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Mr Kent had been admitted to hospital because he had woken up one morning and found that the left side of his mouth was not quite working properly. When he had gone to look in his bathroom mirror, he noticed that this side of his mouth was drooping slightly.
The hospital doctors were concerned that Mr Kent might have had a small stroke, or even just a TIA (a Transient Ischaemic Attack – a mini-stroke).
‘A mini-stroke, now I’ve heard it all, next you’ll be trying to admit me,’ and of course they did.
Luckily none of Mr Kent’s limbs appeared to have been affected: there was no telltale weakness or paralysis in his arms or legs; and even though his mouth had a slight droop, his swallowing had not been affected.
On the third morning of Mr Kent’s stay with us the doctor decided to change his medicine slightly. For the last five years Mr Kent had been taking half an aspirin a day; the doctor now wanted to give him an enteric-coated aspirin, which has a protective outside layer so it’s less rough on the stomach. It was a good idea of the doctor; Mr Kent should have been on this medication years ago.
Aspirin is one of the most common drugs given to patients, but it can help prevent some serious problems. It thins the blood, thus reducing the risk of clots forming, lessening the likelihood of strokes (clots in the brain) and heart attacks (clots in the arteries that supply the heart).
The only problem was Mr Kent seemed a touch reluctant to take the new enteric-coated aspirin.
‘I’ve made it this far on my own with one leg and I will not be told what’s good for me by a boy.’
I could feel my face turning red as I sensed the eyes of the three other patients in the room on me. I had no reason to be embarrassed, and I certainly needn’t have felt stupid, but I did.
I suppose Mr Kent’s stubbornness was a way for him to stay in control of the situation, but I was resolute: I would make him see reason and win, especially as I had an audience. After all, it was for his own good.
‘If it makes you happier, I’ll have the doctor come in and explain things again,’ I offered, but Mr Kent just sat there with his arms crossed.
‘I don’t want to talk to him either,’ Mr Kent said, referring to the junior doctor. ‘I want to see someone old enough to know what they’re doing.’
‘Well, I can’t force you to take it,’ I said, changing tactics and making as if to exit the room.
‘Hold on a minute,’ Mr Kent piped up, ‘I never said I wouldn’t take the blasted thing.’
Why the sudden change of heart? Again, it was another way for Mr Kent to retain some control of his situation.
‘Get the doc. I’ll listen to what he has to say and then decide.’
I didn’t argue. Soon the doctor reassured Mr Kent that the change was in his best interest. Fifteen minutes later, the battle was over and I was the victor – although it didn’t really feel like a victory. As Mr Kent brought the aspirin to his lips he kept his eyes glued on mine; he wasn’t smiling and he certainly wasn’t happy. It wouldn’t have surprised me if he gave in just to have some peace and quiet.
With a sense of relief I left Mr Kent to his own devices and walked away down the corridor feeling at least content in the knowledge that I had done what was right, even if Mr Kent wasn’t 100 per cent convinced . . .
Beeeeeeepbeeeeeeeeeeep!
It was coming from Mr Kent’s room. Someone was probably sitting on their call bell – at least I hoped that was it – but as I turned around and hurried back to his room, I had a sinking feeling in my stomach.
I entered Mr Kent’s room and his eyes locked on to mine. He was struggling to sit up and reach his walking stick, but the right side of his body didn’t seem to be working very well. He kept on falling back on to his pillows. His right arm wasn’t doing what he wanted; it seemed to be determined to lie there like a lump of lead. His droop had worsened and his mouth was hanging slightly open. Mr Kent was having a stroke right in front of me.
I watched, with mouth agape and a sickening feeling in my stomach. The stroke didn’t stop him from being able to talk. ‘You’ve done this to me; you’ve killed me.’
I’m sure his voice must have been slurred, but I heard every word very clearly.
My skin broke out in goosebumps. I tried to help Mr Kent sit up but he waved his good arm in my face.
‘Get away. You’ve done enough damage already.’
I could feel the eyes of all the other patients in the room on me: disbelieving, shocked, accusing. I was to blame; it was my fault – I had forced him to take the new aspirin. At least, that was how they must all have seen this. I was responsible for setting this man on the path to death.
I couldn’t think rationally. I tried to help Mr Kent again; this time he didn’t speak to me, instead he made a loud moaning noise, a noise that spoke volumes. His stroke was progressing rapidly.
It felt like forever before the other nurses rushed in to find me standing there doing nothing – immobilised by shock; racked with guilt. The doctor was called and I left the room on the verge of tears. I was in no state to see any of my other patients. I knew if I went in to see one, I would no longer be able to hold back the flood.
Worst of all is that part of what Mr Kent said was true: the stroke probably was the end of him. Even if he survived, the effect the stroke would have on his mobility would be a huge blow, especially with a prosthetic leg. Once mobility is gone it’s never good; it’s a very slippery slope, especially in the aged.
Looking back now, I realise that Mr Kent’s stroke had nothing to do with either me or with the new aspirin. However, in Mr Kent’s mind, I was to blame. If he is still alive today, he probably still blames me, probably genuinely believes it was my fault. That is not a nice feeling, but I have come to understand that there are some things you cannot change and I can live with it.
I left work that day feeling as miserable as I ever had felt in my life. I was still battling with tears. I was only 21 years old, and just like Mr Kent had said only a short time ago, still a boy really.
The meaning of teamwork (#ulink_33f39977-72d5-55c3-aa4d-509f0b0998f4)
Mr Simpson was 45, fit, and an avid golfer. His biggest worry was whether he would still be able to play after the surgery he was having the next day. I explained that if all went well in the operating theatre, there should be no reason why he couldn’t continue to play golf.
Mr Simpson was by no means my first surgical patient, but he was the first patient that I had prepared for his type of operation. He was going to have a femoral popliteal bypass graft. Basically, the circulation to one of his legs was rubbish, and the surgeon was going to put in some new plumbing that would fix the problem. If the surgery wasn’t performed, Mr Simpson could eventually lose the leg.
As horrendous as my recent experience with Mr Kent had been, I felt happier in my new environment. It certainly helped that I wasn’t dealing exclusively with sensitive matters pertaining to female health, but the main reason things felt better was because of the team I was working with.
Katie was the nurse in charge for the shift, and she was great. Katie was always there to lend me a hand. Whenever I needed help with a wash, a lift, a wound dressing, advice of any kind, she was the person I turned to. Katie had already asked me several times if I was going to be okay looking after Mr Simpson on my own, and after reassuring her that I felt I could cope, she made it clear that I could come to her for help or advice, no matter how trivial. Knowing I had some support gave me a rare feeling of confidence.
Everything went smoothly and Mr Simpson was wheeled to the operating theatre at 7.30 in the morning. I didn’t see him again until one o’clock that afternoon.
‘How was it?’ he asked me for the third time in the last hour. With leftover anaesthetic in his system and a pump infusing him with intermittent morphine, that sort of thing was to be expected. I reassured him all went well.
The next day Mr Simpson was a bit livelier, and asking about when he would be able to play golf, but I still would not give him a definite answer.
By the second day post-surgery, Mr Simpson was in fine spirits, mainly because there was live golf on the television. I left him in peace and reminded him to call if he needed anything.
Thirty minutes later Mr Simpson’s bell went off.
‘My leg feels worse; it’s more painful than normal.’
Up until now his pain had been well controlled, so it was a bit of a surprise that it should start being a problem now.
I began to examine his leg, worried at what this could mean. I checked the pulses in his foot, to make sure the blood was still getting through. I examined his calf and his thigh. Thankfully there was no swelling. As a precaution I went to search for Katie and get her opinion.
I never got a chance to chat with Katie as I was distracted by the call bell of another of my patients.
Mr Dexter was one of my medical patients. He had pain in his chest, caused by angina. Simply put, the arteries supplying the heart were not letting enough blood through, resulting in poor oxygenation of the heart muscle. It’s the lack of oxygen that causes the pain.
Mr Dexter had a small bottle of spray which he was supposed to squirt under his tongue whenever he had chest pain. The medicine dilated his blood vessels, including the ones that supply the heart. Hopefully this would allow more blood and, therefore, more oxygen to the heart muscle.
He explained that he had given himself a dose five minutes ago. I instructed him to give himself some more spray. It works very quickly, within moments of taking it. I waited the recommended five minutes to reassess.
‘How bad is the pain now?’
I didn’t get a chance to hear how the pain was, because the call bell in Mr Simpson’s room went off, and continued to go off. It wasn’t stopping. I ran to his room.
‘Oh shit, it’s agony,’ Mr Simpson said as soon as he saw me.
I looked at his thigh and knee and placed my hands on them. I could feel something hard in his thigh. It wasn’t swollen to the naked eye, but I could definitely feel a lump that wasn’t there before. It was also hot. By the time I went to feel for a pulse in his foot, the other nurses on duty that shift were in the room.
Katie took charge, and within minutes had the doctor at the bedside. Katie told a terrified Mr Simpson that his graft wasn’t working, and that he needed to go back to theatre.
The head surgeon was urgently called back into hospital. During the next hour, myself, the junior doctor and the registrar made what preparations we could to get him to theatre. That hour was probably the most terrifying in Mr Simpson’s life. There was a chance that he would not only never play golf again, but possibly lose the leg altogether.
When he finally left for the operating room, the last of the adrenaline left my body and I felt physically and emotionally drained. It was also at that moment that I remembered Mr Dexter and his chest pain, as well as my other four patients that I hadn’t seen in all that time. I ran to Mr Dexter’s room, expecting to find him either clutching his chest in agony or dead.
He was sitting up reading his book. ‘Are you okay?’
‘Why shouldn’t I be?’ he replied.
I briefly felt relieved, but I rushed to check on my other four patients. Their medications were late . . .
. . . but they’d all had their meds. They were comfortable. All their needs had been taken care of.
Katie and the other nurses had seen to every one of my other patients.
This kind of generosity was not to be unique. Over the next two years I learnt that, in this ward at least, it was normal; the nurses worked as a team, and always watched out for each other.
Big man, big heart (#ulink_885fccf1-a764-5718-80f7-58712f2297c9)
Part 1: Who is Mr Groom?
Feeling part of a team was what made nursing truly enjoyable for me. I no longer dreaded going to work each day. I didn’t have that nauseous feeling in my stomach whenever I had to approach a senior member of staff. The biggest improvement was in the confidence I felt about looking after more challenging types of patients, which was fortunate because I was about to encounter one of my biggest challenges yet.
‘Are you okay having Mr Groom again?’ asked Carol, the nurse in charge.
What could I say? No, I’m worn out, he’s too heavy, too much work?
I had been looking after Mr Groom for what felt like forever and was hoping for a bit of a break, but whenever it came time to allocate his nurse there was always a silence in the office.
My adventures with Mr Groom had begun four days ago. I had just returned from my days off. The problem with coming back from time off is that you are at the bottom of the priority list when it comes to picking and choosing patients. To be fair, everyone is generally pretty reasonable when allocating patients, everyone takes their share of the demanding ones, but every now and then there comes along one patient whom no one really wants to be responsible for.
The first time I had met Mr Groom, I couldn’t believe my eyes; before me lay a sweating, rippling, heaving mass of flesh, covered almost head to toe in traditional Maori tattoos. He was one of the most obese men that I have ever had to look after. He must have been at least 180 kilograms.
Carol tried to be encouraging. ‘He needs someone strong and you’ve done so much for him; you’re good for him.’
I didn’t see exactly how I was good for him. We were too different. I come from an average white family, from an average white part of town. Mr Groom is an ex-member of Black Power, a gang with offices throughout New Zealand. Not a group to cross – even an ex-member – they eat boys like me for lunch.
‘Good morning, how are you?’ I asked Mr Groom.
At the sound of my voice he rolled over towards me, the bed springs protesting beneath him, and greeted me with a huge, gap-toothed grin.
‘Morning,’ he replied, then, after pausing to catch his breath, ‘Could be better, bro.’
Poor Mr Groom, he was only 35 years old, but he looked ten years older and had all the problems you would expect in someone twice his age. I could tell just from looking at his swollen legs, that it wasn’t all fat – there was fluid in them, a sure sign of a failing heart. Just to prove myself right, I poked my index finger into his ankle and left an indentation that faded away very slowly. Mr Groom’s joints also looked swollen and I wondered how much longer they would put up with being abused, before giving out completely.
Mr Groom had never been in hospital before, but he’d developed a bad case of pneumonia. In most 35-year-old men, a case of pneumonia would probably not need hospitalisation, but because of his weight he needed to be with us, especially now, because it looked like his condition was deteriorating.
With someone as big as Mr Groom, it’s never really just a simple case of pneumonia. He already had a diagnosis of heart failure. His joints always ached, and it was an effort to walk, even when well.
Mr Groom was drenched in a cold sweat, his hands were shaking, and as I clasped his wrist, I could feel his pulse racing. His eyes had a glazed look about them, as if he was in a world of his own. But it was his laboured breathing that caused me most concern.
‘How long has your breathing been this bad?’ I asked him.
Surely he hadn’t been struggling for breath all night? I knew the night staff would have done something.
‘It just got bad in the last hour’ – he paused to get his breath – ‘started about six this morning’ – pause – ‘came on really quick.’
He smiled again at me.
‘Why didn’t you call the nurse sooner?’
A rather pointless question, it wasn’t going to help, but I just had to know.
‘They had a busy night’ – pause – ‘didn’t want to bother them.’
Not the answer I was expecting.
There was no time to waste; I grabbed Carol who took one look at Mr Groom and immediately came to the same conclusion as I did. We went into the corridor to discuss our plan of action.
‘We need to get Dr Grey down here right away,’ Carol said.
‘Are you sure?’ I replied. ‘Why don’t we get the registrar instead?’
Dr Grey was the new junior doctor and had only qualified in the last few months. It’s an unfortunate truth that some junior doctors don’t listen to the nursing staff, and it looked like Dr Grey was turning into one of them. Just the other day we’d pointed out to him that one of his patients normally took his blood pressure medications in the evening before bed, because the patient said if he took them in the morning, he fainted. Dr Grey had disagreed and prescribed them for the morning, and sure enough the patient collapsed because of low blood pressure. The nurses were there to catch him. They also suggested perhaps reducing his dose, but this never happened either.
Carol thought over my suggestion for a moment or two.
‘You may be right, but we’ve got to give Dr Grey a chance.’
Fortunately, today Dr Grey surprised us all. He too took one look at our patient and did the wisest thing I had seen him do in three months. He called his registrar. Registrars usually have a minimum of four or five years of experience, and can usually be relied upon when complications arise.
The registrar took Mr Groom’s pulse. It was weak, but pumping along at 110 beats per minute. His breathing was rapid and shallow; he also had a high fever. Mr Groom had developed a sepsis – meaning the infection had got into his bloodstream – and a sudden worsening of his heart failure on top of his pneumonia.
With these added complications, Mr Groom was in a very serious condition. The doctors contemplated transferring him to the intensive care unit, but due to a shortage of beds he stayed with us. He was so weak that he was unable to stand, or even sit himself up in bed; the most he could do was roll from side to side.
‘It’s pretty bad, isn’t it?’ Mr Groom asked me.
It was. He could potentially die, but all he did was smile at me. It seemed I was more worried than he was.
‘Don’t worry,’ he said, ‘I know you’ll be able to fix me up.’
Was he trying to put me at ease, by putting on a brave front? If I were in his position I would be terrified. But his cool calm didn’t seem to be an act. Did he, by some chance, have that much faith in us, a complete belief that the doctors and nurses will be able to do just that? I wish I had that much faith in myself.
Let the battle commence.
