Once Upon A Time.....Part Six

Seems a long time ago since I published Part 5 of Once Upon A Time-back in July. Time to catch up!!

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After my introduction/probationary period on Surgical Ward Two (Delhi Hut) and my having progressed through the nursing training levels Three (bottom rung) and Class Two, my leaders decided I was suitable to be let lose on a wider range of patients. I was moved to Surgical Ward One (S1) later to be re-named Douglas Ward. By this time, Intensive Care Beds had been returned to the ward following completion of the refurbishment and upgrading.

S1 dealt with "Clean Major" orthopoedic and General Surgery. This was REAL nursing. By the way, I don't wish to upset anyone reading this that might say that all nursing is REAL nursing. You would be right of course-its just that for me it was such a change from the pilonidal sinuses, zadeks, dental extraction and piles that had been my bread and butter to date. It was a step closer to getting into Theatre as well.

I came of age so to speak in nursing terms while working there. Firstly, I learned that having passed my Class Two nursing examination did not mean that I knew everything. It was another door opening that led me to gaining more knowledge. Back on Delhi Hut, I had become a kind of "senior" what with the time spent there etc.On S1, I was once again "the boy."

This is where I learned that nursing involved a hell of a lot more than just changing dressings, handing out medicines and tablets, bed baths and massaging pressure points on long term bed bound patients. I learned the art of "observation." No, not simply taking temperatures and recording patients bowel habits, but observation in terms of noting patient behaviour and in observing the relatives of the seriously ill patients which would help me learn how to deal with them during visits.

Noting patient behavior was and possibly still is very important. Some patients became used to and in some ways dependant on remaining in hospital. Others couldn't wait to get out and would sometimes claim to be recovering quicker than they actually were, in an effort to get out quicker.

It was here that I had my first experience of nursing the terminally ill, and, to my everlasting shame, being a part of the machine that did not at that time, allow a person to die with their dignity intact. To be honest though, nursing has changed and what is known as the holistic approach to the patient has changed this. I remember helping to admit an Army Catering Corps Sergeant to Intensive Care and preparing him for a laparotomy the following day. He was convinced that he had stomach cancer. He more than once said, "your'e preparing me for the mortuary." No amount of discussion would get him to think otherwise.

The following day, a tuesday, (general surgery day) he went to theatre. We all looked forward to his return and the good news that his fears were wrong. He came back to us complete with a unit of blood and two more cross matched for him. His notes accompanied him, as did the consultant that performed the laparotomy. One the patient was settled, we nursing staff on duty at the time along with the sister, were taken to the office for a meeting with the consultant. The diagnosis was stomach cancer-our friend was right all the time. I wasn't sure how I would cope with nursing a man who knew he was going to die. This was yet another "growing-up day" for me.

Earlier I wrote that I was part of the machine that did not allow a patient to die with their dignity intact. Today, a patient would be advised as to their state of health as well as the possible/probable outcomes and visited by the palliative care team. All care would be taken to ensure the patient retained their dignity at all times in terms of their maintenance, nursing care and pain relief when required. Back in those days palliative care was unknown. The patients wishes came second if not third, and NURSING came first. I remember having to give this guy injections of pen and strep, injecting into his thigh against his wishes, and hearing him scream as it went in and then cry as the pain lingered for I don't know how long afterwards. I also remember him being taken back to theatre for a second laparotomy-for what reason I will never know. His pain was worsened, he begged to be left alone to die and for something to take the pain away. Of course he did die eventually, and not a moment before time I am sure he would have thought. Dignity however had been taken savagely away from him, his family watched him die without dignity and they would have known that he would not have wanted them see him die that way. None of us wanted that for him-thats just the way nursing was in those days.

Why have I told you this? Because it was the deciding moment for me that nursing was truly not for me. I had thought on occasion that I might stay as a nurse and not move into theatre. Not now though.