Episode 5 - The Denture Disaster

After my 'booze cruise and bruise' on the children's ward came the placement I had been dreading - eight weeks of geriatric nursing at St. Francis Hospital in Dulwich (http://www.kcl.ac.uk/depsta/iss/archives/collect/1sa40-0.html). Previously a workhouse the hospital struggled to disassociate itself from its history and had a poor reputation amongst the general public, many of whom believed that if  you were admitted there you would never come out, except in a box.  The fact that it specialised in care of the elderly and mental health (at a time when long stays were common for psychiatric patients) did little to shake this belief.   Senior student nurses relished sharing horror stories from the geriatric wards.  I steeled myself for endless hours of heavy lifting, commodes, double incontinence and crusty toenails. 

However, from the moment I arrived on the ward I loved it. Though the work was indeed heavy and tiring, I loved being with older people and often felt sad to leave at the end of a shift.  Both of my grandmothers (separately and at different times) had lived with us throughout my childhood and I found that I knew how to relate to older patients, balancing caring for their needs without removing their independence.  There was a steady ward routine which varied little from day to day, presenting less of a challenge for my dyslexia, and I found immense satisfaction in providing good nursing care and making people comfortable.  Patients often arrived from nursing homes in a terrible state - care homes then were less well regulated than they are today. Sometimes they came from their own homes where they had been just managing on their own until succumbing to an illness and losing the plot completely.  Many times we received confused, agitated and aggressive patients, covered in faeces and lying in wet sheets with bed sores, matted hair and grimy nails - as well as the illness or infection that had brought them into hospital.  The transformation was often remarkable once patients had a few days of antibiotics, good nutrition, attention to their personal hygiene and compassionate care and companionship.  The hospital hairdresser and the barber visited the wards regularly - I also became adept at the shampoo and set having watched my mother do this for my grandmother countless times.  Sister frequently whipped round the ward with her razor, militantly getting rid of the old ladies' whiskers!  A new hair-do and the knowledge that they no longer had to cope alone restored some dignity and humanity to our patients and the person that they had been (and still were inside) began to shine through. 

Many patients wore dentures (false teeth) which were kept in dedicated pots on their bedside table.  Cleaning dentures was a gruesome and time-consuming business but an essential part of the morning routine when helping patients to wash and dress. In the small hours one night shift, needing an activity to keep me awake, I decided to collect all the dentures from patients' lockers and wash them, lightening the load a little for staff on the early shift.  Before I had thought this through carefully I  tipped all of the dentures from all of the pots into the sink and set about scrubbing them. It slowly dawned on me with a terrible sinking feeling that I had no idea whose dentures were whose, and which ones fitted together.  It took the best part of a week, and much trial and error, to reunite every denture with its pair, and every pair with its owner! Thankfully sister was kind to me and appreciated that I had the best intentions, even if my actions were somewhat misguided at times.

The ward sister was young and dynamic and ran the ward with military precision, insisting on high standards of care and hard work from her staff. She had a tough job as many of the qualified staff were agency nurses. Some were critical of the sister, saying she had progressed quickly up the hospital hierarchy only because of the unpopularity of geriatric nursing but I learned much from her and from my placement on the ward. I learned, as would learn time and again, not to pay attention to others' opinions of staff or placement area before making my own judgements.

Although many patients responded to treatment, death was also fairly common on the ward and most patients had 'do not resuscitate' orders in their notes. The cardiac arrest team had to come from Dulwich Hospital, separated by a foot tunnel under the railway, so such calls were not often made!  I remember a patient named Aggie who died gently one day whilst talking to the patient in the opposite bed.  When her neighbour realised she was having a one-way conversation she called me over in a piercing voice saying 'Nurse!  I think she's DEAD!' I summoned the ward sister who quietly drew the curtains round the bed and decided not to call for assistance.  Some may have disagreed with her decision, but it was a death with dignity and her family appreciated that no one jumped up and down on her chest at the end of her life.

During the placement I was also studying for my end of year exam which involved learning by heart Virginia Henderson's 'Nine Activities of Daily Living' with the aid of a mnemonic that I can't remember now - only that it was something to do with an elephant! Wikipedia has refreshed my memory of those activities: maintaining a safe environment, communication, breathing, eating and drinking, elimination, washing and dressing, controlling temperature, mobilisation, working and playing, expressing sexuality, sleeping, death and dying.  We based patients' care plans on these activities though working out how old ladies in the geriatric ward could express their sexuality was always a difficult one!

These activities also provided a structure for answers to exam questions. Despite the denture episode I passed the placement with flying colours and passed my exam, progressing into the second year and receiving a maroon belt to match my frilly hat.  That summer I moved out of the Nurses' Home at St. Francis hospital into an attic room at no. 88 Herne Hill, a huge old house shared with 6 phsyiotherapy students and began one of the happiest times of my life.  Those stories will have to wait for the next episode...