Confessions of a Male Nurse (7 page)
Sometimes it’s possible to have the best of intentions, but get things wrong; in some cases, there is a very fine balance between doing just enough to help a patient, and doing too much.
It was particularly hard seeing Mr Belford in hospital – he was such a physical, athletic sort of man, even in his eighties. You could tell he had spent a lifetime working outdoors – his body was lean, hard and tanned. He had never smoked and never been much of a drinker. But even being such a fine physical specimen, I still thought he was far too old to have been standing on the back of a truck, unloading cattle.
Mr Belford was with us after one of the cows had become restless and had knocked him from the back of the truck, causing him to hit his head on the ground very hard. The knock had been so severe he had developed symptoms akin to having a stroke.
‘I’ll get them to move,’ Mr Belford said, as he struggled to wiggle the fingers on his left arm.
Only 24 hours since his accident and the fingers were already looking like a set of claws.
‘I hope so,’ I replied – there are no certainties when dealing with head injuries.
Mr Belford had difficulty moving his left leg as well, but thankfully his speech was okay and although he was unsteady on his feet, he was still able to walk with a stick. Mr Belford lived alone, had never married, and had always done everything for himself. Aged bachelors like Mr Belford are generally pretty strong willed, even argumentative.
‘I’m not helpless,’ he said to me one morning, as I laid out his breakfast tray for him.
I had arranged extra-large eating utensils and made sure everything on the tray was in easy reach of his good hand.
‘Just doing my job,’ I replied, trying to make light of his comment.
‘That may be,’ he grumbled, ‘but there are more sick than me in this place. Go take care of someone who needs some caring. I can take care of myself.’
Having by then had numerous dealings with stroke patients, I wasn’t upset by Mr Belford’s words. I had learnt that anger is a natural reaction.
I left Mr Belford in peace – but not without making sure he had his call bell within easy reach.
I felt I knew all there was to know about dealing with Mr Belford’s situation. I was about to learn a simple, but important lesson.
‘Did you see that?’
It was Mr Belford’s ninth day with us, and small miracles had begun to happen.
‘I saw it,’ I replied, as I watched him slowly move his fingers.
The movement wasn’t perfect, it was awkward and uncontrolled, but it was a great sign. His walk had also become steadier, although he would always be left with a slight limp and in need of a walking stick. He would never be able to climb on trucks or herd cattle again. Despite all the progress, things were going to be different now in Mr Belford’s life; he could never be completely independent again.
‘Can I help you with that?’ I asked, as he began to button up his shirt.
His affected fingers weren’t nimble enough, so he was struggling with his good hand.
‘I’m okay,’ he replied.
‘Are you sure?’ I asked again.
He was really struggling. I watched as it took him two minutes to do up one button.
‘Here, let me,’ I said, as I quickly stepped in.
‘Get ya hands off me,’ Mr Belford bellowed at me, as if I was one of his farm dogs.
I leapt back, stammering an apology, ‘I only wanted to help.’
Mr Belford stared at me in silence for a moment. The angry expression on his face began to fade.
‘I know you mean well, lad,’ he said.
Embarrassed, I felt my face redden.
‘But my life is different now. I can’t do the big things I used to do only a couple of weeks ago.’
His voice was hoarse. He’d always shown the tough, weathered old man-of-the-land exterior. This was a new side.
‘But the small things mean a lot now – like making it to the toilet on time, doing up my shirt, cooking my own dinner. It may take for-bloody-ever, but it’s important.’
Mr Belford was eventually sent to the rehabilitation unit, where he spent another three weeks. In that time, not only did he continue to do well physically, but everything was put in place to make sure that when he went home, he would be as independent as possible. Things like handrails being installed in the toilet and shower. A cleaner was arranged to help once a week, as well as a district nurse who would also be visiting him weekly. He was assessed to make sure he could cook his meals, and his neighbours were made aware of his situation and they promised to keep a close eye on him.
Thanks to Mr Belford, I started to think twice before rushing in to help right away. I learnt to be patient, and realised that the little things can mean a lot to a person, and make a big difference.
During my time in Ward 13, the number of men I saw with prostate problems was extraordinary; it was almost as if they were an accepted part of ageing. Almost all of our urology patients were men needing some form of prostate treatment. (There were exceptions: the occasional female patient, who certainly wasn’t there to have their prostate checked – although it wouldn’t have surprised me to find someone looking for it.)
Some things get better with age; other things can only be appreciated with age. I am quite a long way from my golden years, but the more I dealt with the elderly, the more I found myself wondering if I would eventually suffer some of the ills that often come with growing old – and
when
. I started questioning whether my own water flow was as strong as it used to be. I’d never previously worried about how far I could pee or how easily I could make the colourful blocks of deodorant sitting in the bottom of the urinal move.
And, if I was worrying then, imagine how the patients with actual diagnosed prostate problems felt.
Mr Riley was desperate when he was brought into the ward. He had never had a problem with his waterworks before, although he had noticed that he was peeing smaller and more frequent amounts lately. He thought he could solve the problem by drinking more – and that is just what he did; he drank litre after litre of water. So, it was a bad time for his urethra to block off completely.
When we met him, Mr Riley was writhing on the bed in agony.
‘Please do something – please oh please – the pain is unbearable,’ he pleaded.
His looked to be a simple problem, hopefully easily fixed, so I didn’t waste any time getting Dr King, the junior doctor, to see him.
I didn’t want to palpate the bladder, especially as I could see it protruding up from his lower abdomen, so I left that part to the doctor . . .
‘What the hell was that for!? I could’ve told you it’s full.’
Mr Riley nearly went through the roof as Dr King gently pushed on his lower abdomen. It wasn’t really Dr King’s fault – he was just doing what he had been trained to do: a complete and thorough assessment. He was a bit shaken, but he was new and probably hadn’t seen someone in this much pain from a blocked urethra before.
‘Perhaps we could catheterise him now,’ I suggested.
The doctor readily agreed and we got started.
I don’t have words to describe the look of relief that swept over Mr Riley’s features as the catheter was inserted and the pressure finally released – but I’ll try anyway. Imagine spending a night out on the town drinking and waking up in the morning in urgent need of a pee. Now imagine that no matter how hard you tried, you could not pass a drop. Every minute, every hour the pressure keeps on building, the sensors in your bladder overloading with pressure, they’re screaming out at you to do something, but there is nothing you can do. Then suddenly . . .
‘I can’t believe it. It’s no wonder I was in agony,’ Mr Riley said, as two litres of urine drained from his bladder.
You might think it impossible for a bladder to hold two litres of fluid, but what happens in cases like Mr Riley’s is that over time the bladder slowly stretches . . . and stretches. It took ten minutes to completely empty.
Mr Riley was now on the prostate surgery list; he was entering his prostatic golden years.
Unfortunately, the waiting list for urological surgery is often long and there are many older men sitting at home with a tube of their own because their plumbing has blocked up. Some of these men have spent longer than twelve months like this. Mr Riley didn’t have private insurance and he now had to adapt to this new stage of his life.
It is unfortunate that we often have patients coming in to hospital because they have acquired an infection that has crept up this tubing and into their bladder, or patients whose catheters had blocked up because their urine was full of foul smelling lumps of dead tissue and bacteria. It seemed to me that more time and money was spent in the long run from these complications. And if anyone is going to get a complication it is most likely to be the elderly.
Tom, Simon, Daryl and Joe were four patients who put a lot of trust in their urologist. At 75, Tom was the oldest of the men. He was a prostate veteran; this was going to be his second operation in three years. The rest of the men were virgins – all in their sixties and about to have a trim.
Being four men in the same room, all about to have the same operation, enabled the men to share notes and generally have a laugh (albeit a nervous one) at the situation.
‘You gotta drink lots of water, that’s the secret,’ Tom would repeatedly tell the others. He enjoyed being the expert – although this was almost all the advice that he could remember to give.
He was right though – plenty of water to flush the blood away. The prostate can bleed a lot when it is cut, and you don’t want it to clot and block off the urethra. Drinking plenty of water helps produce more urine, and reduce the risk of clotting.
I was just relieved that none of the men had heart failure. Heart failure means your heart is struggling to pump the blood around your body. If you add more fluid, you put more strain on the heart.
There was only one other piece of advice that Tom managed to remember – and it was a tip I wished he’d forgotten. Tom had the other men so in fear of me that they were distracted about their operations the following day.
As the men spoke about what I was going to do to them, I stood outside their room, hidden. Timing was everything: at the height of the discussion, I burst into the room.
‘Okay boys, who’s first?’
Silence.
It was six o’clock in the evening and it was time for the boys to have what they had been dreading. It was enema time. I didn’t want to give the boys a chance to get away, so I had given them no warning. I entered their room fully armed and ready for action.
The protests began immediately.
‘I’ve just been to the toilet; you don’t need to go waving that bloody thing round, you might poke an eye out,’ said Tom.
The others followed his example.
‘Yes, I’ve been to the toilet as well; I refuse to have one.’
‘You can’t force that on me, I have rights.’
The reason for the enema was simple. The doctor didn’t want to risk his patients becoming constipated, as this would put pressure on the prostate, and potentially increase post-operative bleeding. (Just for the record, they check your prostate by sticking a finger up your backside.)
When I explained to them that it was either have an enema or the surgeon wouldn’t operate, the men soon gave in.
But I still had the difficult job of choosing who to give the enema to first. I knew that if I picked the wrong man, he would kick up a fuss and exaggerate about how uncomfortable the procedure was. Since it was all Tom’s fault, I briefly considered doing him first; instead I picked Joe because he seemed the quietest, but sure enough, I picked the wrong man.
‘It’s blackmail, that’s what it is,’ he complained as I tried to pry his buttocks apart.
‘Stop fighting me and bend your knees up more,’ I ordered. ‘You’re making this much harder than it needs to be.’
I managed to see the target and tried to insert the tube.
‘Arrrgh . . .’
I began to squirt the water, hoping to get some inside.
‘Arrrgh . . .’
Joes butt cheeks were so tightly clenched, I was miles away from the bull’s eye and water was dripping down all over his backside and my gloved hands.
‘Joe, just relax and it will be over soon,’ I kept on saying.
‘Relax,’ he said with indignation, ‘relax? You lie here and let me stick things up your arse and try to relax. Arrrgh.’
He may have had a point, but I had a job to do. By the time I had finished, more enema fluid had spilt around Joe’s buttocks than up his rectum, but I had had enough and so a truce was called.
I pulled back the curtain and my three remaining patients had gone rather pale. I couldn’t help but smile. They turned paler still. The sight of a grinning male nurse with an enema in one hand and a roll of toilet paper in the other must have been pretty frightening.
‘That’s bloody murder, what you done in there, boy,’ said Simon, his voice trembling.
Daryl made the sign of the cross. I imagined bursting into a macabre sort of laugh, but held myself in check.
I approached my next victim – Daryl. He had nowhere to go; he was trapped in the corner.
No one got away that night.
Several years after this incident, I found myself in a urological ward in a large London hospital preparing to give some men their pre-surgery enema when the doctor in charge asked me what the hell I was doing.
I explained that this is what we were instructed to do at home.
‘That went out with the dark ages; it hasn’t been used in years, unless there is a specific need.’
What our surgeon had prescribed was fine, but procedures and protocols change, and some doctors don’t change as quickly as others – certainly not quick enough for Joe and the rest of the lads.
Like most professional environments, in hospital wards you have to learn to work with all sorts of people, even people who may be difficult or even unpleasant to be around. However, sometimes when the work pressure is particularly intense, cordial relationships are not always possible. When this happens in my line of work, everyone can suffer.
Dr Baker had been the head urologist at the hospital for many years. He had worked so long and so hard for the local urology patients that nearly every man over fifty knew of him. The old men only talked good of Dr Baker, and I can’t say that I blame them. He was the only urology surgeon that the city had, and he had saved a lot of lives and improved the quality of many more.
The New Zealand government had decided that the urology waiting list needed urgent attention. Many elderly men were pottering around their homes with a tube up their penis for more than a year, and during that year, many of these men had also presented to the local emergency room with blocked catheters, urine infections, bleeding, or a combination of all three.
The solution was simple. We got funding for 40 extra prostate operations, which would need to be performed over three weeks, on top of an already full surgery list.
Forty prostate operations is a huge amount to undertake in three weeks. Performing this many would keep two or even three normal urology surgeons busy for that time. It isn’t just a matter of doing the actual surgery; it’s also a case of making sure patients recover with as few complications as possible.
The ward only had 26 beds. Considering a common stay for a prostate operation was between four and seven days (and that doesn’t take into account the extended stays due to complications such as excessive bleeding or infection), this certainly seemed a tight schedule. It was nice of the government to give us the money, but it would have been nicer still if they’d given us some additional doctors and nursing staff to get us through those three weeks. Instead, all operating fell upon the shoulders of Dr Baker.
Dr Baker went into a prostatic trimming frenzy. He would begin operating at seven in the morning and when five o’clock came around he just kept on snipping away. Time meant nothing to him – he continued to operate well into the night. He reminded me of Dr Frankenstein working feverishly in his lab. The theatre staff said they had never seen him quite like this before, he was manic – and even more-short tempered than usual.
With such a large volume of patients being put through the system, the amount of work for the nursing staff, as well as the junior doctors, was also immense. We were overrun with patients. Everywhere I looked I could see them comparing notes, deciding whose urine looked the least blood stained and whose the most. The old boys were pottering around cautiously, always careful not to stretch their urine bags too far, get tangled up in the tubing, or forget the whole thing altogether. It always made me cringe with sympathy whenever I saw someone forget their catheter bag and then be literally pulled up short by their manhood.
To make matters even worse, we still had other non-urological patients to care for. There were still the odd general surgical patients as well as the medical patients, plus two days a week we had to take new patients from the emergency room. I had a tough job making sure I didn’t forget about my non-surgical patients, but there was one person who felt the brunt of the frenzy more than anyone.
Lisa was the urology registrar working under Dr Baker. She had been working for him for six months as part of her surgical rotation and she was having a pretty tough time of it. The problem was not just the work, but because she was female. Everyone knew Dr Baker was irritable with his female staff.
‘I can’t keep on like this. There’s too much work to do for one doctor,’ Lisa declared.
Lisa was in tears after the Saturday morning ward round. Lisa wasn’t the first and definitely wasn’t the last female doctor to cry after a ward round with Dr Baker. At his best, he was barely tolerant of women, but in the event that something was not done his way, then any woman involved would get a verbal battering. I’d sometimes make the same mistake as a female colleague, like leaving the catheter tubing on top of a patient’s leg, instead of under it, and he wouldn’t say a thing.
No one knew why Dr Baker behaved this way towards female nurses and doctors, although there were plenty of theories. Mine is that he felt women should be subservient to men. I got this impression from the way he would order women to do tasks, but he would ask me politely. At other times he would only ask
me
to do certain jobs, complex jobs which he usually did himself, like flushing blocked catheters. I could easily see Dr Baker working in a ward 20 or 30 years ago, where nurses had firm boundaries to what their jobs entailed, and where the ward sister controlled the place like a military barracks. I could even imagine him having the nurses standing at attention while this god-like being did the ward rounds.
All that really mattered was he made an already challenging job much more difficult and unpleasant.
‘I can handle working for such an unpleasant man,’ Lisa began, ‘but he’s left me to do it all. I hardly ever see him.’
Lisa went on to explain that aside from this morning’s ward round, she hadn’t seen or been in contact with Dr Baker all week. He wouldn’t answer her calls, and made no effort to contact her. She felt she had no support and was worried that she would make a mistake.
I asked Lisa if she’d let me tell the other nurses how she felt. She was reluctant at first, but when I explained that she wasn’t alone, female nursing staff had admitted to having problems with Dr Baker, she agreed.
Everyone was furious, and instantly agreed to do their best to help Lisa get through the next three weeks.
The problem was, it wasn’t only Lisa who was being affected by Dr Baker’s behaviour. The hectic period was shaping up to be just as crazy as we’d imagined, but what we hadn’t expected was that Dr Baker would start to act a little crazy himself.
It was late that night that Dr Baker visited to check how his patients were. Well, they were asleep, like all good patients should be at 11 p.m. It was cruel, but I had no choice, so I turned on the light. Two of the old boys never noticed a thing and kept on sleeping, but the other two patients in the room woke with a start.
Dr Baker was keen to check the irrigation system on each of his patients. This system involved a bag of fluids, which were slowly infused up the catheter, flushed around the bladder, and back out the tubing again. The catheter in these cases had two, sometimes three separate channels to allow this to happen. Nearly all Dr Baker’s patients had this in place. It wasn’t until moving to London that I discovered that this practice was not the standard for everyone any more but usually reserved for the more serious cases where there is heavy bleeding.
Dr Baker always liked to give the tubing a gentle but firm, steady tug. He would then adjust the rate of the intravenous fluids as well as the irrigation fluids before wandering over to the next patient, usually without washing his hands, and having a pull on their tube.
His patients didn’t know what was going on. Wouldn’t you be a touch confused, waking up in a strange environment to find someone pulling on your private parts?
The last few nights had been bad enough with Dr Baker turning up at 10 p.m. to do a ward round; 11 p.m. was going too far. Dr Baker needed to be told to do his ward rounds at a more appropriate time, but I didn’t have the courage to stand up to him.
‘Tell the charge nurse,’ Sheryl suggested one night at 11 p.m. when Dr Baker had just left. ‘She’ll have a word with him.’ Sheryl had been working on the ward for five years, and was a valued member of the team, but she wasn’t ready yet, either, to confront Dr Baker herself.
When we told our charge nurse what was happening, the first thing that came out of her mouth was, ‘He’s mad.’
She told us we did not have to accompany him on ward rounds at such ridiculous times and promised to speak to him.
Still, however, the following night Dr Baker came around at 11 p.m. and no one had the courage to protest. We weren’t sure how he would react to a forward approach, so instead we came up with another strategy that would keep us out of harm’s way and prevent us from having to do the ward round.
‘He’s coming, quickly everyone, move.’
Every nurse in the ward disappeared into the woodwork. Some hid in the sluice room, some in the treatment room, while Sheryl and I hid in the kitchen. Great plan – we were hiding like a bunch of disobedient kids. The girls were even giggling like school children.
In the silence of the night, the clip clop, clip clop, clip clop of Italian designer shoes could be heard restlessly pacing up and down the ward. Suddenly the kitchen door swung open – we were going to be caught! However, by some miracle Dr Baker didn’t bother to look behind the door. It must not have occurred to him that anyone would try to hide from him. As the door swung closed there was a collective sigh of relief.
‘This is bullshit,’ Sheryl said. ‘We’re supposed to finish at 11 p.m., and I’m not wasting any more of my time.’
She decided she was no longer going to avoid Dr Baker and followed him out. I wanted to stay hidden, but with a morbid sense of curiosity, I crept out to watch the confrontation. It was the least I could do to support her. I wasn’t alone; all the nurses crawled out in meagre comradeship.
‘We have been instructed not to do rounds with you at these times,’ she opened, with impressive assertiveness.
Dr Baker was silent. I almost thought he was going to have a heart attack. His face didn’t register anything at first. He took a step closer to Sheryl. I thought for a second that he would hit her.
‘You won’t have a job after today, none of you will,’ he hissed.
Sheryl turned her back on him and walked into the office. The battle was over and Dr Baker stalked off.
The next night, no one knew what to expect: would he turn up late again? Six, seven, eight, nine o’clock went by and he didn’t arrive. Things didn’t look promising; I felt sure he was going to do his late night rounds again. Ten o’clock passed, then eleven, and still no sign. Dr Baker didn’t turn up at all that night. In fact, he didn’t come for the next two weeks.
The entire ward workload fell upon Lisa’s shoulders. She had to decide who was well enough to go home and how best to treat the complications that surely arise when so many operations are performed.
We did all we could to help her out, but she still came close to breaking down – she would turn up each day looking exhausted, her shoulders slumped, her eyes puffy.
I don’t know exactly how but we managed to get through all those operations without anyone dying. When the last of the operating patients was discharged, Lisa promptly quit her job. She headed to a bigger city, where she found a consultant who didn’t mind having women on his team and knew how to adhere to the rules. I was pleased to discover she stayed in the surgery field, although not urology; she was one of the bravest and strongest doctors I had ever met.
