I caught up with Dr Hitchcock in the staff office.
Im sorry to interrupt, I said, standing over him as he sat at the desk chatting to one of his colleagues.
He looked up with that same look of annoyance on his face. I placed the drug chart on the desk in front of him.
I dont want to disturb you unnecessarily I tried to keep the sarcasm out of my voice, but I dont think I succeeded because his expression showed even more agitation but this will only take a moment.
He glanced down at the prescription I indicated. What is your problem? He looked genuinely confused.
Well, can you please change the antibiotic to intravenous? Shes even got a line in already, I added.
Dr Hitchcock sat there in silence for several seconds, before he eventually responded to my query. If a doctor has prescribed it that way, then it is to be given that way.
With that said he handed me my chart, turned his back on me and continued the conversation with his colleague.
When a nurse gives a medicine that is wrongly prescribed, then that nurse takes some of the blame actually the nurse can lose their job, while the doctor gets a verbal telling off, so it is important to clarify anything you are unsure of. We all make mistakes, but the way to reduce errors is to be willing to listen to advice. I knew that one day Dr Hitchcock would stuff up, it was only a matter of time, but I was worried that he would stuff up big time now and I would be involved. I have seen an abscess form at the site of a deep injection and Ive seen the abscess worsen and eventually cause an infection that affected the whole body.
Half an hour later the registrar, a senior doctor, came to the ward and I wasted no time getting the change I needed.
No problem, the registrar said. I dont know why he prescribed it that way, thats very rarely used.
As the registrar seemed rather friendly, I told him about the problems I had been having with Dr Hitchcock.
Leave matters with me, he said, sounding very pissed off, Ill have a word with him, right now.
I wanted to stay and watch the action, but instead went to give Mrs Thornton her now overdue antibiotic.
After dealing with Mrs Thornton, I caught up with Dr Hitchcock again.
I have another problem.
It wasnt really a big problem, another minor prescription error, but I couldnt resist hurting the man when he was down.
What is it now? he hissed.
One of your patients has had a bad reaction to the enema you prescribed him.
Hes had a reaction to an enema? Dr Hitchcock responded, sounding incredulous, although I cant say I blame him, as Ive never seen anyone react to an enema.
I explained what the problem was.
Well, you did prescribe the thing orally instead of rectally, and it didnt go down too well.
Dr Hitchcock called me something rather unpleasant but it brought a smile to my face to leave him standing there seething.
Bad news, good porn
Youre a man, someone said to me when I explained that I was the agency nurse for the afternoon.
Last time I looked, I replied.
I can make good use of a man, she added, a thoughtful expression on her face.
The woman with the acute observation skills was Stephanie, the charge nurse for the afternoon. I took notes while she read off a list of patients, their problems, and divvied them up among the four other staff nurses. I waited for my names, but received none.
Um, Stephanie, you havent given me any patients.
Stephanie smiled and nodded her head.
Thats right. Ive got a very special patient, just for you.
But, one patient? I added, wondering what exactly she meant by special.
Oh, dont worry. We meant to cancel you, but never got around to it, so were one staff up. Dont panic we treat our agency staff well here.
The patient Stephanie was going to give me was a young man who was away from home, alone, and had been in hospital for eight days. He had just turned 18.
Stephanie took me to his room and introduced him to me as Jan.
I immediately found myself unable to take my eyes off him even though I had known what I was going to see. From the whites of his eyes to his bony ankles, Jan was yellow.
As you can see, hes extremely jaundiced, Stephanie explained. The doctor is very worried about him. We should be getting some test results today.
Id seen plenty of adults with Jans condition, whether due to liver disease, obstruction in the ducts to and from the gall bladder, or cancer, but I had never seen an 18-year-old boy with such discoloured skin.
The yellowish pigmentation you see in jaundice patients is a result of the livers inability to remove bilirubin. Bilirubin is made up of red blood cells which have naturally broken down. It combines with bile (which is produced in the liver) and is normally excreted in the bowel motion (its what gives a stool its yellowish/brown colour). If this process is impeded, the build-up makes the skin turn yellow.
Hello Jan, I said.
Jan looked at me with a smile on his face. Dzien dobry, hello, hello, he replied.
How are you? I asked.
Dzien dobry, hello, he repeated.
I looked over at a sheepish looking Stephanie.
His English is not the best, she confessed. I think he could do with some male company. Hes had nothing but women around since hes been here.
I knew some people who would pay good money to be surrounded by women all the time, but I suspected Stephanie had a point.
We have an interpreter coming in about half an hour. The doctor is going to give him the results of the tests he has had done, Stephanie said before leaving the room.
What does one say, or do, with a yellow-tinted Polish teenager who has very limited English? Speak slowly and loudly.
I.Am.From.Neeeew.Zeealllaaaand.
Jan looked at me. His brow was knitted in concentration, but there was no sign of comprehension.
Do.You.Need.Anything?
I still saw no indication that he understood, although he was smiling obviously enjoying the entertainment. I was about to ask something different, when Jan interrupted me.
You are funny. When the doctor here?
His English didnt seem so bad after all.
Half an hour later, two women accompanied Stephanie into Jans room. One had the usual white doctors coat and was introduced as Dr Brown; the other was dressed in casual, but tidy clothes. Her name was Kasha and she was the Polish interpreter. No one was smiling; in a flash the mood changed from awkward and amusing, to sombre and serious.
We have the results back from your tests, Dr Brown said.
Everyone waited while Kasha translated.
Jan nodded his head.
Im afraid it isnt good news. You have cancer of your liver.
After Kasha translated Jan sat there unmoving, silent, staring ahead.
Can you treat it? Jan asked through Kasha.
We can try. We want to begin treatment tomorrow. I cant promise you anything. Its looking very serious and Im sorry to say, but there is a chance that treatment may not work.
Rarely had I heard such blunt words from a doctor. Normally they were a bit more diplomatic, usually waiting until treatment had begun before talking about success or failure. For Dr Brown to be so frank the cancer must be well progressed. Jan seemed to come to a similar conclusion.
How long have I got? Jan finally asked Dr Brown.
There was no answer.
I looked at Stephanie, she was staring at the ground. The doctor sat on the bedside and clasped Jans hand.
We dont know for sure. The sooner we get started, the better. The translator stumbled over her words and had to repeat herself. But the answer wasnt good enough for Jan. He again asked how long he had.
I could see Dr Brown struggling with an answer, but Jan again insisted on a time frame.
Maybe a year. Maybe four months, Dr Brown finally said. But we dont know for sure. You could respond well to treatment. Its just too early to tell.
Jans calm exterior cracked and tears streamed down his face. I sat down at the foot of the bed, my legs weak. Stephanie and Kasha sat down as well and grasped Jans hands in their own. No one spoke.
Eventually Jans whispered voice filtered through: Mum and Dad will be here in two days. Dont tell them anything yet. I dont want them to worry.
Stephanie, Dr Brown and Kasha made to exit the room.
Is there anything you need before we go? Stephanie asked.
After Kasha translated, Jan shook his head. I got off the bed and looked at Stephanie, my eyes pleading dont leave me here.
Ever-observant, Stephanie asked Jan if he wanted me to stay.
Jan looked at me.
Yes, Jan replied in English.
Just before Kasha left the room she pulled me aside.
He understands a lot more English than you think. Stay with him. He likes you, and he shouldnt be alone right now.
What does one do with a yellow-tinted, Polish teenager who knows a little English, and has just been told he may die within the year? You sit in silence because there is nothing to say. Even if there was, I couldnt be sure exactly how much he would have understood. I got off the bed and turned on the television. I sat with my eyes glued to the screen, waiting for him to make the first move.
Do you have girlfriend? he asked me.
His question caught me off guard. No. No one will have me.
I guess he understood because he managed a small smile.
Do you have one? I asked in return. He shook his head and managed a small chuckle.
Not get girlfriend now. Not this colour.
It was a clever remark, but I didnt find it amusing. I pictured myself in his position, away from all my family, counting my life in months, weeks, days; Im sure I would never laugh again. Maybe Jan was being brave for my sake. Maybe he needed to be alone after all, so he could let it all out: cry, howl, scream, punch, hit, slam something.
I considered leaving, but then wondered if it might have been me that had the problem?
Id never been in this situation before. Until then everyone who had died or was expected to die had been old. It was always sad, often unfair and it could be heartbreaking, but it was more acceptable than this, and was easier to cope with.
Its okay, Jan said to me. Its okay.
What was he talking about? I got the feeling he was trying to reassure me. Was I being that transparent?
Jan turned his attention to his bedside cabinet; he pulled out a small stack of magazines, and handed me one from the top.