Well come on lad, speak up.
For the first time in the two weeks that I had been doing Mr Mannerings dressings, I heard a note of concern in his voice. I thought of the words he had said a moment earlier: Ill leave everything in your capable hands. I dont think he meant it quite so literally.
As I crouched at the end of the bed, unable to think of anything to say or do, I had a vision of holding up his toe and offering it to him.
We have a slight problem, I finally said. But its nothing to worry about really.
Mr Mannering leant forward. Whats wrong?
Its your toe; your little toe, I began to explain. Its come off.
Come off, what do you mean come off? Toes dont just fall off.
He had a point, toes dont generally fall off.
Well, I pulled a bit too much and it just, well, came away in my hand, I said.
Mr Mannering took a minute to collect his thoughts, while I was still kneeling at the end of the bed with his toe between my fingers.
As the silence grew, I tried to justify my actions in my head: It really isnt my fault. His feet are rotten. Hes going to get them chopped off anyway; surely he realises this.
I looked at Mr Mannerings face to try to gauge his reaction. Then I heard a strange sound. It couldnt be but it was. Mr Mannering was laughing a deep, throaty, contagious laugh. I found myself joining in.
Theyre going to chop it off anyway, lad. Youve just made their job a bit easier, he said to me.
Ever thought of being a surgeon? he added and broke into another round of laughter, as if this were a great joke.
Well, what do you want me to do with it? I asked the discussion finally coming around to practicalities.
Well, I dont want it, he said. Throw it in the rubbish.
It didnt seem quite right throwing it in the bin after all, it was a body part but then again, a pretty gross part, so in it went.
Two days later, Mr Mannering went to surgery and had not just his toes, or even his foot, amputated, but his leg from just below the knee.
Mr Mannering had been the first male patient I had worked with as a registered nurse, and it was as if I had seen a light of hope at the end of a long tunnel. I found myself not only comfortable working with Mr Mannering, but actually enjoying it. This was just as well, because my time in the gynaecology ward was nearly up. I had received word from management that, as part of the graduate programme, I was to be rotated to a general surgical and medical ward. I just had to survive one more week.
II
A glimmer of hope
Six months after graduation, I was moved to Ward 13. I knew from the very start that it was going to be challenging, but hopefully in a good way. It was a small hospital and space was at a premium. The ward had surgical patients, medical patients, and urology patients.
The surgical cases often involved abdominal and vascular surgery, as well as urology surgery, which is anything to do with the kidneys and their associated plumbing. While the medical patients were a mix of everything. It was only in the years to come that I would learn that this set-up was not very common (although it happened often enough because of a shortage of bed space). It was certainly not ideal, but one huge benefit of the situation for me was that I gained a whole lot of experience in a relatively short space of time. I began to see things truly from the perspective of a caregiver.
Whos to blame?
Horrendous, horrible things sometimes happen in my line of work. Things that make hospitals seem like a living nightmare. But good can come out of even the worst experiences, even if it is just a new way of looking at something sometimes, perception is everything.
Interpretations of a situation can vary tremendously, especially when it comes to a patients perspective versus that of a nurse. Its to be expected that the nursing staff will have a better understanding of health and illness and how the body deals with sickness. What is not always appreciated is a patients understanding, or lack thereof, of a particular problem.
Get ya hands off it; I dont want ya breaking anything.
I put Mr Kents leg back in the corner. It wasnt a whole leg just the lower part of his right leg.
Ive been living without a leg since before you were born and I dont need your help now.
Mr Kent had lost his leg in a motorbike accident when he was 25. He had never married, always lived alone and never had to depend on anybody for anything well, apart from the prosthesis manufacturer.
I was just trying to help him strap the thing on speed things up a bit because he was taking so long to get ready. I know it sounds terribly impatient of me, but he looked helpless as he groped for his walking stick while struggling to sit up in bed.
Once Mr Kent had his leg strapped on and was on his feet he was a different person. He was mobile and, if not exactly nimble, he could move pretty quickly.
I dont need to be here, it will pass, he kept saying.
And every time, I responded the same way: Its just a precaution, the doctors know what theyre doing; youll probably be home in no time at all.
And every time, I responded the same way: Its just a precaution, the doctors know what theyre doing; youll probably be home in no time at all.
Mr Kent was a very strong willed man. He was so fiercely protective of his independence that he would not let any of the nurses help him in any way. The closest he had come to asking for assistance, was pointing his walking stick at the television and saying, Be a good lad will you and change the channel for me.
But for all his tough demeanour, I suspected he was more worried than he let on.
Mr Kent had been admitted to hospital because he had woken up one morning and found that the left side of his mouth was not quite working properly. When he had gone to look in his bathroom mirror, he noticed that this side of his mouth was drooping slightly.
The hospital doctors were concerned that Mr Kent might have had a small stroke, or even just a TIA (a Transient Ischaemic Attack a mini-stroke).
A mini-stroke, now Ive heard it all, next youll be trying to admit me, and of course they did.
Luckily none of Mr Kents limbs appeared to have been affected: there was no telltale weakness or paralysis in his arms or legs; and even though his mouth had a slight droop, his swallowing had not been affected.
On the third morning of Mr Kents stay with us the doctor decided to change his medicine slightly. For the last five years Mr Kent had been taking half an aspirin a day; the doctor now wanted to give him an enteric-coated aspirin, which has a protective outside layer so its less rough on the stomach. It was a good idea of the doctor; Mr Kent should have been on this medication years ago.
Aspirin is one of the most common drugs given to patients, but it can help prevent some serious problems. It thins the blood, thus reducing the risk of clots forming, lessening the likelihood of strokes (clots in the brain) and heart attacks (clots in the arteries that supply the heart).
The only problem was Mr Kent seemed a touch reluctant to take the new enteric-coated aspirin.
Ive made it this far on my own with one leg and I will not be told whats good for me by a boy.
I could feel my face turning red as I sensed the eyes of the three other patients in the room on me. I had no reason to be embarrassed, and I certainly neednt have felt stupid, but I did.
I suppose Mr Kents stubbornness was a way for him to stay in control of the situation, but I was resolute: I would make him see reason and win, especially as I had an audience. After all, it was for his own good.
If it makes you happier, Ill have the doctor come in and explain things again, I offered, but Mr Kent just sat there with his arms crossed.
I dont want to talk to him either, Mr Kent said, referring to the junior doctor. I want to see someone old enough to know what theyre doing.
Well, I cant force you to take it, I said, changing tactics and making as if to exit the room.
Hold on a minute, Mr Kent piped up, I never said I wouldnt take the blasted thing.
Why the sudden change of heart? Again, it was another way for Mr Kent to retain some control of his situation.
Get the doc. Ill listen to what he has to say and then decide.
I didnt argue. Soon the doctor reassured Mr Kent that the change was in his best interest. Fifteen minutes later, the battle was over and I was the victor although it didnt really feel like a victory. As Mr Kent brought the aspirin to his lips he kept his eyes glued on mine; he wasnt smiling and he certainly wasnt happy. It wouldnt have surprised me if he gave in just to have some peace and quiet.
With a sense of relief I left Mr Kent to his own devices and walked away down the corridor feeling at least content in the knowledge that I had done what was right, even if Mr Kent wasnt 100 per cent convinced
Beeeeeeepbeeeeeeeeeeep!
It was coming from Mr Kents room. Someone was probably sitting on their call bell at least I hoped that was it but as I turned around and hurried back to his room, I had a sinking feeling in my stomach.
I entered Mr Kents room and his eyes locked on to mine. He was struggling to sit up and reach his walking stick, but the right side of his body didnt seem to be working very well. He kept on falling back on to his pillows. His right arm wasnt doing what he wanted; it seemed to be determined to lie there like a lump of lead. His droop had worsened and his mouth was hanging slightly open. Mr Kent was having a stroke right in front of me.
I watched, with mouth agape and a sickening feeling in my stomach. The stroke didnt stop him from being able to talk. Youve done this to me; youve killed me.
Im sure his voice must have been slurred, but I heard every word very clearly.
My skin broke out in goosebumps. I tried to help Mr Kent sit up but he waved his good arm in my face.
Get away. Youve done enough damage already.
I could feel the eyes of all the other patients in the room on me: disbelieving, shocked, accusing. I was to blame; it was my fault I had forced him to take the new aspirin. At least, that was how they must all have seen this. I was responsible for setting this man on the path to death.