Tuesday, 7 February 2012

Episode 3: Waking the dead

After gynaecology came my first placement at Dulwich Hospital on Barry, a Male Medical ward on the second floor.  It specialised in skin and respiratory diseases and was run by an excellent 'old fashioned' sister of whom everyone was terrified.  She was a great teacher though, and wonderful with the patients - does anyone remember her name?  I saw the agonies of eczema and psoriasis in young men who returned time and again for daily dressings and ultra-violet light treatment.  I became adept at the application of Texas catheters and bathing dirty old men without getting groped!  I also had my first experience of laying out the dead, juddering with shock as the deceased elderly patient let out a groan from his lungs as we turned him over.  It was a privilege to perform the age-old rituals of death, offering a last wash and a shave and preparing a body before the porters were called to escort it to the mortuary.  However busy the ward, this task was never rushed and curtains were drawn around all the other beds as the body was removed to avoid distress.

We had not yet had our lectures about death and dying but thankfully I had mentors to guide and support me as I learned  the ropes.  However, one of my fellow students learned the hard way.  The ward sister left her alone with a dead patient to 'make him comfortable' whilst she phoned the old man's relatives and attended to other duties. Some time later the sister returned, escorting in the family of the deceased to pay their last respects.  Imagine everyone's horror to find Grandad, not lying in the bed wearing a shroud and covered in a sheet, but sitting up in his arm chair, fully dressed with his glasses on, reading the paper.  The student had thought this semblance of normality would be reassuring for the relatives!

Thursday, 2 February 2012

Episode 2

Being a student nurse in the 1980s wasn't easy.  Others' memoirs from earlier times (such as Jennifer Worth's 'Call the Midwife') chronicle nursing as a way of life rather than a job with little pay, no time off, rigid hierarchies, rationing of 'late passes' and strict rules - an almost monastic existence.  However there was also a solid support structure with matrons, sister tutors, home sisters and communal meals.  Kings College Hospital in the 1980s thought itself progressive and, though traditional uniforms and hierarchies were still very much in evidence on on the wards, student nurses were free to come and go as they pleased with swipe cards to enter the Nurses' Home out of hours.  The staff canteen served food at meal times but there was no expectation of communal eating - and thus little sense of community. It could be a lonely place at times for a girl like me from a sheltered background with little experience of city life.

I had never really been one for parties.  A life-long struggle with my weight gave me little confidence in such situations and I felt more at home cooking a meal for friends or in small groups of those known to me than out at the student Union Bar (can anyone remember its name?) or trawling London's nightclubs.  Whilst loving the career I had chosen I battled homesickness for a while and often went home to Kent on days off, or to my aunt's house in London where there were 4 young cousins to play with. I was also exhausted for much of the time.  We worked long hours with huge amounts of responsibilty placed upon us and were the lowest of the low in the pecking order.  I underwent a host of medical investigations into my exhaustion for which no cause was found.  I now know that I am dyslexic and that adjusting to new situations can cause extreme tiredness for those with dyslexia (learning new routines and procedures requires and huge amount of effort and a drain on working memory).  The benefit of hindsight!

Two members of our 'set' came from Guernesy (Julie Brouard and Tracy - can anyone remember her surname?) and were Salvation Army members.  They had chosen Kings for its proximity to the William Booth Salvation Army College and Citadel at Denmark Hill. They swapped their nursing uniforms for 'The Army's' navy and maroon outfits on their days off.  For me, joining a local church and becoming involved with the Hospital's Christian Union (CU) made a huge difference.  These provided the sense of community that I found lacking elsewhere and introduced me to other student nurses, physios, medical and dental students who would become lifelong friends.  On Sundays off we often congregated for lunch at 'Auntie Bren's' - a single lady in the church who opened her home to students and other singles - and went for walks in Dulwich Park to work off our extra calories!  The church also provided me with an outlet for musical expression and I became a regular member of the Herne Hill Baptist Church worship band, playing piano and flute and singing my heart out.  Some time later, after we had moved out to private accomodation, my flatmate and I joined one of the church's homegroups - and enjoyed evenings in the home of a retired local surgeon who was a member of the House of Lords!  The CU weekends away to youth centres and campsites cemented the group and my place in it as resident caterer and musician and my homesickness soon resolved as I developed a sense of belonging. My faith also helped to make sense of some of the sadness I saw on a daily basis at work.

Meanwhile, life on the wards continued.  Eight weeks of introductory school - where we learned the basics of nursing care and had increasing contact with clinical areas - was soon finished and I started my first 8 week placement on Ferguson, a Gynaecology ward.  The sisters at Kings wore bottle green uniforms with starched collars and cuffs and Ferguson's glamourous sister (can anyone remember her name?) complemented the green dress with her silver bob and scarlet lipstick!  There were three sorts of patients - women having regular gynae operations such as hysterectomies and repairs of their prolapses, those with gynaecological cancers undergoing radiotherapy in a closed room, and young girls coming in and out for terminations of pregnancy in a six-bedded side ward.  The student nurses were mostly allocated to the main ward and we were judged on how quickly we picked up the medical abbreviations in common use during the nursing handover such as  'The women in bed 12a [never bed 13 for superstition's sake] has had a TAH, BSO and HI' (Total Abdominal Hysterectomy, Bilateral Salpingoophrectomy and Hormone Implants!)

Every patient having gynae surgery was admitted the night before their operation and had a pubic shave and 2 glycerine suppositories as soon as they walked through the door.  Late shifts were very busy, admitting several new patients and undertaking their pre-operative care whilst simultaneously putting the longer stay patients to bed where required, doing any evening dressings and providing for their toilet and hygeine needs.  Working on Ferguson I soon became proficient at giving intramuscular injections.  Every patient had pre-op medication of 'Om and Scop' - Omnopon and Scopolamine - given intramuscularly into the upper outer quandrant of the buttock! I also learned the basics of nursing from working with fellow students.  One evening I learned how to show love and compassion to my patients by watching another student - not much more senior to me - dress a lonely elderly woman's pressure sore then provide a bedpan, give her a wash and change her into a clean nightee, smooth her pillows and tuck her in  with a hug and a kiss.  The student's name was Emma - thank you Emma, wherever you are.

On one such busy late shift we had 7 or 8 new admissions for surgery the following day.  The staff nurse was frazzled - not enough staff and too many patients - and dispensed the newest student nurse (me) to give 2 suppositories to a new patient in preparation for her surgery the following day.  The present NMC rules for administration of medicine had not been invented yet. I had seen suppositories being administered before, but mostly under the sheet and I had not looked too closely at the precise location for penetration.  I was also gloriously naive about my own anatomy, never having examined it at close quarters.  Armed with the suppositories, a  plastic glove and some KY jelly I squared my shoulders and walked towards the patient with an air of confidence that belied my inner anxieties.  It couldn't be too difficult could it?  'Well Mrs. Jones, I have two suppositories for you here that the doctor has ordered.  Please remove your underwear and lie down in the bed on your side'.  Mrs. Jones duly did as asked, though she appeared surprised at such a request - the hierarchy of hospitals in the 80s was such that patients did not question the doctor's orders.  Donning my glove, with a squeeze of jelly and a swift removal of the sheet, I lifted the patient's buttock and popped the suppository in the nearest hole.  'There Mrs. Jones, all done'.

The shift finished at 9.15 pm and I returned for the early shift at 7.15 the following morning.  The staff nurse approached me with an angry face and questioned why I had not administered the suppository last night as she had requested.  My protestations fell on deaf ears and the surgeon was most disgruntled that his patient had not undergone the necessary bowel preparation.  Meanwhile, whilst I was making the beds Mrs. Jones drew me to one side.  She told me she was a nurse and she did not think the suppositories had been meant for her - and that I had put them up the wrong hole.

To be continued!

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