Bed 4 A blonde, 42-year-old, overweight woman with right upper abdominal pain, awaiting diagnosis. Experience told me this would be gall stones. She had all the risk factors: female, fair, fat and forty.
Bed 5 A 70-year-old woman with leg ulcers, probably going to need vascular surgery at some point. In the meantime, she was on bed rest with daily leg dressings. Other than a commode, she shouldnt be too much work.
Bed 6 Located next to the window was Mrs Jackson. At 89 years old, she was the oldest patient in the room. She had been admitted because she had been neglected at the rest home she lived at. The result of that neglect was that she was left with bedsores on her sacrum, hips, elbows and heels. She needed hourly turning at the very minimum, half hourly if possible, but with my workload it was not always done on time.
I checked with Mrs Lawrence in bed 1 when Mrs Jackson was last turned.
Im not sure, it must be at least an hour, she answered.
With no one to help me I did what I was not supposed to do. I lifted the tiny frame of Mrs Jackson off the bed and turned her on my own. It didnt exactly hurt my back, but I could feel the muscles straining a little as I leant over her bed.
Cubicle 3 The seriously ill room
Cubicle 3 was closest to the nurses station and as such, was reserved for the most unwell patients. It had two beds: Bed 1 My only empty bed. I prayed it stayed that way.
Bed 2 Mr Peters was 58 years old and had had a huge tumour removed from his abdomen. Surprisingly, the tumour turned out to be benign. Unfortunately, Mr Peterss heart had taken a turn and he had developed chest pains. He was on a heart monitor, and an infusion of medicine to help keep the pain away.
Its getting lonely in here, Mr Peters said to me as I walked in the room.
Well, I hope it stays that way, I replied.
Mr Peters chuckled at my reply. Incredibly, the bed next to Mr Peters had been empty for the last two days.
Claire walked into the room.
Ive found you some help.
She sounded cheerful. It seemed she had forgiven me for my outburst back in the staff room.
Shell be here at five.
The shift had started at two and it was now four. I should have walked out when I had the chance.
Five oclock came around and my nurse assistant arrived.
Her name was Grace, and she looked as if she was barely 18. She was nervous. I discovered she was a first year nursing student.
I didnt want to make Grace do anything out of her depth, so I had her check everyones blood pressure and other vitals.
I was angry, not at Grace, but at the people who had put her here. She was so naïve that she had no idea of the possible danger she could be putting herself in.
While she went to do my requests, I took ten minutes to eat a stale sandwich for dinner, before returning to answer Mr Peterss call bell.
Ive got some company at last, Mr Peters said, as I entered his room.
Lying in the bed next to him was a middle-aged man with a tube up his nose, a tube coming out of his penis, and an intravenous drip connected to his arm.
I went in search of Claire.
Claire explained that Mr Skove had a bowel obstruction, and was for surgery in the morning. When I asked her if there was anything in particular I needed to know, she told me to read his notes.
I found Mr Skoves notes sitting in a disorganised pile in the nurses office. I sat and began to read, and the more I read the more worried I became. I went back out to talk to Claire.
Weve got a problem!
Whats wrong? she replied.
Did you know that Mr Skove was supposed to go to theatre tonight? I said.
She didnt seem surprised.
Yes, and I was told they changed their plans and he would be going in the morning instead.
She almost sounded smug with her thorough answer.
But do you know why they delayed surgery?
She couldnt admit that she didnt know.
Theyve been busy in theatre and decided he could wait until morning.
It wasnt exactly a lie, but it wasnt the truth either.
The reason hes not in theatre now is that his haemoglobin is very low. They want to transfuse him three units of blood tonight.
Claire made herself look even more foolish.
Of course, hes for blood, she said, trying to sound as if she knew all along. But hes not urgent and they were happy to wait for morning.
He was urgent, it even said so in the medical notes.
If you ever think things cant get worse, then youre sure to be proved wrong.
There was the slight problem of the blood not having been prescribed, and no paperwork in the notes indicating that a sample had been sent to the lab to be cross-matched.
The last thing Mr Skove needed was to think his doctor was incompetent. At the front desk I grabbed the phone.
Who are you calling? Claire asked me.
Er, the doctor, I replied.
Why?
I was taken aback. Claire had never questioned why I wanted to use the phone or call a doctor.
The doctor forgot to prescribe the blood, I told her. I dont even know if the lab has done a cross-match.
Claire grabbed the phone from my grasp and slammed it down on the desk.
We do not go chasing doctors, she ordered me. Its the doctors mistake.
I felt as if I was having a bad dream; this just couldnt be happening for real.
Were far too busy to go chasing after doctors and fixing their mistakes, she added.
I cant do that, I said with raised voice. I cant not call the doctor, knowing my patient urgently needs blood, knowing he urgently needs to go to theatre.
Claire tried to speak, but I overrode her.
This is ridiculous. You cant be serious.
Claire got up from her seat and came around the desk.
Dont dare speak to me like that again, she began, getting ready to let loose, but I interrupted her before her tirade could begin.
Youre angry at the way Im talking? You should be worried about your patient not getting his transfusion and bloody well dying. Why cant you see that?
Into my office, now! Claire yelled. If looks could kill, I would have been struck dead then and there.
It was then I realised my time was up.
I had never before walked out of a job. My error was agreeing to work at all that shift. Over the years I had been working, as well as my time as a student, everyone, from tutors, managers and colleagues, had all said never to put yourself at risk. If its not a safe environment, dont do it. In reality, nurses often work in less than ideal conditions, uncomplaining, but unhappy with the work environment we find ourselves in. Its easier to plod along and stay quiet than to speak up.
There is a problem with speaking up: ironically, to speak up means putting yourself at risk. Management may say Why didnt you say something sooner? To which you will struggle to find an answer. Management will then look at how well youve done your job. Theyll see that you werent perfect. Theyll see that things were not always on time, and that some things may not have even been completed. They may even go back over your work records for the past few days, or even weeks, and find all the little faults youve made. In the end you could be the one who is negligent for not reporting a problem sooner.
Im off home, I said to Claire. This place is dangerous enough without you making it worse.
With those last words, I turned my back and walked out.
As much as my decision to walk out was rash, or brave (still not sure which), it was the first time Id been stopped from not only doing my job, but doing something that was vital for the health of the patient. Normally Im trying to catch up, but theres a huge difference between being overwhelmed with the workload, and actively ignoring a medical mistake.
I found out from my fellow nurses that my patient did get his blood that evening. But what if I hadnt pointed out the error and the patient had died? Who would get the blame? The doctor for forgetting to prescribe it? Or the nurse who knew about it, and did nothing because it was the doctors lapse?
I found out from my fellow nurses that my patient did get his blood that evening. But what if I hadnt pointed out the error and the patient had died? Who would get the blame? The doctor for forgetting to prescribe it? Or the nurse who knew about it, and did nothing because it was the doctors lapse?
It was at this stage I decided my time in the UK was done. Within two weeks I flew back to New Zealand.
IV
Reality check
What goes through your head when you hear the words psychiatric patient? I wouldnt be surprised if you came up with some rather unpleasant thoughts. I was just a student when I had my first glimpse into the world of the psychiatric patient and like most young males, I was comfortably ignorant and happy to stay so of things psychiatric. But, I didnt have much choice I had to graduate.
I remember very clearly my introduction to Waverly House. It was in my third and final year of training, and this was to be my last placement before my final exams.
As I drove to my first shift, I thought I must have made some mistake. I was in a rather affluent neighbourhood. The houses were big and modern, though nearly all had solid, high protective fences. I wondered if this was because they knew they had a madhouse in their midst. Id seen enough movies where the psychopathic killer was standing outside the window peering in at a helpless, attractive and soon-to-be-next victim. Obviously these residents had as well.
I missed my destination completely, driving right past. I wasnt expecting the place to be posted with a big sign saying crazies live here, but I thought that somehow it would stand out from the rest. Instead, I found a house just like the others, with a high, solid looking fence, presumably to keep everyone in.
Standing on the doorstep, with little idea what to expect, thoughts like would I be safe? or would they follow me home? ran through my head, I imagined someone suddenly opening the door and thrusting their face right up to mine, with eyes bulging, asking what I wanted. The door did open suddenly.
Ah you must be my student nurse; come in, the kettle has just boiled.
I was hustled inside and to the kitchen by a tiny little woman who came up to my shoulder. Far from the welcome I had been expecting, I felt stupid for having let my imagination get carried away. She introduced herself as Josie Jones.