Ho, Ho, Ho, Part 2

Well despite my fears our department remained very quiet over the Christmas holidays. I don't think anyone died with us, we only had about half a dozen overdoses and most of the patients went home. Even better, the hospital had beds so no one waited too long. After my post of Christmas eve about having back pain and requiring a TENS machine I was a bit put out that the first 3 patients who attended on Christmas morning had back pain but had not bothered to take painkillers. We had loads of food, one girl made a superb home made soup and one of the doctors made a superb curry using his mum's recipe which was very tasty and there were chocolates and nibbles and cakes. I have not had a proper healthy meal for 2 days. But I managed to get away early on Christmas day.

Aren't Amazon wish lists a wonderful thing? This year I got loads of books and DVDs that I really wanted, brilliant (Note to family; sorry about the comments I made about you on 17th December). For some reason my wife has given me a guitar so I felt quite adolescent for a time as I used to play guitar when I was younger but this will keep me busy relearning how to play. Unfortunately I don't have the hair that I had when I first got a guitar (shoulder length) and I now have twice the stomach.

I hope you all had a peaceful and happy time, I hope that Santa was good to you and if I don't post before it, I hope you have a happy New Year and if you are working I hope it remains civilised.

Ho, Ho, Ho.

How did you spend Christmas Eve Grumpy?

Wired up to a TENS machine thank you. Over 25 years of humping patients about means my back is knackered and hurts on a fairly regular basis.

I have a load of presents sitting under my tree and as I will be working all day Christmas day I will open a few tonight. I will also open a few tins of cider and perhaps a bottle of wine.

I hope you all have a merry Christmas and if you are working I hope it is civilised for you - I will not use the Q word.

IT and Merry Chistmas

Hi everyone, sorry I have not posted recently but I have been having discussions with our IT department. I asked them about the hospital's policy on blogging and the answer was really what I expected, "Don't do it as you will breach patient confidentiality". Since this report about a doctor abusing the IT system came out there has been a bit of a crack down on IT stuff so I am keeping my head down. I have had a load of things to write about but unfortunately they are too easily recognisable to people. As there are only 5 million people in Scotland and only 5 large cities local stories tend to stick out and therefore identities become known. Once some time has passed and people have forgotten and I can figure out a way to tell the stories without identifying anyone I will write them.

It's almost Christmas - Ho! F'n Ho! - I am of the persuasion that Ebeneezer Scrooge was a badly misunderstood man, I am definitely a Christmas? Bah Humbug! person. This year I am working so I will have to put up with jollity from my colleagues and the result of what happens when people are being happy from my patients. I'm quite sure there will be broken bones, RTA's punch ups and the odd heart attack to keep us busy.
Bit of nostalgia now, in Scotland Christmas was never a holiday. Our holiday was New Year. I remember getting up on Christmas morning going out on the bike I received from Santa and delivering papers, Christmas was a working day in Scotland and it wasn't until the 70's and 80's that it changed. I enjoyed Christmas when my children were young it's just as I've gotten older I can't be bothered with all the nonsense that goes with it - pushing through crowded shops, people laying in enough food to last through a biblical famine - honest the shops will only be closed for 2 days at most and I always seem to get silly presents from my family, I sometimes wonder if they have actually met me. I have been told that what I really need are grandchildren and then my attitude will change. Ah well, I hope YOU all have a good Christmas and Happy New Year.

Complaints

I have received many complaints over the years from patients and relatives. Some have been justified and are usually caused by bad communications. Most however are a waste of time and are usually caused by us (the hospital) not doing what the patients wants when they want it. These complaints are usually about the wait to be seen but two complaints recently have just topped them all.
The first was from a couple of young guys - early twenties - who when I asked when the patient had hurt themselves the friend said "Well it will be about three hours ago now the time we have waited here." This time I thought hang on, I know we are busy but our waiting time is not that long so I checked their arrival time. From the time of arriving in the department to being seen by me was 40 minutes, on our busiest day of the week with a full waiting room. They were complaining about waiting 40 minutes. I was less than diplomatic and asked if they had noticed the number of people surrounding them in the waiting room? No, they just felt that having to wait under an hour was still too long.
The other complaint was definitely the weirdest one I have dealt with. I was giving a patient a meal - that he had ordered from a menu - and he complained that the food was too white. What? The food was too white. White cod, with white potatoes and white cauliflower all on a white plate. How do you answer that one? Turns out he was a lecturer in catering and felt that a bit more thought should have gone into presentation, despite the fact that he had ordered it. He also mentioned (complained?) that the green salad had some red tomato in it. Still don't know if he was winding me up or serious.

Thank you.

I would like to thank the people who have commented on my posts, I do not always get to answer them due to work commitments. When I do get a chance to answer the comments it seems to me that the moment has passed. But please keep commenting, good and bad - especially good. Every one of them is appreciated.

I wasted my F'ing time!!!

That's what I was told the other day, this poor patient had come all the way to hospital at his own expense and we did nothing for him. Never mind that I gave him a complete examination of his injury, sent him for an X-Ray which probably cost between £100-£200, gave him my opinion on his X-Ray and diagnosed his problem and then to finish it all I treated him and gave him advice for after care and told him it would take 2-4 weeks to heal completely. Because I did not 'fix' his injury so that he was pain free NOW he wasted his time coming here and walked out telling all and sundry that we are useless and don't do anything for people. Ah well, such is life in any ED in the world.


I was at the gym again today, and thought one of the people was having a fit. I was all ready to rush over in full life saving mode when I realised that what I thought was a seizure was this idiot practicing a karate move and had accidently hit the wall and bounced off. Why he was doing karate moves in the actual gym and not upstairs in the studio I'll never understand, but it is better than TV.

Silly Boy

Junior doctor thought that the nursing staff were being annoying because we kept calling him to get a patients pain controlled. Eventually he thought of a plan; he would get the nursing staff to carry out 15 minute neuro obs as the patient had a headache. We tried to get him to change this, arguing it was not in the patients best interest as he would not get any sleep and he was not ill enough for this level of observation. we even pointed out that if the patient really needed 15 minute obs they should be transferred to a neuro ward or at least be CT scanned. No, the bold boy was going to get the nurses running around because we had annoyed him. Being the experienced nurse I am I took him aside and spoke to him male to male and told him that if he insisted on this then we would do it and then we would page him and tell him the results. Every time we took a set of recordings he would be told. OK he said, go ahead, I will just turn off my pager. Then I dropped the bombshell onto his little power play. If you do not answer your page when we call we will keep paging you until you do answer. If after 15 minutes you have not answered we will then phone the registrar on call (his senior) and tell him the results and ask him what he wants done, and we will do this no matter what the time is. 2 minutes later, order cancelled and a junior doctor suddenly aware that a) he is at the bottom of the pile and b) nurses have ways of getting our own back and making uppity doctors behave.

Later on he turned out to be an OK guy, he was just having a bad day and had tried to take it out on us and we let him know we would not put up with it - everybody happy.

Nursing

I came across this post by a midwife today which has me worried, is this normal? Does this really go on in our hospitals? I have been a patient a few times recently and I have had on the whole a good experience. I realise that as soon as nurses in wards find out that I am a Charge Nurse, my wife is a Staff Nurse and my mother is a retired Sister I am going to get good care as at the very least they do not want us carrying tales around the hospital about 'that awful ward' and in all fairness, I think my hospital is pretty good anyway. But it started me thinking, is there a lack of knowledge in today's nurses about basic things? I have a degree in Nursing, my colleagues all have degrees in Nursing and I must assume that most of the nurses in the hospital have a degree in Nursing. So, does this make us better nurses than those nurses who have retired or are my age and heading rapidly towards retirement? In other words, am I a better nurse for having a degree than I was before I got it? The answer in my case is that it has really made no difference, but mainly because I got my degree fairly recently and managed fine for years without it. Having all nurses with degrees should make us a better profession but it does not make us better nurses. What does make a difference is training and having a pride in what you do. When I started training I worked with an old fashioned ward sister, everybody was afraid of her but her patients loved her. Why? Because she knew every patient on her ward, she knew what was wrong with them, she knew what drugs they were on, she knew their families and she knew what was going to happen to them. She ran her ward with a rod of iron, it was her way and her way only, the nursing process, team nursing and patient allocation were only words to her. If any nurse on her ward had dared to say to a relative "he's not my patient I'll find his nurse" she would have shouted and screamed at the offender so much that they would never, ever say that again (every patient was yours). I had worked in construction and in factories and she terrified me. So if she was such a tyrant why do I think very fondly of her? Why does everyone I speak to who remembers her speak fondly of her? Because she taught us our jobs, no excuses were tolerated, if a patient was sick that was our priority. Now we have recording sheets with colour coded areas which give 'scores', the higher the score, the sicker you are, she would have thrown them out - she knew when a patient was sick.
So what was the difference between then and now? Firstly, the college of nursing taught us what we needed to know, we learned about diseases and the disease process and how to nurse someone with those diseases, you learned hands on nursing on the wards. Secondly, student nurses were not 'supernumerary' they were there to do a days work and to learn while doing (we were paid a wage for this, not a bursary). Thirdly, there was less paperwork to complete and there was not the same pressure to document every little thing (OK I appreciate that this was perhaps wrong and documentation is important but paperwork is very time consuming). Lastly, there were more staff on the wards, even if those staff were students they had a lot more responsibility then, often caring for up to 6 patients with an auxiliary nurse (Health Care Assistant). So can we move back to those days? Probably not, but we can at least try to make our nurses proud to do the job, take pride in having done the best for everyone in our care, but can we please get the tools to do the job we are trained to do. A few more staff on the wards would go a long way, government actually giving a c**p about the NHS and can we please get rid of some of the managers. I read in a blog somewhere this comment - "If half the managers in the NHS did not turn up for work tomorrow, would we notice"? Now substitute managers for any other job title and ask the question.

Credit Crunch? What Credit Crunch?

Just a quick post today, they tell me there is a credit crunch going on. US is bailing out the banks to $700BN and the UK is giving banks £50BN, nationalising banks and telling us all that we are going to have to tighten our belts and that mortgages are going to be impossible to get, blah blah, wrack and ruin, blah blah, doom and gloom etc. So can someone please tell me why my bank has written to me INCREASING the credit limit on my card because I have been a good boy. I did not ask for this, I do not need this and I don't particularly want it but I've got it.
No wonder people spend too much and land in trouble.

Love

Isn't it nice when people fall in love? You hope that they will be happy and that it will last and they can go onwards into the future together as a couple. The reality in A&E is somewhat different. Young couple brought in from the street by ambulance, both absolutely out of it with alcohol. Both 20 so should know a bit better. She had wet herself and had vomited so her face and hair was covered in puke - lovely! He was only drunk. We put them in separate cubicles on trolleys but next thing he was in her room talking to her and holding her hand, fair enough, it will keep them both quiet for a bit. Next thing we hear is him climbing on the trolley to lie beside her and we can see this on the security cameras, so someone went to stop this. By the time they got there they were really trying to 'get it on' in a very confined space and although love will find a way, it won't in our department, in public and on camera. So we separated them and put him back in his cubicle by which time he was covered in her puke. They left 2 minutes later hand in hand and she was giving us abuse for being perverts(?). Ah well, I'm sure the long walk home would cool their ardour as no taxi would take them the state they were in.

Thank you

Wow, I have 6 followers, thank you every one of you and thank you to every one who spends some time of their day reading the "stuff what I wrote" I really appreciate it. If I do not put you down for following it is not personal it is just that I don't have the computer skills to add you. I read a lot of blogs on Google reader as it saves having to look at every blog and I only see the ones that are updated. So thank you again.

Fred died today.

Fred died today, not a problem, he was old and had been ill for a while and it was just his time. Why am I telling you this? Trauma Queen has a post here which reminded me of a couple of sets of parents. the first was a mum who worked in the hospital, her son had 'gone off the rails' when he was 12. The usual, he was being bullied so started missing school then he joined in with a few others and began shoplifting then more serious thefts and assaults until he was spending most of his life in jail. I first met him after he had been assaulted, fairly serious but the police still came and arrested him on discharge. Mother was absolutely distraught but was completely aware of what her son was doing but as she said "He's my child and always will be." I still see his name in the local paper being involved in theft and assault and his mother still cares about him.
The other set of parents had 5 sons, they grew up in the same area that I did so I was aware of them but never knew them. Throughout the 70's, 80's, and 90's the parents, and us in A&E, watched these young men become more and more dependent on drugs. They would sometimes get clean and settle down. Could not get jobs but at least were going straight. Then one by one they would slip back into drug use. This became their lives, cycles of drugs, prison then release and a methadone programme. Eventually, one by one they all died from HIV related illnesses. Their parents, Fred and Joan, both very nice people could not understand how their family turned out the way they did. What did they do that caused all of their sons to become dug addicts? This thought has haunted their lives and yet throughout it all they remained supportive and loving. I once watched Joan take one of her sons shoes home when he was in hospital to keep him in - her words were "If he has no shoes I know he will be here where he is safe", did not work. He discharged himself against medical advice with a chest drain in (we took it out before letting him go) and he walked out in his socks. He had managed to stay with us for 2 days but the call of the drugs,and his equally addicted friend, were too strong. Strangely, every time I met the sons they were never violent or aggressive, they had been well brought up and never gave us any trouble. They were just drug addicts.
So, rest in peace Fred, I have often admired you and your wife that you never gave up on your kids and hope that if I was in your place I would be as tolerant.

I'm back,

I've been on holiday, had a great time but start back to work next week. Ah well, it's like I've never been away.
Had an experience which made me think while I was away. I was taking a picture of a pretty village in England and happened to get a couple of kids (about 7 years old) in shot, thought nothing of it until my wife pointed out that it could look very suspicious a fat, bald, middle-aged man taking photos of children but I should be OK as she was with me!! This got me thinking that perhaps in this day and climate of child protection that she was right so I deleted the picture (the joys of digital cameras) and took another picture which had no children in it. But afterwards reflecting on it (see I did learn something at university - how to reflect) I thought back to my student days when I had to work on the paediatric wards. No police checks in those days, I was assumed to be safe with children as I was a nurse.
I recall one instance where I was allocated 3 children to look after in the morning, nothing unusual, happened every day. This day I decided to shower 2 of the kids and wash the other, have no idea of diagnosis and illnesses after all these years but the children were all independently mobile and were looking forward to a shower. My own kids at that time were about 10 and 12 so I was used to dealing with children. Anyway, one of the kids, a little girl of about 8 disappeared and I could not find her, she could not get out of the ward as the handle was too high for her so I was not too worried, but she was holding me up. Found the poor girl in the shower trying desperately to turn it on and shower herself for me, obviously in floods of tears and cold and naked. What did I do, the only thing I could do, I found a big warm towel and wrapped her up in it and gave her a big cuddle, I then washed her under the shower and we carried on with our day. No harm, everybody happy and I did not even think to put the incident in her notes. Would I do the same thing today? Not a chance, I have not changed (apart from getting older) but the world has changed. I could not put myself into a position where I would be alone with an 8 year old girl in a shower. To my mind the way it seems to work is that this would just be an informal way to resign my job. It is not just males, one of my colleagues used to do voluntary work with cubs and beavers but found that what they sometimes needed was a quick cuddle then on they go - she was not allowed to do that.
Nowadays I have an Enhanced Disclosure (Scotland) number and we have had people who came to us for jobs having to be unemployed for a couple of weeks as they had resigned from their last job and their disclosure form was not through.
One of the games I played with my own children and some of the patients at the time was to put your noses together and then you have to try to bite the other persons nose while all the time still touching noses, if the noses came apart you had to stop. Children of a certain age love it because it is totally stupid and impossible to actually bite anyone. But there is no way I could do something like this now.

Pee

Those of us who work in health related fields particularly nurses ambulance people and doctors have a rather strange bodily function which we all seem to develop. This is the ever expanding bladder. In my case I go to the toilet at 7:00pm and suddenly realise that the last time I was at the toilet was 6:30 am that morning. I really, really need to drink more water.

On a related subject, young guy came in to us complaining of passing blood, no pain but urine was red. OK asked the usual questions, being doing anything different, strenuous or kinky but no, nothing unusual. Checked vitals and put him in a cubicle. Got a specimen of urine and tested it - no blood, not even microscopic amounts. Asked again anything out of the ordinary? Oh yes, I was eating a load of beetroot yesterday.

My cold is better, and my wife still has not got it, but strangely enough all her workmates are starting to phone in sick with colds. I told you, 'Typhoid Mary'.

Baby Docs

Well we're into September now and the new doctors have been here a month and are settling in a bit. Because of the new training for doctors it is strange having a mixture of people who are very experienced and some who are inexperienced. Because all the doctors are new, we don't know who is who and can have an occasional mix up. One doctor was sitting in the department the first week not doing anything so one of the nurses gave him a patients card and pointed him in the direction of the patient. Rabbits and headlights immediately sprang to mind, with a whimper of fear he was out of his seat and in a quavering voice stammered that he was just the junior doctor and with that he ran off up the corridor. Poor guy was just qualified and had never seen a patient before as a doctor, we brought him back and reassured him and he seems to have settled in to the department and is doing jobs more in keeping with his experience. One thing that I have noticed with this bunch, and keeping the grumpy bit of my name going, is if I tell a doctor not to do something because it is not departmental procedure or protocol or because the consultants won't like it, why do they argue with me? Also some are self assured, some are a bit diffident and others are way overconfident and need very careful watching. I'm sure this is the same all over when new doctors start and as we get to know each other everything will settle down and we will work as a team again.

Sick

I'm back, sorry but I have been busy at work and not had time to post and I have also been sick. Nothing serious just a touch of Bubonic Plague or Double (treble?) Pneumonia or terminal Flu with a touch of Ebola.
Yes you're right, I had a cold, which lasted for 3 days. No I did not stay off work, I took some paracetamol and lots and lots of handkerchiefs. It is amazing the advice you get from people about how to deal with colds but I am of the Barbara Woodhouse school of thought which says that the virus just wants to be tucked up in bed with a nice hot lemon drink so I refuse to give it what it wants.
I hate being sick, one of the good things about getting older is that you don't get so many colds as you have met all the viruses in the past and your body has developed the immunity required. So it is annoying when you do get one. Strangely my wife did not get a cold so I must have got this one from her (is she a typhoid Mary?).

While I was feeling miserable a young foreign guy attended the department with obvious flu. Normally I am quite harsh with people who present at A&E with flu as all they are doing is infecting the waiting room and the staff and we are not going to do anything for them. But I did feel a bit sorry for this youngster. He had obviously heard of the wonders of the NHS and his presenting complaint to me was "I have the flu, I need someone to look after me," you are absolutely right, you do need someone to look after you but it ain't going to be us. What a shame, poor kid, I gave him appropriate advice and sent him home to bed - it is his mum he needs, not hospital.

More Sunday thoughts

I don't care what we say in public, when all hell is breaking loose in resus, when you have 2 patients with multiple injuries, another 2 are expected, patients with chest pains and difficulty in breathing are presenting at your door that is when it is really fun. This is why we work in A&E.

Why is it, that I will still smile at you when you tell me "the wife" or "pain" or "hospitals" or "work" when I ask you if you are allergic to anything? Do you have any idea how many times I have heard that? Oh, and by the way, you either have or do not have an allergy, telling me "well not really" is not helpful.

Why am I polite to the 19 year old ned who thinks he is a hard man but isn't and I am abrupt to the real hard man who could kick me all round the department and not get breathless? Do I have a death wish? I certainly have poor judgement at times.

Sunday thoughts

A couple of times I have mentioned the arrogance of doctors in their dealings with nurses, other members of the team and the public and their thinking that sometimes the rules don't apply to them. It is therefore with a bit schadenfreude that I have discovered that they are equally arrogant with each other. Apparently a junior doctor in Highland region has been suspended for daring to write about the person who masterminded the MTAS/MMC debacle in a less than complimentary manner. What he wrote so upset the person concerned's friend that she had another senior doctor in the Highland deanery suspend this doctor. The full story (and follow ups) can be found here, here and here, at least the poor guy has been reinstated but only after the newspapers became involved. So I give you exhibit A, the arrogance of senior doctors who think that they can screw up someones career because they do not like what they have said and never mind whether it is aimed at them or whether it is factual, oh, and by the way, sod employment law. A few years ago junior doctors were controlled by the fear of getting a bad reference from a consultant but that seems to have changed, now it is fear of friends in high places getting you thrown off your training. I am going to ask a question, is their any realistic way of disciplining, controlling or getting rid of senior doctors? Answers on a P45 please.

August

The new doctors start today, all over the country newly qualified FY1's will be starting their first jobs on the way to being consultants or whatever. Every department will get new FY2's and maybe ST grades as well, this is going to be fun for the next week or two until they settle down. The jobbing doctor has posted about it here. The big problem that we as an A&E department have is trying to change the doctors priorities, what they learned on the wards is not necessarily what we want them to do and also the nursing staff in A&E have different priorities, we do things differently. Never mind, they will get the idea soon enough.
Today though, I want to mention the doctors who have just left. In a time when there seems to be a lot of them and us and Dr. Crippen repeatedly alienates nurses, I want to take this opportunity to say that the doctors who have left my little part of the NHS were without exception excellent. They were good clinicians, they were nice people and it was a pleasure to work with them. Many seemed to be going into General Practice so despite The Jobbing Doctors misgivings, GP land (at least in Scotland) is going to be well catered for. No names, but I will miss you all and I wish you all success. I hope that your replacements are as good.
The Jobbing Doctor in his post mentioned that this is not a good time to go into hospital as the junior doctors are new and can make mistakes. I have commented that I have read somewhere that in fact the junior doctors are full of enthusiasm and tend to over treat and in fact the death rate goes down in August. Unfortunately I don't know where I found that particular gem and I don't know even if it is true. So if anyone has the real figures I would appreciate the reference.

Trauma

There has been an RTA, a car has veered over the white lines and hit a minibus head, on there are multiple dead and injured. Then the injured start trickling in, the first and most serious arrives by helicopter, unloaded and the helicopter heads back to get more patients. We start to work on this lady, multiple injuries, where do we start? We know we have to work quickly, not only for her but because we know that more are coming. We know this lady needs surgery, but who goes first? Surgeons or Orthopaedics? We let them sort that out between them and get her to scan then theatre. The next one arrives and then more. It becomes a blur of injuries, tubes, wires, recordings, blood, people calling out for equipment and the various bits and bobs that go into a major trauma. As nurses we divorce ourselves from what is happening, we try to listen to everyone and as a doctor will talk over a plan with a colleague we listen so that we can get the next bit of equipment, yes it can sometimes make you feel a bit like their servant but it is what the patient needs at that time and lets be honest, that is our job. We know where everything is kept and how it works.
After a time it calms down a bit, it becomes less frenetic and we can look around and take stock. We have 4 spaces in our resus room, space 1 has an injured male who is going to go to orthopaedic theatre for various fractures, space 2 is going to general surgeons for exploration of her abdomen - she is bleeding somewhere internally plus has broken bones. Spaces 3 and 4 have dead people in them who crunch when you move them, I hate crepitus, we have not had time to take them to the viewing room. We have time before we have to deal with relatives, they are all from the other side of the country and will take time to get here so we can make the dead presentable. There is blood everywhere, the floor is a mess of discarded packages, swabs and the odd bit of equipment that fell off the trays. My colleague and I look at each other and and think "if our families could see what we do".
All this carnage and so many peoples lives ruined because someone tried to overtake on a corner.

Numpties and Neds

I feel I've got a bit political recently which is not really what I do (it's enough that the writing is on the wall for Gordon Brown), so I've gone back to my first love for this post - the idiots that seem to inhabit my world, or at least my night shift world. In these cases however, I'm sure you will agree that I am not picking on the innocent or the unlucky.

The first young lad I saw had a sad tale to tell, how he was minding his own business and had been attacked and had had to defend himself and hurt his hand in the process. I am always prepared to give the benefit of the doubt to someone and I try not to judge but I was feeling just a bit sorry for him then one of the other sides friends appeared. Screaming and shouting and swearing at him that he had no business here after hitting his pal with a glass and giving him some very nasty facial lacerations. A fight started in the middle of reception, We did not have security and I was on the other side of the reception desk and unable to intervene but luckily an ambulancewoman was passing and got between them and stopped the fight. Turns out far from being the innocent party, he had started the whole thing by hitting some guy with a pint glass for no real reason. He then asked for a loan of my pen and stuck out his hand which was covered in blood - no way mate, if I gave you that I would have to throw the pen out. He was arrested and taken to the cells for assault.

If you are going to threaten to punch your girlfriend, don't do it when I am passing and can overhear and don't do it where there is CCTV camera coverage. You were really unhappy when I told you that if you did punch her you would be on your way to jail as I always called the police and I always ask for arrest not just removal from premises.

The third patient had a minor injury and had had a wait of about 40 minutes. I went into the waiting room to explain that we were busy and he would probably have to wait another hour at least but he was not happy with this. He asked who I was and when I explained I was one of the nurses his only comment was "poof". He was lucky, I wanted to get him arrested but my colleague had a better idea, we kept moving him to the bottom of the queue so that he would not be seen for hours. We told him we were going to do this hoping he would leave but the numptie kept waiting. After 4 hours of this he was eventually seen, by which time he was a bit more sober and a bit apologetic. Unethical I know but understandable under the circumstances.

Nursing Heroes

Who are your hero's?
I was at the gym the other day and while on the jogging machine a trailer came on the TV for the programme Heroes and you know the way your mind wanders? I thought about who my heroes are. It is a question that is asked at the start of courses so that it can be used as an ice breaker and get everyone talking. My usual answer is Homer Simpson! It usually generates a bit of comment and as I am aware of the reason for asking the question in the first place I don't mind taking a bit of ridicule. Actually I can justify it to an extent, he loves his family and does not let anything get in the way of what he wants and it always works out for him in the end - if only real life were like that.
I thought about the use of the term "Hero" and it seems to me that it is way overused. There is not, in my opinion, a sportsman in this world who deserves the title hero. They are training to do what they do and are very well paid to do it so they are out of the hero stakes. Comic book heroes are fine but do not exist. I am going to be controversial - firemen used to be automatic heroes but lost the right to the title when they stated doing risk assessments before going into dangerous situations. Lifeboatmen/women and people like mountain rescue personnel who put themselves in danger for someone else without pay are to me much more deserving of the title.
I then thought about nursing, do you have a nursing, or medical, hero? There have been plenty of doctors who could qualify for the title but not so many nurses. Everyone will tell you about Florence Nightingale although her hospital was several miles to the rear of any fighting during the Crimean war. Black nurses may mention Mary Seacole who was to be found at the front line during the same war treating soldiers from both sides. What about modern times?

One of my nursing heroes is Graham Pink. Mr. Pink was fired from his hospital in 1990 for 'whistle-blowing' after attempting to point out over two years the deficiency of care on the ward he worked on. No one listened, (does this sound familiar?) and he was eventually dismissed for 'breaching patient confidentiality', which he later fought in court and won. He did a tour of the country talking about his experiences and I was lucky enough to be in the audience at my hospital when he spoke. He received a standing ovation at the end of it from all the front line nurses. Sadly one of the nurse managers was overheard stating that she could not believe that this man could get that kind of reception and she would have gotten rid of him much sooner. Read the story here and think that almost 20 years on, nothing has changed - see here. Two parts of Mr. Pinks story has stayed with me since I heard it, the first is the way his supposed colleagues (all female, all senior nurses) failed him by refusing to back him up and in some cases denying there was a problem and the second thing is his account of being behind the screens with an elderly ill patient who he and his HCA could not leave (no other staff) and hearing the padding of footsteps going down the ward and out of the fire exit onto a metal staircase and the helplessness he felt as there was nothing he could do.
We should choose our heroes with care and not because they are popular, well paid or high profile.

I know my place

This story about surgeons making extra money from successful surgery caught my eye. It's nice to know what the government thinks of us. If the surgeon has a good surgery he gets extra cash, but what about everyone else? Despite what they believe surgeons do not operate in a vacuum. There are a whole host of staff around to make sure that surgery is successful - his medical team, the anaesthetist, the nursing team in the theatre, the nursing team in recovery, the ward nursing staff, the domestics who clean the place, the porters who transport patients, the physios, the laboratory staff, and the sterile supplies people to name but a few. Every one of them vital to a successful operation. So why should only the surgeon be rewarded? In fairness, in all the reports I have seen, there is not one report of a medic who has said this is good and they have actively spoken out against it. So where does the Department of Health get the notion that this is a good idea? This goes along with the idea of rating nurses for compassion. More government interference.
How about developing a scheme that will allow medical and nursing staff to do their jobs with enough staff and resources?

Google Analytics

I was put on to google analytics by some fellow bloggers and thought I would give it a try, it has given me a couple of strange results already. Someone asked google "what happened to Lakelandcam?" and I am the top result - weird. Sorry Tony Richardson who owns Lakelandcam I did not mean to steal your thunder and I have credited the photo I took from your site. As I have said in an answer to a comment I love the English lake district and have put one of most favourite hills at the bottom of this blog. I find Catbells such a nice place, peaceful and invigorating. The only thing wrong is that it is too popular and there can be a lot of people about but I have a fix for that. In the lakes people seem to get off the hills very early and I find that come 4:00pm it can be quiet whereas I am used to the Scottish hills where you can still be at the top of a hill at 6:00pm so I have no problem staying out that little bit later to get the peace and tranquility I want.
For some beautiful pictures go to www.lakelandcam.co.uk updated (almost) daily.

Ratings

The doctor blogs have been commenting on a new site that has been built for rating doctors called iWantGreatCare. Now I am normally for anything which makes people aware of any difficulties with health care but in this case I feel the need to agree with Dr. Crippen, The Jobbing Doctor and the Ferret Fancier ( I must be sickening for something when I agree with Dr. Crippen) and any other doctor who who has written about this. A member of my family is a teacher and they have a site called Rate my Teacher but as they point out, it is only ever written in by children who they have had a run in with. So no one takes it seriously and in fact no teachers even bother to read it as any sensible comments are buried under the childish, the vitriolic and the puerile comments. And this is the problem with this site, there may be some good constructive criticism written but no one will look at that. It is much easier to believe that Dr. X is an arrogant, unfeeling, uncaring martinet written by someone with a grudge than to believe that perhaps Dr. X had a bad day. Dr. X may be all these things and there has to be some method of complaint about doctors (and nurses) and they must have the right of reply but a public, unsecured, anonymous website is not the way.
Nurses have always known the value of popularity contests (otherwise known as patient satisfaction scores) and we consistently score higher than anyone else. Does this mean that we are better than everyone else? Course not, it means that we deal with patients on a day to day basis and are the visible presence of the hospital for patients - we are the ones who get them the cups of tea or the blankets or the pain medicines. For interest, Dr. Shipman was loved by his patients and many did not believe that such a nice man could do what he was accused of despite evidence to the contrary that he was, possibly, the biggest mass murderer in this country.
Out of curiosity I looked up a random department from my hospital, only 3 doctors are listed; 1 moved on a year ago, 1 only works one session a week and the other is a staff grade. That is it, no consultants, no middle grades, no juniors. So who are they going to rate?
I believe that in America they have introduced a system where the hospital payments are linked to receiving good patient satisfaction scores. So what is your priority? Good care or popular care? Sometimes they can be synonymous but only sometimes and very rarely in Emergency Medicine where you have long waiting times.
Sometimes consultations between doctors and patients/relatives do not go smoothly, sometimes it's the doctors fault, sometimes it's the patients/relatives fault and sometimes communications just fail. Doctors have recognised this and a greater amount of time is being spent in medical schools on communication using video technology so perhaps in future consultations can go smoothly and popularity contests will not be required.

Summertime

Summertime, and the living is........... painful!
It has started, we are seeing kids coming in with nasty fractures to wrists, elbows and even clavicles. Has there been a mass outbreak of child abuse? Well yes, in a way. Their parents have bought them trampolines for the garden.
Trampolines are great fun, bouncing away, getting rid of all that energy, playing with pals and annoying the neighbours. What more could a red blooded child want? Well, a bit of supervision would be nice.
Trampolines are great, trampolines are fun, trampolines are good exercise, trampolines are DANGEROUS!
If you give your kids a trampoline, supervise them, one child at a time on the thing, use the safety nets, they are higher than they look.
I have seen more injuries where the patient had a good chance of losing their limb from trampoline accidents than from motorbike accidents.

Fathers Day (The Answers)

I was going back over some of the things I have written and I realised I have forgotten to tell you what I got from my kids.
I received a book I wanted, a new rugby shirt and a model boat tool from one and a model 18th Century boat to build from the other - they know I love 18th Century sailing ships and they are expensive to buy. Wife gave me a (expensive) DVD collection that I wanted for my birthday. All in all, very nice of them and I will make sure that they are remembered in my will

Pudding

A story over at Space to Rant reminded me of something that happened a few years ago. I was working a nightshift on an observation ward, just me and an HCA with about 4 male patients and 8 female ones in an old fashioned Nightingale ward, but we knew we would get more patients in later. One gentleman of the street was admitted, known alcoholic and lived in the local down and out centre when he remembered to go there. It was near Christmas and he had been admitted as he was drunk and had fallen and hit his head (PAFO - pished and fell over) no great worry and he only needed observed overnight. However he had Christmas puddings in his bag, I don't know if they were stolen or a present or if he was in a Christmassy mood but each one weighed about a pound, and I had placed them in the ward kitchen to keep them safe (there was no way any of us were going to eat his stuff so it WAS safe). After a couple of hours sleep he woke up and demanded his Christmas puddings, I explained it was very late, that he would get them back in the morning, that he should get his head down and go back to sleep. I even told him that he was barred from eating in the ward outwith mealtimes. No effect, he demanded his puddings and was actually singing "I want my puddings, give me my puddings I'm hungry give me my puddings" He was annoying the other patients as well as me so I made the decision to give him his puddings for a bit of piece and quiet. I did NOT say the words "I hope they choke you" as I gave him the pudding (honest), but perhaps it crossed my mind. So I had quiet for a few minutes as he ate his pudding, suddenly I realised that perhaps that was not snoring but a choking sound coming from his bed. I rushed over to find his mouth full of pudding and he was choking on the rest - the stupid bug**r had pushed the whole pudding in in one go. I scooped out what I could and performed the Heimlich maneuver a whole gob came out and he started breathing again, I called for medical help and he was fine in a very short time after we made sure that he had not aspirated a pudding into his lungs. He still had the cheek to demand his other pudding after everything had settled down.

Weekend

Saturday was very busy and not made any easier by the drug addict who informed me that he had missed his chemist and did not have his medication - what was I going to do about it! Answer, nothing pal, it is your problem. He then thought he would try the guilt card - if we did not give him medication, he would be forced to get illicit drugs. This does not work on me or our department so he was thinking about getting aggressive and abusive but thankfully changed his mind and left. If you had not thought that it was 5:00am instead of 5:00pm you might have realised that you need to get to the chemist instead of coming to us and telling us that your head was "buzzing". He managed to get a taxi to the department and blamed the taxi driver for not telling him it was the afternoon instead of the morning. How does he manage to afford a taxi? I have been unemployed in the past and struggled to afford bus fares never mind taxi fares, but then I always wasted my unemployment benefit on food and rent for my family. I'm really starting to wonder if being unproductive and lazy and sitting at home sponging from the state is the best way to go. Never mind, I will do enough sponging from the state when I retire in a few years, only problem is, I have managed to build up a pension through the NHS so it is unlikely I will qualify for benefits when I retire. Ah well, can I still work as a nurse at 70?

After having to work Saturday I decided I needed some down time, so having relatives in Dundee I went there to catch the Blues Bonanza on Sunday. Absolutely superb and I can thoroughly recommend it if you like live music in a nice friendly atmosphere. A couple of bands I saw were the Rattlesnakin' Daddies and The Jed Thomas Band, very very good. Next year I will make sure I am off for the whole weekend.

Being Scottish

At last, we men are getting a screening all of our own. Women have, quite rightly, had smear tests and breast screening for years and we have had at best bowel cancer screening - although this is a unisex one. Finally, there is one being offered to men only. It's for Aortic Aneurysms see the report here. Unfortunately for the rest of the UK it is only being offered in Scotland. Now I don't know if this was first thought up by the previous labour executive but it has come in under the SNP executive, and along with other things that are going on up here - prescriptions going down in price until they are free springs immediately to mind, makes you wonder if one bunch of Scots can do some things so well and so popular, what happened to the other Scot in Number 10 Downing Street? Why are they not offering this screening down South? Being Scottish has it's advantages, despite what they say in Trainspotting. Unfortunately we still have the highest death rates from Heart problems in the UK.

A Sunday Morning Moan

The weather is horrible here, I was supposed to be going to a family barbecue which will now be held inside and my wife is working today. So a quick moan.
When patients present at triage they say some strange things, we have a few tricks to allow us to determine whether you are really sick or if you can wait, these are unfortunately mostly down to experience and take a bit of time to learn, sometimes you will see something once and then never see it again. But these are the things which give us our challenges.
If you attend and tell me you are breathless I don't believe you - if you can tell me you are breathless in a full sentence, your not!
Telling me you have been unable to stand on the ankle you hurt 2 days ago and have not taken painkillers for will not get you seen quickly, I was watching you walk towards my room.
If I ask you for your pain score - 0 to 10 and I say that 10 is the worst imaginable do not say it is a 12. It makes you look a moron and we disregard everything you say. If you really are a 10 you are unable to tell me and I will know - trust me. (Yes, yes, I know other bloggers have mentioned this. It is a common theme with ED staff).
Don't tell me you lost gallons of blood from your little laceration, the human body does not hold that much, and a little blood goes a long, long way. Oh, and by the way - only very, very rarely is that the bone you see in the bottom of your wound - honest.
Telling me that you did not want to give your child his/her Ritalin or other medications or any pain relief "in case it masked the symptoms" is just stupid, no other word for it.
I know you are his mother, I know that he lives with you and that you love him,that he is your little boy and don't want to see him hurt, but please, let him answer the questions himself. He is 25 after all.
If I ask you about pain or disability or your problems, tell me the truth. I know you are sick, don't say you are fine, downplaying it does not help you, and it makes me look incompetent when my colleagues find out just how serious your condition is.
If you are 19, unemployed and have been since you left school, you do NOT pay my wages (nor does your dad). Get a job and then tell me that - and you're still wrong.
And finally, one for staff, if a patient comes in complaining of headache first thing in the morning and it is New Years day, do not assume that she is hungover. She probably is but she may not be. And the last I saw of that particular patient was her being wheeled to theatre after having a CT scan which showed a bleed in her brain. If nothing else it cured me of my cynicism.
Have a good day everyone.

We are the champions

Why do people fight in the middle of the night? They should be sleeping or at least sitting quietly watching TV. A radio call from the ambulance alerted us. "35 year old male stabbed in the chest, no pulse. We'll be there in 5 minutes". Luckily the senior doctor has not gone home, so everyone is alerted and standing ready. He is blue lighted straight into our resus room and the dance begins. It is unfortunately all very well rehearsed, we have done this before. Clothing is cut off, IV access is obtained CPR is ongoing monitors are attached fluid is hung up and run through. everything is getting done. Blood warmer which doubles as a pressure bag is already primed and ready. O negative gets started and blood is taken for cross match. The blood transfusion people are called to get more O neg while we are waiting, "Whats the patients name?" they ask, "we don't know" we tell them. "You need a name to get more blood" true but there are systems in place for situations like this. This technician has never heard of them and is not giving his blood out without a name. Only time I have ever heard the senior doctor swear. He grabs the phone and shouts down "Get the fu***ng blood here now." Blood duly arrives. Meanwhile we are fighting a losing battle. This guy is dead unless we do something but we are not giving up yet. Stab wound through the heart, blood everywhere. Get the thoracotomy tray, we are going to open him up. My job in all this has become a combination of photographer and transfusion nurse. I am taking photographs and then putting blood up and repeat - we can put a unit of blood through in 3-4 minutes and every one has to be documented and checked so I am kept busy as is everyone else in the team. The chest is opened, the wound in the ventricle found and sutured all while one doctor is doing cardiac massage but success, we eventually get the heart going - thready and weak - but going. Surgeons appear and take this guy to theatre to close his chest and then to ITU. He has got massive problems ahead of him, was he deprived of oxygen for too long, will he get an infection? Unfortunately, we will never know unless he dies tonight, as once patients disappear into the black hole that is the hospital we never hear of them again. But, he was dead when he reached us and he was alive when he left us. Good job by us and a quick chorus of Queen's "We are the champions".
What caused this stabbing? He was arguing with his brother while they were both drunk.

Fathers Day

What did you get for Fathers day? I got the chance to work a full shift and see a lot of injured people, actually had a good day, and even managed to get home on time. Mrs. Grumpy had made my favourite meal and the kids had left cards, well one had left a card, the other card had been delivered via those fine people at moonpig. Is there any presents for me? I asked. No, eldest is giving you a combined Fathers day and birthday present which you will get next week and my youngest's present (also a combined one) is coming in the post. Do I want to know what it is? What a dilemma, of course I want to know but if it is good then I will want it NOW, if it is poor I will have the time to practice my "isn't that wonderful" look. So I decide, no I will wait. After all I am middle aged and not a little boy waiting for Christmas - although I'm sure if you ask any wife she will tell you we are all little boys. I will keep you posted.
MY dad received his card and present on Saturday in plenty of time - but that was only because Mrs. Grumpy dealt with it all.

Doctors and Nurses

Doctor Crippen has posted a comment on his site from a junior doctor here. This piece shows how one doctor feels that he is embarrassed to cash in his cheque that he receives for signing cremation forms. He could have written a nice bit about this but (and I suspect this is the real reason Dr. Crippen posted it) he decided to tell about how the nursing staff are judgmental and abusive towards him, how the ward secretary hides notes from him and even the mortuary attendant does his job with no spark of intelligence and with minimum grace. I of course have added my twopence worth along with other commentators and I want to make my position absolutely clear.
I like junior doctors, the hospitals would fall apart without them and they have had such a crap deal recently with MTAS and pay and they are invariably great fun on a night out. I have a huge respect for medical training, I am sometimes overwhelmed by the encyclopedic knowledge that doctors display. However, doctors are not always the nicest of people. Their very training makes them abusive, arrogant and competitive. Some of the brightest doctors are in fact some of the most ignorant people. For many years doctors were bullies towards everyone, including each other, I have already mentioned this in a post here, most hospitals now have a bullying policy. Quick anecdote, young female nurse working on ward, consultant comes in to do the ward round and she is talking with a patient while he is doing the round. His reaction? He threw a ruler at her which hit her in the neck then carried on doing the round. Why were the police not called? Because he was a consultant and she was a nurse. A nursing lecturer liked to tell a story of one consultant she worked with who would some mornings start shouting and swearing at people, their reaction was to get him a coffee and toast as his blood sugar was running low. The common denominator here? Male consultants, female nurses. Bullying still goes on but it is less, what has changed? The ratio of males and females. There are more male nurses and female doctors now. However, the female doctors are just as aggressive and competitive as their male colleagues. But one big difference is that the number of males coming in to nursing has changed things. Consultants are a bit less willing to shout at a male who is liable to ask them the question "Who do you think you are speaking to?" Do not for one minute think that I am making doctors to be the villains and nurses the angels here, nurses are just as likely to be nasty to junior doctors and some nurses can be the absolute bitch queen. When I was training, one of my male colleagues (ex army) stated that he was going to ask a particular trained nurse if she was married and that if she was could she bring her husband in to the ward. When I asked why he replied that she was such a bitch that he wanted to punch her but could not bring himself to hit a woman so if he could get her husband then maybe he would sort her out, (it didn't happen). This behaviour by both sides is wrong, we are supposed to be professionals who work together for the benefit of the patient and on the whole this is what happens. But, when one profession thinks that they can get away with being nasty to other professionals then problems can occur. I would like to make it absolutely clear, when I go into work I do not expect strife and conflict, these thing only very rarely happen as we are a team and have respect for each others skills and knowledge. Happens a bit more around the time we get new doctors and it's mostly to do with changes of procedure and trying to get doctors to realise we are not like ER or Casualty.
Back to the point of this post, the junior doctor that Dr. Crippen writes about has obviously had a hard time, he is disillusioned and demoralised. Whose fault is this? He blames the nursing staff for making his life harder than he feels it has to be, but is he correct. These things tend to work both ways, if he gives attitude, he will receive attitude. He is only in the ward for 4 to 6 months so nobody has to care about him, but if he makes an effort in his next placement, tries to be nice to people, who knows, he may even get the nursing staff to help him. "Stupid is as Stupid does." (Forrest Gump 1994)

Arrest Avoidance

Have not posted for a while as a post by mouse here has given me food for thought. I have had a lot of things to write about but it has been difficult to make them truly anonymous, so as I like my job and still have a mortgage to pay I have held back. This story however could and does happen in every city.
Female brought in by police under arrest for shoplifting. Caught in the act but decided that she did not want to go to jail or was trying to make the police's life as difficult as possible. Claimed that she had taken an overdose of Diazepam and needed to be taken to hospital. Police know that this is BS but have no choice but to bring her up. We know this is BS but have no choice but to admit her for observation. So she is admitted to the ward with 2 policemen as escort. First thing she does is demand food, now as it took a while to process her through custody then get her up to us it is now well past dinner time, next food will be breakfast in approximately 13 hours. We will stretch to some tea and toast and we might be able to find a sandwich but that is all we have to offer. Not good enough for this lady, she informs the police that they have a duty to feed her - correct, but she is not in the cells so they can't help and the hospital has different rules and is not governed by the criminal procedures act. She then starts shouting at us to feed her. We pointed out that this is a hospital, not a hotel and once the meals are finished that is that and we have no way to get her food. Next thing was a demand for food to be brought in from a fast food shop - curry, kebab, pizza, whatever. Sorry, that is against hospital policy in case of food poisoning. Surprise, surprise, she decides that there is nothing wrong with her after all and wants to discharge herself. So off she goes back to her cell instead of a nice comfy hospital bed which also releases 2 very amused police officers to go and do something just a bit more constructive.

Bank Holiday Monday

It's taken me this long to get my thoughts together and get over it. Monday started off well, traffic reduced and plenty of space in the car parks. It's not a holiday here but the schools are off for in service training so it all seems quieter, and of course there is always better stuff on TV. Nice quiet start to the day but I came back from breakfast to find a patient vomiting, not just vomiting but VOMITING!!!! I have never seen so much from one person - and of course he too had had a good breakfast. I no longer do vomit well, nowadays I am very likely to join in with the patient out of sympathy. Any way patient cleaned, sorted and admitted. The rest of the morning was uneventful until a young man appeared who had been dropped off by workmate. Writhing about in agony from his abdomen. Started asking the questions, "where are you sore?" "In my side going into my groin." "Does the pain come in waves or is it constant?" I asked. "I've not been sick" was the reply. "???" I thought I had strayed into a Two Ronnies sketch where you receive the answer to the question you were going to ask. Finally got an answer to my question. "OK, I need a specimen of urine then we will get a doctor to see you." Off he goes to the toilet with his little foil bowl. After 15 minutes I finally get 2 drops from him. I go off to test it telling him to make his way back to his trolley - which he can see as it is right in front of him and at most 50 feet away. I come back and no sign of him so I bang on the toilet door - yeah he'll be out in a minute. I get on with other stuff. 15 minutes later still no sign of him so I open the toilet door, he's lying on the dirty toilet floor - not passed out or anything sinister, just lying on the floor. I get him to walk to his trolley and a doctor goes to see him. Sounds like this guy has Renal Colic, best treatment is intra muscular Diclofenac which is a none steroidal anti inflammatory drug so I go to get it ready. I hear the doctor asking the correct questions - does he have asthma? Yes he does, OK, it is a bad idea to give diclofenac to asthmatics but he says he has had none steroidals before. Doctor decides to give Diclofenac. Just as I am about to prepare it he decides to inform us that while he has had none steroidals before he reacted badly. This is bad so to try to avoid killing this person we give him Morphine. This eases his pain so much that he now wants to wander round the department and go for a smoke. I got him out of the department as quickly as I could as I really wanted to strangle him.
After lunch there was a steady stream of elderly ladies with fractured neck of femurs some patients who thought just because their GP was on holiday ALL GP's were on holiday so came to us with primary care problems, and the usual holiday overdoses, self harmers, abdominal pains and generally unwell people. This kept me and the department very busy until home time - late off again. Next Bank holiday I'm going to have a day off and enjoy the TV or the sunshine like everyone else, whether it's a holiday here or not.

At the gym

Been a bit busy this week and not had time to post. Just been to the gym, need to keep the old bones nice and solid and stop any osteoporosis and try to keep the joints supple and the heart ticking over. Had a good session but why do people insist on walking right by me when I'm doing quad extensions? By the very nature of the exercise my feet are going to come up and hit you. So please move over 6 inches and don't give me a dirty look.
While I'm on the subject, this is to the guy who is an obvious candidate for steroid abuse. It's bad enough that you grunted and groaned like a mad thing when you did your exercises. It's also bad form that you slammed the weights into the stack every time you lifted instead of controlling the machine. But did you really have to move the pin to the very bottom of the stack when you were finished so that anyone coming up behind you would think you were lifting twice the weight you really were? I saw you doing it and I thought "dickhead" then I laughed.

Big white taxi

Something that Paramedics diary wrote here reminded me of a story from one night a few years ago. A young man from one of the outlying towns had been on a night out in another town about 10 miles from home. Had a good night and had spent all his money. Did not fancy a walk home at 2:00 am. So, as his home town had a small hospital with an Accident & Emergency department the bold boy thought it would be a good idea to dial 999 and tell the emergency operator he had taken an overdose. This way he would be taken to his local hospital and could then discharge himself against medical advice - apparently he had heard of it being done and was supposed to be good way of getting home. Unfortunately, what he did not know was that his local A&E department had been downgraded to a minor injury unit and he was brought to us, 16 miles from home. Give the lad his due, he was really giving an Oscar winning performance as what he thought an overdose should look like for the ambulance crew (who were not fooled in the slightest). Kind of spoiled it a bit when he leaped off the trolley when he arrived with us and said he was going home and had only called the ambulance so he could get a lift home. We asked him to sign the DAMA form, which he did, and off he went. Back in 2 minutes asking where he was, when informed that he was in our fair city he demanded that he be taken to his local hospital. It was pointed out that his local hospital could not deal with his presenting problem so he had to be brought to us. Next question was how was he to get home? I'm afraid we laughed a bit and said it was his problem and he now had further to go than when he made the call. He was given the phone and had to call someone to come and get him. I think one of his parents came but he did not let them come and talk to us and I think he told them he had fallen and hurt himself rather than that he was a selfish twat who abused the 999 service.

Nurses Day

A quick post tonight, just realised that it was nurses day yesterday (Monday 12th May), if I had not been reading the blogs I would never have noticed. Far too busy at work to worry about it and did not get a chance to read my e-mail from the RCN until it was all over. I was not the only one, none of my colleagues knew about it. I wondered why the American nurses were making a big thing about getting freebies from their employers - mostly cakes and pens - but hey it's better than nothing and more than I got and they even had a whole week for nurses. All I got was a very busy Monday and the chance to stay on after work for an extra hour as I could not get away on time. Ah well, maybe next year (hollow laugh).

Colleagues and other animals.

Had a young man in the other night with a minor laceration to his hand. Wound was closed and dressed but while he was alone in the cubicle I heard the cupboard door opening. Went in and had a look and there is the lad with a pocketful of tape and alcowipes. We asked him what he thought he was doing and got the usual answer - "nothing". We took the tape and alcowipes from him, he did not even know what the alcowipes were, never mind what they were for. Asked why he had taken them he did not know, they were there so they were his. Now I hate thieves, I really, really hate thieves. I sometimes think that there is a place for cutting off hands, but let's not get into that just now. I had a look in the cupboard and noticed that the needle stock seemed a bit low so I asked him to put the needles back. He of course denied he had taken needles. gave him one more chance - "put the needles back or I call the police". No, he did not take the needles. OK, police were called. To give the chap his due, he did not run off as I expected but hung around the department demanding that I search him - no way was I going near him.
Police arrived and had a word with him and his girlfriend, did a quick search and of course nothing was found. I was called to reception to have a word with the policeman where he informed me of the outcome but then said that the toe-rag was accusing me of assaulting him and his girlfriend was backing up his story. I was horrified, and tried to explain that the last time I hit anyone was 1969 when I was 14 and at school, where just occasionally you do have to hit people. Policeman was all apologetic but said I would have to make a statement and come down to the police station. I can't go anywhere, I'm in charge of this department we are short staffed as it is. then I remembered, we have cameras, surely that would show that I was no where near him. At this point the policeman, my colleague and the reception staff who were listening to this all burst into laughter. B*st**ds!! They were winding me up, the policeman blamed my colleague and said that he had been asked to do it by him and had quite happily gone along with the gag. Must have been a slow night. Not much I can do to the policeman but at least it proves that they do have sense of humour, but my colleague however will suffer, as soon as I can find a suitably dirty job for him to do.

Sugar, sugar

She's lying on the trolley as I walk past. A huge big mound of flesh, snoring. That doesn't sound right. What's this ladies story I ask. Brought in by ambulance with back pain. She's sweating profusely, pale and unresponsive and not really maintaining her airway. Since my CABG I do not try to lift people - especially someone as large as this lady - it hurts. So I can't turn her on her side. I try a jaw thrust with only a slight improvement in breathing - she has big fleshy jowls which are making it difficult to get good position. Airway, where will I get an airway? I've only worked in A&E for 15 years and this department has been opened for 10 years so where the h*ll are the airways? In the arrest trolley which is right next to me - idiot! I grab a nasopharyngeal airway, gel it and start to work it in - success, those ALS, ATLS and TNCC courses were good for something after all, not just an excuse to have a p*ss up. Her breathing immediately improves and this gives me time to get a blood sugar, 1.1mmols and considering "4's the floor" that's pretty damn low. She's cannulated and given IV glucose and within seconds she pulls her airway out, wakens up and starts ordering us about as if nothing had happened. This lady is a known (but not to us) diabetic, had taken her medication but had not eaten anything. I have seen this reaction before with patients who have very low BM's and it never ceases to amaze me how quickly people become better.

Ghosts in the system

This is not my story, but I will tell it as it was told to me with names changed.

A friend of mine once worked in a cardiothoracic unit in a large city. One night shift they were looking after the usual sick patients and expecting Mrs. Smith to die that night - family were called and everyone prepared. Another patient had overheard and stated to them "Mrs Smith is not going to die tonight but Mr. Jones over there is". "No, no" they said, "He is fine, it Mrs. Smith who is dying". the patient then said "No, Mr. Jones will die tonight as I can see all his relatives around him waiting for him". This is taking place after visiting time and the ward was empty except for staff and patients. Later that night Mr. Jones died unexpectedly and Mrs. Smith survived the night.

I tell this story because Jobbing doctor has something similar on his site here and every nurse has heard stories about green ladies, grey ladies etc. When I do nightshift in one part of the hospital, I am convinced I can hear a baby crying although there is no way that a baby can be in that area - other nurses have heard it too. Although I have wandered all over our old hospital on nightshift I have neither seen or heard anything out of the ordinary. One of my friends, a big rough tough guy is absolutely convinced that our old department is haunted. I leave it to the reader to give any explanations or reasons.

Smoking

Right from the start I am going to declare an interest, I smoked 20 a day since I was 15 but stopped 20 years ago.What is it about smoking that makes people illiterate? Our hospital, like every other one is completely none smoking and in fact does not allow smoking in the grounds. So, why is that people still smoke at the main entrance? They will smoke underneath a no smoking sign, they will even blow smoke onto the no smoking sign BUT they will not READ the no smoking sign. There is always any amount of patients and visitors who congregate there puffing away and forcing everyone to walk through their stink. Patients in pyjamas in the middle of winter, patients with drips, pumps and catheters all out chasing their fix as "they have a right" to smoke. I have even heard of patients in pain, being given morphine for the pain and then going out for a cigarette - this is a disaster waiting to happen but patients now talk about their "human rights" and the wards cannot stop them. What about my right to walk through a smoke free atmosphere? No, I'm just a grumpy old ex smoker who is interfering with their pleasures. The hospital has erected a shelter which is fenced off for those patients who have to have a fag, it is sign posted and out of the way, and more importantly it is not at the main entrance. But is it used? Not a chance! Now patients who smoke and are in for a while I can understand needing a smoke, but there is no reason on this earth for visitors to smoke - what do they do on air flights? If any member of staff dares to question these people and point out the no smoking signs, they are met with a torrent of abuse and occasionally violence - a doctor had his nose broken not that long ago because he had the temerity to say something. It can get worse, what about patients who take ill at the door? Who deals with that? The A&E department I work in has made it clear that any inpatient who collapses or faints at the front door has nothing to do with us. They are there against the hospitals advice therefore it is unfortunately their wards problem and the ward staff have to deal with it. We are not going to get into a situation I saw on television where an A&E was being filmed and the staff were called to the front door because a smoker from a ward had collapsed and a nurse and doctor had to leave what they were doing and rush to the aid of a smoker.Is there any solution, probably not, but at least we have managed to stop people smoking inside buildings. Although there is still the odd idiot who will light up in a toilet - and then deny it when challenged. We need to make smoking socially unacceptable the way drink driving is now. We need to try to educate people about the dangers, but they don't listen to TV adverts or education they receive. Despite the price of cigarettes and despite the fact that you cannot buy cigarettes in Scotland until you are 18, as I type this, I can see school children walking up the road smoking.
Moan over.

Face

A quick grump this morning. I'm in my 50's, so why does my face think I am 15? I am continually finding spots and blackheads, almost as much as when I was a teenager - well that's an exaggeration but you know the feeling. I moisturise, I clean my face but no, I still find spots. If only other parts of my body thought I was 15!

Eating our young

There is a post from FaithWalker here about being very shabbily treated by a ward sister, the Devils Kitchen has picked it up and had a few comments. Unfortunately this is not new, when MrGrumpy was training the abuse started in training school (we didn't go to university in those days) with the head of the school telling myself and the other male students that she did not like male nurses and we always caused trouble. I watched as a tutor picked on a young student as a way of controlling the rest of us (a (very) old army trick). I was aware of a sister on a ward who would abuse any young nurse she had until it got so bad that students were removed from her ward. I watched the new head of the school of nursing (a male, but not in my opinion a man) threaten to throw 2 girls out for allegedly falsifying documents - they had left their records of instruction in the changing room of the hospital and when they went back they were gone. So, on the advice of a tutor they got a new book and tried to get as many things signed off as they could in the weekend left. I should say that if the record book was not completed you could not progress in the class. Turned out, this "mans" wife had picked up the books and given them to him and instead of passing them to the girls concerned he kept them and waited to see what they would do. So when they turned up with signed books he accused them of forgery and tried to get them sacked. I have seen pre-reg students - students who had passed their finals and were just waiting for their 3 years to finish before they got jobs - in tears because a sister had abused them. I made up my mind then that I would never be treated like that, I failed, I had some problems from management. But I learned, I learned never go to a meeting alone, always to use the magic words "Lets see what the union thinks about that" and the even more powerful magic word "No".
I am going to play devils advocate for a minute, I wonder if Faithwalker is going about this wrong, should she be asking questions of the consultants in her first year? Would she not be better asking for information from the nursing staff, after all it is a nursing degree she is doing. I'm not saying she should not ask questions, but ask the right person - no-one likes a smart arse. I do not want students who work with me running around behind my back doing things without my knowledge - in A&E this is dangerous, and on the wards can lead to things being half done or missed out. And there is always more than one side to a story.
This is a problem which is international, there are many comments on nursing forums about this very subject so it is well known. I do not think that this is the reason for the large drop out rate of student nurses but is certainly a contributing factor. I would also like to say that I have seen students who say I will never be like that, and then when they reach senior posts become exactly like that. This seems to be an institutional problem and probably should be expected with an organisation as large as the NHS. We work with doctors whose very training makes them think they are better than everyone else, I refer you to almost any post by Drs Crippen and Rant. Some doctors think it is acceptable to be aggressive physically and/or verbally to nurses (but strangely not male nurses) although this type of conduct is slowly changing it is still out there. This behaviour would not be tolerated in industry, I have seen managers in industry punched who tried it on - I am NOT advocating this (although I do have a list of people who I think would be improved by a punch). All we can do is try to care for our students and colleagues the way we care for our patients.

Entertainment

Went to see Cirque de Soliel on Wednesday, absolutely wonderful, thoroughly enjoyable. Can recommend it. One complaint, why does it take forever to get out of the car parks, surely there could be a better system than 2 exits for hundreds of cars. And why do some people not read big red signs that say you have to pay to get out? One woman held everyone up because her bag was in the boot of her car, so she had to get out of the car and go get the money forcing everyone in the queue to wait even longer.

Eyes

Today was an eye day, saw about 4 people with Foreign Body (FB) in eye. I love these, they are so satisfying. If there is an FB you remove it and show the patient what a tiny thing was causing them so much pain. If the FB has gone you tell the patient they have a corneal abrasion - after staining the eye and making the abrasion glow a lovely shade of green. Patients who present with FB eye are a joy.
Today I had one lad who for the first time ever I was unsure if he could read the Snellen chart, I really was not convinced that he could read. He managed fine but was absolutely fixated on the "bits of plastic that went in my eye" I could not convince him that the plastic was gone and that what he had was a largish corneal abrasion. Got there in the end. One was a young lad who had mud in his eye 24 hours previously, sent up by GP as he did not have a slit lamp to examine eye properly. This time it was mum who was fixated on the FB, "did you see the top of the eye? That is where the mud was". Reassured and discharged. The last patient was a gentleman who had had left eye problems a couple of years ago which required the input of the ophthalmology service and had got a piece of wood in his right eye 5 DAYS ago and was concerned that he might lose his sight but had not bothered to come and see us or see his own GP. Reasons, - we required 2 bus journeys and he did not like his GP. Again treated appropriately and discharged, but what was I going to do 5 days down the line if there had been something wrong, and more importantly, what were the ophthalmologists going to do?

Young Doctors and new technology.

We've got new docs! Aren't they cute? However, one of them is not going to last. FY1 (JHO in the old money) was overheard speaking to someone and saying that he loves working in a heirarchical environment, as "he was able to tell people what to do". Oh dear, he is going to learn, and probably the hard way, that he is actually at the bottom of the heap. But they are there to learn and it is our job to teach them, but how he has got this far with such a stupid attitude?

Mr Grumpy has embraced modern technology, I have a mobile phone with a camera and MP3 player. My last phone was just that - a phone, nothing fancy it received and sent messages and calls and all was well in my world. This phone is WAP enabled and is driving me demented as I do not have a clue how to change my number or download or even make a call on this one. Does anyone have a spare teenager I can borrow?

Sex on the wards (again) and Angry nurses

Just when all the sensationalism was dying down and nursing was getting back to normal The Sun has got a front page article here about a male nurse having sex with a mentally ill patient. What is it with these people, they should know they are going to get caught, and they are just making life difficult for the 99.99% of us who behave. No one will remember that in over 25 years I and my colleagues have never abused anyone but this idiot, oh and the guy who was found guilty of killing patients a couple of weeks back are the ones that are remembered. When I came in to nursing it was very unusual to have male nurses but we worked at it and gained the trust and respect of patients and colleagues but there is always some clown will spoil it.

In another blog Disappearing John has written about nursing blogs that only seem to be about how bad peoples jobs are and how they hate their work and their patients and their colleagues. He suggests that perhaps if things are that bad they should move on and find another area of work. I had a look through some of my posts and there are one or two negative things but I think they are balanced by some other posts. In case they are not, let me put some perspective on my work; I love it, I would not do anything else and I have great colleagues. Last year when I was ill I was overwhelmed by the response from my colleagues and even last week when I was admitted over the weekend they were great. I would also like to say that my immediate management has been very supportive of me. However, I would like to say that I am lucky where I work as there are other areas that I would not work in for a pension. So in future I will try to remember that I think I am lucky but some more money would be good.

Overdose

She staggered in the ambulance entrance with an ambulance man on one side of her and a policeman on the other, "are their no fu***ng thin nurses in this hospital" she said to myself and my colleague. Charming, I thought, here we go again. "An overdose of unknown quantity of unknown tablets with alcohol" was the handover. There's a surprise. Then the policeman gave his side. "I don't have a lot of time for this nonsense usually but this is different". Turns out that this lady had been on a night out a couple of months ago and had left her children with a babysitter, unfortunately a fire had started in the house, no-ones fault it just happened, but her kids had died while she was out enjoying herself. Now all she wants to do is be with her kids. What do you say? What do you do? We can look after her physically but no matter how much psychiatric help we give her she still wants to be with her kids.

Retribution, divine or otherwise?

After my misbehaviour of Friday night and and my abject apologies of Saturday morning I thought I would be fine for the rest of the day. I was feeling well with only a minor hangover and looking forward to getting into work. However, as I went to my car I felt a slight chest pain - I should say that I had an MI and a CABG last year but felt I was making good progress. Pain resolved while driving but had another episode in work and working in an A&E unit everyone went into overdrive. Result? - seen by A&E consultant and admitted over the weekend. Everything was fine and I was allowed home Monday afternoon. So, many thanks to my colleagues and the staff in both wards I was in. Hmmm! I wonder if this had anything to do with Nurse k over at Crass pollination has she cursed me? I must have really pissed her off - nah I'm sure she's a nicer person than that.
Strange thing though, I have noticed that I seem to have acquired 2 pairs of pyjamas that are only for hospital use and my wife managed to fill my toilet bag only with what I needed and not with the crap that I usually put in it - has to be a girly thing. Oh and I really, really hate being on the other side - I do not make a good patient.
One good thing though, I managed to read Tom Reynolds book Blood, Sweat and Tea from his blog Random acts of reality I can thoroughly recommend it as it is a good read and is well written by someone who knows what he is talking about and more importantly seems to love what he does.

Oh dear! Here we go again.

Mr Grumpy likes a few sherbets on Friday night, this is a custom which has gone back years. People I work with all know this and almost all who live in the direction of the pub/club I frequent have been coerced into giving me a lift. I would like to point out that the maximum I have is 5 pints (10 units) and is usually only 4 pints. Although this is officially classed as binge drinking it is the only alcohol I have all week so I don't feel too bad about it. However, the point of this entry.
Last night I had the usual 4 pints but came home and had another 2 tins of cider (my wife was working night shift and was not there to keep me in check) and then I made the big mistake - I went onto the computer and looked at the blogs I have marked as favourites, . Oh dear! I apologize to anyone I have offended as I tend to get a bit bumptious with alcohol and tell people (online) what I think of their comments, the problem is that occasionally I have a sensible moment and delete my comments without publishing them but sometimes they get through uncensored. So to Nurse K at Crass-Pollination: An ER Blog and anyone else I have offended again I apologize.

I am now off to work to try to forget my little madnesses and hopefully fix other peoples.

Great to be back

Well I have survived, and I have only put on about 3-4 pounds (sorry 1.5kgs) and would like to thank the nice bars, restaurants and places of interest in the lovely city of York for keeping me and my other half amused and entertained. We had a great time and will be back. I seem to have missed an awful lot in blogland, blogosphere whatever the cyber world we inhabit is called. Trauma Queen has a couple of absolutely brilliant pieces here and Drs. Crippen and Rant with Mousethinks and I'm a medical student are all going on about the 4 hour targets in A&E. Now MrGrumpy knows a thing or two about this and thinks that properly organised they are the best thing for patients and staff but the emphasis has to be on "properly organised". I hear horror stories about patients being basically thrown out of A&E whether they are ready or not - this is not the way to do it. It has to be a collaborative system between A&E, GP's, Out of Hours, NHS direct, Physicians, Surgeons, Orthopods, Management and anyone else who is connected with patient care. It cannot be left as A&E's problem.

Anyway enough of my chuntering, it is nice to be back and I return to work next week refreshed in mind and body prepared to face the challenges of the 21st century NHS, (Oh God! Now I need another holiday).

Holiday

Mr and Mrs Grumpy are having a few days away together, we managed to get a really good deal for a short city break and hope to increase our cholestorol and alcohol levels by eating and drinking way too much and certainly more than is good for us. Who knows, there may even be a bit of marital rights thrown in. Leave on Sunday morning and wont be back until Friday.

The future

I liked this blog and agree with it so much that I have lifted it verbatim from "madness: tales of an emergency room nurse" and the original can be found here

I am one of the nurses you hear about that will be retiring in the next 10 years. I plan to retire in 5 years. I can retire early because it was negotiated into my union contract. The only thing that keeps me going to work at the hospital and not changing job is knowing that I am out of there in 5 years. If it wasn't for that I would have been gone long ago. There is no incentive to stay. Why should I keep breaking my back to do this job beyond five years from now? I could easily work for another 15 years at that place but I won't. Hospitals have no real interest in retaining nurses. They make piddly attempts like thinking magnet status is somehow going to attract and retain nurses. The average nurse doesn't give two shits about magnet status. You know what we want? We want more staff to be able to give the care the patients deserve. We want more money. We are worth way, way more money. Without us the health care system would crumble. But we won't get more staff. We will get our piddly 3-4% raise. We will continue to pay hundreds of dollars a month for health care even though we WORK in the health care system. The hospitals don't do more because they don't have to. Nurses haven't demanded in any nationally organized manner that they do more. The public hasn't demanded that they do more. They will. People don't realize the state of health care until they come into places like the emergency room and are shocked that they have to wait 5-6 hours for a bed. Its a wake up call. In fifteen years 5-6 hour waits will be a picnic. There will be many fewer nurses to take care of you, so plan on spending days in the ER waiting. Not only will there not be the numbers of nurses in the hospitals, but those who do go into nursing will not be working in hospitals long term. They are crazy if they do. Why would anyone in their right mind choose the degrading, stressful environment hospitals have become? If I were a new nurse I would run as far from the hospital setting as I could...So good luck to those who are now in their early fifties and up, because people like me won't be there to take care of you. The only way I would even consider it is if I made a lot more money then I make now. Otherwise in 5 years I'm out...

_____________________________________________________

GrumpyRN says,

I am in my early 50's, I have a lot of colleagues who are in their early 50's and we are getting tired. None of us want to be humping patients about in our 60's but in our university they had to cancel a new intake of nursing students due to lack of students and the next one was only half full. Even though this was written from an American point of view I could not put it better. The nursing profession the world over is getting old, tired, demoralised and just fed up of the continuing increase in workload.
When Mr Grumpy started nursing part of his job was to talk to patients to reassure them, to explain things to them (I had an old fashioned ward sister who shouted on me one day but insisted that I finished talking to the patient first as that was more important). I knew every patient in the ward and what their diagnosis was and what their treatment was. I would have been bollocked severely for saying to a relative "that's not my patient" they were ALL my patients because I was on that ward. I was proud to be a nurse, and although this sounds like snobbery I was a bit above the rest of the hospital staff because I was a nurse. I will give an example, when I started nursing, smoking was allowed in the hospital concourse, however, nurses were not allowed to smoke there even though they were not in uniform as this was seen as too "common" and gave a bad impression but other staff (including doctors) were allowed to smoke. Now the porters and the cleaners (who all have important jobs to do) are rated higher than me by management. If a job comes up the almost automatic statement is - let the nurses do it. We have cleaners who won't clean human waste, so, who does that? Yes you're right the nurses. I am trained to degree level in nursing, they are trained in cleaning but hey I'll do it. I am not talking about cleaning patients, I have never, ever been "too posh to wash" that is a basic function of my job.
So what happened? When did there suddenly become not enough nurses to give good quality care? I took it as a personal insult if one of my patients was not fed or lying in dirty linen or not washed if they were soiled. I don't work on a ward now but I remember. When did we start not having enough time to care for patients and looking after their basic needs. This needs a post all of it's own.
So hopefully, there will be a change and we get some good nurses who are well trained, well rewarded and well motivated before I retire and become decrepit and need somone to look after me.