I suggested that he be transferred to a medical ward.
Things happen at a slower speed in a medical ward. At the very minimum theres not the hurried rush to get someone to theatre, pick patients up from it, less intravenous fluids to monitor, none of the intensive immediate post-op care. As for skills, its not unusual for nurses to be specialised in surgery only, or medicine only. Ive known many surgical nurses not know what to do when their surgical patients develop medical problems, and vice versa. Fortunately, at that time, I had experience in both.
I found Mrs Benson at her husbands bedside again. In the same seat, and the same position with her head bowed, holding her husbands hand in silence. She had not let anyone know she was here. She couldnt make it every day because she was unable to drive and was reluctant to use the bus because of a fall getting off one a year ago. She couldnt afford a taxi. She had to rely on the warden from the supervised accommodation where she and her husband lived. The warden tried to make a trip to hospital every day, but this was not always possible.
Ive never seen him so frail.
It was the first time Mrs Benson had actually spoken to me.
I nodded my head and sat down on the side of the bed.
Were doing all we can. Can I get you anything? I asked her.
Tea would be nice.
I hurried away and got both Mr and Mrs Benson a cup of tea. It was the first time I had managed to sit down with Mr Benson and not be interrupted. There was work I should be doing, but it would have to wait.
Day 5
Mr Benson wasnt my patient today and I only saw him once. He was being wheeled past me in a wheelchair, on his way back from X-ray. He didnt notice me, but I took the chance to look at the results and was disappointed to see there was still a large white area at the base of his lung. I looked at his previous X-ray, taken on admission, and if anything the white area seemed more consolidated. The antibiotics werent doing their job.
Day 6
Mr Benson had been moved to a single room in the middle of the ward, right in front of the nurses station. During the night he had developed an extremely high temperature, 39.8° centigrade. Even before I entered his room, I could hear the rattling noises coming from his chest. He no longer smiled, he was too exhausted. When open, his eyes were rheumy, but, most of the time, his eyes were closed. He was drifting in and out of consciousness. His antibiotics had been changed to the strongest that the hospital had to offer, but I didnt think it was going to be enough.
Mrs Benson was sitting at her husbands bedside.
Hes very ill, I said, as sensitively as I could.
I know, she replied. She wasnt crying, but the expression on her face said it all.
He had a rough night, but weve started him on new antibiotics, I said.
It was always easier to talk about the treatment than the prognosis. I didnt want to bring up the subject of death, but the right thing to do was to find out if Mrs Benson was aware exactly how sick her husband was and that this was a possibility.
Hopefully the new antibiotics will help.
I watched Mrs Benson closely to gauge any reaction. She showed no sign of having heard me.
We should know soon if they will help, I added.
She turned her head towards me.
What do you really think? Please.
I felt a lump in my throat, but as much as the truth would hurt, I had to tell her.
Its not looking good, I began. He could get better, but the infection seems to have spread. His whole body is battling it.
She nodded.
Is he suffering? she asked.
I looked over at Mr Benson and his eyes were closed. His temperature was down and even though he looked horrendous, I judged that at the moment he was not suffering.
Hes not in pain, I said.
Thank you.
Day 7
Hes not in pain, I said.
Thank you.
Day 7
I was allocated Mr Benson today. I asked Claire if we had a resuscitation order for him, but was told not yet because they wanted to wait until another family member was here to discuss the matter.
He was alive. The rattling in his chest was still there. It was a lot quieter, but that wasnt because the infection was improving, but because his breathing was so shallow and irregular. He would breathe two or three slow breaths, and then pause. Mr Benson had no control over this, as he was no longer conscious.
The nurse assistant and I went to turn him on to his other side, and as I placed my hands on his arm and hip he felt cold, lifeless.
We began to roll him from his side and when he was on his back the assistant gasped, Hes stopped breathing.
I felt for a pulse, and to my surprise found one.
I ordered the assistant to press the arrest alarm. I didnt want to. Mr Benson should have been left to die in peace, but the choice wasnt mine to make. I placed a bag over his head and began to breathe for him. The arrest team arrived in moments.
The doctor couldnt find a pulse and I was told to commence compressions.
I began to press on Mr Bensons chest and had to clench my stomach as I felt a familiar crack. I dont think Ive ever managed to do compressions without breaking a few ribs.
8 p.m.
There were two doctors plus two specialist arrest nurses. They relieved me from the compressions; my arms were tiring. I stood back and watched. It was a shame the doctors couldnt see there was nothing more to do, and ironic that Mr Benson was receiving all this intense attention, from so many people now, when all he needed was a little attention to begin with.
It felt like forever, but finally everything was over, the doctors were defeated. Mr Benson was pronounced dead.
Maybe Mr Benson would have died regardless of the level of care he received. Maybe it was his time. The painful thing is that we never gave him a chance. What would have helped during that week is another registered nurse. Two registered nurses plus a nurse assistant may have been enough to give Mr Benson a chance at survival. Still, I felt guilty.
I felt guilty about Mr Bensons death because I knew that his care could have been better. It was frustrating because I felt that I just couldnt give the care I knew I was capable of giving.
It isnt always like this, with vast numbers of patients to a single nurse, but it has not been an uncommon experience for me. Hospitals have budgets to balance, though I do wonder if theyve ever calculated the long-term costs. I hear that billions of pounds are set aside by government to provide compensation for legal cases brought against hospitals by patients and their families, but how much of that would be saved if we employed more staff and reduced workloads?
There would be less burnt-out nurses. Thered be less medical errors. Thered be less staff sick days, and greater retention of staff. Thered also be more time to spend with patients, and to do the simple but vital tasks of caring.
Gotta get out of this place
Mr Bensons death was the beginning of the end for me. To my colleagues, I was unchanged, but inside I was angry at not being able to do the job to my satisfaction. Things finally came to a head one day when we had a staff shortage.
It was the afternoon shift, and again I had beds 1 to 16. The problem was that the regular nurse assistant had called in sick, and they couldnt find a replacement. I bluntly refused to work until they found someone to help me. Claire promised to find me an assistant. So I got to work.
Out of 16 beds, 15 had patients in them, one of them a new admission.
Cubicle 1 Mrs Wright
A confused elderly lady who thought she was in her own house. She thought her husband was still alive, but occasionally had lucid moments. She was complaining about the pain in her legs, and when she pulled back the covers, I was horrified to see two blue legs. They were the most ischaemic (poor blood supply) legs Id ever seen. The pain must have been incredible. She had an infusion of heparin (to thin the blood) at the bedside, which was empty.
I promised to get her some analgesia, and get a new infusion of heparin.
It took three minutes to get the morphine ready, and another ten minutes to prepare another heparin infusion, but it took a further ten minutes before a nurse was available to come and check my preparations. By the time I eventually administered the morphine and replaced her infusion, Mrs Wright had been suffering for 25 minutes.
Cubicle 2 Mr Lewis
Mr Lewis was a below knee amputee due to go home the next day, and wouldnt need much assistance from me. Thank goodness.
Bay 1 Male six-bedded bay
Bed 1 A man recovering from bowel surgery and on a liquid only diet.
Bed 2 A patient recovering from a large gastro-intestinal bleed. He was nil by mouth and on a drip.
Bed 3 A patient on bed rest because of his leg ulcers, which had been grafted.
Bed 4 A blocked bowel; nil by mouth, this patient had a tube running up his nose and into his stomach to drain out the contents, and a tube up his penis because the doctor wanted to accurately monitor the fluids going in and out.
Bed 5 Next to him was a man who was in his second week post a partial resection of the pancreas because of cancer. It was only a matter of time before he died. The longest I had ever seen someone that I was directly involved with live after pancreatic surgery, was six weeks.
Bed 6 Last, but not least, was a man recovering from a cholecystectomy, or in other words, he had had his gall bladder removed. The surgery is often done using the keyhole technique, but because of complications, in this case he was obese, the surgeon had to do things the old-fashioned way and open him up completely.
There was enough work in that one room alone to keep a registered nurse busy for the whole shift. But there was more.
Bay 2 Female six-bedded bay
Bed 1 Mrs Lawrence was 61 and one of the more lively patients. She was always looking out for the other patients in the room and was due to go home soon. She had had her gall bladder removed, and fortunately the keyhole technique had been successful.
Bed 2 A 25-year-old woman recovering from an appendectomy. Fortunately, she was independent and would be going home in a day or two.
Bed 3 A 53-year-old woman on intravenous antibiotics for cellulitis of her left calf. Also on bed rest until things got better.