Road To Nowhere

I got on to a big red double decker bus. I couldn’t find a seat and so I sat at the front upstairs. The bus took an unusual route and headed for the country. I turned around to see how many people were left on the bus. I was now alone. I couldn’t get off here because it was very far out of the city. I sat expecting the bus to change route but it didn’t. It turned and drove along the shore. I could see the sea but it wasn’t a calm day. The sea was throwing itself against the rocks turning white and frothy as it did so. The bus kept on going and the road became less than safe. It was narrow and we were driving along the edge, it felt like we could topple over into the sea. I felt frightened. Still the bus kept moving. It turned and creaked over the steep narrow roads. We were really high up over the sea, I kept looking out to see the journey ahead. The bus sped up and now we were going really fast. I saw a bigger bit road ahead and decided I would get off here. The driver looked angry at me as I left the bus. I was at the beach; it was now nice and sunny. To my left was the beach and to my right up the hill was a tennis court. The beach was full of people sunning themselves and children played in the sand. I looked up at the sky and it was changing from daylight to night time. The sun was blocked out by big black clouds. The sea was coming crashing in at a terribly fast rate. Everyone screamed as they tried to pick up their belongings before running away. The sea started to swell up onto the road where I was standing and I was up to my knees in it. I couldn’t move I was scared and even if I wanted to run there was nowhere to run all exists were blocked off. Why did I come this far, I thought?


I'm alright honest!

I jumped out of bed, looked at the clock and I had awoke ten minutes before my alarm. Driving on to work I couldn’t stop thinking about my dream. It was quite warm this morning and I looked up at the sky which still had some stars and was very clear. I wandered into the ward and before I could reach the room to get handover, the sister in charge said she wanted a word with me. She ushered me into a cold room with table and chairs. I sat down wondering what I had done. She had a mug of coffee in a cup with a cat on it. I looked at it as it was the only thing on the table to focus on. She began calmly by asking how I was getting on. I looked up in to her face, youth had deserted her a long time ago but she had a face that could be fixed up but anger had down turned her mouth and it had obviously set. She smelled of strong perfume and she had spilled something down her dark blue overall. Her eyes were a deep blue and she had died her hair a brown colour. Her face was darker than it should be with the tell tale signs of foundation lines around her chin. I said I was alright but then I went on to address some of the issue I had. I said I needed support in the ward to learn a new specialty not isolation. She went on to say that she was annoyed that I had contacted the union. She reminded me that she was my boss and if I have problems then I should address them to her. I said that while this may be true some of the staff is bullying me and I felt I could not speak to her. I said I can’t work in this environment. She got very angry with me and her top set of dentures slipped down as she shouted at me. ‘How dare you involve the union.’she said, ‘who do you, think you are?’ ‘What exactly is it you want’? She said. I told her calmly I just want to get on with my job and to be supported in that. She stood up and walked right over to my face, I could smell the coffee from her breath when she shouted ‘you are making me look like an idiot.’ I asked if that was all and could I go. I was quite scared but I dare not show her. ‘I want you to say everything here is alright, isn’t it?’ I replied, ‘er yes yes.’ I thought if I tell her what she wants to hear she will leave me alone. I reply, ‘well actually things were bad but now they are alright.’ She shouted at me, ‘GOOD!’ I put on a pretend smile and stood up. I walked down the ward feeling really scared. She had just bullied me and I needed to get out of here. In my break I phone the union and tell my steward what happened.

A date has been fixed for me to attend a meeting. I go into the meeting the next day feeling really anxious. I just want a peaceful life, going to work and then getting on with life but this has so far never happened. A woman from human resources and the directorate manager are there along with my steward. I am asked to discuss my issues with them. The directorate manager turned around and said that the sister said you are now alright now, is this true? I replied that I was not alright and I had to say this to get away from her as she was shouting at me. The meeting ends with me being allowed to work elsewhere. I am allowed to go home after the meeting. I am so happy to be away from this unit but through my experiences I do not know if things will be different anywhere else. Nursing has already got a set culture but surely there must be good places to work.


Enough To Raise Your Blood Pressure

I walk away with my back pack over my shoulder. I go into the staff canteen and see one of my old university mates. I ask how she is. She informs me that she is leaving nursing. I ask if she has contact with anyone else. She tells me that there are few of us left and that many have now gave up to do other work. I feel quite sad about it all, we all spent such a lot of time together and very few of us are happy. There must be a reason for this. Nursing is set in a busy environment were mistakes must not be made or we can be struck off. Paperwork is getting deeper and deeper. Our hours are long with very few breaks and we are always short staffed. This is a dangerous culture. It frightens me to think that any slip up could place me in front of the magistrate’s court. If you don’t document a patient’s condition, it didn’t happen; if you did it has to be precise. Omissions are just as bad as poorly written documentation. Damned if you do and damned if you don’t. Every piece of paper we sign our name too is a legal document. I like the way each ward has its own way of writing the notes and everyone blindly copies the same format for example, ‘patient had settled day, non-complaining, all care as planned’. One thing is, who on earth has a settled day in hospital? To write in the notes non-complaining, doesn’t say much about a patient at all. The best one is ‘all care as planned’. To write ‘all care as planned’ is obviously assuming the nurse has carried everything out that is to be carried out for the patient. However, if the nurse gets home and then realises she has forgotten to do something and the patient has an adverse reaction then the record of this has legally implicated her because she has stated that all care was given as planned. However, if the nurse writes nothing then the nurse could be deemed to not have carried out her duties.

There is no fool proof way of recording about patients but at best it pays to be honest. If the patient is complaining about pain, best write that the patient was complaining about pain and what you did as the nurse to alleviate it. As for observations, they are the most important key of how a patient is doing. If blood pressure is low or high and the patient looks well and is up and about, it pays to check back what their normal BP is because it may always be low or high and this could be their normal. New devices though are needed to cut out paperwork.
I walk out into the afternoon sun and go into my car which is boiling. I turn on my music and drive off with a sigh of relief over today. I just hope that my next ward is going to be alright.

Culture of Discontent

I lie reading a book on the Mayan and Aztec cultures. The culture is amazing but with some very grizzly ideas, but then it’s easy to cast judgment outside of a culture. Aztec law appeared barbaric and theft was dealt with by strangulation. Those found drunk would have their heads shaved on the first occasion and on the second they would have their house knocked down. The punishment on the third occasion rises sharply to death. I lay back thinking that I did not know anything about this culture until I read about it. The outsider of the nursing culture does not know what really goes on in nursing and I bet they would be just as horrified to read what goes on as I was to read about aspects of the Mayan culture.

I dream of what it must have felt like to climb the steps of the great Mayan pyramids knowing that death was to follow through ritual sacrifice. The dread from it all must have been so terrible that I could never imagine. All these people who died needlessly but then their leaders needed to look like they were in control and so their rituals appeared to have significant meaning to the people. Did their people never question why these people had to be put to death? It is so poignant that people accept their fate from what they are told by others and never ever question anything. This behaviour is nothing new as I lie thinking about my glossy filled book which still harboured a smell fresh from the bookshop, which incidentally also sells the most amazing coffee.

A Little Rash

I close my eyes and then the alarm goes off. I am feeling the dread of work and the only analogy I can think of at this time is walking up the steps of that big Mayan pyramid to be put to death. I think about phoning in with various excuses but don’t we all do that? ‘Hello, I’m sorry I can’t make it in today, yes, yes my cat choked on a chicken bone and well I need to take him to the vet.’ Or, ‘I was looking after a little old lady yesterday in the ward and she had a strange rash all over her face and now I have it.’ I doubt they would believe it. Oh well I must get up! I drive up towards the hospital and there are other nurses slowly wandering in. I can always tell the standard issue dark blue trousers with the white tunics hanging below the jacket. They wander in like zombies. They all look miserable and walk slowly from all different directions as though if they walk slow they will miss their shift altogether. As I wait at the lights I gaze across to a field and the dark lush green grass has a wet coating across it crystallised with dew, like a frosty icing on a cake. The trees look dark and eerie with a glimmer of sunrise in the background giving them a silhouette appearance. Green lights set my wheels moving and I turn off my music, my music is my only sanity in all of this, and a day spent without music is a sad day. I watch blue lights flash quickly past me and I see an ambulance bring another sick patient to be cared for. I wander to my ward and quickly get changed. I go to hear my handover and exchange very simple pleasantries but they are not reciprocated.

Maya Head

I try to write quickly but am unable to do so and miss lots of details out. I quickly ask if some details can be restated, I hear a sigh and I pretend I did not hear it. I am not familiar with this ward and many terms are abbreviated and I do not know what they all mean. I am told that I will be caring for beds 16-30 with another nurse and a care assistant. I quickly get started; the other nurse Brenda ignores me as I try to make conversation. I help the care assistant get the patients out of bed while the other nurse decides she is giving out the drugs. The care assistant has been here for many years and also ignores me. She sighs at me as I do things differently to her. I have my justifications and hers are just a way she has built up over many year. Why she does it, who knows, because she has always done it that’s all! She doesn’t ask questions she just does her job. She is an angry looking woman whose appearance has obviously withered in her anger with a face like the large carved head at the Maya city of Copan. She moans at me but I am too nice to speak back although I feel resentment. She never washes her hands and patients are moaned at too, so I am pleased I do not think it is not a personal vendetta against me.

The other nurse Brenda is clinically obese, an all too common sight these days and she wears the dress uniform. She likes to be in charge even although she is band five, the same as me and she has had no managerial skills to be in charge of me. I accept though that I am still unsure of this ward so do not care. She reminds me a patient is getting home for the day, she is having ongoing intravenous antibiotics but has now stopped them and she is due back later in the day to have more. She wanted it that way! As the patient leaves I throw out the intravenous line which is filled with some of the patient’s blood. As I close the lid on the bin Brenda shouts at me across the room filled with patients. She says that this intravenous line was good enough to use again when the patient came back in ten hours time. I think to myself and I examine my actions. I say ‘well it is in the bin now’. Afterwards I thought about this and just for one split moment I thought maybe she could be right and the ward is saving money. When I returned from the world of the insane I was glad I threw it out. How much money does the NHS actually save by reusing intravenous lines, attaching them back to the patient many hours later? What is the point in giving antibiotics for infections when they are pumping old blood but into the patient some ten hours later? Disgusting! If I was the patient I would refuse anyway. What sort of barbaric practice is this? Let’s go back to the old ways of giving the syringe a clean in between patients. What research was carried out to justify reusing these lines?

Mirror Mirror On The Wall Who is the Evilest of Them All?

I watch this nurse all day after this and examine her practice. She also never washes her hands and doesn’t even try to speak to the patients. If I was a patient and she came near me I would get out the bed and run as fast as my legs could carry me. She converses with the care assistant with the stone cold Mayan head but looks at me as though I where the mother of all evil. I check my appearance in the mirror as I go for my break to eat my cereal. I look at myself in the mirror feeling sorry for myself, beginning to wonder if I am emitting evil from somewhere unsuspecting. Perhaps I need to smile more I think, I try to smile in the mirror but just look stupid and just feel sad. It is hard spending each day at work without anyone to speak too. I don’t belong in nursing, I am not like them I think. Maybe they have something I do not. I comb my hair and walk towards the door when it is flung open. In walks a nurse that I saw from afar today in the other part of the ward. She looks up at me and says ‘I hate nursing, this is just my third month and I regret every bit of it’. ‘Maybe you will get used to it’, I say. She said that she was looking for another job already. She speaks to me about her experiences and bursts out crying. She is now getting counselling to cope with the bullies in her job until she can get another one. I understand what she is going through but I don’t want to tell her my experiences because I may make her feel worse. I go into the staff room to eat my cereal and I listen to a conversation about a poor young eighteen year old girl who has a severe illness and has no longer got the ability to do anything for herself. They discuss her very condescendingly because the patient was refusing to have anyone wipe her bottom after the toilet. How dare she be the spanner in the works of their cosy routine? One nurse pipes up, ‘she will just have to get used to it because that is her life from now on’ another nurse sarcastically laughs saying, ‘she says she will be going back to the gym, she is so out of touch with what is really going on.’ I felt so sorry for this young girl all her mobility cut off so young and I just couldn’t stand the way they were dissecting her life as though it were just another episode of Eastenders. What eighteen year old girl would gladly succumb to having all her dignity ripped away from her like that? Imagine having Mayan head lady come up to you saying, ‘I’ve come to wipe your butt’. Scary thought! The young girl may not be facing up to her realities yet because if she did then it would sink her as it would anyone. A big part of her life was going to the gym and why shouldn’t she dream of getting back there. Ripping away someone’s dreams is the cruellest thing any nurse could do! Hope is something that we all need! Nurses all need to be taught counselling skills.

Hope For Us All

I go back to the ward one patient is just thirty and she is so happy that she will be getting home at the end of the week. I didn’t get to know her but we had great conversations on everything and laughed together. Her face was very yellow and her eyes were sunken. She informed me she was getting married and she was so full of joy about it I could feel her happiness. She was diagnosed with cancer and was given three months to live. She shook me by the hand as she left the hospital at the end of the week and said you have been a great tonic. I looked into her sunken eyes as she left and I wanted to make her well but knew only a miracle would save her. It is hope that kept her going. The Mayan headed care assistant now thinks she is in charge and attempts to boss me around while the other nurse look smug. She informs me of so called ‘unit errors’, which are all trivial and are done by way of culture rather than any rationale. I ignore her and make some excuse for myself but then feel bad for not challenging her. She makes my life a misery. A little elderly man comes in and has traveled far, saying he is unsure of the visiting time. He asks if he can briefly see his wife as he has not come in before now. His wife is very unwell and the little man looks so upset. I open my mouth but before any sound comes out Mayan head lady shouts harshly, ‘you will need to wait until visiting time’. She expected the man to wait until mid afternoon. His car in the car park would be clocking up cash. I turn to the other nurse who agrees with the care assistant. So I am overruled. This upset me as I watched the little elderly man walk away slowly with his little brown leather holdall. I know we need to be strict but this is surely excessive. I accompanied his wife to have a procedure done and we came back for lunchtime. She started to deteriorate and became less responsive. Brenda checked the lady’s oxygen saturations and moaned that the equipment was faulty and just sighed and walked away. When she left the room I placed the oxygen probe on to the lady and noticed her oxygen levels were sitting at 82% and she was already on high flow oxygen. This was a bad sign. I immediately went to the doctor. The doctor said that the woman will not survive the next few hours. I went to the woman’s notes to find her next of kin contact, this was her husband. I tried to phone him but he had obviously been in. I contacted the patient’s daughter who came rushing in. The little elderly lady died and the daughter did not get the chance to say goodbye. Sadly, neither did the husband. I felt so cruel and heartless. Why did I not say something, I thought to myself?


We Are Just Obeying Orders!

I watched the elderly man hug his wife for the last time as I closed the curtains on them to be together. Mayan head lady said ‘well it’s not our fault we have rules to adhere too.’ This reminded me of an experiment carried out by Stanley Miligram whereby he showed that people adhere to authority figures. In this case an actor was receiving electric shocks for getting his answers wrong. In a social psychology article Stanley Milgram summarised his experiment in his 1974 article, "The Perils of Obedience" writing: I set up a simple experiment at Yale University to test how much pain an ordinary citizen would inflict on another person simply because he was ordered to by an experimental scientist (an authority figure). Ordinary people carrying out their jobs and without any particular hostility on their part can become agents in a terrible destructive process. Additionally, even when the destructive effects of their work become patently clear and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority. In this case the care assistant and the nurse had caused pain to adhere to orders. I myself had to go along with this because I did not have the authority to overrule the situation.


The Incredible Hulk


Later on I saw Brenda walking about in a plastic apron on top of her uniform. She had sweat running down her face. Mayan head lady asked her why she didn’t take her apron off. She turned around saying that she has burst the zip and doesn’t have another one to change into. Nobody in the ward was her size. She was to swelter under plastic for the rest of her shift. Plastic suited her because she was a plastic nurse with no feelings or care for others. She was the opposite of the plastic Barbie doll. Brenda the bull I thought. I discovered later that Mayan head lady was angry that I was filling the post her friend wanted. I being there ruined her cosy little set up. Oh dear, how sad, never mind. I open up my car and sit down reflecting on today. I do not know how long I will last in this ward but I have no choice right now. I felt like David Banner searching for a cure for the Incredible Hulk, the Incredible Hulk is the beast that is the culture of nursing. I drive home with wiper blades sweeping away the rain as it hits the car with great force. There is something peaceful about the rain and I do not play music as the rain plays its own song.