Good shit, he said.
I was holding a porn magazine.
The next hour was one of the most unusual of my life. A young Polish man with limited English and a New Zealander with a dreadful, drawling accent tried to rate the talent of each woman on display. When I eventually left I felt, if not exactly happy, at least a little more at peace with the world.
So far, in the few months that Id been working in London, I had worked with people from all over the world. And, it didnt matter whether people were from deepest Africa, Norway, South America, or any place in between, if a person had a sense of humour, it could make a bad day, good.
Magic medicine
You wont be having any patients, said a tall blonde nurse.
Her name was Susan and she seemed very serious. I suppose that wasnt surprising considering the area she worked in.
Its not that we dont trust your abilities as a nurse, but we dont know you and this is a very specialised area. We cant afford to get things wrong here.
I nodded my head, and kept a solemn expression on my face. Some nurses might have been offended by being told this, but I took a different view. In fact I couldnt think of a better job; no patients and a full days pay. I made a mental note to thank Tracy back at the agency for setting me up with this one.
Fine with me, Im just here to help out but what exactly do you want me to do then?
We need someone to regularly check everyones observations, their pulse, temp and blood pressure every hour. The patients here can become very unwell very quickly. Is this okay with you?
I nodded my head.
Do you have any questions?
I was worried about how ignorant I would sound, but I had a few that I felt I really did have to ask.
Susan, this is all very new to me. I mean Ive heard of heart transplants, lung, liver and kidney transplants, but I dont know the faintest thing about bone marrow transplants. I dont even know what sort of things I need to watch out for.
I was given a quick rundown of cancers of the blood, or in more medical terms, leukaemia. I was also reminded of how susceptible a leukaemia patient is to infection, because the body has very few white blood cells left to defend it.
Whatever you do, dont be afraid to ask for help, were Susans last words.
Ill be careful, I promised as I headed towards room 1 and cautiously opened the door leading into the first patients room.
STOP! Dont use that door, a voice yelled out at me.
I turned around to see Susan gesturing to another door.
Never walk directly into a room, always use the side room. And always wash your hands and put on a gown.
I had been wondering why all the rooms seemed to have so many doors.
Sorry, wont happen again, I said. I hurriedly shut the door, then headed into the side room to prepare for entry.
By the time I had washed, gowned, gloved and masked up, I was becoming a little worried at what I would find in the room. Exactly how sick was the patient going to be? I peered in through the small window in the door to get a look at the occupant, Mr Tait.
Id seen some terrible sights in the few short years Id been nursing, but the sight of Mr Taits face made me panic I was certain I was staring into the face of death. His cheeks were grossly sunken and hollowed, the bags under his closed eyes stretched down to his cheeks. His skull was emaciated and his skin was a greenish yellow. My eyes wandered down his body to his chest, where I was looking for movement. I eventually saw some, a very slight rise that told me he was still alive.
Mr Taits eyes opened and he briefly glanced in my direction then closed them again.
Water, he rasped.
There was a jug and an empty glass in front of him. He didnt have the strength to pour for himself so I made myself useful. A thin arm reached out and clasped the glass, then slowly, almost painfully, brought it to his lips. He took his first sip.
Arrrgh. His sudden cry literally made me jump.
He glanced up at me again and grimaced no, it wasnt a grimace, he was smiling.
I look like shit and I feel even worse, he said to me. I would give anything to take away the pain.
My second lesson of the day: bone marrow transfusions are painful.
Wheres the pain? I asked, trying to figure out where it could possibly be. The whole body perhaps? Or maybe deep down in his bones?
My mouth, he answered.
Your mouth? Whats wrong with your mouth?
He opened up as wide as he could, and I brought my face close to get a good look. His mouth was a mass of raw, red ulcers, some of which oozed. I pulled back suddenly, trying to make it look as casual as possible.
It seemed Mr Tait could read me like a book: Its a side effect of the treatment; they have special medicine for me. Go get me some, he ordered.
I didnt question him and went in search of Susan. I caught up with her in the treatment room.
Everything okay? she asked.
Well, yeah, I suppose. But Mr Taits asking for something for his ulcers. He said theres a special medicine? I explained.
Oh, thats no problem. Here, take this. This is the mouthwash hes talking about.
I looked at the label on the bottle of liquid in my hand.
Ah Susan, are you sure this is right? You want me to give him this as a mouthwash?
It was unlike any treatment I had ever used or even heard of being used in this way before.
Sure, its no problem. We use this all the time. We go through heaps of the stuff.
Mr Tait wasted no time in ordering me to pour him a generous portion.
His drug chart said between five and ten mls, as often as required. He requested ten.
As I poured, I worried what sort of side effect he could experience.
Um, arent you supposed to spit it out? I asked Mr Tait as instead of spitting out the mouthwash he swallowed it.
No, was his monosyllabic reply. He then ordered me to pour another ten mls, which he again swallowed.
The next patient I saw was Mr Henry. He didnt look anywhere near as ill as Mr Tait, but he too had some very nasty mouth ulcers.
Can you get me some of the mouthwash, theyre really bad today? he asked me as I sat there measuring his observations.
The scene with Mr Tait was repeated.
When I again questioned the swallowing of the medicine, he sounded a trifle offended: Of course not. Dont be ridiculous. If you ever end up like me, and I pray you never, you will understand.
I quickly left the room.
I understand that your mouth ulcers are particularly painful today, Mr Johnson, I said.
Worst theyve been for quite some time, he said, as he showed me just how bad they looked.
I was steadily becoming suspicious but I didnt want to upset another patient and I repeated the cycle again, except this time I refrained from saying anything when he didnt spit out the mouthwash.
The ward had a total of 12 patients and out of those 12, eight had requested mouthwash and five had swallowed it. An hour had gone by and I was back in Mr Taits room to check his observations again.
Good to see you again, said Mr Tait when I walked back in.
Well, he certainly seemed a bit brighter than before.
Youre new here. How you finding it? Mr Tait still sounded terrible, but he was definitely a bit brighter. I left Mr Taits room with a nagging feeling that I had messed up. I could only hope no one noticed.
Susan caught up with me before I had a chance to check on Mr Henry.
The patients seem very cheerful this morning, she said to me. I had a sinking feeling in my stomach.
I notice on the drug chart that quite a number of patients have had mouthwash; more than normal, in fact. Have you been making sure the patients spit out their mouthwash? she asked me. After all it is hospital quality cocaine theyre using, she added.
The patients seem very cheerful this morning, she said to me. I had a sinking feeling in my stomach.
I notice on the drug chart that quite a number of patients have had mouthwash; more than normal, in fact. Have you been making sure the patients spit out their mouthwash? she asked me. After all it is hospital quality cocaine theyre using, she added.
I shook my head.
Dont believe them, if they tell you theyre supposed to swallow it. They try it on with all the new staff.
Susan left the matter at that, although I swear I could see a hint of a smile at the corners of her lips.
That was the first time Id seen cocaine used in hospital. In this case, it was the best medicine for the terrible ulcers that are a common side effect of the treatment these patients receive. Apparently nothing works as well as cocaine mouthwash. The medicine is not to be swallowed, but the dosage is actually very small, so no harm done if they do.
A different world
After my first year of nursing in London I knew which wards, or even hospitals, to avoid, as well as knowing which hospitals and wards were great to work in. Fortunately, the nice places outnumbered the bad. But even in the places that I liked, I had to get used to a different style of nursing. Naturally there were always going to be differences in the system I had left behind in New Zealand to the British system.
1. The major difference was the patient to registered nurse (RN) ratio. I was used to working with one RN for every six patients. In the UK I often had 10 or 12 patients, with just one nurse assistant to help me.
2. I found it difficult to delegate tasks, especially the unpleasant ones, to a nurse assistant. I was used to doing it all, from the highly skilled stuff, to helping someone off of a commode. It was also hard knowing exactly what each assistant could do as it varied from place to place. Id find myself doubling up on certain aspects of patient care, such as wound dressings, which some assistants would do, while others wouldnt. Back home, I was used to one nurse assistant for the whole ward.
3. Another shock was working 12-hour shifts. Not all places in London scheduled like this, but most did. Back home I only ever worked an eight-hour shift, maximum. In the UK, if you did a run of three or more days, it sometimes felt like you practically lived at the hospital.
4. I find the small things can make a big difference, so the lack of wheelchair accessible showers in London was a real nuisance. I was used to any patient who could at least sit in a chair being washed in the shower, every day. In London, the few showers I saw in the wards were small, enclosed spaces, often with standing room only. I think this came about because when these hospitals were built, people didnt shower, they bathed. Its not possible to have all of your patients bathe every day. I soon felt I could never get my patients as clean as I would like.