Confessions of a Male Nurse
Mr Smith was brought into the ward at eight o’clock on a Sunday evening. His chest was heaving as he strained to pull air into his lungs; you could hear him wheezing, coughing and spluttering from outside his room. Mr Smith had been a bit off-colour for nearly a week. What had started out as a mild cough had gradually stained his handkerchief with white, then yellow, then green and now red speckled sputum. The infection had crept insidiously into his lungs, spreading lower and lower like a cancer. The nurses from the rest home had advised him to come to hospital earlier, but like many men in his position, he was stubborn and refused to move. By the time he agreed to go to hospital, he didn’t really have a choice: it was go to hospital, or die.
I liked Mr Smith instantly.
‘I’m only being a burden; just put me out of my misery,’ he said between gasps.
He even managed a brief smile. It says a lot about a person’s character when they can joke at a time like this.
I told him to stop talking rubbish; that once the medicines kicked in he would be feeling much better.
Forty-eight hours of intravenous antibiotics later, and Mr Smith was rapidly improving. He could speak whole sentences without getting out of breath. He was not coughing up so much sputum. He even managed to get himself up out of bed and into the reclining chair.
Watching your patient get better, knowing that you are one of the people responsible for making the difference, is one of the greatest feelings in the world. Though, while I’d love to be the one to take the credit for his progress, it’s always a team effort. It wasn’t only a matter of antibiotics fighting an infection: nurses cleaned, dressed, toileted, exercised and talked to the patient; the physiotherapist came in twice a day to exercise his chest; the laboratory and X-ray people visited daily to draw his blood and irradiate him.
Between us all, I was sure we would get Mr Smith back home.
It was Wednesday, Mr Smith’s fourth night in hospital, and he and I were discussing the merits of a commode versus a regular toilet.
Like most patients, Mr Smith had never liked using the commode, but up until now he had been too sick to risk taking too far from the bed. ‘I won’t sit on that disgusting thing again. There are other people in here and it is embarrassing.’
He had a point: there’s no way to completely hide the smells and sounds that go with taking a dump in a shared room.
‘I’m not using it and that is final.’ Mr Smith was adamant, and began to get out of bed. ‘You could try making yourself useful by handing me my walking stick.’
I had a vision of Mr Smith collapsing in the middle of the corridor: ‘Please, wait a moment and I’ll grab you a wheelchair.’
To make things easier, I used a portable shower chair, so that once I had him seated I could just roll it straight over the toilet and he wouldn’t have to move one bit. As I wheeled him down the corridor I noticed he was still wheezing, not nearly as badly as he had been on admission, but I still set him up with some portable oxygen to help things out.
Naturally, I wasn’t keen to leave Mr Smith alone, so I waited discreetly outside the partially open bathroom door, calling out every 30 seconds, ‘Are you okay in there?’
To which he responded, ‘Can’t a man take a crap in peace?’
But on my fourth call, Mr Smith was silent, and then I heard a thump. My heart leapt into my throat as I rushed in.
Mr Smith was still sitting in the chair, but he had slumped against the wall with his eyes staring sightlessly ahead. His nose and lips were a bluish purple, and darkening before my eyes.
This was it: my first arrest.
I’d actually felt a little envious of fellow student nurses who had been involved in an arrest during their training. I’d also heard experienced nurses casually talking over lunch break, ‘Oh yeah, Mr Brown, he was in VF and we shocked him a number of times; we got lucky – he pulled through.’
But this wasn’t exciting like I’d imagined. I couldn’t ever envisage casually discussing this over a sandwich. This was a nice old man whom I liked and who seemed to like me. A man who had been getting better.
An arrest can refer to arrested breathing, or an arrested heart. In Mr Smith’s case, he definitely wasn’t breathing, and if his heart hadn’t already stopped, it would very soon.
I called out for help, shouting down the corridor, and kept my finger on the call bell, until the doctor and another nurse came running.
The bathroom is not the easiest place to begin CPR and neither is a shower chair.
‘Grab his shoulders and don’t let him fall,’ Dr Jackson instructed as we wheeled him back to his room.
Between the three of us we literally threw him on to his bed and the doctor barked at me to push the arrest alarm.
The alarm was in the corridor. I walked past it dozens of times each day – in fact, I’d often wondered if I would ever get to push it – but suddenly it had disappeared. It should have been right in front of me, but the wall seemed so damned big at that moment.
It could have only been about ten seconds before I found it, but each of those seconds was one more in which the life was draining out of my patient. I jammed my finger on the button – which, of course, had been in front of me the whole time – and raced back into the room.
The doctor yelled at me to begin compressions. Holy shit, compressions. I jumped on Mr Smith’s chest and began pumping up and down at a furious rate, while the other nurse used an Ambubag to pump air into his lungs. The doctor was trying to get some intravenous access, because Mr Smith’s old line wasn’t working – what a horrendous time for a line to pack up. I hoped they wouldn’t blame me for that; he was my patient after all. I could see the swelling around the old IV site where the doctor had tried to inject some medicine.
‘Not so hard,’ the other nurse said to me, as I felt a sickening crunch as a rib or two cracked under my hands.
Within a minute, the arrest team arrived and the professionals took over. They asked me to stand back while they did their work, and in my hurry to get out of their way I knocked over the drinks bottle that was sitting on the bedside. It’s a strange thing to remember at a time like this, but it was a glass bottle full of black-currant concentrate, and when it hit the floor it splattered bright red everywhere, like fresh arterial blood.
As the arrest team got underway, I was amazed at how calm, quiet and confident they all were whereas I was shaking from all the adrenaline pumping through me. I watched as they hooked Mr Smith up to a monitor and wondered if they were going to shock him with the defibrillator, but it was too late for that. He had no electrical activity left in his heart.
In a lot of TV shows, someone yells ‘Stand clear’, and they shock the patient with some paddles, but Mr Smith didn’t need this. In fact, most TV shows get it wrong. Those shocks don’t start the heart, they actually stop the heart. When a heart arrests, the electrical activity which once made the heart beat doesn’t stop immediately: it goes haywire, shooting in all directions. It makes the heart a quivering jelly, shaking with all that uncontrolled current. When we shock someone, we’re trying to briefly stop this craziness, in the hope that the patient’s own heart will start again in a healthy rhythm. Another way to think of it is a lifeguard who swims out to rescue a drowning swimmer, but the swimmer is so panicked, the rescuer can’t do his job, so the rescuer slaps them really hard, to shock them into calming down.
Sadly, Mr Smith died that night and it was not a nice way to die; he was sitting on the toilet for goodness’ sake. The nurse with me during the arrest was Rose. She was in her early fifties, and had been a nurse all her life. She could see how shaken I was and took me aside for a quiet word.
‘There’s nothing you could have done,’ Rose said to me, ‘it’s quite common for people to die on the toilet.’
Registering my surprise Rose told me that it’s not unusual for people to want to empty their bowels before having a heart attack. She then explained that the effort to try to pass a bowel motion was often the trigger that set it off. She even said she’d lost a few in the toilet over the years.
But, instead of feeling better, I began to feel guilty. I shouldn’t have let him go. I knew he should have stayed in his room and used the commode.
‘It’s not your fault,’ Rose repeated, then let out a brief chuckle. ‘There’s no use feeling guilty. When it’s your time, there’s nothing we can do.’
Rose’s words helped a bit but there was still a sense of guilt. I was determined never to let any of my elderly patients use the toilet again; they could wait for the next shift to come on.
Rose offered to help me prepare Mr Smith for his family, who would arrive shortly. This was another new experience for me.
As we began to wash Mr Smith, Rose did something unexpected. Every time she did something to Mr Smith’s body, she would use his name and explain what she was doing, just as you would with a living patient. She was gentle, and spoke softly. You could tell she still cared.
Heartless
‘I’ve learnt my lesson,’ Mr Holdsworth said, pausing to look me in the eye for emphasis, before continuing. ‘I’ve learnt it the hard way.’
I nodded my head in sympathy, even though I’d heard the story at least three times. He seemed to think of himself as some self-sacrificing guru of wisdom; wisdom gained through pain and suffering. Well, I guess he was at least part right.
‘Don’t make the same mistakes I . . . arrrgh—’ He never finished his sentence because he was clutching his chest.
Having looked after Mr Holdsworth during his last two admissions, I was quite used to his frequent attacks of chest pain.
I placed an oxygen mask on Mr Holdsworth’s face, told him I’d be back shortly, and left the room. When I returned I was armed with morphine. ‘This should do the trick,’ I said as I injected the narcotic directly into his vein.
Often providing oxygen can be enough to relieve a patient’s angina, but if this isn’t enough, then morphine is another option. It not only relieves pain, but helps reduce the workload of the heart.
I watched Mr Holdsworth’s expression as the pain slowly eased from his chest and an almost calm, albeit glazed, look came over his face. It’s sometimes hard to believe that medicine can have such an amazing effect.
‘How much that time?’ Mr Holdsworth asked.
He always asked this and every time I was reluctant to answer. It’s not as if he didn’t need the medicine. People rarely ask how much. Maybe it was his background that made me reluctant, or maybe it was because I was giving him more each time, which meant his heart was getting worse.
‘Thirty milligrams,’ I reluctantly replied, avoiding his gaze.
‘Hell, I’ve never had that much in one go.’
Mr Holdsworth didn’t sound upset, more intrigued, as if curious about how much his body could take. You see, Mr Holdsworth used to be an intravenous drug user. Over the years that he had injected morphine into his veins, he had built up a resistance to the drug. This was also how he damaged his heart. Most of the damage occurred on the occasions he took so much that his breathing stopped (one of the primary risks of morphine). Once his breathing stopped, it wasn’t long before his heart stopped. Fortunately paramedics were able to revive him. Each time, he survived, but the damage to his heart was permanent.
‘Not a good sign is it?’ he added.
Sometimes it pays to tell the truth, even when it can hurt, but it’s still hard. Should I tell him that I’ve never given such a high dose of morphine in one push, or given it as frequently to one patient, in my entire career? Should I tell him that I’m even a little nervous giving 20 to 30 milligrams pushes of morphine every half an hour? He probably already knows this, especially given his background. He probably already knows that for most people one to two milligrams is a sufficient amount.
‘You’re probably just having a bad day,’ I replied with false bravado and an equally false smile.
‘Now I know you’re trying to be nice, but stop the bullshit. You know as well as I that I probably won’t make it to Christmas.’
Mr Holdsworth tried to say this as casually as if he was talking about the weather, but I could tell his efforts were as forced as mine.
‘You’re still young, there is a chance. Something could happen any day.’
Unfortunately, Mr Holdsworth had had his first heart attack at the relatively young age of 36. It had been his first wake-up call, but now after four heart attacks, and four subsequent areas of dead, scarred heart muscle, there was very little that either drugs or a healthy lifestyle could do to help him. Christmas was one month away and unless a miracle happened Mr Holdsworth was probably not going to see it.
Still, we had to hope, sometimes it’s all that keeps us going, and there was one chance, one possibility, that we could help Mr Holdsworth. At the age of 47, the only thing that could save him was a new heart, but after five years on the waiting list already, it seemed a very small chance indeed.
With Mr Holdsworth’s rapidly declining health, the topic of conversation was often how much longer he would last, and whether a miracle would happen.
‘I feel sorry for him . . . sometimes,’ Jenny said to all the other nurses in the office, ‘but at other times, I think he doesn’t deserve our compassion, or a new heart.’
‘I know we’re supposed to be caring, but we’re only human,’ I said to Jenny. ‘Today I felt sorry for the poor guy, but I’m like you. I don’t always have much sympathy for him.’
As I looked around at the other nurses in the office I could tell, by the nodding heads, that we all seemed to have similarly mixed feelings. ‘I guess it doesn’t really matter what we think now,’ Jenny continued, ‘he’s paying for his mistakes.’
Four weeks passed. It was now only a few days until Christmas Day. The girls had been busy decorating the ward, and I nearly broke my neck balancing precariously on a patient’s bedside cabinet to put the finishing touches to the tree. I love this time of year – everyone is in such great spirits – even the patients don’t seem so sick.
With half the ward empty we had time to sit around gossiping and reminiscing about who was the drunkest at the Christmas party – until it came time for me to check on Mr Holdsworth.
‘How much that time?’ he asked.
‘Forty milligrams,’ I replied. ‘Is it enough?’ I added.
He had stopped clutching his chest but his face was still creased with pain.
‘Could you try a little more, just another ten? That should do the trick.’
The instructions given to us by the consultant were to give Mr Holdsworth whatever it took to keep him comfortable, so I administered a further ten. With the additional dosage the last vestiges of pain left his face.
‘You’ve been good to an old fool like me,’ Mr Holdsworth said.
‘We all make mistakes,’ I replied.
‘It won’t be long now and I’ll pay the ultimate price.’
My mind was blank. There was no suitable response. I chose that moment to leave the room, my Christmas spirit well and truly dampened.
The next morning something strange happened; as I headed towards the nurses’ station I found myself taking a detour until I was standing outside Mr Holdsworth’s room. The first thing I noticed was that his name had been removed from the door; the second was the deathly silence in the room.
I felt strangely depleted. I think that deep down, I had been believing that a Christmas miracle might happen. I quietly opened the door and there, staring me in the face, was an empty room. I headed to the office, where the nurses seemed to have gone mad.
Jenny greeted me with a big smile. ‘Have you heard the news?’
I didn’t know what news she was thinking. I know we all had mixed feelings about Mr Holdsworth, but it didn’t seem quite right to be so damn happy first thing in the morning when a patient has just passed away.
‘It’s Mr Holdsworth,’ she was almost exuberant. ‘They came for him last night. They found a donor. He’s getting a new heart.’
Everyone in the office was so genuinely happy that he was going to have a chance at life – regardless of whatever past mistakes he had made. Without a doubt that had to be the best Christmas present ever.
Mr Holdsworth’s transplant operation had taken place far away in a big city hospital, so Jenny had to phone the hospital every few days to get an update on how our patient was doing.
‘He could be discharged soon,’ Jenny informed us, three weeks after he had been taken away. ‘The doctors say he is doing really well. No sign of rejection.’
Three months later and Mr Holdsworth was back at home and living a normal life – although, we assumed, a much more careful, healthy life. It makes sense that a near death experience makes a person wiser.
During the two and a half years I had spent with patients in the medical/surgical ward, I thought I’d seen it all. I had seen how high the human spirit can soar, and then how low and selfish humanity can be. But then, along would come someone new, who would set up new boundaries, whether high or low.
One April morning I was greeted by Jenny, who had news to share: ‘Mr Holdsworth is in the emergency room.’
‘Organ rejection,’ I blurted out.
‘Oh no, it’s much worse than that’ – What could be worse than your body rejecting your new heart? – ‘He’s back to his old habits. He’s overdosed on morphine.’
Jenny didn’t attempt to hide the scorn in her voice.
‘But that’s not even the worst part. When he gets out of here, he’s got an interview with the police. It seems he’s been selling it as well.’
I guess not everyone learns from their mistakes. As I look back at some of the ambivalent feelings I had had while looking after Mr Holdsworth, I wonder if deep down I doubted that he really had changed. That heart could have gone to someone else less likely to waste it. I try not to judge, but the fact is we’re all human and we do have opinions. I just hope that as a nurse, I can always accept people for who they are and give them the best care that I can.
Making a difference
‘Mr Henderson has taken a turn for the worse,’ Colleen read to the assembled nurses. ‘He wouldn’t get out of bed today and his chest is sounding bad.’
Colleen looked pretty upset about this; moisture was pooling in the corners of her eyes. Colleen was straight out of training and hadn’t lost a patient yet; everyone was wondering if Mr Henderson was going to be her first.
All of the nurses liked Mr Henderson; he was a truly genuine, down-to-earth sort of man, with a heart of gold. At the age of 69 he should still have had some good years in front of him, but he had a bad case of pneumonia that the antibiotics couldn’t seem to get rid of.
‘The doc requested another chest X-ray. The infection hasn’t improved at all,’ she continued. ‘He even thought it was a bit worse. Every breath Mr Henderson takes is an effort. It’s horrible to listen to.’
The sound of a rattling, bubbling, straining set of lungs is never nice.
Everyone kept quiet – we had all had our first lost patient, and though Colleen might shed a few tears if Mr Henderson passed away, she would eventually recover.
With the report over, we filed quietly out of the office, talking with muted voices about the patient, as if he had already passed.
I was helping Colleen with Mr Henderson that day. As I entered his room, I took in his sickly grey skin. ‘Good afternoon, Mr Henderson, I hear you’ve been giving the girls a bit of trouble.’
This brought a smile to his face. ‘Could be better, son,’ he rasped.
That was Mr Henderson, having a joke in the face of death. I grabbed a passing nurse and together we heaved him upright in his bed to help his breathing.
‘I don’t think I have much time,’ Mr Henderson said to me when his coughing passed. ‘I’ve had a good life. I’m not ashamed of the life I’ve led.’
I felt a lump in my throat.
‘It’s not over yet, Mr Henderson’ – I had to at least try to be optimistic – ‘The doc has just started you on a new antibiotic; you might feel like a new man tomorrow. Besides, you can’t go letting young Colleen down after all her hard work.’
Mr Henderson managed a wry chuckle before bursting into another round of coughing.
‘You’re a bad liar, but you and the wee lass have done a lot for me – it would be a shame to disappoint you.’
Still, I wished there was something more I could do. Often it’s just a case of being there for a patient, and willing to listen. Every so often, though, there’s the option of doing something extra. Later that evening I had a chat with the other nurses about how we could make Mr Henderson more comfortable.
‘Room 5 is free. What do you say to that?’ I asked Rose.
‘The poor fella is in a four-bedded room. It’s not nice for him, or for the others in the room. Let’s move him,’ Colleen added.
This was the same Rose who’d been with me during my first patient death. She was the acting charge nurse for the late shift. She had as much experience as most of us on the ward put together, but she would never be a full-time ward manager. For her, nursing was a hands-on profession. Hands on patients, not hands on pen and paper. Once you started to move up the nursing ranks to managing you lost a lot of that daily contact with your patients.
Thankfully, Rose approved the move.
What’s so great about room number 5? Just ask Mr Henderson.
‘I never get bored with the view,’ he told Colleen and I as we gave him his bed sponge.
It was early summer and the view from his window was pretty spectacular. It was on the top floor, and looked out over the local gardens and playground. From room 5 you could see mums and dads playing with their children; you could watch as young couples strolled through the rose garden; and, best of all, room 5 was at the end of the ward and had windows on both sides, so it was possible to watch both the sun rise and the sun set.
‘It sure is lovely,’ Colleen said. ‘I don’t think I would get bored either.’
Still, Mr Henderson had been in room 5 for over a week now, but had only slightly improved.
‘I guess it must be frustrating to be so close, yet so far,’ I added.
I don’t often make such shrewd observations, but I just knew that Mr Henderson would give anything to be outside in the fresh air. He didn’t reply, though; he had dozed off to sleep, but little did I know how much my comment had affected Colleen.
It was a gorgeous, early summer Sunday afternoon and now Mr Henderson’s fourth week in hospital. Unfortunately, he had taken another slight turn for the worse. It’s not uncommon for a patient’s health to have its ups and downs. The infection in his lungs had spread throughout his body. The doctors were using terms like sepsis and triple antibiotic therapy, but nothing we administered seemed to make any difference.
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