Resistance

In 1928 a Scotsman discovered the strange effects of a specific fungi. Along with a German and an Australian this fungi was turned into a drug. On March 14th 1942 the first patient was treated with this drug.

The drug was of course Penicillin, the Scotsman Sir Alexander Flemming, the German Ernest Boris Chain, and the Australian was Baron Florey. These men made potentially the greatest contribution to modern medicine. The bacteriostatic and bacteriocidal effects of penicillin were noted long before 1928, however these men did more than just make some mildly interested notes and move on. They developed this drug. However I would suggest their achievement will only be temporary.

Since the 50's almost everyone in the western world has come in contact with penicillin. A hundred years ago if you had a minor infection you would have a fever, a headache, maybe some localised pain. You would put your feet up for a few days and your body would take care of the infection. Your immune system would be better for it as it would create markers to prevent that same bacteria having such an effect again. My generation is given pencillin and other anti-bacterial drugs for almost any complaint. Our immune systems are weaker which means we are getting sick more often. But it gets worse, our bodies are becoming resistant to the penicillin, the constant exposure is causing our immune systems to neutralise these drugs before they can have a theraputic effect. Also as I'm sure you are all aware bacteria are surviving one dose of antibiotics and what they grow back into are resistant to that anti-biotic(MRSA is the big one everyone has heard of). Once the effects of these drugs are completely useless our bodies will have a hard time even fighting a simple streptococcus infection.

We are now sending antibiotic drugs across the world to third world nations. Into jungles to near untouched tribes of humans, to places a strong immune system is vital.

Dealing

In hospitals there are certain things that you simply learn to deal with. Death and Illness are the obvious. The more annoying are the co-workers who get away with doing zero work. The medical team that NEVER respond to their bleepers, even when you fast bleep them. The SHO who sticks a giant needle into a patient with an insanely high INR and then blames his subordinates when the patient bleeds everywhere.

Honestly the deterioration and death that are commonplace in hospitals are actually much easier to deal with than the politics you find on the wards. I know every workplace has its fair share of politics, however of all the places I have worked I have never come across it in such high doses as I have in hospitals.

Even as a student nurse your superiors dont give you any support in learning to deal with these issues. You sink or swim, with luck you'll have your own support structures in place, partners, friends, other student nurses. I honestly dont know how I'd have survived my first year as a student nurse had it not been for these people. I cant help but wonder, of the three hundred people still on my course, there must be some who have no support structures in place, what effect is all this having on them?

Movies

Its only since I have started working on this placement that I have noticed the accuracy in television programmes like scrubs and house. The medicine in them is generally way off, but in regards to life in a hospital. Even some of the more unrealistic plot lines come to pass in a real hospital. The hospital benefactor becoming a patient, the dementia patient making a break for it and being found hours later down the local pub, the old woman who attacks any nurses in range with her walking frame, the two patients in their late seventies being caught having sex in a side room, the doctors with funny beeper tones and occasionally the odd medical mystery.

If you listen really, really, really hard whilst on the ward you can almost hear the backing music which I'm sure alternates between the benny hill theme and how to save a life by the fray.

Patients 2

During my shift yesterday one of the nurses called me to the nurses station. She informed me that our Emergency Medical Assessment Unit which is sort of like a buffer after A&E where the patients get sorted to the appropriate wards, has a patient for us. A female in her eighties, she had a fall(as old ladies do) and sustained no injury. She had asthma which was well under control with the use of her salbutamol inhaler and there were no other obvious medical or psychological abnormalities. I asked why this patient wasnt checked out in A&E and sent home. The nurse assumed that there must be more to the patient than her notes led us to believe.

The nurse was wrong. What we had was a lady in her eighties who was fully mobile and self caring with no apparent medical problems besides her asthma....what we had was a patient who was in better condition relative to her age than any of the staff on the ward.

She is a lovely lady and i'm glad we werent sent another high care patient. However her being in hospital despite more than adequate social means for discharge and no medical treatments to be performed is costing in the realm of £900 a week to the tax payer. She doesnt want to be in hospital as shes going to miss her weekly cards evening with the ladies from her church group. Why was she admitted? why is she still on the ward?

On another note one of my favourite patients died yesterday. I know its unethical to have favourites but you cant help it, you treat all patients the same but you do become fond of some more than others. This upset me as I was certain he was going to be one of the ones who walked out of the place. I was holding it together up until his daughter told me she was grateful to me for taking such good care of him and that he really enjoyed spending time with me. I didnt cry but my voice broke rather spectacularly.

Patients

My ward is acute respiratory medical. By and large most of what our mission statement covers is COPD. Each of the nurses on this ward has had years of experience and training in respiratory care. The doctors on the ward are specialising in acute respiratory medicine. Our respiratory patients can rest assured that they are in the hands of experienced, highly trained specialists.

Only seven of our twenty seven beds are occupied by patients with any manner of respiratory complaint. I admitted a patient last week who was in due to central chest pain, elevated troponin level and a vast history of myocardial infarctions(heart attacks). All these things indicate the patient was both high risk for an MI and in all likelihood had probably had a minor one prior to admission.

The first thought that ran through my mind when I read this patients
emergency medical assessment unit(EMAU) report was that there cant be any spare beds on our cardiac ward. This I have come to accept, patients go where the beds are, not where the specialists are.

I later had cause to phone our cardiac ward regarding another patient. It turns out that they had five spare beds. Somewhere along the line the powers that be decided that this high risk cardiac patient didnt deserve to be on the cardiac ward.

I know all nurses recieve the same basic training. And this patient was at least admitted to an acute medical ward. Fortunately the nursing intervention for cardiac arrest and respiratory arrest is the same. Had this patient been high risk vascular patient, or a neuro patient then they would not have received the best possible level of care. Which is what the NHS claims to strive for. Most bed managers have been promoted from the clinical ranks and know more or less what they are doing. They tend to be unsuccessful due to the enormity of their task and lack of support from their clinical colleagues who become less co-operative after the bed manager has sent their surgical ward a patient with pylonephritis.

Sick

I'm sick. This is not good as it means I have to make up some placement hours at a later date. However it is unmistakably my bodies way of retaliating to the high stress, low sleep and food, dehydration that comes with being a student nurse on a massively understaffed Acute Medical ward.

For the first time in my life in care work, yesterday we still hadnt completed all of the patients washes by the end of the early shift. All of the meals were handed out up to two hours late. We had two carers taken away from us by the bleep holder due to the fact the ward had 'two student nurses' on duty. The shift was chaos, however I tip my hat to the ward sister who was on yesterday, she ensured that all of the patients received their medications on time, all of the patients were sent for their tests as the doctors ordered. She delegated tasks incredibly.

For now I've got three scrubs box sets, a large bar of chocolate, and a huge bean bag. I've just got to hope i'm fit for work tomorrow.

Hospital

I've had a few manic shifts recently. Those shifts where you are flat out rushed off your feet for the entire shift but when you look back you cant remember a single thing you have done. All of my interactions from putting a patient on a bed pan, to removing a patients cannula have mattered to the patient involved.

The truth is when you are truely, insanely busy in the hospital, you go on autopilot. You talk to the patient whilst your removing their wound drain, listen to them talk about their pet cat and you respond in a warm way. But you arent remembering any of this. And if the removal goes as it should there is no reason to remember it past adding a note to your handover sheet.

This doesnt bother me. You do what needs to be done and then you move on to the next task that needs to be done. Despite all this there is a place in the back of your mind that the hospital has infected. No matter where you are or what you are doing a small part of your brain is thinking about the ward, about a patient who was deteriorating when you left your last shift, who wont be there when your next shift starts, the MRSA screening you forgot or didnt have time to swab a patient for. The trick is making this part of your mind as small as possible

Today I got to insert my first NG(nasal gastric) Tube. This is a tube that goes up the nose, down the throat and into the stomach. Its used to aid a patient who isnt safe to take food orally(usually if they aspirate). This may not sound too impressive to any qualfied nurses who read this, as inserting them is so mundane by the time you qualify that they usually find a student to do it for them. However I am fairly sure it is the longest object I am legally allowed to insert into my patients.

Once the tube is in place you draw back some of the fluid from its end point and drop it onto litmus paper to ensure you have reached the stomach and found stomach acid. You then flush the tube with about 50mls of water to ensure it is clear and ready for food. You then connect a pack of high nutrition liquid to tube. This gets connected to a pump to ensure that you are feeding at the prescribed rate.

Its all fun. Despite how exhausted I am I have had two good shifts. I've learned a lot and had a lot of opportunities to make a difference in patients worlds. I suspect my shift tomorrow wont go so well. The cumulative fatigue was having a noticable effect on my performance today. I've got two more early shifts ahead of me and then a day off.

Life

In the interests of confidentiality all names herein are pseudonames. Should anyone be interested this conforms with the Nursing and Midwifery Council Code of Professional Conduct(2008) in regards to Confidentiality.

I get a phone call last night. Its a Charlotte, a friend of mine, shes hyperventilating. She informs me that her boyfriend Sam has drunkenly punched a car and run off.

There are three reasons Charlotte called me -
1. She knows I'm a student nurse, and a more than experienced first aider.
2. She knows we are close as shes just left the pub we are at.
3. She knows my girlfriend is with me and that she is a qualified nurse(this trumps student and first aider).

So I leave my girlfriend to take care of Charlotte and I run off in the direction Sam ran. When I finally find him he is on the floor, more out of intoxication than blood loss. There is a fairly impressive amount of blood issuing from his hand. I call and ambulance and then notify Charlotte of our location. All the time attempting to keep Sam sat with his back to a wall so that he doesnt fall down and crack his head, and keeping his hand elevated(not easy and this chap isnt terribly co-operative when sober, let alone when he's been drinking for 9 hours).

Charlotte arrives with my girlfriend driven by Denise, a friend of ours(also a first aider).

The ambulance crew arrive in less than eight minutes. Despite how clear I made it to control that this wasnt a high priority call as Sam was 100% stable. They clean up Sam and fill out the paperwork to get us into A&E and call the police who formally arrest Sam for criminal damage but immediately release him on bail in order to have his hand checked out at A&E.

Denise drives myself and Sam to A&E. Where he is seen promptly by the triage nurse, then the radiographers in xray. We spent some time waiting for the House Officer to review Sam but eventually decided that there was no real damage and that his hand only required irrigating to remove any small fragments of glass left. So we left with a letter for his GP.

2100-0200 this is how I spend my time.

I have to admit that given how poorly my new ward is treating me I did need this night to remind myself that I am damn good at what I do and that I belong in critical care.

Defence

The human body is full of defence mechanisms. Billions of years of evolution has led to a species that is designed to survive a huge amount. I suspect this is largely due to the individuals need to pass on their genes(something they cant do if they are dead)

You are in a car accident, adrenaline hits the vascular system causing vessels to constrict which limits bleeding. The heart beats faster, breathing increases in depth and rate allowing oxygen to get to the muscles. This allows you to get away from the danger and survive long enough to reach hospital. This is not such an uncommon scenario. Unfortunately when you get to hospital the first question you are asked is usually 'where does it hurt?' and the adrenaline is numbing the more significantly injured areas. The risk comes when the adrenaline is no longer being secreted and patients go from stood up talking calmly to dead on the floor in the space of seconds.

You lose a loved one in this same crash. Your mind decides how to process the loss. It could repress it, it could compartmentalise the feelings or it could allow you to grieve and release them. The immediate best option is chosen to allow the individual to survive as strongly as possible.