Paediatric Nursing ~ Poor Michael

March, 1979 (I was still single)

I remember when I returned to work on a new ward from one of my maternity leaves.  There was a young man who was about 18 suffering from Duchenes muscular dystrophy.  I had never nursed him, in fact I didn’t even know him.  The nurses on 5F knew him well and had been treating him for various complications for quite a few years.  The MD had wrecked his body and was slowly but surely destroying his ability to use his respiratory muscles.  He apparently got so bad that he had to be transferred to ICU, because he could not breath on his own.  Michael was a favourite of one of my colleagues, Jessie.  Jessie was a registered nursing assistant.  She was perhaps in her early 50’s when I first met her.  She and her hubby had emigrated to Canada from Scotland when she was only 17….. and she still had her Scottish accent.  Jessie had a wonderful sense of humour and a canny, motherly personality that appealed to our young patients.  Most of the other staff loved her too.  She visited Jason in ICU every day she worked, as did other 5F nurses.

I always listened with interest when my colleagues would report on Michael’s progress, which sadly continued to deteriorate.  I wasn’t back more than a week when I heard that Michael was being given continuous IV morphine to make him more comfortable.  The poor young man was on a ventilator and it was obvious that he would never come off it to breath on his own again.  He had the more severe form of MD and was never going to get better.  A day or 2 later, Jessie told me that Michael and his parents were now being asked subtly about a ‘do not resuscitate’ order.  She told me that as she was stroking his forehead, he lifted his heavy hand and put it to his throat in a slash movement.  She said that he had made his wishes known …. that he wanted to let go.   His poor parents were in agreement with Michael and so he was ‘snowed under’ slowly with morphine until he passed away.  Many of the 5F nurses went to his funeral.

Jessie unfortunately is no longer with us.  I was told last year when I visited my former colleagues at HSC that she passed away from a cancer in the early millennium.  God bless her.  She helped so many hapless little souls during their suffering.

Memorial Hospital & the hell that is geriatrics

Halfway through my first year of training in London, I was sent to the Memorial Hospital, which was associated with the Brook, to do my geriatrics training.  I must have bussed it from my room at the Brook Nurses Home, as it was not very far from there, … in fact it was on the same road, Shooters Hill Road.  Interestingly enough, this small hospital only had 3 wards (I think).  Male geriatrics, female geriatrics, and  a gynaecology ward where (among other common ailments were investigated and treated??)  therapeutic abortions were performed!!  Strange, I know…

Geriatrics must be one of the most difficult disciplines in a nurses training.  You get senile, or physically infirm or both, end up on an open ward with 40 beds and exist there until you die!  Listen, it could happen to anyone of us!  Working in the female geriatric ward in the Memorial, had me acknowledging a constant song in my head which back then when I was 20, stirred up the same sentiment………..“hope I die before I get old”! by the good ole Who.  Of course, now that I am 61, I sometimes think: how old is old?  I guess as long as you can keep going by yourself ‘old’ happens when you cant!.Hospital-wards-A-nurse-sw-010

 

Anyway, I did my best, but one of the worst part of geriatric nursing is that the patient load is very heavy and the staffing is woefully inadequate!  I didn’t mind the patients.  It was not their fault that they became frail or senile, just like it is not the fault of a patient suffering from kidney disease on a medical ward.  Unfortunately and understandably, many of the patients had given up in body mind and spirit, and no longer took much responsibility for their remaining time on earth.  There was a lot of heavy lifting, feeding, cleaning, adult diapers, changing soiled clothes and beds, but the worst single incident I came across concerned a lovely old lady, Ivy who suffered from senile dementia.  She would have her lucid moments, but these were few and far between.  I don’t remember if she had any visitors, in fact all those years ago, the presence of any family visitors on that ward are are a blank in my mind.  Ivy must have been a beauty, because she still had her delicate features and very few wrinkles.  Her episodes of dementia were not loud or vicious, like so many other of those who suffered this awful part of the aging process.  One morning I was starting the morning routine, of giving the patients, most all of whom were still in their beds, a quick wash to the hands and face, and getting them sitting up with the bed-table ready for the breakfast trolley.  When I got to poor Ivy, my heart dropped, she was lying there in her bed, awake, and she was eating her excrament!  Yes, I was disgusted, but I knew it was not her fault.  It was quite the task getting her cleaned up…. her hair, her hands, under her nails and all over her face.  I could not help but wretch as I tried to figure out where to begin…images

There was the Sunday morning, when the 2nd year pupil nurse I was working with, told me with dismay, the two nursing aides scheduled to work with us, had both called in sick, and that the matron was trying to find us another aide, but did not know if and when this would happen, at least for the morning.  So there we were, 2 of us, to care & feed forty mostly bedridden souls.  The breakfast trolley had arrived and we had barely begun setting the ladies up to eat, or feed!  Yes, I would say that at least half of our patients could not feed themselves!  Needless to say, it was a hellish morning, where we barely finished handing out the breakfast trays, let alone cleaning up the ladies!  We did of course change up a few urgent adult diapers, and don’t even think about taking your morning break.  Later that morning a relief aide showed up, but our whole day shift remained hours behind.images (1)

It was easier and yet more heartrending when some visiting family members would place a framed photo or else a photo stuck to the bedside table with sticky tape, of the women in their younger years. … To see past pictures of them, a lot of whom were now forgotten and left in a home, when they were young and vibrant, with their babies and everyday life really makes you realize these a lot of these women most likely lived a full life, just as ‘us younger women are now’.  They are not nameless old people who did nothing in their lives, and ended up in the geriatric unit… although it can be hard to remember that they were once just like us… walking into a ward of elderly people, unresponsive, or staring into space, unable to care for themselves lost in their thoughts or their minds…  Oh human frailty!

I must say  a couple of times I was mortified at the behavior of some of the aides… a lot of these women were decent and caring and good, then there were some real bad eggs… earning a minimum wage I believe, you get all sorts.  Some would have been better working in a laundromat, for all the compassion they showed..  One morning I witnessed on awful incident !  There were 2 nurses aides showering Ivy, who was sitting on a commode, basically unable to do much for herself.   They actually lifted up her aged floppy breasts and then let them fall back down, saying ‘what are these things Ivy, do you need these Ivy”?  When they saw I was there, they went back to talking to each other, and started to dry Ivy.  What indecent disrespect.!. I should have said something, but I was too timid.  I still had half my rotation to go, and thought it would not be a prudent move.  I was not close with any of the ward staff, so I couldn’t even discuss the situation, let alone report it to the Sister, who I don’t even remember to this day!  Not that it is any excuse, but I don’t believe Ivy noticed what was going on, thankfully for her.  These 2 aides were permanent workers on the geriatric ward, so I tried to keep out of their way, whilst getting my work done.  What I did notice about the terrible two, is that they both seemed to have enormous ‘chips’ on their shoulders, and became somewhat surly when I would ask them where something was, or had Mrs Smith had her lunch…

Oh I was so glad to get back to the Brooke and away from that big understaffed ward of sad lost souls. and those cruel caregivers!

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I found this on GooGle…. on http://ezitis.myzen.co.uk/memorial.html all about LOST HOSPITALS OF LONDON.  Actually it states that the Memorial Hospital is still up and running as it has been designated as a historical site, due to it’s services to soldiers. I just cut and pasted the more recent history..  Even though it doesn’t mention the gynae unit, I swear there was one... perhaps it was temporary,  maybe it was a short stay unit for T.A.’s !!!?

It sure looks nice in photographs… hell, I wish I could remember it!!!

Although originally dealing with general cases, by 1965 the Hospital began to specialise in surgery.   It had a Casualty Department, but it was felt that its facilities were too limited to deal with the increasing number of road traffic accidents in the area.  In 1969 the Department closed when the new Accident Centre opened at the nearby Brook General Hospital.  The acute wards were transferred to the Brook General Hospital and St Nicholas’ Hospital in Plumstead.In the 1970s  the Memorial Hospital became a geriatric hospital, with 128 long-stay beds.  A Day Hospital was built in 1975.St Nicholas chapel opened in 1986 following the closure of St Nicholas Hospital; fittings from that Hospital were installed in the chapel and a window in the chapel – the Golden Window – was transferred from Goldie Leigh Hospital. The tondo from the British Hospital for Mothers and Babies, which closed in 1984, is also displayed here.
Present status (July 2009)Oxleas NHS Foundation Trust now owns the site.Although this huge Hospital appears closed, the buildings are still partly used for a day care centre and out-patient facilities for pschiatric patients.  The main building is currently undergoing renovation and will eventually house a new day centre for the elderly. Originally scheduled to finish in autumn 2007, the building works are still going on.The ward blocks at the rear of the site were demolished in 2006 and replaced by two modern wards.
Entrance gatewayHospital buildingThe entrance gateway and the Hospital building on Shooters Hill.Hospital buildingfront elevation from the eastThe Hospital building from the grounds (left) and the front elevation from the east (right).

sink or swim NHS student nurses

Learning the hard way…

To illustrate the ‘sink or swim’ method of being a student nurse in a British hospital in 1972, here is the tale of the stoma. I don’t remember much about how we were assigned patients during the day and evening shifts or if we were given particular tasks in order to broaden our ward experiences?

.A staff nurse told me to change Mrs. X’s dressing.  I guess I might have tried to ascertain information about my patient’s chart or maybe not.  More likely I was directed to change a dressing on a patient I knew nothing about!   We already had been taught how to do a basic dressing in class. So I gathered up a disposable dressing tray and headed to her bed. She had an abdominal dressing, so I proceeded to take it off following aseptic technique.  To my utter shock, under the dressing was a dark pink fleshy bulge protruding out of her skin! I quickly told the patient that I had forgotten something and would be right back.; of course I covered her ‘wound’ with a couple of sterile swabs, before I left.  I had never seen anything like it and had no idea what had happened to her. I found the staff nurse and expressed my concerns. She looked at me as if I was a nincompoop and stated that Mrs. X had had a colostomy and that meant part of her bowel was exposed and that is what her ‘wound’ was!

4 weeks of classroom training had not prepared me for that!  I had never even heard of a colostomy!   Well, live and learn.

Psychiatry…………painful!

Student nurse in Toronto, 1973

The psyche rotation was another matter!  One month at Queen St Mental Health Center, also known back then in 1973, as 999 Queen Street, or even just nine, ninety-nine !!  A Toronto institution with an ominous reputation, for decades thought of as the ‘loony bin’.

queen street mental health centre back in the 40/50s

queen street mental health centre back in the 40/50s

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dont know the time period of this photo?

Queen_Street_Mental_Health_Centre

I believe the main entrance looked like this in 1973…….. I could be wrong… of course there definitely were no recycling bins back then!

Interestingly (to myself), I have no clear memories of how the hospital looked when I did my psych rotation there in the 70’s, however this is the one image that did stick in my mind along with these  lyrics of Pink Floyd…

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All in all it was all just bricks in the wall.
All in all you were all just bricks in the wall

My group of about 6 fellow student nurses were assigned to a ‘Day Hospital’ setting.  There were about 12 patients, most indigent, living in ‘half-way houses’, who came in Monday to Friday from 8:00am to 4:00pm.  These poor souls were so dysfunctional, tattered and torn that one wondered if these were day patients, what were the in-patients like!!

The Day Hospital daily routine included group therapy, a social worker who spoke with each patient and would ensure they had transit tickets, dealt with disability funds and residence issues,  psychiatrists who checked in once a day re the condition of the patients and regular consultations at set times,  a rest period, individual counseling, an hour of crafting and the availability of a TV and a record player for social time in the afternoon.  Staff could also refer patients who had medical issues to MDs in the building (social medicine offered more in those days!).

I remember how awkward the group therapy sessions were, as most of the time none of the patients offered any words, and the room would be heavily silent.  One of the patients, a 6Oish woman, who looked more like 8O, and never spoke, sitting all day in an armchair, smoking a cigarette (patients were allowed to smoke in hospitals in the 7Os), well she would take a couple of puffs, and then continue holding the lit cig in her fingers, while it burnt down to her fingers.  She must have done this for many years as she had horrible scars on her knuckles of these 2 fingers.  At least in Day Hospital, we could attend to this issue and put out the cigarette or remind her to either smoke or extinguish it.

Yes, I am sure a lot of these patients were in a state of sonambulance due to the medications they were prescribed.  The alternative to not being medicated I am sure would have been worse and probably negate the essence of the Day Hospital function.  I am not saying that it is good for patients to be too doped up,  but what a conundrum.  I believe that the psychotropic drugs were prescribed in ‘good faith’ in earnest efforts to help these patients function.

the only good things about our psyche rotation were

  • we were allowed to wear our civvies
  • We had the most amazing instructor, Milly B.  She was empathetic, compassionate and had a sense of humour.

There was many a day where you could pass Milly’s assigned office on the day hospital unit and find one of us crying our eyes out.

We of course were each assigned a patient.  Mine was Mary D.  She suffered from a plethora of psychiatric ailments, including paranoid schizophrenia.  Mary was about 35 and alone in the world. She had never been able to keep a job and had often ended up living on the streets.  She had suffered many physical injuries and had been raped more than once.

Mary was of small stature, thin, and pale with stringy, greasy long brown hair.  She looked like she had given up as she paid no mind to her personal appearance, and often smelled of urine, body odour and worse.  She frequently wore the same wrinkled stained clothes from day to day looking like she had slept in them.  It was extremely difficult to talk to Mary.  She would never look me in the eye and often ignored or did not hear my questions.  This was the common scenario and the reason my colleagues and I found this experience so depressing and left us feeling inadequate and hopeless about helping our patients and making a difference in their lives.

One of the obvious functions of the Day Hospital, was that we would administer their medications during the 8 hours they were with us.  It seemed difficult to imagine that most of these patients in various states of lost and fractured minds could regularly remember to take their pills.  Patients were offered hospital meals of breakfast, lunch and an early supper in Day Hospital, for some of them, probably the only good food they had access to for the whole week.  They also had access to showers.  Mary never wanted to take a shower and I often needed Milly’s help to persuade her to wash or take a shower.

I had read in Mary’s chart that one of her phobias was hair.  Apparently once, she had shaved off all her hair, and plucked out every hair on her body, including her eyelashes!

The last day I saw Mary nearing the end of my rotation, she continued to be uncommunicative, but did agree to a full shower, took her meds for me and ate a little from the meals offered to her.  We (the students) left, as always, 30 minutes before the end of the Day Hospital day which closed at 4:30pm.  I said goodbye to Mary, who was sleeping, sitting up, at the end of a couch, not an unusual occurrence in this unit.

The next morning, arriving at Day Hospital for our shift,  I was thunderstruck to hear that Mary was dead!  At the end of  yesterday’s shift, when staff had tried to awaken Mary to go ‘home’,  they discovered that she had no vital signs.

OH MY GOD………………….Mary was my patient!   Was it my fault? Should I have checked that she was breathing, felt for a pulse when I said goodbye to her????  She didn’t look any different snoozing that afternoon than she did snoozing at any other time.  Her lips were not cyanotic, she did not feel cold to the touch, when I patted her hand.

I was relieved when Milly told me it absolutely was not my fault, and that Mary was most likely alive when I last saw her… but still I felt so guilty and inadequate!

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Such was the psychiatric rotation at Queen Street in 1974…

student nurses learning………the hard way

There was a night that I was working with Jasmine, a girl from my class.  I cannot recall if she was a Brit or had come from another country to train.  I believe that there was a more senior student (we were 1st year student nurses) on duty that night and a nurses’ aide.  Our superior had gone for a break and left the aide to guide us.  The aide was an older lady who had been working there for many years.  Jasmine and I decided to do rounds.  So with a flashlight in hand we started to go from bed to bed to check on our sleeping patients.  Halfway through our rounds we noticed an older woman who was not a healthy colour.  I believe that I felt for her pulse and could not find it, nor detect her heartbeat.  We both declared in a whisper that she was dead.  We both headed away to get the aide.  As I was closing her curtain, the patient let out an enormous breath.  Poor Jasmine and I shrieked, but mindful of an open ward full of sleeping women, we somehow shrieked very quietly.  I think this poor woman was probably dying, because there was no emergency, no code for a cardiac arrest.  The aide showed us how to clean and prepare a dead body for the mortuary.

The poor woman died all alone in the night…

A sobering night for Jasmine and me…

my guardian angel….

Oh, the rigours of being young…. It wasn’t easy, but at 53 and as I confess that I have not been overly good to my body, I wonder what it was like to move with ease, no creaking bones and aching muscles.  Of course, when one has the gift of youth and a strong adult body (even the right leg must have been relatively strong), one would not even notice facile activity.

Anyway, enough rambling on… Here I will recount some lucky strikes.  I can only but wonder at the escape from injury or death!

Back in 1975, when I lived with my drunken amour, and worked down Oxford Street, I had an afternoon off, so rather than go home, I thought I would go to Selfridges which was just a short walk past JJ toward Marble Arch.  I was at an intersection of xxxx (I cant recall) and Oxford Street where the big store was located.  The light was green, but as I was not situated bang on the corner, I crossed between cars (about 3 from the crosswalk (!)).  As I almost reached the pavement I stalled.  Somehow my mid-length blue trench coat had become stuck in the back bumper of the car I was passing.  So I gave my coat a pull…. nothing… a bloody great yank! … Somehow the hem of my coat was well and truly wedged in that bumper.  To my horror, I seemed to notice that the light had turned amber.  I continued with my struggle to free my coat and in those split seconds a few thoughts went through my mind…. I could take off my coat….. I could jump on the back of the car and pound on the rear window, or I could be dragged to horrendous injury or worse.  In those minute nanoseconds, I realized that I actually did not have time to take off my coat as the line of traffic had begun to move.  The next thing I know I had hurled myself onto the back of this car (I have no idea what make, I believe it was big, posh and black) and pounded on the rear window.  An older woman turned and with a mortified look on her face she must have instructed her chauffeur to stop the car.  The uniformed man approached me.  I was on my feet as thankfully the vehicle was stopped.  He gave my coat a tug… nothing!  Then he pried the bumper from its position tucked so tightly against the car, and finally I managed to extricate the offending corner of my coat from this car.  Knowing what a polite woman I am, I am sure I thanked him.  He returned to his front seat and rumbled off.  I, in shock, completed my crossing to the safety of the pavement.

I entered Selfridges and immediately sought out the ladies’ loo where I entered a stall, sat shaking and sobbed.  I did not accomplish my mission to Selfridges, whatever that was.  I made my way home, thinking of how horribly injured I would have been if I had not managed to grab that woman’s attention.  I also thanked my lucky stars that I did.