Mr Mason chose that moment to slip through our grasp and landed in a kneeling position with his forehead touching the floor and his butt pointing in the air.
Dont move him; clean his back and butt while hes like that, I told the girls as they got stuck in.
It wasnt the most orthodox technique but it worked. Mr Mason didnt seem to mind; in fact, he appeared to have gone back to sleep.
Forty-five minutes later the room was spotless, with Mr Mason lying on a clean mattress, clean sheets, wearing clean pyjamas and as far as I could tell, completely shit free. The assistants attitude had changed dramatically. They did everything I asked instantly and without question, but I didnt have time to enjoy their cooperation, because I still had ten other patients to visit.
As I headed home on the bus, I found that I wasnt tired, despite the long shift. My mind wouldnt stop going over what had happened that night. I kept on thinking about Beatrice and how the negligence of one nurse left a man lying in his own waste.
I vowed to myself to write a factual, but scathing, letter of complaint to the hospital management.
After waking from a fitful sleep that day, I was no longer so sure. The problem was not a simple one, and I even called in sick that next night, in order to think things over.
It was my word the word of a transient agency nurse against that of an experienced staff member, with a lifetime of nursing behind her. If I laid a complaint, they would look at not only Beatrices performance, but my own. They would ask why my evening drugs were given after midnight. They would inquire why I didnt get to my other patients sooner, and ask why I didnt call management when I didnt receive a handover. There were so many ways it could go wrong for me, from not doing my job properly, to asking why I didnt walk out at the start of the shift. Thats what management and lawyers are good at, looking back and picking faults, when theyve never been confronted with such a situation themselves. They miss the whole caring part of it.
My plea of doing it for the patients, of doing it because I care, probably wouldnt stand up in court. Although I wouldnt have to go to court to be screwed because all Id need was to lose my registration. That would be more than enough.
In the end, I didnt lay my complaint. I had convinced myself I would end up second best. But a part of me still feels guilty for not. The patients deserved better than they were getting.
Tough love
James couldnt lie flat on the bed because his body wouldnt allow him. Instead, he sat on the edge of the bed, his shoulders hunched forward, trembling hands gripping his knees as he struggled to find the energy to keep himself upright.
Nothing works, he managed to say before pausing to get his breath. Cant you give me something stronger?
Nothing works, he managed to say before pausing to get his breath. Cant you give me something stronger?
I nodded my head.
As I listened to his chest, checked his blood pressure, pulse and oxygen levels, my mind had already come to its own conclusions. This 17-year-old boy had neglected himself, and seemed determined to continue to do so.
It was frustrating, because James was asthmatic and a heavy smoker, and he was literally guaranteeing himself a life of lung disease if he continued.
But I could also sympathise with him, because he was only 17, unkempt, in hospital alone, with no family or friends around him. I even felt a little empathy, as I remembered being a teenager and feeling like the world was against me.
I asked James what he normally takes for his asthma, and was presented with a Ventolin inhaler; the most common one around, used to treat an actual asthma attack.
Is this all you have? I asked. He just shrugged his shoulders.
Its what the doctor gave me, and it doesnt work. He paused for breath, but he sounded angry. The doctors useless.
I gave the inhaler a shake, and found it to be empty.
You do know theres nothing in here?
James scowled at my comment. Im not stupid! But it doesnt work anyway, even when its full.
He hadnt had any Ventolin in over a week.
Instead of getting into an argument with him, I got the doctor to quickly prescribe a nebuliser. This is a mask that sits on the face, and provides oxygen, mixed with medication, that the patient can breathe directly into their lungs.
Once this was up and running, I took the opportunity to find out some more about my patient.
Have you been back to your family doctor, and told him it doesnt work?
James shook his head.
Why not?
Why would I? His medicine doesnt work.
I was getting nowhere with this line of discussion, so I changed the topic.
Have you ever tried a preventer?
Dont know. Thats my preventer there, isnt it? he said, referring to his Ventolin inhaler.
It was surprising to see that he knew nothing about his asthma, and while it was also frustrating that he didnt seem to care, it was sad that we werent going to be able to make any real changes here. Wed get his breathing settled, and then probably send him home, from there it would be up to him to follow up with his family doctor.
Well, there are actually lots of treatments your doctor could try. And your Ventolin inhaler isnt a preventative all it can do is relieve the symptoms of an attack. You need to talk about what else is out there with your doctor.
I explained how dangerous it was to smoke when you had asthma. I even went as far as to say that if he kept on smoking, he was almost guaranteed to end up with lung disease. But I could sense that these words had no effect, after all, theyre just words.
I left James alone to give him a chance to mull over what Id told him. I informed the doctor of how things were.
When can I go home? After three hours in the emergency room receiving treatment, James was much improved. His breathing had settled completely, the wheezing in his chest had nearly gone, and he could lie back on the bed and relax. He even dozed off for an hour.
Where is home, James? Can we call your parents to pick you up? James explained that he didnt live with his parents, but with a group of students. He didnt want his parents to be involved.
I left him in the doctors capable hands.
At the end of treatment, the doctor gave the usual advice about the need to stop smoking, and the need to be more proactive in his own care. He also reiterated what I had said earlier, about the deadly combination of smoking and asthma, adding that 80 per cent of people with lung disease were smokers. He was given a new inhaler, and the contact details for an asthma support/education programme.
I was working the following Saturday evening when James presented to the emergency room again. His asthma was playing up, and he was also complaining about how useless the inhaler we had given him was. His problems were exacerbated by the fact hed developed pneumonia. Generally a young man of Jamess age would not need to be admitted to hospital for such a diagnosis hed be able to be at home while taking antibiotics but James was too unwell.
I told you it doesnt work, and you sent me away. Even though Jamess anger seemed directed at me, it was really directed at everyone.
Listen, mate, lets play the blame game later. Right now, we just want to get you better. And youll have plenty of time to get yourself sorted out, because youre going to be admitted.
James lifted his head off his chest. Im not staying in this shithole, no way. Just give me some proper medicine, something stronger, like you did last time.
I tried the honest approach. People die from asthma young people like you. If you have a death wish, youre free to go, right now. We wont stop you. Amid much moaning and fuss, James let himself be admitted to a medical ward.
When I transferred James to the medical ward, I was pleasantly surprised to see that it was Gwen who was going to take over Jamess care. She had been a nurse in the NHS for 25 years, and in the process had managed to raise three teenage sons and one daughter. If anyone could get through to James, it was her. Gwen wasnt one to just do her job, and give out medicines and advice that would most likely be ignored. She did whatever it took to make a change.
James would be sharing a room with three elderly men; two heart attacks and a stroke (no offence intended, but its not unusual to identify patients by their illnesses). It was Jamess first time sharing a room, as well as his first time staying in a hospital overnight.
The effect of being in a hospital ward, seeing, hearing, smelling and feeling what its like, is sometimes enough to bring about a change for the better. Its often a wake-up call. Unfortunately, it seemed to have no impact on James.
After two days of intravenous antibiotics, James hadnt improved. Gwen put it down to the fact that he spent most of his time outside the front door of the hospital, in the cold, smoking. Hed have a cigarette or three, and then wander back to the ward for his next antibiotics or nebuliser. Something had to be done.
Gwen went to Jamess room and began packing up his things. Whats going on? Am I being moved?
Gwen nodded her head, and kept on packing.
Where am I going?
Home, of course.
James sat stunned. He began to protest, but Gwen cut him off again.
Whatre you moaning for, boy? You kicked up a fuss about coming here. I wouldve thought you couldnt wait to get out of this place. Or dont you want to get out?
James was caught off guard by Gwens attack. Ah yeah yeah, I want to get out.
Well, at the rate youre going, the only way out of here is in a box. What dont you understand? Youre killing yourself. I hope its quick, for your sake.
James rallied. You cant talk to me like that.
Why, does it upset you? Does the truth hurt? Why do you think Im talking to you like this? Why?
James was speechless.
Because we might care, but we can only do so much. You have to start helping yourself. I want to help, but Ive got other patients who need my help, and are willing to listen. Are you going to start listening to me from now on?
James nodded his head. Im sorry, he finally stammered.
James didnt change overnight.