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!