Lessons

It is official. I dislike nursing homes. I am not going to delve in to the politics surrounding the death traps but I am just not keen on them. I suppose they are like any other care facility, you get some good and some bad. However, I only ever seem to turn up to the most horrendous nursing homes you could ever imagine!

I had spent the best part of my Friday with a palliative care nurse specialist and so far so good. I had met two patients who were having regular reviews and emotional support, and both meetings went extremely well. The last patient of the morning was an elderly lady who had been referred to the palliative care team from a nursing home.

We were led through a maze of corridors to the patients room where we were greeted by an odd looking lady. Why does she look so... oh dear god, don't tell me she's gone before we arrived!

We approached the patient's bed side with caution, looking listening and feeling. To our surprise she took a breath. A sigh of relief made its way around the room and we proceeded to change her syringe driver. Sadly, we concluded that she would not last the night.

I suppose it is meetings like this that make you come away and think long and hard about how you would feel in that situation. If it was a loved one, if it was you even. By dwelling your not helping anyone, and I think I am slowly learning that lesson.

Naive

When we are in the confines of the hospital we take it for granted that we can just 'predict' what is going on in the patients home. 'Assume' that we understand how they live and the comings and goings of family members. It is after all our job to report on patient's who we feel need a little helping hand from social services right?

Since experiencing community nursing these 'predictions' and 'assumptions' have been scrapped. I have realised, the hard way, that nothing will ever prepare you for the kind of ways people live in their own homes. I guess you have a genuine belief that everyone lives the same way that you do. You then find yourself in a bit of a muddle when you come across someone who doesn't.

We were on our daily call out to an elderly gentleman who needs assistance with his insulin injections. My mentor kindly provided a little sit rep for me before leaving the car.

'You know how to give insulin injections?'

'oh yes..'

'ok good. Just to warn you, this gentleman opens the door in his underpants. I hope that he doesn't today but you never know. Also, he is very unkempt so your feet will stick to the floor, and try and ignore the overwhelming smell of stale urine.'

Why oh why did she have to tell me that?!

We entered the flat, and just as she had told me, my feet stuck to the floor as if the carpets were made from syrup. The smell of old urine mixed with the humidity of the flat as you walked in was not just overwhelming but it was lingering, clinging to my uniform and my hair. I just wanted to get out.

The next day I was faced with numerous bed bound patients. They had carers but for the majority of the day they were confined to their hospital supplied bed. Unable to get up to use the toilet, or to quench their thirst with a glass of water. These people were truly alone.

I have another 3 weeks left, so lets see what other revelations come to light.

What do you think?

"You are a member of the ward team that has to decide which patient is to be put in to a side room, but you need to debate and discuss the reasons for and against for each patient..."

It is not every day that you are in the position to make such a decision, one that could potentially be critical for your patient. As student nurses you are often involved in the decision making but the sole responsibility is always left to someone who is qualified and more senior within the team. Occasionally bed managers make the decision for you, but that is a whole different blog post!

"Mr Smith is a 53yr old gentleman who has had an open and closed*. The Surgical team have discovered that is tumor is now at a stage where it is inoperable. He is drifting in and out of consciousness and reaching the end stages of his life. Mr Smiths family are extensive and would like to be with him as often as they can..."

Do you think a dying man should be left to die in dignity in a side room, surrounded by his family and away from the prying eyes of other patients.

OR

"Mr Kemp is a 24yr old gentleman who has ulcerative colitis. He is in hospital because he is due to have elective surgery. He is currently anaemic and is suffering from terrible diarrhoea which is making him self conscious. The smell is offensive and asking for a comode or bed pan all the time is a little embarrasing..."

Could this young man be saved the embarrasment of having to run to the toilet every few minutes. After all hospitals are not places for young people.

OR

" Mr Jones has recently had surgery. Swabs were taken from his wound site and the results have come back positive for MRSA..."

Surely infection control procedures should be followed in order to protect patients from infecting MRSA.

The decision is yours!

I bet I know what your thinking. You instantly chose the dying patient, yes?

Every patient has the right to die with dignity surrounded by the people they love in a comfortable environment, right? Well of course they do. So why not send them home or to a hospice. Hospitals are places for the acutely ill and patients who no longer require 24hr care can be reffered on to other care providers. This does not mean that I advocate pushing dying patients out the door, it is not that at all, but in an ideal world we would love to put everyone in to a side room who deserved to be in there. However, we can not provide that type of service.

The young guy who was quite unwell. Yes, he is young. So what? Age does not play any kind of part in the overall care that a patient recieves. Yes, age is considered in alot of treatments (e.g. contraindications of surgery, drug dosages etc) but saying that he deserves a side room because having diarrhoea is embarrasing for a 24yr old guy is not good enough. Turn the tables a bit, if he was 84 would your opinion be different? I guess you would just give him a bed pan because why not he's lived his life. What if the patient was an 84yr old female? Would your opinion change again?

Some illnesses come hand in hand with some pretty nasty and horrible symptoms. Diarrhoea, vomiting, flatus, oozing, seeping, incontinece, dribbling, sweating.. and the list goes on. All of those things are embarrasing, they all lower the patients self esteem. This is something we do need to take in to consideration but to put someone in to a side room to maintain their street credability is not good enough.

Last but not least, MRSA. This could either be aquired from the patients home before being admitted, or it can be hospital aquired. In this instance it was hospital aquired and at the wound site. Isolating this patient is paramount. He does not require an armed guard but do be sensible.

I could sit here for hours and tell you my opinion on the subject matter, but I guess we all have a different take on things.

What do you think?

Welcome to 2010...

I am on my knee's in front of a patient, dabbing at the large cut on his eyebrow.

'Did you black out at any point? Do you have a headache? How much alcohol have you had to drink this evening?...'

My interrogation carried on whilst all around me were the bodies of wounded strangers. They were sitting in chairs, laying on stretchers and a few were wandering around aimlessly.

Some bright spark decided that throwing glass bottles into the air whilst in the middle of a crowd would be a fun game. The bottles returned to earth crashing into anyone that stood in their way. Slicing into faces, arms, torso's, feet.

I found myself zoning out, blocking out the noise and urgency of other patients whilst I made sure I did a good job on the one sat in front of me. I patched him up and sent him on his way. As i returned to the masses the noise gradually became louder, the crying and whaling of other patients became increasingly unbearable. I had come out of my 'zoned out' state and walked back into reality.

Who will I treat next? Shall I go for the unconscious, unresponsive teenager or the multiple facial trauma? or how about the suspected spinal fracture?

Yes, you guessed it. I chose the suspected axial burst fracture! Wahey! I get to play with some toys, puff out my chest and play with the big boys. hehe.

She was sat in a chair with a nurse holding her head, I retrieved our kit and applied a hard collar. The plan was to slide the long board behind the chair and tilt the chair down until she was flat on her back, on the board, on the floor. I am pleased to say that it went rather smoothly, I had hold of her head whilst the Dr cleared her. She was assessed and we were happy to send her on her merry way, without the added accessory of the spinal board of course!

By this point Big Ben had chimed, fireworks had gone off and it was finally 2010. I did not see midnight but I did see a very nice splatter of second hand kebab that night.

Happy New Year.

Bah Humbug

I know its a bit late but I wish you all a Merry Christmas and a Happy New Year!

Christmas and New year was a busy time for me. I spent some time over Christmas volunteering for Crisis Christmas (Crisis.org.uk) It was an enlightening experience to say the least.

I spent time with people who I would not usually socialise with in any other circumstance. I ate dinner and drank tea with people who could tell you stories that would make your toes curl, but I loved every minute of it. I was seen as an equal despite there being very clear and obvious differences.

My first job of the shift was to stand on the front gate and welcome in the guests, do a quick pat down for alcohol and weapons, if all was clear, send them inside. This sounds easy enough right? Think again!

One particularly loud lady approached the entrance to the centre, I'm guessing because of her extrovert nature the other girls on the gate did not want to search her so dispersed, leaving me on my own. I proceeded to pat her down, after all what's the worst that could happen?

'Do you have anything on you that could harm me or other guests?' I said calmly.

'Are you accusing me of being a druggie?....that's so typical of people like you... you come down here trying to save the world and you think because i slur my words I'm a druggie so I'm going to prick you? ... well you can f**k off!....'

To say I was slightly taken aback would be an understatement. She carried on with her speech for 5 minutes whilst I stood back and let her get it off her chest. She began to calm down and let her friend do all the talking, I approached her (with caution!) and apologised.

'Thank you, I'm sorry I shouted. Its just I'm always labelled you know?'

Sadly, I think we all understand the implications of labelling and stereotypes. Only this time I will take it a little bit more seriously.

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