My sorta-mentor asked me to work a full day instead of an early, and I was glad to oblige. Today was full of stuff. I mean, y'know, crammed. And I'm a bit dead-ed. So I'll keep this late night session brief.
I looked after a teary woman full of odema, a man who has but a few days to live, my favourite ever patient and my personal bay which has turned from a lovely exercise into Saved By The Bell: The New Class. Hard work, and without that classic comedy atmosphere.
I worked hard, sweated hard and am exhausted. But god-damn I love the 'core.
Monday 30 June 2008
Thursday 26 June 2008
Do when in a good mood.
I'm pleased. Despite the fact that Final Fantasy Tactics A2: DS doesn't come out until tomorrow. I'm also amused by recent news articles.
Firstly, can't women wear ties? Enough said.
Secondly, the whole positive discrimination part of the Equalities Act being put through it's paces today. Highly amusing. Don't get me wrong, a lot of the Act is a good idea. Equal pay, for example, or lack of, is a fucking joke. The law shouldn't really mess with the policies of private companies, but the fact that some government jobs don't pay men and women equally is just a bit stupid. If the government kicks it's gender-pay-issues into touch, private enterprise might follow. The whole issue should be sorted out, if not for red tape. This much I agree with.
The idea of using positive discrimination to try and sort of these issues is unworkable false economy at best. The whole concept seems to revolve around: 'If two identically qualified candidates were up for the job, and performed identically at interview the employer could pick a woman/person from a ethnic minority if it'd make things more equal'. What the latter bit refers to, I hazard to think. I suppose they mean that if an area was populated by 60% Asians of Pakistani descent then someone who was of similar origin would get the nod to be police chief, or whatever.
The whole first part of this fictional scenario will never happen. Two candidates will never be identical, so surely the point of the legislation is to use ethnic background and sex to 'smooth out' any 'inequality'. But surely, this idea that someone got a job because of their biological background instead of their talent doesn't help anyone. In fact, does it not undermine the whole fight for equality?
Two wrongs don't make a right, as the saying goes.
Now, given around half the people in hospitals at any time are male, does it mean men will be fast tracked into nursing posts? I'm massively talented and don't really need a cheating opportunity from the government, but even so in two years, I certainly hope so.
Edit: It seems that this positive discrimination will operate before interview. So if there's a pile of similar CVs of people with identical experience then employers could pick the female and ethnic ones over white and/or male ones to fill any sort of quota supposedly towards equality. So what happens if you pick people on evidence of their CV and biological background and find they all interview terribly? Do another round of admission to interview without the filters on? Interesting idea.
Firstly, can't women wear ties? Enough said.
Secondly, the whole positive discrimination part of the Equalities Act being put through it's paces today. Highly amusing. Don't get me wrong, a lot of the Act is a good idea. Equal pay, for example, or lack of, is a fucking joke. The law shouldn't really mess with the policies of private companies, but the fact that some government jobs don't pay men and women equally is just a bit stupid. If the government kicks it's gender-pay-issues into touch, private enterprise might follow. The whole issue should be sorted out, if not for red tape. This much I agree with.
The idea of using positive discrimination to try and sort of these issues is unworkable false economy at best. The whole concept seems to revolve around: 'If two identically qualified candidates were up for the job, and performed identically at interview the employer could pick a woman/person from a ethnic minority if it'd make things more equal'. What the latter bit refers to, I hazard to think. I suppose they mean that if an area was populated by 60% Asians of Pakistani descent then someone who was of similar origin would get the nod to be police chief, or whatever.
The whole first part of this fictional scenario will never happen. Two candidates will never be identical, so surely the point of the legislation is to use ethnic background and sex to 'smooth out' any 'inequality'. But surely, this idea that someone got a job because of their biological background instead of their talent doesn't help anyone. In fact, does it not undermine the whole fight for equality?
Two wrongs don't make a right, as the saying goes.
Now, given around half the people in hospitals at any time are male, does it mean men will be fast tracked into nursing posts? I'm massively talented and don't really need a cheating opportunity from the government, but even so in two years, I certainly hope so.
Edit: It seems that this positive discrimination will operate before interview. So if there's a pile of similar CVs of people with identical experience then employers could pick the female and ethnic ones over white and/or male ones to fill any sort of quota supposedly towards equality. So what happens if you pick people on evidence of their CV and biological background and find they all interview terribly? Do another round of admission to interview without the filters on? Interesting idea.
Wednesday 25 June 2008
Don't blog in a bad mood..
So I let myself simmer down. Then I invited my bestest friend around for a cup of char and a pot of laugh-filled bitching. Once girls, work and the world at large had taken a bit of a bashing, I felt better.
And after explaining, at length, how bribing people without putting a bid in on eBay doesn't work I've decided to chronicle trials and tribulations of the day.
I was shouted at earlier, which is something I'm used to. The Charge Nurse was annoyed that I'd undermined their orders. Whereas I was concerned with the four beds I was looking after (this Charge Nurse had asked me to care for them, after all), the Charge Nurse was looking at things from a more global level. It was a stern telling off, but I'm pretty thick skinned. It wasn't a lot more fuel to the funeral pyre of my foul mood.
What was surprising is that the Charge Nurse apologised not once, but twice! The first one seemed like a bit of an afterthought, like when someone bumps into you in the street and apologises, despite the fact they knew they would anyway. The second time seemed more heartfelt. The Charge Nurse told me I was wrong, but there was no need to respond to me as they did. I don't think I was wrong, but perhaps they had a more realistic set of priorities. And I perhaps shouldn't have undermined their orders, but, as I told them, I was being obtuse and standing up for my patients. And I'd do it again.
What made me more upset was further evidence of my skill stagnation (I'm aware it's a bit rich to talk about this as a first year, but it's a problem). I got to change a dressing today, and people endeavoured to try and make me feel quite stupid in the process. A common theme on this ward. The bottom line is: this is the first dressing I've done in three months, so I'm totally out of practice. And without practice, I can't learn anymore or at least get back to my previous stupendous level.
This is a recurring problem on this ward, and makes me feel quite excited to get off of it. With no new skills to be learned, I'm just going through the motions. And just talking about that edges me back to the previous foulness. So I'm going to stop.
And after explaining, at length, how bribing people without putting a bid in on eBay doesn't work I've decided to chronicle trials and tribulations of the day.
I was shouted at earlier, which is something I'm used to. The Charge Nurse was annoyed that I'd undermined their orders. Whereas I was concerned with the four beds I was looking after (this Charge Nurse had asked me to care for them, after all), the Charge Nurse was looking at things from a more global level. It was a stern telling off, but I'm pretty thick skinned. It wasn't a lot more fuel to the funeral pyre of my foul mood.
What was surprising is that the Charge Nurse apologised not once, but twice! The first one seemed like a bit of an afterthought, like when someone bumps into you in the street and apologises, despite the fact they knew they would anyway. The second time seemed more heartfelt. The Charge Nurse told me I was wrong, but there was no need to respond to me as they did. I don't think I was wrong, but perhaps they had a more realistic set of priorities. And I perhaps shouldn't have undermined their orders, but, as I told them, I was being obtuse and standing up for my patients. And I'd do it again.
What made me more upset was further evidence of my skill stagnation (I'm aware it's a bit rich to talk about this as a first year, but it's a problem). I got to change a dressing today, and people endeavoured to try and make me feel quite stupid in the process. A common theme on this ward. The bottom line is: this is the first dressing I've done in three months, so I'm totally out of practice. And without practice, I can't learn anymore or at least get back to my previous stupendous level.
This is a recurring problem on this ward, and makes me feel quite excited to get off of it. With no new skills to be learned, I'm just going through the motions. And just talking about that edges me back to the previous foulness. So I'm going to stop.
Tuesday 24 June 2008
Magna Carta
This old, lovely document has had a lot of publicity around the idea of 42 days detention and how it should be respected. The news, though, of how law lords have ruled that anonymous witnesses can no longer be used within trials is a very linked problem.
And an interesting one, philosophically. On one hand, the idea the accused should be able to know who is accusing them of a crime is enshrined in English law. No matter how nasty they are. On the other hand, witness protection is important, too. Not just in gang warfare, as is something concentrated on in the current news stories, but in cases of rape, child abuse and other sexual assaults (remember, men can't be raped, legally).
The Magna Carta is important. The issue is: is it black and white? Some of these people, rapists and gang members and other such scumbags, are nasty people who deserve, at least, to be in prison. And surely we should try our best to get them there. But can we compromise morals to do this, or is that just as bad as 42 days?
And an interesting one, philosophically. On one hand, the idea the accused should be able to know who is accusing them of a crime is enshrined in English law. No matter how nasty they are. On the other hand, witness protection is important, too. Not just in gang warfare, as is something concentrated on in the current news stories, but in cases of rape, child abuse and other sexual assaults (remember, men can't be raped, legally).
The Magna Carta is important. The issue is: is it black and white? Some of these people, rapists and gang members and other such scumbags, are nasty people who deserve, at least, to be in prison. And surely we should try our best to get them there. But can we compromise morals to do this, or is that just as bad as 42 days?
I'm in a bad mood...
... so I sharn't bore you with the details of why.
Suffice to say I spent my last hour of work doing the work of support workers, half of which couldn't be arsed to do what they're paid for - after turning up late - and the other half who couldn't be bothered to turn up at the start of their shift.
If student nurses (I won't use the s-word. It's already obvious) weren't there, who'd pick up the slack?
The age-old issue.
Suffice to say I spent my last hour of work doing the work of support workers, half of which couldn't be arsed to do what they're paid for - after turning up late - and the other half who couldn't be bothered to turn up at the start of their shift.
If student nurses (I won't use the s-word. It's already obvious) weren't there, who'd pick up the slack?
The age-old issue.
Sunday 22 June 2008
Consent
Just a quick one, since it's Sunday.
Dr. Crippen's theoretical post about 'medical rape' got me thinking.
Consent is a funny issue with lots of people in the sphere of healthcare. I try to see it as a bit of a black and white issue, as it's easier.
The situation is thus:
In my comment on DC's site, I mention how I'm not sure what'd happen if the Doc would've removed the forceps at the moment the pregnant refused. For example, if this would've caused damage to baby and/or mother than the doctor is in an ethically screwed area. On one hand, s/he does something for the best: to sort out a problem and keep both parties as healthy as possible whilst running the risk of being called a rapist. On the other, s/he takes notice of the patient and lives with the consequences. This could, essentially, go against ethics or morals. To do no harm, and to do good, specifically.
Even so, I'd go with the latter option. There might not be a court in the land who could try and prosecute a doctor for doing what s/he thought was right, i.e. delivering the baby, however in this new consumer-obsessed world of 'choice' and the like, the latter choice would be the one for me. As long as you've explained what you want to do (before doing it) and then, once the patient has asked you to stop, explained what the consequences of not doing/completing the procedure, I don't see the problem in stopping. If the patient complains about it in the future, you could just play the old 'respecting your wishes card'.
Brilliant.
Dr. Crippen's theoretical post about 'medical rape' got me thinking.
Consent is a funny issue with lots of people in the sphere of healthcare. I try to see it as a bit of a black and white issue, as it's easier.
The situation is thus:
You are a hospital doctor, working in obstetrics. You are called to the Labour Ward by the midwifes. Ms Smith is a 29 year old barrister and is in labour. Her partner, aged 32, and also a barrister, is with her. It is her first baby and she is towards the end of the labour which has been uneventful but a little longer than expected. She declined an epidural. She has, at her own request, had only “gas and air” for analgesia. She has been fully dilated for nearly an hour. She was pushing well at first but, suddenly, she is very tired, and she can no longer push effectively. The foetal heart rate has dropped suddenly and precipitously. The baby’s head is on the perineum, but Ms Smith cannot push it out.
The baby must be delivered quickly. You tell Ms Smith that she needs to have some help, that you need to do a forceps delivery. She is close tears and exhausted. She agrees. “Yes, please, just deliver my baby as quickly as possible.” Ms Smith is put up in the stirrups. You infiltrate some local anaesthetic, put the forceps on the baby’s head without difficultly and are about to do what the obstetricians (not the patient) would call a “simple lift out”. You start to apply gentle traction on the forceps. The baby’s head begins to move easily. At this point, Ms Smith starts to scream, “No, no, no, stop, take those bloody things out of me now.” Ms Smith’s partner mops her brow. She continues to scream, “Take those bloody things out of me”. You ignore her request saying “it won’t take a minute” and continue to increase traction on the forceps. Ms Smith screams more and keeps saying “take them out, take them out.” Twenty seconds later, the baby’s head is born, and you remove the forceps. Ms Smith stops screaming. The rest of the birth continues without problems. The on-call paediatrician is present. The baby has a low Apgar at one minute but then pinks up very quickly and is handed to the mother alive and well.
In my comment on DC's site, I mention how I'm not sure what'd happen if the Doc would've removed the forceps at the moment the pregnant refused. For example, if this would've caused damage to baby and/or mother than the doctor is in an ethically screwed area. On one hand, s/he does something for the best: to sort out a problem and keep both parties as healthy as possible whilst running the risk of being called a rapist. On the other, s/he takes notice of the patient and lives with the consequences. This could, essentially, go against ethics or morals. To do no harm, and to do good, specifically.
Even so, I'd go with the latter option. There might not be a court in the land who could try and prosecute a doctor for doing what s/he thought was right, i.e. delivering the baby, however in this new consumer-obsessed world of 'choice' and the like, the latter choice would be the one for me. As long as you've explained what you want to do (before doing it) and then, once the patient has asked you to stop, explained what the consequences of not doing/completing the procedure, I don't see the problem in stopping. If the patient complains about it in the future, you could just play the old 'respecting your wishes card'.
Brilliant.
Friday 20 June 2008
Another Friday...
But today is payday!
Huzzah!
I get to buy earphones that don't sound like shit, get a haircut, chewing gum. All sorts of stuff. It makes me happy.
Not much on today. I took my usual four patients and looked after them competently. I made up an iloprost, which involves Antiseptic Non-Touch Technique, whilst watched by a Charge Nurse, which was a sternish test. All good fun.
I look forward to the weekend. There are more things to buy, more fun to be had. Although I might just kick back and relaxxxxx.
Huzzah!
I get to buy earphones that don't sound like shit, get a haircut, chewing gum. All sorts of stuff. It makes me happy.
Not much on today. I took my usual four patients and looked after them competently. I made up an iloprost, which involves Antiseptic Non-Touch Technique, whilst watched by a Charge Nurse, which was a sternish test. All good fun.
I look forward to the weekend. There are more things to buy, more fun to be had. Although I might just kick back and relaxxxxx.
Thursday 19 June 2008
Junior Doctors
Today, I had a quite distressed patient's spouse come to me. This spouse almost broke down in saying how depressed their love one was, at not knowing what was going on, what their fate was or if they were going to be around for much longer. I had some vague knowledge that the patient was having all kinds of scans and bloods done, so it was just a depressing waiting game of diagnosis. I told this, more sensitively, to the spouse who expressed great relief in actually hearing something from someone, and asked if I'd say such to the patient. Being not entirely clear, I told said spouse I'd try to find the nurse in charge or at least get my facts straight beforehand, but I'd be happy to try.
Whereas I try to know everything pertinent about the people I look after, this patient was not particularly one I knew lots about. Their nurse was in a hefty handover session, so wouldn't be around for a bit. I looked through their notes, and found the House Officer assigned to the patient. The HO was hesitant to tell me... well... anything. Ward Rounds were four hours away with the big consultant type and so the HO repeated for me to wait until then. I revealed the spouse might not be around at that time, to a muted reaction. Eventually I recieved permission to at least have an informal word with the patient, now my facts were clearer. Which I did.
The patient expressed dismay. They referred to doctors as 'Gods walking around the hospital'. Finding myself in the rare position of having to defend doctors, I replied that medics are not all knowing and all powerful. They have to wait for blood results, for scans to come through, etc. My arguments, I'd like to think, were compelling, but the patient was mostly unmoved (although their spouse was very grateful, so the talk was not for naught).
The HO said that they would go and have a word 'at some point', but with ward rounds on the horizon I doubted it'd happen (my shift ended before rounds began, unfortunately).
I'm, as Hot Third Year seldom lets me forget, a mere first year. But my talk with this patient helped, at least a tiny bit. I wondered why the doctor couldn't go and have a big word, before rounds. I'm not saying the junior doctor should've went and made unrealistic promises, or lied, or anything like that! Rather give him a little more information about the tests and results, stuff like that.
The HO I'm thinking of is, to be honest, wet. Lovely, intelligent but a bit of a wet squib. I was with this HO and another patient earlier, where the HO was consenting the patient for two rather uncomfortable procedures. Now, don't get me wrong, I'm aware that noone in healthcare should make promises they can't keep, on pain of suing, but the whole thing was a bit doom and gloom. The procedures are Gastrointestinal-based, which means I have some knowledge of them, and have watched doctors consent patients for them before. The procedures are quite... well. Everyday. The risks are pretty minimal, and if I was a doctor I'd be pressing this point home a bit more, as I've seen other (more senior) doctors do. Inspiring a bit of confidence, without making unrealistic promises. This HO left the patient a bit... uninspired.
So I got to thinking. Is being wet, mild mannered, quiet and subservient like some evolutionary response to working under certain consultants? Does it make life easier, or does it make you more likely to be promoted or have good things said about you? I am not for one second criticising junior doctors, let it be known. 'Wet' is not a criticism and although I suppose a lack of charisma counts as one, it's not meant as a barb. The ability to inspire confidence is certainly one learnt through experience, but it is also something some people are talented with just through their use of words. Naturally, almost.
I'm sure a lot of junior doctors grow in confidence as they grow in experience, and make terrific Senior House Officers and beyond. It seems a shame, however, that the role of HO, the medic the patients see more than any other, is home to quiet types, when some patients could do with someone with a bit more... pep.
Whereas I try to know everything pertinent about the people I look after, this patient was not particularly one I knew lots about. Their nurse was in a hefty handover session, so wouldn't be around for a bit. I looked through their notes, and found the House Officer assigned to the patient. The HO was hesitant to tell me... well... anything. Ward Rounds were four hours away with the big consultant type and so the HO repeated for me to wait until then. I revealed the spouse might not be around at that time, to a muted reaction. Eventually I recieved permission to at least have an informal word with the patient, now my facts were clearer. Which I did.
The patient expressed dismay. They referred to doctors as 'Gods walking around the hospital'. Finding myself in the rare position of having to defend doctors, I replied that medics are not all knowing and all powerful. They have to wait for blood results, for scans to come through, etc. My arguments, I'd like to think, were compelling, but the patient was mostly unmoved (although their spouse was very grateful, so the talk was not for naught).
The HO said that they would go and have a word 'at some point', but with ward rounds on the horizon I doubted it'd happen (my shift ended before rounds began, unfortunately).
I'm, as Hot Third Year seldom lets me forget, a mere first year. But my talk with this patient helped, at least a tiny bit. I wondered why the doctor couldn't go and have a big word, before rounds. I'm not saying the junior doctor should've went and made unrealistic promises, or lied, or anything like that! Rather give him a little more information about the tests and results, stuff like that.
The HO I'm thinking of is, to be honest, wet. Lovely, intelligent but a bit of a wet squib. I was with this HO and another patient earlier, where the HO was consenting the patient for two rather uncomfortable procedures. Now, don't get me wrong, I'm aware that noone in healthcare should make promises they can't keep, on pain of suing, but the whole thing was a bit doom and gloom. The procedures are Gastrointestinal-based, which means I have some knowledge of them, and have watched doctors consent patients for them before. The procedures are quite... well. Everyday. The risks are pretty minimal, and if I was a doctor I'd be pressing this point home a bit more, as I've seen other (more senior) doctors do. Inspiring a bit of confidence, without making unrealistic promises. This HO left the patient a bit... uninspired.
So I got to thinking. Is being wet, mild mannered, quiet and subservient like some evolutionary response to working under certain consultants? Does it make life easier, or does it make you more likely to be promoted or have good things said about you? I am not for one second criticising junior doctors, let it be known. 'Wet' is not a criticism and although I suppose a lack of charisma counts as one, it's not meant as a barb. The ability to inspire confidence is certainly one learnt through experience, but it is also something some people are talented with just through their use of words. Naturally, almost.
I'm sure a lot of junior doctors grow in confidence as they grow in experience, and make terrific Senior House Officers and beyond. It seems a shame, however, that the role of HO, the medic the patients see more than any other, is home to quiet types, when some patients could do with someone with a bit more... pep.
Wednesday 18 June 2008
Ten Thousand Men?
If you haven't heard today, perhaps you've been hiding under a rock for the past 24 hours, I don't know... But if you haven't heard, a female soldier died in Afghanistan today. Four men died, and scores have died previously, but the media sees fit to mention this gender-based tid bit again and again and again.
How we're supposed to get anywhere near to equality when this fact is repeated over and over, I have no idea.
Unlucky for those four soldiers who died today. Males get second billing on the death front.
Update: Does the media view each death equally? See this story and make your own mind up.
How we're supposed to get anywhere near to equality when this fact is repeated over and over, I have no idea.
Unlucky for those four soldiers who died today. Males get second billing on the death front.
Update: Does the media view each death equally? See this story and make your own mind up.
Tuesday 17 June 2008
Swings and Roundabouts
Today started off really well. I got to work with the Ward Manager who was happy to give me four patients to personally look after. Responsibility is something of a drug, sometimes, and I was drove on by this new challenge. The patients in the bay arguably like me a lot, so it seemed like a good day. Two of the patients caused a little trouble with insulin-based hilarity, but nothing we couldn't handle. Still, there's no such thing as a perfect day.
Doctors, chest pain and upset
One of the patients in my bay has been in hospital for a long time, awaiting a CABG (a heart bypass, essentially). Noone was really sure why the patient is in. The patient seldom scores anything on EWS and previously managed their own condition outside of a hospital setting. I pressed for weekend leave yesterday, which was accepted. Today, however, a consultant decided the patient was fine to leave and have their CABG done as an outpatient. The nurse in charge refused to give this news, much to the annoyance of one of our HOs (House Officer, not gangsta-type ho). The nurse in charge says that this is a medical issue, and leaves it at that. The patient is told, and is elated.
Obviously, this good news would be too lovely to happen without a hitch.
After telling the patient that they could go, the HO then decided to ask them about chest pain. I wasn't there, but apparently the patient admitted to having slight chest pain frequently, although it went away with medication. Ho went off to speak to said consultant. Guess what? Discharge denied.
There was some debate about this issue within the nursing team, inspired by yours truly. I frequently jump in on ward rounds and, considering the patient's history of cardiac problems, they are never quizzed about chest pain. I argue that it's a bit stupid of the doctors to give such news without having all the information, as well as the fact that they never quiz him about such pain on rounds. The nursing team ask patients about pain three times a day, and until now the patient has always denied any. Senior nurses argued that the patient was a grown human being and should've reported said pain off their own back. This, anyone in nursing may realise, is a big problem in itself.
Now, don't get me wrong. The patient isn't in the right 100%. But some more, let's say, old fashioned types can be hesitant to admit anything that they (or they fear others, perhaps?) could see as weakness. Doctors should be aware of this. Whereas one (including me) could argue the patient has lied to the nurses about experiencing chest pain, at least the nurses asked. The doctors did not. This - on top of the fact the doctors revealed the news of a discharge without getting all the pertinent information - puts them slightly more at fault. I was upset, but have cheered up a little bit since. The saddest part is that the patient is not only in a terrible mood, but has admitted that they will never tell the truth about chest pain again as they believe it'll keep them in hospital more. This breakdown of trust between the patient and the MDT is probably the worst fallout I could think of.
Burning everyone out, even the young?
Hot Third Year, a sometime reader of his organ, is the latest in a long list of people on my current ward suffering with burnout. The sad thing about said ward is that it makes people feel deskilled. For an idealistic young first year like myself, it's fine. But for people who are actually good at their jobs, it can be a motherbastard at sucking away confidence and love of the job. There are good days and bad days, clearly, but I know, for example, Hot Third Year had one of the latter today. I'm too inexperienced to have been onto one of those bad days, yet, but I'm not looking forward to them.
As of today, I'm feeling a lot better. As observant readers may observe, I'm home excessively early from working a long day. Getting let out early is lots of fun. And despite the challenges today, I feel psyched still. On the whole, I looked after my four assigned patients as competently and well as could be expected. Hell, more so, even. I've even put a couple of spoke placements in the pipeline. Productive, eh? To paraphrase Sgt. Apone:
Doctors, chest pain and upset
One of the patients in my bay has been in hospital for a long time, awaiting a CABG (a heart bypass, essentially). Noone was really sure why the patient is in. The patient seldom scores anything on EWS and previously managed their own condition outside of a hospital setting. I pressed for weekend leave yesterday, which was accepted. Today, however, a consultant decided the patient was fine to leave and have their CABG done as an outpatient. The nurse in charge refused to give this news, much to the annoyance of one of our HOs (House Officer, not gangsta-type ho). The nurse in charge says that this is a medical issue, and leaves it at that. The patient is told, and is elated.
Obviously, this good news would be too lovely to happen without a hitch.
After telling the patient that they could go, the HO then decided to ask them about chest pain. I wasn't there, but apparently the patient admitted to having slight chest pain frequently, although it went away with medication. Ho went off to speak to said consultant. Guess what? Discharge denied.
There was some debate about this issue within the nursing team, inspired by yours truly. I frequently jump in on ward rounds and, considering the patient's history of cardiac problems, they are never quizzed about chest pain. I argue that it's a bit stupid of the doctors to give such news without having all the information, as well as the fact that they never quiz him about such pain on rounds. The nursing team ask patients about pain three times a day, and until now the patient has always denied any. Senior nurses argued that the patient was a grown human being and should've reported said pain off their own back. This, anyone in nursing may realise, is a big problem in itself.
Now, don't get me wrong. The patient isn't in the right 100%. But some more, let's say, old fashioned types can be hesitant to admit anything that they (or they fear others, perhaps?) could see as weakness. Doctors should be aware of this. Whereas one (including me) could argue the patient has lied to the nurses about experiencing chest pain, at least the nurses asked. The doctors did not. This - on top of the fact the doctors revealed the news of a discharge without getting all the pertinent information - puts them slightly more at fault. I was upset, but have cheered up a little bit since. The saddest part is that the patient is not only in a terrible mood, but has admitted that they will never tell the truth about chest pain again as they believe it'll keep them in hospital more. This breakdown of trust between the patient and the MDT is probably the worst fallout I could think of.
Burning everyone out, even the young?
Hot Third Year, a sometime reader of his organ, is the latest in a long list of people on my current ward suffering with burnout. The sad thing about said ward is that it makes people feel deskilled. For an idealistic young first year like myself, it's fine. But for people who are actually good at their jobs, it can be a motherbastard at sucking away confidence and love of the job. There are good days and bad days, clearly, but I know, for example, Hot Third Year had one of the latter today. I'm too inexperienced to have been onto one of those bad days, yet, but I'm not looking forward to them.
As of today, I'm feeling a lot better. As observant readers may observe, I'm home excessively early from working a long day. Getting let out early is lots of fun. And despite the challenges today, I feel psyched still. On the whole, I looked after my four assigned patients as competently and well as could be expected. Hell, more so, even. I've even put a couple of spoke placements in the pipeline. Productive, eh? To paraphrase Sgt. Apone:
Another glorious day in the 'Core! Day in the Nursing Core's like a day on the farm: every meal's a banquet; every paycheck a fortune; everyformation a parada - I love the core!
Monday 16 June 2008
Good days
A short one today. Post, not shift.
I try to keep the interest of my patients in the forefront of things all day, clearly. Part of this involves trying to jump in on ward rounds to translate (usually later, as to not irritate or undermine any doctors) the medical speak for them. This is reasonably important and makes me feel happy, like I'm accomplishing something. Always a bonus.
I was sad to find that, despite me handing it over, writing it on handover and telling people face-to-face that noone had enquired into the possibility of weekend leave for one of my patients (they don't belong to me, but they're under my team juristiction so I group them as 'mine'). When I first brought it up with a support worker within conversation, they were pretty negative about the whole thing, betting the patient wouldn't be allowed to go home. This, though, is no reason not to at least broach the subject.
Happily, I did this morning and said patient, who is still waiting for various tests, will be allowed to go home this coming weekend. The patient was happy, so I was. Another tiny, but important, victory.
I try to keep the interest of my patients in the forefront of things all day, clearly. Part of this involves trying to jump in on ward rounds to translate (usually later, as to not irritate or undermine any doctors) the medical speak for them. This is reasonably important and makes me feel happy, like I'm accomplishing something. Always a bonus.
I was sad to find that, despite me handing it over, writing it on handover and telling people face-to-face that noone had enquired into the possibility of weekend leave for one of my patients (they don't belong to me, but they're under my team juristiction so I group them as 'mine'). When I first brought it up with a support worker within conversation, they were pretty negative about the whole thing, betting the patient wouldn't be allowed to go home. This, though, is no reason not to at least broach the subject.
Happily, I did this morning and said patient, who is still waiting for various tests, will be allowed to go home this coming weekend. The patient was happy, so I was. Another tiny, but important, victory.
Friday 13 June 2008
Nurse Promotion
It has recently been pointed out that this blog is, for the majority, pretty down on nursing. Mostly because it's my only anonymous outlet to whine about shit, so my bad days probably seep through more than the good days.
But, despite the flak and fire that I have to put up with, I still love what I do. I wouldn't want to do anything else, now, as the thrill of actually helping people is the kind of satisfaction that can't be beat.
I set up this account to talk about issues around being a male, student adult nurse in 2007 and there are a lot of problems that I, personally, face, but that doesn't mean there aren't rewards. If there were no rewards, believe you me I would not - like some nurses I've met - be still training. I'd go make thousands selling some miscellaneous, unnecessary shite to stupid people.
I love what I do, and that all-encompassing passion works in mysterious ways. I'm glad I get annoyed at the crap that goes on, as it shows I still care. But, I should be careful to highlight the awesome bits, too, of which there are - thankfully - many. Too many nurses say, sometimes precisely, 'Don't be a nurse'. I say - if you think you can stand the challenges and want to do something you'll actually give a shit about, do.
But, despite the flak and fire that I have to put up with, I still love what I do. I wouldn't want to do anything else, now, as the thrill of actually helping people is the kind of satisfaction that can't be beat.
I set up this account to talk about issues around being a male, student adult nurse in 2007 and there are a lot of problems that I, personally, face, but that doesn't mean there aren't rewards. If there were no rewards, believe you me I would not - like some nurses I've met - be still training. I'd go make thousands selling some miscellaneous, unnecessary shite to stupid people.
I love what I do, and that all-encompassing passion works in mysterious ways. I'm glad I get annoyed at the crap that goes on, as it shows I still care. But, I should be careful to highlight the awesome bits, too, of which there are - thankfully - many. Too many nurses say, sometimes precisely, 'Don't be a nurse'. I say - if you think you can stand the challenges and want to do something you'll actually give a shit about, do.
So, I haven't failed...
Bonus, right?
Well, obviously. One essay got a spanking 65% (not bad for zero effort) whilst one got a sort of 'Pretty terrible with sparks of brilliance' review of 49%. Both passes, which is good since I blagged them with little preparation. But points to consider:
- Firstly, I hate the stupid concept of, whilst being an academic, having to explain every little technical term. Wards around the country use the Early Warning Score. It's a piece of evidence based practice. So why should I have to explain what it is? If you end up explaining every little thing in an essay you won't get any debating done.
e.g.
"Jane was a human being. A human being is a carbon-based lifeform from planet Earth. Earth is the third planet from the Sun. 'The Sun' is the term used by humans for the star their planet orbits. A star is..." etc. I jest, but there's a serious point in there. Where does this process start and stop? The answer is debatable, but one thing is clear. Some markets like everything explained, some are less draconian.
- Secondly, I was always taught that introductions were something to get out of the way, lest too much labour be spent. And yet in both of these essays I've been told mine are too short. So, it seems this University wants me to labour the point. Fine.
- Finally, I have no complaint that some of my references didn't match my bibliography perfectly. That's easily improved.
Anyway, I aim to be much more organised in the future. And I'm excessively good at learning from my mistakes, my next essay is going to blow some socks off. It's decided.
Well, obviously. One essay got a spanking 65% (not bad for zero effort) whilst one got a sort of 'Pretty terrible with sparks of brilliance' review of 49%. Both passes, which is good since I blagged them with little preparation. But points to consider:
- Firstly, I hate the stupid concept of, whilst being an academic, having to explain every little technical term. Wards around the country use the Early Warning Score. It's a piece of evidence based practice. So why should I have to explain what it is? If you end up explaining every little thing in an essay you won't get any debating done.
e.g.
"Jane was a human being. A human being is a carbon-based lifeform from planet Earth. Earth is the third planet from the Sun. 'The Sun' is the term used by humans for the star their planet orbits. A star is..." etc. I jest, but there's a serious point in there. Where does this process start and stop? The answer is debatable, but one thing is clear. Some markets like everything explained, some are less draconian.
- Secondly, I was always taught that introductions were something to get out of the way, lest too much labour be spent. And yet in both of these essays I've been told mine are too short. So, it seems this University wants me to labour the point. Fine.
- Finally, I have no complaint that some of my references didn't match my bibliography perfectly. That's easily improved.
Anyway, I aim to be much more organised in the future. And I'm excessively good at learning from my mistakes, my next essay is going to blow some socks off. It's decided.
Thursday 12 June 2008
I almost failed my course and all I got was this lousy t-shirt...
So, yeah. Busy week.
On Tuesday I was told my paperwork was due in on Thursday. That's today. As previously discussed, my current ward has staffing issues. Which means, on Wednesday I had to flutter my eyelashes a bit to get this anywhere near finished. So I worked a whole day Wednesday to meet one of my mentors (I have about seven, thanks to said staffing issues) who was coming in on a night. I begged her to finish the important bits overnight so I could hand it in and be done with it. I got up at 6 this morning to pedal all the way there to pick it up. I had to wait an hour to have it signed off by one of the Charge Nurses. I pedalled all the way back, scanned it, got it signed off and handed it in. Phew.
Except for the sheer amount of pencil I've used, and the fact it's a rush job, it counts as a pass. I'm eternally thankful for said fortune.
Ontop of that, I was supposed to pick up essay feedback a month ago that I forgot about. I've sorted picking it up from the big cheese of the University tomorrow. Hopefully I'm going to get through that with the minimum of interrogation. I might pass, too. That'd be nice. But the resits are at the end of next month, which I'll certainly pass, worse case scenario.
The only other issue today: I found someone's practice placement book today and, after e-mailing them to tell them where it was, had a peek. They've done lots more spoke placements (in other parts of the hospital) than me and have dressed things up more. I mean, they've wrote this big blurb about watching cathertisation happen, as an example. Now, I've saw bits and pieces and took a catheter out myself, I just haven't tarted it up for my book. And insecurities aside, I'm predominantly happy. I'm still a good student nurse, impressing third years I work with, so I can't be doing that bad. A couple more spokes, and I'll quest to get some more skills on ward. Good to go.
Now, I might sleep.
On Tuesday I was told my paperwork was due in on Thursday. That's today. As previously discussed, my current ward has staffing issues. Which means, on Wednesday I had to flutter my eyelashes a bit to get this anywhere near finished. So I worked a whole day Wednesday to meet one of my mentors (I have about seven, thanks to said staffing issues) who was coming in on a night. I begged her to finish the important bits overnight so I could hand it in and be done with it. I got up at 6 this morning to pedal all the way there to pick it up. I had to wait an hour to have it signed off by one of the Charge Nurses. I pedalled all the way back, scanned it, got it signed off and handed it in. Phew.
Except for the sheer amount of pencil I've used, and the fact it's a rush job, it counts as a pass. I'm eternally thankful for said fortune.
Ontop of that, I was supposed to pick up essay feedback a month ago that I forgot about. I've sorted picking it up from the big cheese of the University tomorrow. Hopefully I'm going to get through that with the minimum of interrogation. I might pass, too. That'd be nice. But the resits are at the end of next month, which I'll certainly pass, worse case scenario.
The only other issue today: I found someone's practice placement book today and, after e-mailing them to tell them where it was, had a peek. They've done lots more spoke placements (in other parts of the hospital) than me and have dressed things up more. I mean, they've wrote this big blurb about watching cathertisation happen, as an example. Now, I've saw bits and pieces and took a catheter out myself, I just haven't tarted it up for my book. And insecurities aside, I'm predominantly happy. I'm still a good student nurse, impressing third years I work with, so I can't be doing that bad. A couple more spokes, and I'll quest to get some more skills on ward. Good to go.
Now, I might sleep.
Friday 6 June 2008
Friday, I'm not in love.
So, two shifts later. I spent a hungover late Thursday shift, with little sympathy from staff or patients.
I decided to bash through an early on Friday, which this mood of mine is the end of. I had a busy shift, in bits. One bedfast patient caught a lot of time from various members of the nursing and student teams, soaking effort up like a sponge. This patient should really be in either rehab (they are, according to rehab teams, not rehab-able) or a home. Not an acute medical bed.
I spent most of the rest of the shift (which I should've spent working with my actual mentor) was wasted down in Ear, Nose and Throat with one of my patients. I've made this jape again and will make it. Our time down there was like a Bob Monkhouse show. Joke, after joke, after joke (Geddit??). Firstly, despite booking the porters in time, they didn't arrive, hence why I had to take the patient down. Then two reception desks were closed, leading us on a merry dance. Then ENT had no idea what we were there for, so I had to explain what was already in the notes. We waited an hour before they came back, asking us more questions about why we were there. Finally, after a while more of uncomfortable waiting, the patient was dealt with.
This is not the first time I've waited forever in ENT. If they know there are always delays, why schedule the appointments so close together? Dolts.
I got back, roped into helping to change that bedfast patient. Just to prove my skills are still immense, I also ran the blood sugars of the patient who I'd pushed and pulled down to ENT for those hours. They were also a diabetic, which is another reason waiting two hours somewhere with no suitable food might be a fucking stupid idea. It was high, so I suggested DGN give the patient ActRapid, which is treatment for high blood sugars. DGN looked at me, stating that ActRapid was only to be used if the blood sugar (BM) was over a score of 20. With an enviably level of humility, I informed her that this patient was to have a lesser dose of ActRapid if the BMs were over 16, which they were. Good to know I was still on the ball after all that.
In other news, my paperwork has almost been started. 5 weeks into the placement. Not a big surprise. In fact, I'll be more surprised when someone actually gets my paperwork done on time within these 3 years. When or if.
I decided to bash through an early on Friday, which this mood of mine is the end of. I had a busy shift, in bits. One bedfast patient caught a lot of time from various members of the nursing and student teams, soaking effort up like a sponge. This patient should really be in either rehab (they are, according to rehab teams, not rehab-able) or a home. Not an acute medical bed.
I spent most of the rest of the shift (which I should've spent working with my actual mentor) was wasted down in Ear, Nose and Throat with one of my patients. I've made this jape again and will make it. Our time down there was like a Bob Monkhouse show. Joke, after joke, after joke (Geddit??). Firstly, despite booking the porters in time, they didn't arrive, hence why I had to take the patient down. Then two reception desks were closed, leading us on a merry dance. Then ENT had no idea what we were there for, so I had to explain what was already in the notes. We waited an hour before they came back, asking us more questions about why we were there. Finally, after a while more of uncomfortable waiting, the patient was dealt with.
This is not the first time I've waited forever in ENT. If they know there are always delays, why schedule the appointments so close together? Dolts.
I got back, roped into helping to change that bedfast patient. Just to prove my skills are still immense, I also ran the blood sugars of the patient who I'd pushed and pulled down to ENT for those hours. They were also a diabetic, which is another reason waiting two hours somewhere with no suitable food might be a fucking stupid idea. It was high, so I suggested DGN give the patient ActRapid, which is treatment for high blood sugars. DGN looked at me, stating that ActRapid was only to be used if the blood sugar (BM) was over a score of 20. With an enviably level of humility, I informed her that this patient was to have a lesser dose of ActRapid if the BMs were over 16, which they were. Good to know I was still on the ball after all that.
In other news, my paperwork has almost been started. 5 weeks into the placement. Not a big surprise. In fact, I'll be more surprised when someone actually gets my paperwork done on time within these 3 years. When or if.
Wednesday 4 June 2008
Co-Payments
Unity responded to DK's quite naive post about co-payments with his usual meticulous fisking, and I've commented but I'd like to expand upon my comment (below) a bit:
The NHS is free and equal to all. It's not, but it's supposed to be. The consumerist society we live in mirrors the free market economy model, which implies that you can have what you like if you have enough cash. This should not automatically transfer to the NHS. The National Health Service was designed to be, above all, fair*.
If you can buy add-ons, providing you have the money, then how is that fair? It pisses me right off. And, like the new news that private 'managers' are going to be brought in to improve the efficiency of 'failing' hospitals (that is to say hit more crappy targets), this is one more step to a private health service. It might piss me off, but it's the poor of the country who're going to get pissed on.
Anyway, good day. Started in a bad mood, kept my shape, kept my character, threw down some awesome nursing manoeuvres, and now I'm in a splendid mood. And I'm going out on the piss, which is even more exciting. I'm working my first late tomorrow, possibly hungover, so we'll see how that goes. Quietly, I'll guess.
But now, of course, I have quite likely jinxed it. Woo.
* People will use the term 'equitable', but ignore it. Far too open to interpretation.
Excellent post, as ever. Good to know there are medics willing to make a shitload of cash from people’s misery. Some things never change.
And that’s the bottom line, whoever has a problem with co-payment. If any of you have worked in healthcare, you’d probably see the problem more clearly. Imagine you have two patients with similar diagnoses. One is part of the affluent middle-class, one has a more working-class background. Both have paid NI all their lives. Both are informed of these random, maybe-effective drugs that could prolong their lives, but only one can afford the treatment. What do you say to the patient who cannot? ‘Tough shit’?
The NHS is free and equal to all. It's not, but it's supposed to be. The consumerist society we live in mirrors the free market economy model, which implies that you can have what you like if you have enough cash. This should not automatically transfer to the NHS. The National Health Service was designed to be, above all, fair*.
If you can buy add-ons, providing you have the money, then how is that fair? It pisses me right off. And, like the new news that private 'managers' are going to be brought in to improve the efficiency of 'failing' hospitals (that is to say hit more crappy targets), this is one more step to a private health service. It might piss me off, but it's the poor of the country who're going to get pissed on.
Anyway, good day. Started in a bad mood, kept my shape, kept my character, threw down some awesome nursing manoeuvres, and now I'm in a splendid mood. And I'm going out on the piss, which is even more exciting. I'm working my first late tomorrow, possibly hungover, so we'll see how that goes. Quietly, I'll guess.
But now, of course, I have quite likely jinxed it. Woo.
* People will use the term 'equitable', but ignore it. Far too open to interpretation.
Tuesday 3 June 2008
In other news...
We now have three patients taking up acute medical beds who have no acute medical problems. Hurrah!
Not.
This is a serious problem on my current ward. We seem to be used as something of a hold over place. Someone finishes with a cardiology procedure and can't be discharged. For social reasons, for example. So they get sent to us to twiddle their thumbs. It's fucking irritating.
Otherwise, we have two patients who deserve to be in a specialised rehab unit or in a nursing home. But both refuse to accept the patients, so we're stuck with them, with nothing else we can do. Nice one.
Not.
This is a serious problem on my current ward. We seem to be used as something of a hold over place. Someone finishes with a cardiology procedure and can't be discharged. For social reasons, for example. So they get sent to us to twiddle their thumbs. It's fucking irritating.
Otherwise, we have two patients who deserve to be in a specialised rehab unit or in a nursing home. But both refuse to accept the patients, so we're stuck with them, with nothing else we can do. Nice one.
Homophobia Vs. Old Fashion
One of my patients, who I quite like for the record, is quite annoyingly homophobic. This could be chalked up to 'old fashioned', but that's bullshit. Prejudices shouldn't be allowed just because someone's a bit old. Their homophobia comprises of insulting me for occassionally placing a hand on my hip, asking if I go out in the gay district (which I do, since it's quite popular) and saying 'Hello, sailor'. I shit you not. Anyway, I'm not going to make an issue of it just now, but it's pretty annoying.
Additionally, I realised I was in a bad mood today. But it's a good sorta bad mood, because I - rationally - know I'm going through it. I realised when I kinda almost shouted at Year1Semester1 student nurse. In all fairness, they did fuck up yesterday and, in messing with a machine in my bay were messing around with the whole nursing team system - which is in place, for better or worse. Anyway, I was being slightly irrational but also doing the right thing. I told them to go away, anyway, as they very well might've made a mistake.
I don't really like Year1Sem1 much. They're a bit like me when I first started, except without the character. A bit bland, all told. They live in the same block as me, but I'm not really excited about making them into a new friend. That says enough.
Anyway, here's hoping my mood improves.
Additionally, I realised I was in a bad mood today. But it's a good sorta bad mood, because I - rationally - know I'm going through it. I realised when I kinda almost shouted at Year1Semester1 student nurse. In all fairness, they did fuck up yesterday and, in messing with a machine in my bay were messing around with the whole nursing team system - which is in place, for better or worse. Anyway, I was being slightly irrational but also doing the right thing. I told them to go away, anyway, as they very well might've made a mistake.
I don't really like Year1Sem1 much. They're a bit like me when I first started, except without the character. A bit bland, all told. They live in the same block as me, but I'm not really excited about making them into a new friend. That says enough.
Anyway, here's hoping my mood improves.
Monday 2 June 2008
Back in the saddle
First day back after the weekend is always a toughie, it seems. But today wasn't so bad, for me, as a person. The day started terribly, with one Staff Nurse missing and no replacement, so my mentor was busy with 1 and a 1/2 a shift's worth of patients. I got on with the obs, and the old reliable 'basic patient care'. I do a lot of this anyway, but we were also down one Support Worker so there were tonnes of gaps to be filled. Patients were more worried about where their next cup of tea was coming from. Sweet, in a naive sorta way.
My main duties revolved around showering and shaving my blind gentleman patient. He's a dear, all in all, and it was good to spend some time with him, even if said time did involve me wet through my shoes. He actually got quite upset when he spoke about people dissing the NHS for getting such bad press when he thought all the staff he'd met, which was a tiny bit harrowing. But we survived, I got some valuable experience shaving someone else (which is *not* easy) and he was happy, in the end.
We have three student nurses, including myself, as of today. One is on their first ever placement, but is reasonably skilled, whilst the other is on their last ever placement and only started today so I have yet to get a bead on. She, as she is a she, is reasonably hot and I've been doing my best to show myself as the amazing human being I am. I could do with a date, just to keep myself in practice, to be honest. She asked me what the ward was like and, being an honest kinda chap, took her to one side and told her, quite simply, that we don't do anything exciting and it's full of bank staff. She was a bit frowny, but I reasoned it'd be pretty stress free and therefore allow her an easy end to the year. I'm an awesome diplomat.
Moving on, there was an issue linked to my previous issues about not forcing people to eat, today. That issue is... not starving people, too!
We had a situation, more down to low staffing levels and the YearOneSemesterOne student, in which a worried patient had refused to stay Nil-By-Mouth. This patient had something to eat, and then accidentally got sent down to the X-Ray they were being kept NBM for. For those not in the know, the X-Ray Department get pissy if people have had something to eat, and told the patient's nurse this down the phone. The patient's nurse wasn't really in on the loop, having been in handover, and it sounds like the X-Ray receptionist was being a fucking arsehead about the issue. The medics also seemed unamused.
These people are not nurses, clearly.
Just because someone - a doctor or an X-Ray operator, in this case - wants a patient to be Nil-By-Mouth for x-amount of time, it doesn't meant they have to be. You cannot, as a nurse, starve someone for 'their own good' without a bloody good reason. They're individual people, and can do what they like as long as they know it'll screw up their treatment. If, as in this case, a patient demanded food then you can't keep it from them. It goes against the code, to do no harm, for starters...
My main duties revolved around showering and shaving my blind gentleman patient. He's a dear, all in all, and it was good to spend some time with him, even if said time did involve me wet through my shoes. He actually got quite upset when he spoke about people dissing the NHS for getting such bad press when he thought all the staff he'd met, which was a tiny bit harrowing. But we survived, I got some valuable experience shaving someone else (which is *not* easy) and he was happy, in the end.
We have three student nurses, including myself, as of today. One is on their first ever placement, but is reasonably skilled, whilst the other is on their last ever placement and only started today so I have yet to get a bead on. She, as she is a she, is reasonably hot and I've been doing my best to show myself as the amazing human being I am. I could do with a date, just to keep myself in practice, to be honest. She asked me what the ward was like and, being an honest kinda chap, took her to one side and told her, quite simply, that we don't do anything exciting and it's full of bank staff. She was a bit frowny, but I reasoned it'd be pretty stress free and therefore allow her an easy end to the year. I'm an awesome diplomat.
Moving on, there was an issue linked to my previous issues about not forcing people to eat, today. That issue is... not starving people, too!
We had a situation, more down to low staffing levels and the YearOneSemesterOne student, in which a worried patient had refused to stay Nil-By-Mouth. This patient had something to eat, and then accidentally got sent down to the X-Ray they were being kept NBM for. For those not in the know, the X-Ray Department get pissy if people have had something to eat, and told the patient's nurse this down the phone. The patient's nurse wasn't really in on the loop, having been in handover, and it sounds like the X-Ray receptionist was being a fucking arsehead about the issue. The medics also seemed unamused.
These people are not nurses, clearly.
Just because someone - a doctor or an X-Ray operator, in this case - wants a patient to be Nil-By-Mouth for x-amount of time, it doesn't meant they have to be. You cannot, as a nurse, starve someone for 'their own good' without a bloody good reason. They're individual people, and can do what they like as long as they know it'll screw up their treatment. If, as in this case, a patient demanded food then you can't keep it from them. It goes against the code, to do no harm, for starters...
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