Lost

Through the small window in the door I can see her laying in bed like a little kitten snuggled up amongst the blankets. Only her head sticks out the top, slightly sunken in the pile of pillows she is resting on.

I let myself in to her sanctuary and place the jug of water I'm delivering on to her side table.

"Who's there?" She squeaks.

"It's only me Sylvia, I just came to replace your jug of water"

"Oh well that's all right then"

As I make my way around the bed to meet her gaze I am greeted with a toothy grin and a wink.

"Where have you been? I have been waiting for you. Just look at the mess they have made, look!"

I peer down to the bottom of the bed where she is pointing. Her covers are ruffled up past her ankles so her feet poke out of the end like sticks. The bandages on either foot have been cut down the middle and spread so that the odd ends lay either side of her feet, exposing the rotting flesh beneath.

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This lady was admitted after a fall which left her with an open fracture to her ankle. As a result of poor vascular return she has gangrene in both feet. She has ulcers all over her feet and some of her toes have turned black.

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"Why are my toes black?"

Tears have begun to well up in her eyes and something inside of me tightens. I sit myself down in the chair beside her bed, placing one hand on top of hers. She weeps silently turning her face away from me. How much differently can I explain to her, what has already been explained many times before?

"I miss my mother you know. I miss her terribly"

I nod and smile in the right places as I listen to the unfolding story. It is a tragic tale of how much she loved and adored her mother, how beautiful and caring she was. They shared a loving relationship until one day, Sylvia was 15, and upon arriving home from school her mother was not there. There was a note left behind, from a stranger, telling her to make her way to the local hospital.

Sylvia arrived at the hospital flushed with anxiety not knowing what to expect. She was greeted by the matron who led her to a quiet room. Sylvia was told that her mother had suffered a stroke, she was looked after as best they could but she didn't make it.

"Your mum must be so proud of you being here, looking after old cry babies like me"

Suddenly I can feel a lump in my throat and my lungs can't find the air. My heart starts to pound and I am overwhelmed by a strong feeling of loss. Rationally I know that I have not lost anything, but listening to this story has stripped me of my professionalism and made me vulnerable.

I have to get out of the room.

I mop Sylvia's tears, stroke her hair and give her a few squirts of her favourite perfume. She gives me that heart piercing smile and I make my way out of the room.

I look at the clock and ask to be relieved for my break. I make my way to the changing rooms where I sob uncontrollably. I grieve for Sylvia's mother and all the things they was not able to share together.

I then write a text to my own mother.

'Hope you are having a good day, I will see you later, I love you xx'

Gerry Will Fix It

I turned over the television only to find a rather interesting program.

"Can Gerry Robinson Fix Dementia Care Homes?"

This program was right up my street. It highlighted many important points about what we are lacking as a nation. We lack compassion, empathy, realism, enthusiasm, motivation.... I don't think I need to add any more to the list, you get the idea!

Although I am studying Adult Nursing, what some know as general nursing, I do have a keen interest in mental health. Especially with Dementia patients. In my opinion, this programme touched on some important issues and opened up our eyes to the ongoing problems that face care homes across the UK.

There is a lot to be said about one-to-one care for dementia patients and I believe that patients benefit from such close care from their carers. For example; I spent time on the ward with just one patient. She had Alzheimer's and she was pretty far advanced. Just having me around her had a marked improvement in her behaviour. She had previously pulled out her catheter, left the room and was wandering. With me around, she was eating all her meals and enjoying them, having conversations about the weather and things she liked and disliked.

It breaks my heart to see patients admitted to care homes and just left there with no stimuli.

Let's not let this happen any more. Tune in next week for the second part.

Dreams

For the past week I have found it extremely difficult to sleep and when I do my mind decides to take me deep into weird and wonderful dreams. Some have reoccurred but on the whole I get a fantastic vivid new episode every evening.

My latest one.

I am in my Nan's flat, surrounded by most of my family (On our annual get together I suspect). I am then stood there trying to steady my nan, she is wobbling all over the place. I can't seem to catch her in time and she crashes into the door banging her head fairly hard. She recovers momentarily but then she collapses in front of me.

I immediately call out to her, lean over her and shake her. No response.

My family all look at me, my mum and aunt already in tears. I pick her up, in my dream she is weightless, and I take her to the sofa. I check her over but she just lays there motionless, not giving off any signs of life. In my mind I am willing her to move, I am thinking over what to do next but I am also conscious that it is a dream and what ever I do wont work.

The next thing I know, I am transported to another place as I make my way to my nan's kitchen. I don't recognise the place, its dark and woody. I think I am outside and I am also on my own. I try and wake myself up, 'wake up, wake up...'.

Soon enough I am awake and I am slightly disorientated to the time and place, its dark and I am overcome with emotion. I hope my Nan is ok.

This has now happened two nights in a row. I don't know if some outside force is trying to warn me about something or not?

NOISE

When I first came across this article I recoiled in horror - http://news.bbc.co.uk/1/hi/health/8387836.stm

In an ideal world we would all like hospitals to be quiet tranquil places, offering us a place of sanctuary when we are recovering from an illness. You should be able to have your privacy and dignity maintained and get rest as and when you require it. For those of us who have had the pleasure of staying in hospital, or for the few of us who work there, you know that this is not what happens in reality!

I am somewhat disgusted to know that there are people out there who are putting figures on what should be acceptable noise levels in places where this is just not achievable.

"patients should not be exposed to noise above 35 decibels or a loud whisper..."

So what you are trying to say is that of all the million and one things I need to do for my patients, I am going to struggle to do them if I am required to speak quieter than 35 decibels? I do hope that none of may patients are hard of hearing!

What about the patient with dementia who is wailing at the top of her voice as she hobbles down the corridor? Or the 'quiet top' bin lids which are no longer quiet which have failed to be repaired by the domestic staff? Not to mention the gaggle of student medics who are gathered at the nursing station gossiping.

It is not realistic. It is not achievable. It is not going to happen!

Answers

What do you do if you have missed the opportunity of a lifetime because you were too blind to notice just how much it meant to you at the time?

Answers on a postcard

Faith

I enter the room and immediately I can hear the classic wheeze of an asthmatic. He sits in a chair looking up at me craving relief from his inability to breath out. It kicks in fairly quickly that I am the one to provide that relief, so with introductions over I put him on a nebuliser and continue my assessment.

I look to my crew mate to get some vitals as I continue with the treatment. He responds well to the Neb and I get a little more history out of him. He was on his way home driving down the motorway when he began to feel breathless so pulled into the services. He wound down his window in the vain attempt at making things a little easier but some fresh air provided no relief so he summoned the help of a shop worker who then called us.

He has been asthmatic almost all of his life and has been hospitalised before after a particularly bad attack. *Cripes* i thought, best get the RSI ready! (Just in case of course). I consider all the possibilities so that I am keeping my options for treatment open, and I think its time to bundle the patient into the truck and get him off to hospital.

My crew mate agree's so gives me a smile and a nod.

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'Right, you can stop there'

*Phew* the scenario is over and I can stop trembling now. I take a look around at my team, one playing the role of the casualty and the other playing the role of my crew mate. They both give me the thumbs up. I then take a look at the assessor.

'Well done. You were calm throughout and you explored every possibility and narrowed it down'

I was chuffed with this critique. I had been nervous all weekend about whether or not I could make the grade. I was one of the least experienced members of the group so I thought I didn't stand a chance of passing.

I came away from that course having learnt that I CAN do it. I know what I am doing, I just need to apply myself and have a little faith in my abilities. I also learnt; in the wise words of a very funny northern chap -

"If it isn't going to kill you or make you pregnant, then what have you got to worry about?"

GP = Ghastly Practice

As of this morning mother has been signed off work for another week. She's not a happy bunny. After the MI in august she was off of work until the new school year and more recently she has been off for a week with Laryngitis. However, this has progressed into a serious chest infection warranting heavy antibiotics. The GP has been most unhelpful by just writing up a sick note and telling her he hopes she feels better soon.

My question is; Does it rely on training and experience as to the kind of treatment you receive?

I know that GP's are not masters of the universe and do not know everything, but I know from my own training that if you complete a full assessment and you listen to your patient, then you can't go far wrong. This works for any health profession. Nurse's, Doctor's, Ambulance personal etc. Cracking out a book to check so that you can be 100% sure would not be a problem. When I was 7 I had an inner ear abscess, my GP pulled out his encyclopaedia and confirmed his diagnosis was correct. I thought this was great, it proved that he was not going to second guess himself.

Do these quick spin GP's just see patients for 10 minutes at a time, with only enough time to only discuss one problem to then write up a prescription and wish them well until next time? It takes the average member of the public around 3 days to acquire an appointment to then be told about what you can and can not talk about with your Dr. Your made to feel like a time waster if your problem is deamed as trivial so you wait another 6months until your limbs are hanging off before you make another appearance at the surgery.

Most of the time you go in to find that you are not seeing your regular GP and instead you have an over zealous locum smiling and nodding at your every word, whilst incessantly staring at the computer screen. Maybe this is a new way of assessing patients that I just haven't heard of yet?

From my own personal experience I was diagnosed with Chondromalacia patella using a two year old MRI scan. The GP I saw know's I am a student nurse so threw the symptoms back at me asking for my opinion. She was some what disgruntled when I told her that if I knew what the problem was then I would not be sat in front of her! I had the scan when I was 18 so now two years on my symptoms are worse, the pain is sometimes unbearable and I have the added fear that if the problem has worsened it could potentially ruin my career.

I know that I should be offered another scan so that the Orthopaedics can reassess and I can either be treated conservatively or with much heavier treatments such as a knee wash out or key hole surgery.

Than again, what do I know, i'm only a student!

Are we really professional?

As some of you may know I volunteer some of my time for a first aid organisation. 99.9% of the time I love it, the other 0.1% of the time I just want to leave.

It is an organisation full of hypocrisies, politics and a good ole' pile of bulls**t. I do not say this to put anyone off of joining or taking part but just like any organisation we have the; 'too many Chiefs and not enough Indians' syndrome. I am part of a division that has been run by the same person for over 10years. She is set in her ways and does not embrace change. She refuses to use technology as a form of communication which majorly stunts our progress into the 21st century!

We have a fantastic bunch of members, some of which are health care professionals (HCP's) or like myself are student HCP's. We spend a lot of time at events and enjoying each others company, sharing knowledge and having a laugh. It's about getting a job done and doing it efficiently. We are after all looking after REAL people with REAL problems.

Maybe it's because I know what damage can be done if you take your eye off the ball, or if your not equipped with the right training to treat such patients.

I have just written an email to the person in question, let's see what reaction I get. If I get one at all!

Frustration

Yesterday I met with a good friend of mine who happens to be a Paramedic. For this change in heart I blame him! (well, not really)

When talking to him it became very clear that he loved his job. His face lit up when he spoke about his role in the Ambulance Service, the kinds of people he works with and the good vs. bad about his patients. I want that feeling.

I want to be able to talk about my job and actually 'Love' it. Don't get me wrong, I love nursing and all the ups and downs that come with it but I am not getting that 100% satisfied feeling any more. I'm not too sure why, I can only presume its because i'm still a student who is not appreciated and has no moral standing on the ward what-so-ever. For example;

I have a thing about unnecessary blood transfusions. My patient had a Hb of *7, so my mentor forced the Dr to prescribe 2 units of blood. In my opinion, and what I have been taught is, make the Dr's aware of the decrease in Hb but you need to assess if the patient is symptomatic or not. If the patient is suffering symptomatic anaemia then go right ahead and get the blood, but if not why waste it? Blood costs over £200 a bag! Needless to say, when I brought up this point I was just shrugged off and told it was some far out policy somewhere in the abyss of the NHS that I should reacquaint myself with. Poor excuse in my opinion.

I hate not being able to have my say about these patients. As a student you spend as much time with them as the staff nurses do and yet what you have to say apparently doesn't count. The Dr's only want you to make up their equipment trolleys and tidy them away once they are finished and the senior nurses don't even have the common decency to remember your name.

I guess its the kind of things I have to suffer until I recieve my pin, which hopefully will not get lost in the 'Great postal strike of 2011'!!

;o)

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* Hb - Hemoglobin. The normal range for Hb is 12 - 18. However there are variants according to gender and Age

Splish splosh

Have you ever worn a clean crisp white shirt/top and spilt something colourful down yourself?

Do you remember how it slowed right down into slow motion, and as you frantically tried to catch it you just weren't quick enough?

Imagine standing behind a patient who has explosive diarrhoea which finds its way out of the patient and splashes on to the floor. I experienced that slow motion moment! Except I didn't try and catch it. I just hoped that it hadn't in any way got on to me or my shoes!

Bursting Point

80yr old female admitted due to severe abdominal pain. Bowels not open for 5 days so Dr's queried a bowel obstruction. Upon opening her up they find that she has not got an obstruction but instead is full of metastases from the liver which has progressed into the other structures surrounding it.

If you are not medically minded you may be finding it hard to imagine what a patient with this kind of condition may look/feel/sound like. So let me explain.

I meet this lady whilst she is sat in a chair. She is a pretty lady with coiffed greying hair and a delicate dressing gown wrapped tightly around her so she doesn't feel the cold. From one arm she is attached to fluids which are keeping her hydrated and in the other, Intravenous painkillers.

I greet her with a smile, I introduce myself and ask her how her morning has been. In a voice as delicate as her dressing gown she tells me how difficult it has been since she has lost her mobility and independence. She can no longer stand up or walk without the help of a mechanical aid. It is at this point that her tone of voice changes and she occasionally looks blankly into the distance. I complete my list of questions and finish the task in hand, being mindful that she may not be taking in any of the information I have to offer.

She shuffles in her chair and winces with the pain. Her abdomen is distended, her thighs and lower legs are full to burst with fluid which has also travelled to her arms and hands. She is feeling heavy and rightly so. I take a glance back down at my notes and notice that she is unaware of the Surgeons findings. She asks me;

'What is happening to me? Am I going to die?'

I glance behind me at the team of people who are overseeing me and they look just as perplexed as I do.

What would you say?

Pain In The Neck

Falling down a flight of stairs is scary stuff for anyone, but imagine that you are over 80 years old and mildly confused. You can no longer function as you used to due to your debilitating bowl cancer and you sometimes cannot find the enthusiasm to get up in the morning. It is times like this when I get the wake up call that my job really is bitter sweet.

(Firstly I would like to point out that I am currently on clinical placement on an Orthopaedic ward and it has only been 4 days since I started!)

I have been put in charge of a bay of 4 female patients. I commandeer everything that goes on in the bay and am the first point of call if anyone needs any help. So when I discharged a patient the night before it was inevitable that the following day I would be admitting one. By 11am the bed was occupied and there I was going through the motions of admission.

This lady had fallen down the stairs and had a ?C-spine fracture along with a HUGE haematoma (bruise/swelling) on her left temple. She must have fallen down in the most spectacular fashion as she had ended up against the wall with her legs up the stairs!

The Ambulance crew had placed her on a spinal board and applied head blocks and a collar to keep her head immobilised. She had come on to the ward with the head blocks still in situ which posed a bit of a problem as they kept sliding about the bed and not really doing the job they were designed for. She was unable to move all day and had been laying on her back since 06.00am, so as you can imagine my worries lied more with pressure sores and such rather than what she was going to have for lunch!

The Dr's are not about in large numbers at w/e and that causes a problem in itself. We had one who came to assess her, he did his bit and then said he would be back in the afternoon to re-assess. However, he did not return. This poor lady had been left all day on her back, NBM and still very confused. She had managed to wriggle out of her head blocks several times and I was getting frustrated as there was no other alternative.

At the end of my shift I left the nurses and went to see this lady. She was upset that she was alone and I had to explain I wouldn't be back until a few days later. I walked away from her feeling a little heartbroken and sad at the state she was in.

Yes I did shed a tear.

Impending sense of doom

So it's been a while since I have posted on here and I have finally had the time to sit down and write out a post of recent goings on.

Since my last post I have completed my clinical placement and I am now on summer holidays. I have some time before I go back to Uni for my second year to sit down and relax, take a load off.

However....

Last week on the 11th I returned home from work to find some friends round, my mum and I had some dinner and we retired to bed. Mum then called out to me and said that she had chest pain and when looking at her body language she was holding her left arm tightly to her body. I knew what I had to do as I have been through the motions so many times at the hospital and through volunteering, but this time it was my mum. I flapped and txt a friend of mine who insisted I phoned 999, so I did.

Since then she has had a weeks stay in hospital an angiogram and returned home. The two weeks I have off for my summer break I will be spending caring for mum, I have no choice.

So, I am tired, emotionally exhausted and currently spending a lot of my time worrying. But at least mum is well and at home.

The meaning of the job

It is coming to the end of my time on clinical placement, the 15th of August to be exact. I do think I'm going to miss it, but I will certainly not miss the 5am starts! I have learnt a fair amount, I could have pushed myself and learnt more but as a first year you must stick to your boundaries set out on paper. Tis' rubbish, very restricting.

On occasions it's been difficult, upsetting and heartbreaking. For example; yesterday I was assisting a CCF patient to the toilet. On our way she was telling me about how her and her husband used to be a respectable couple, clean and well kept. 'Now I'm just swollen and I smell', she sobbed. What can I do? How do you comfort someone who is feeling down?

'Every night I pray to get out of this place, I never knew I'd ever see hell but now I have. Why can't god just take me out of my misery'

This lady is extremely depressed and she looked to me for answers I couldn't give. I could only offer a warm hand and a shoulder to cry on. Once again I broke down inside.

After lunch I spent some time with an Alzheimer's patient. She has been in bed the whole time she has been on the ward, but she is in the end stage of her condition. She lacks insight and understanding and is very restless at times.

It was dinner time and I was feeding her. I encouraged her that she was doing well, I asked if she liked vegetables and we joked about horrible brockley. She smiled and she laughed. She ate her way through her dinner with no problems and desert too. She then took my face in her hands and told me that she loved me.

Through her confusion and frustration she was able to string together three little words of appreciation.

'I Love You'

It made my day.

That is why I chose to be a nurse.

The Good, The Bad and The Dying

I like nights. On the plus side you get time to play around with stuff, like revision etc, that you normally wouldn't have time to do during the day. On the downside the time drags out and there isn't anyone to txt or call because they are all at home tucked up in bed!

I did a night shift last night. It went pretty well considering we have several confused patients on the ward. All of them slept well through the night with no issues raised.

At around 04.30 I went to check on a lady of mine who, if I'm honest, I've grown quite attached to. She is usually intermittently confused at night, reaching out to the air and calling out names. Last night she was a little more confused than normal and was not making sense with her words but was uttering pure gibberish. But in the early hours whilst checking on her she tilted her head back and became only responsive to pain.

I immediately called the nurse and I took some obs. I had not a clue what was going on but all I knew was that she wasn't very well. As time went on it was clear that she possibly had a TIA, to you and me, a mini stroke.

She was shaking all over and was unable to speak or swallow. She displayed no one sided weakness and was able to squeeze my hands with a little effort. If I put all the clinical stuff to one side for a moment, this lady was scared. She did not know what was going on and she couldn't speak to me, she could only hear and see me. She despairingly stared at me waiting for me to tell her what was going on, but I couldn't. All I could do was hole her hands and reassure her. It broke my heart.

What I have come to realise is that every single patient has an effect on you, even if you don't realise it, even the bad ones. But last night that lady took a part of me, a precious part of me that I so desperately wanted to hold on to. I will go back into work tonight and see how she is, I just hope that when I do see her that she has recovered enough to say hello and give me a little smile.

Disorientated

I was moved wards in the morning, so as you can imagine I was a little perplexed.

It has taken me a while to get used to the speciality I was currently working with but to be moved for one day shakes things up a little bit. I can't complain too much as I love a challenge. On my ward I work with Parkinson's patients but yesterday for one day I was working with Oncology and Chronic respiratory patients. Mind F***!

I had a pretty good day. My patients were awesome and I got to play Dr's for a bit with a Nippy* and another insertion of a CVP* line. These kinds of things get my blood pumping and it really makes you think of things other than drugs rounds and wiping bottoms.

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1. Nippy is nickname for NIV, Non invasive ventilation machine. Its a mask that sits over the patients face and pushes either air or Oxygen into the patients lungs, the patient is able to talk and eat normally which is a benefit compared to intubation. However, it is rather loud!

2. CVP - Central Venous Pressure. It is a line that is inserted into a large vein, most often in the neck (Internal Jugular Vein), groin (Femoral Vein) or the chest (Subclavian Vein). It's main use is to measure CVP but the lumens can be used to give medications, feeds and to obtain blood.

Learning from others

Visiting times can be interesting on the ward. You get to meet the family members of your patients, it also provides you with an opportunity to see who has visitors and who doesn't. It really does help you figure out social situations.

For me its a bit emotional at visiting times. I find myself looking in on their life stories; seeing the love between married couples, the love of a child for a parent, concern for aunts uncles and siblings. You really do get to see the best and the worst of humanity in this job.

There is one couple in particular. Her husband comes every day, in the afternoon and then again after dinner. She saves her mouse from her lunch for when he comes in so he can help her. He washes/brushes her hair and you can see she adores him.

What really got to me was the story she told me yesterday whilst I was helping her wash. She is 79yrs old and is in hospital because of dehydration, UTI and Parkinson's. She is a lovely women but is very anxious.

At 21yrs old she got married, had a few blissful months but then suffered a stroke which left her weak down the right side. Her husband cared for his new bride, he was involved in her recovery helping her to walk again, to speak and to get back to the way she was before. She then went on to get Endocarditis at the age of 35 which led to an aortic and mitral valve replacement. She was in intensive care for 3 weeks and after that had an equally as long stay in hospital. Again, he was by her side every step of the way.

She is the type of lady that becomes unwell quite frequently. I guess some people are more susceptible than others. This particular couple just fills me with hope and faith in relationships.

Lately I've had a pretty bad time in a relationship and I have to let it go. I hope that I can find a man like this one day.

Going through the motions

I haven't posted in a few days. Today has prompted me to post a little something.

It has been a difficult day, I woke up feeling awful in every sense of the word. I was able to catch a lift from my brother into work which got me out of the rain. I then spent all of the morning washing my patients, which as always is a pleasant experience.

Once all the washes are done lunch arrives and you find yourself in a bit of a tizz as several patients all need feeding but you only have one pair of hands after all. I found myself going from one patient to the next in a bay of four ladies, I was then asked if after lunch i could get all these four ladies back into bed. Again, only one pair of hands. Poses a slight problem.

On the other side of the ward I have a patient who was very very drowsy. Only responsive to pain which made it difficult to do anything with her. I suspect she is in end stage Parkinson's but I'm no doctor. I grabbed my obs machine, and the BM machine. I took all my bits and pieces and then relayed it back to the nurse. She didn't show too much concern so I left it with her and moved onto getting my patients into bed.

Since the start of this particular placement I have been suffering with (its a self diagnosis) Sciatica. It is excruciatingly painful some days and today was one of those days. Its started to affect me sitting too, I must go and see a physio if I can.

I left today without having learnt anything, without that good feeling I usually get. I guess it was a 'normal' day.

Mobily

I have a bad habit of not charging my mobile phone, and then moaning and groaning when it dies. Hmpf.

Coz' you had a bad day

Wednesday's shift was a difficult one. I spent the day looking after two patients which then multiplied to four in the afternoon. I was wandering around after my mentor hoping that she would finally spend some time going over some medications work with me. They whole day went by and half an hour after my shift finished she decided to take me for some formal learning.

Needless to say I was not amused and told her that I was busy with something else and she could wait. Of course I got in trouble and reluctantly left my paperwork to one side.

You see, the most difficult thing about being a student nurse is that you are constantly told that you are a member of staff, supernumerary, but staff none the less. So naturally I put myself into a responsible position and make my own decisions. I just have a bad habit of not being very diplomatic when I'm in a terrible mood, which was why at the end of the day I had my bottom well and truly kicked for being stroppy.

I then had to wait forty minutes for the out of hours bus ride home which caused me to tear up on several occasions.

Wednesday was a bad day.

Sometimes

So I have spent a lot of my time on clinical placement wondering; Where will nursing take me?

The answer to this question is several things, but right now, it has been crossing my mind on more than one occasion that maybe Nursing isn't for me. I am finding it hard to get my head around the idea of not being able to save everyone. You just have to do your best and do the most for the most.

You get so caught up with your patients that you want to save them from everything. From falling at home all the way to reassuring them about a life threatening condition. Sometimes you can't be that person, you have to work with your colleagues and hope that they get the message as loudly and clearly as you did. You hope they can see where this person needs help, what would improve their quality of life, however, sometimes this doesn't happen.

Sometimes, patients fall through the net.

Sometimes we fail as human beings.

Sometimes YOU fail.

The eternal sleep

I was caring for a patient who had cancer. Pretty much every where in his body sadly. It was a sorry sight, he was taking nothing orally and spent all day crying out in pain (Despite the cocktail of pain relief he had been prescribed).

I remember the day of his passing very clearly. I had arrived on shift that morning and I saw that his family were in with him. This is usually a sign that it is near the end. I went about my duties and by 8am he had passed. His family stayed with him for twenty minutes before telling us he had died.

I guess you get caught up in the moment and time passes so slowly. Everything in that room would have come to a stand still and the only thing that mattered was them and their father. It is their right to address his death how ever they wish and we respected that, so we waited for them to leave before we carried out last offices.

I was asked by the ward sister if I would like to help. I was a bit unsure but I thought that now was as good a time as any to get stuck in. So we collected our equipment and in we went.

I spent the first 5 minutes staring at his chest. It did not rise, it did not fall. He was yellowing all over except for a pool of pink down the posterior portion of his body. He was no longer making a sound, just the occasional movement of air that escaped his lifeless body. his mouth was wide open, I will never forget that.

The rest of my shift was done in near silence, with precision and full concentration. I didn't have time to focus on anything else. If my mind slipped I would be thinking about him. How he looked, so lifeless and cold. My emotions would well up and I would be of no use to any one.

You have to rationalise death. Consider the suffering before the event and then put it into perspective. This human being is no longer in pain, no longer wishing to die. They can pass on into the next life and join loved ones in a place of tranquility and happiness. The family left behind can remember them for who they were and not for how they were in hospital. Life will carry on.

This is just how I deal with it. Its sad, of course it is. Sometimes I do think about it again, but you learn. You come to terms with it.

Melancholy

Today is a rather grey and dull day. I am sat in front of the TV watching films, popping popcorn and pondering the thought of going outside for a run. I do have a charity run to prepare for. However, I can not be bothered.

I am in a morose mood and not really in the mood to make an effort with anything. So instead I will continue to sit here and procrastinate.

Ho Hum.

Yuk

Its taken me quite a while to get used to my role in the hospital. Its a tough job trying to learn when you know that there are so many jobs that need to be done. You are, in theory, supernumerary. In reality this is rarely the case.

Yesterday I spent a lot of my time delivering bed pans and commodes to patients. Albeit that one patient had a *PR bleed which was literally water! This part of my job I hate. I don't like Poo. I can't help it. No matter how many types of stool I come into contact with it is still your bog standard poo (no pun intended). Its a dirty job when fulfilling patients needs. Sadly that includes sputum pots, bed pans, leg bags, flaky scalps, dirty finger nails, dribble, scabby thighs, sweaty balls, smelly feet and dirty sheets.

So why exactly do I want to be a nurse again??

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* PR - Per Rectal, means bleeding from the bum. (To put it bluntly)

Time

'Doris* where are you going?'

'I'm going down there, I want to go home. It's only down the road.'

She was wandering around the ward as if she was walking the streets of her home town. She knew where the shops were, where her house was and also where the local pond was. In reality she was referring to the day room, the nurses station and the toilet.

Its a sad sad situation when you have to care for someone who is no longer themselves. The family visit an empty shell of aggression, violence and confusion. You spend twice the amount of time talking about sausages flying through windows. 'No Doris, I have never seen that.'

I like to spend time with these patients. Find out what makes them tick, what makes them comfortable. I have found many different triggers. One lady reverted back to jokes of the 40's. You know the picture of the boy peeping over the top of the wall with a large nose hanging over? She certainly did, and that came out long before I was even born. Another lady likes close contact. I would have to hug her to calm her down. It doesn't take much to find out these things.

But where do we find the time? I have 19 other patients, some in a more critical state. So where do we draw the line at proper nursing care and rushing to get a job done? Ticking boxes as we move along through the day.

Sleeeeeeeep... zzzz

It has taken me a while to get used to night duties. I can never find a a healthy balance, thus ending up falling asleep at the nurses station. Which is not a good thing when your trying to impress your mentor.

Note to self; Don't fall asleep while at work!

Newbie

I remember my first day on the ward. It was very reminiscent of my first day at school. Putting on my uniform for the first time, looking in the mirror and trying to smooth down the ‘love handles’ my tunic refuses to disguise.The only catch to this magical moment was that it was silly O’clock in the morning and I was still dosey from the lack of sleep the night before, my nerves were also making my tummy grumble. It lead to me walking on the ward and breathing in the sweaty air with a triumphant yet wobbly grin. As you would expect the staff knew instantly I was the newbie. If the student name badge and fancy fob watch didn’t give it away then the perfectly ironed uniform did!

I was greeted by a rather large staff nurse who was way too jolly for 7am. She welcomed me into the nurses station and shoved a sheet of paper into my hand. The blessed hand over sheet*. I was a mixture of confusion and more nerves, I was also overcome with the strong urge to pee. What on earth do I write down on this paper? Will I have to write so small, in the minute space provided, that I could barely read it later on? I didn’t really have time to work it out, but as a small Scottish nurse handed over I peered over the shoulder of my mentor, my breathing then returned to normal.

As we went around the ward from patient to patient there was one common theme. The majority of patients were elderly, with a few middle aged thrown in. It is important to bear in mind that the ward I was to work on was a urology ward. So, these patients were also mostly men. It is a sad fact that if a man lives long enough he is most likely going to develop problems with his prostate**. This will then potentially lead to urine retention and thus, ending up on my ward. I would just like to say that all of the gentlemen I cared for in my time on the ward were as I just stated, gentlemen. In every sense of the word.

Anyway, I digress. My first day was not exactly a barrel of laughs and I learnt a lot by being thrown in at the deep end, leading to me becoming extremely red faced whilst trying to find answers to questions I was not even sure existed. All whilst my mentor quietly observed and watched me sweat. It also included; one splat in the face with water whilst washing out a bladder, via a catheter (I‘m sure my mentor did it on purpose), slipping on some diarrhoea in the gents, looking blankly at a nurse whilst she played with a mechanical bed insisting I recognise the fault and last but not least, vomiting to hard after work that I felt one of my eye balls had fallen out.

I was hoping that it was not proof of things to come. How wrong I was.

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*The hand over sheet is your Bible/Koran/Tenakh (What ever media form you chose to read for religious purposes, I do not wish to discriminate). It is the list of patients on your ward, personal details such as age, along with their diagnosis and plan for the day. You refer to this and record on it as the day goes on and the patients make developments or in the not so positive way, deteriorations. You then refer back once again at the end of the shift to hand over to the following team of nurses.

** It is estimated that 60% of men over the age of 60 have some degree of prostate enlargement