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?