haven't really looked after. Ill Old Dear (IOD) is in a sideroom due to MRSA. They presented with oesteoporosis (spelling?) and other rheumatic conditions. Their renal system is also not amazing, and on top of all this a stroke is being queried from an episode over the weekend.

DGN does not like IOD. IOD is quite needy, whiny and otherwise hard to look after. IOD does not, essentially, need to be on a acute medical ward.

IOD needed an MR scan today to properly diagnose a stroke/TIA from the weekend. IOD also needed a podiatry review, so my mentor decided to mix these into one round trip. My mentor also decided that it would be good experience for me to go on the round trip, which I knew wasn't a good idea but could not convince my mentor out of. So, wget ready to go at about 1000 when I am, essentially, not quite finished with my own patients. IOD needs a bedpan before, so an NHS Professionals support worker puts them on one.

Clearly not very well. The bedpan is misplaced and a massive mess is made. A different support worker grabs me and we clean up the mess, replacing the sheets. The replacement sheets become soaked, too, so we replace the replacements - by which time IOD is in quite a lot of pain and additionally stressed by the constant turning. We round up some reinforcements and move IOD from high-tech mattress to stiff old trolley. Obviously missing the porter, and so have to wait an hour for another to come, which stressed IOD out even more. I sit with her and chat, when she can, her wheezing and shortness of breath getting in the way of things.

Eventually we get down to the MR Scanner and wait some more. We get into the antechamber only to wait even longer, but to IOD's distress. I accidentally disconnect IOD's fluids as the Radiology nurse told me "it" would have to be disconnected. It was only after they'd watched me do it that it turned out "it" was the IVAC machine. This was just one of the very poor pieces of practice exhibited from the team, in my opinion, but whatever.

Much later, and with scant manners, they kicked us out to wait for a porter. By now IOD was in quite a bit of pain and exhibiting worrying sounds when breathing. My mentor had originally wanted to transfer IOD to a chair and get a porter to podiatry but after speaking to them and listening to their worries, I did not feel at all comfortable putting them through that. I phoned my mentor, explaining the situation and expressing my clinical judgement. Thankfully, my mentor agreed - I was going to bring IOD back to the ward come hell or high water, anyway. So I did, and the Ward Manager sent me for a break whilst they sorted IOD into some new sheets.

It was an interesting experience. I agreed with DGN that IOD shouldn't be with us, and I still do, but I get the impression DGN might not have given IOD a good enough chance to get to know them. IOD's a lovely old human being, deep down, full of opinion and chat. But then again, maybe some of it is an act and I have to learn to be a bit more ruthless. I told someone yesterday that it isn't always the 'good' patients that make the job worthwhile. Sometimes it's the patients you don't like but grow to like. IOD was one of those. And, to sound dramatic, before today I was losing a bit of interest in the vocation. Today was a perfect example. My mentor being careless-cum-irresponsible. The radiology nurses being shit. Being placed on a quite time intensive and low value job. But I made some progress with someone I didn't think I would've done so with. That's the kind of Disney-shite that keeps me smiling and keeps me interested.

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