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.