I've spent the last week off sick due to a pesky little virus called the norovirus. The basic symptoms of this virus are D+V. When I got back to work yesterday and my ward is closed to all admissions and discharge due to this virus. 25 of our 27 patients have it. One week may not sound like a huge amount of time to have off sick but thats only the amount of time it took before I was no longer infectious. The 72 hours starvation and massive dehydrated have taken their toll. I've lost 10kg in 6 days and still feel week as a kitten. Now I am reletively fit normally and its hit me this hard. Imagine how its hitting the elderly and recently post operative on my gastro ward. Additionally all the nursing staff are having to work harder under more stress because they are massively understaffed and this is making them more vulnerable to the virus.
The patient who originally had the virus died shortly after she was admitted to the ward, in the space of two hours she manged to infect enough people to start this. The interesting thing is this virus is ancient, its been around since hte begining of recording history (that or virii very similar to it) and its learned to adapt and survive everything the human body can throw at it
I'm not saying we should all be in awe of this virus but I am. Its defied the basic principles of evolution - Survival of the fittest, and its not evil, its not a life form going about its dark purposes, its just an entity that is doing what all living things do, finding means to replicate, the damage it does to the environment that supports it is completely accidental.
It has been stated that the only thing that exists beyond good and evil is death which does not discriminate, does not seek the good or evil, it strikes all without thought or intention. I would argue that life also its beyond good and evil, the struggle to survive against any and all odds without intention or inclination towards either good nor evil.
Monday, 24 November 2008
Wednesday, 12 November 2008
The Rain
As a gastro medical/surgical ward, my ward sees a lot of alcoholics. Many of these are frequent flyers. Many bloggers from the ambulance service tell you about the trouble drunks give them on a regular basis. So I thought I would give you a little insight into what happens when those drunks actually get admitted to hospital.
Michelle(obviously a pseudoname) has wrecked her body with drink. Her brain barely functions and she often just sits and stares at the wall, saliva streaming out of her mouth and pooling in her lap. She is perfectly mobile and can answer direct questions. Her liver barely filters out the everyday toxins that wouldnt cause a healthly liver any problems. These toxins occasionally accumulate and attack her brain further. She has been a regular on and off the ward for almost a decade. Every time she comes in, we stablise her with a regimin of vitamin supplements and iv fluids and discharge her. The doctors insist their tests show she is mentally fit enough to look after herself, so they release her back to her home which has no electricity, no heating, and no water because the complexities of paying bills is a little beyond her level of comprehension. That night shes found roaming the streets of her town, naked in the pouring rain. Shes brought back into A&E, they send her back to us and the cycle starts again.
Now section three of the mental health act states that any patient who is deemed a danger to themselves or others should be placed into an appropriate mental facility where they can at best be rehabilitated, at worst protected from themselves. However the medical team in their infinite wisdom suggest that this women isnt a danger to herself. Their tests prove it.
On this ward I am learning how truely frustrating this job can be. We are working ourselves to the bone in order to save people who dont want to save themselves. But we still do it, with the same vigor we show patients who havent brought their conditions on themselves.
Michelle(obviously a pseudoname) has wrecked her body with drink. Her brain barely functions and she often just sits and stares at the wall, saliva streaming out of her mouth and pooling in her lap. She is perfectly mobile and can answer direct questions. Her liver barely filters out the everyday toxins that wouldnt cause a healthly liver any problems. These toxins occasionally accumulate and attack her brain further. She has been a regular on and off the ward for almost a decade. Every time she comes in, we stablise her with a regimin of vitamin supplements and iv fluids and discharge her. The doctors insist their tests show she is mentally fit enough to look after herself, so they release her back to her home which has no electricity, no heating, and no water because the complexities of paying bills is a little beyond her level of comprehension. That night shes found roaming the streets of her town, naked in the pouring rain. Shes brought back into A&E, they send her back to us and the cycle starts again.
Now section three of the mental health act states that any patient who is deemed a danger to themselves or others should be placed into an appropriate mental facility where they can at best be rehabilitated, at worst protected from themselves. However the medical team in their infinite wisdom suggest that this women isnt a danger to herself. Their tests prove it.
On this ward I am learning how truely frustrating this job can be. We are working ourselves to the bone in order to save people who dont want to save themselves. But we still do it, with the same vigor we show patients who havent brought their conditions on themselves.
Thursday, 6 November 2008
Wow
Unbelievably one of the patients who had a GCS of 4 and was indeed on the liverpool care pathway came around. After two days being completely unresponsive with no pupil reactions she was sat up eating soup and chatting about her grand children. I have never seen anything like it.
Monday, 3 November 2008
New Ward
So I'm settled on my new ward. Gastro Medical and Surgical. Its an interesting place to be. I've experienced a surgical ward on my first placement, and a medical on my second. Caring for both sets of patients in the same place is interesting.
Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.
The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.
I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.
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*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.
**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.
Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.
The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.
I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.
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*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.
**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.
Monday, 27 October 2008
Suits
One of the key issues with working in healthcare is you spend most of your time covered in sick peoples bodily fluids. Obviously this is just part of the job and it doesnt really bother you. However when you get out of the hospital you cant help but feel the need to clean thouroughly and get into some very clean cut, neat clothes.
In short I honestly need more reasons to go out wearing suits. Unfortunately there are only so many weddings you can go to. I dont know if this is just because I have come from a job where you spend most of your time in suits/neat uniforms.
In short I honestly need more reasons to go out wearing suits. Unfortunately there are only so many weddings you can go to. I dont know if this is just because I have come from a job where you spend most of your time in suits/neat uniforms.
Wednesday, 22 October 2008
BLS BS!
As a student nurse I am required to sit through three hours of bls training every year. As a member of St John Ambulance I tend to keep my skills sharp much more regularly than that. Unfortunately the two sometimes conflict.
During my Basic Life Support training yesterday the nurse stated emphatically that should you have a patient with a possible spinal injury and they vomit into their mouths you are not to do anything. In short you sit back and watch the patient suffocate. In St John we are taught that Airway, Breathing and Circulation come first, as long as those are secure you can start taking care of other injuries. In this situation with sja or any other first aid organisation it would be appropriate to put the patient in the recovery position (in the absence of a suction unit) regardless of the risk caused by a possible spinal injury. The rationale is that if you move them the MIGHT die or suffer paralysis, if you dont move them they WILL die.
After taking some pains to explain my moral objections to the former concept being taught as protocol for 'healthcare professionals' I went above the trainers head to her boss. who supported my arguement. Unfortunately the trainer had already drummed this faulty concept into five groups before us.
One a more positive note I went to see my new ward today. Its a gastro medical and surgical ward and I'll only be there for six weeks. The ward seems wonderful, the staff were very friendly and welcoming and whilst the specialty is not a real passion of mine I still find it fairly interesting. I think this is just the placement I need after the mess with my last one.
During my Basic Life Support training yesterday the nurse stated emphatically that should you have a patient with a possible spinal injury and they vomit into their mouths you are not to do anything. In short you sit back and watch the patient suffocate. In St John we are taught that Airway, Breathing and Circulation come first, as long as those are secure you can start taking care of other injuries. In this situation with sja or any other first aid organisation it would be appropriate to put the patient in the recovery position (in the absence of a suction unit) regardless of the risk caused by a possible spinal injury. The rationale is that if you move them the MIGHT die or suffer paralysis, if you dont move them they WILL die.
After taking some pains to explain my moral objections to the former concept being taught as protocol for 'healthcare professionals' I went above the trainers head to her boss. who supported my arguement. Unfortunately the trainer had already drummed this faulty concept into five groups before us.
One a more positive note I went to see my new ward today. Its a gastro medical and surgical ward and I'll only be there for six weeks. The ward seems wonderful, the staff were very friendly and welcoming and whilst the specialty is not a real passion of mine I still find it fairly interesting. I think this is just the placement I need after the mess with my last one.
Tuesday, 7 October 2008
Back to Work
Due to all the hassle regarding my last placement I requested my exit forms from my academic tutor. She said "No", she was point blanc refusing to let me leave. So I attended a crisis meeting where it was agreed I'd spend a further week on the ward and my mentors would no leave my sight. This worked well and I got all my proficiencies signed off. Unfortunately me handing my documentation in late was an immediate fail ....or so I thought. As my academic tutor was so determined not to loose me she arranged for all my paperwork to....go away. It was very nice. Even had I completed the placement normally there would be a mountain of paperwork for me to sign but shes taken care of all of it. She also felt that I needed something to bolster my resolve. Something to hold on to and help me through the harder times. She told me I am guarenteed a placement in A&E in my third year. The day we accept the offer to start the course at the university they have the whole three years of placements mapped out. Its nearly impossible to change their plans and we are not allowed to know where our placements are other than the next one. So she bent a few rules but It has helped. I get my dream placement at the perfect time.
So I'm in a fairly good mood. The university are bending over backwards to ensure I stay (which I may be taking advantage of a bit). However I have two assignments due in soon so I am currently sat in the library trying my hardest not to start them. I have been fairly socially active with the other memebers of my course recently and some of them raised a point that my 'intellect is very intimidating' my immediate reaction to this was to laugh. Then I realised I have a fairly broad knowledge of most things, but very little in depth knowledge of anything. I know enough to know I dont know anything but the range and variety of my knowledge must present very differently to how I thought it did. I found this information very unsettling.
My first assignment is on Long Term Conditions. I had chosen Chronic Lymphocytic Leukemia but my academic tutor suggested this might be showing off a little. So I have decided to write one on COPD. I am still planning on writing the same assignment on CLL but I wont submit it. I find the condition facinating and writing this assignment will cause me to efficiently explore the medical and social implications. Is it sad that I do things like that?
So I'm in a fairly good mood. The university are bending over backwards to ensure I stay (which I may be taking advantage of a bit). However I have two assignments due in soon so I am currently sat in the library trying my hardest not to start them. I have been fairly socially active with the other memebers of my course recently and some of them raised a point that my 'intellect is very intimidating' my immediate reaction to this was to laugh. Then I realised I have a fairly broad knowledge of most things, but very little in depth knowledge of anything. I know enough to know I dont know anything but the range and variety of my knowledge must present very differently to how I thought it did. I found this information very unsettling.
My first assignment is on Long Term Conditions. I had chosen Chronic Lymphocytic Leukemia but my academic tutor suggested this might be showing off a little. So I have decided to write one on COPD. I am still planning on writing the same assignment on CLL but I wont submit it. I find the condition facinating and writing this assignment will cause me to efficiently explore the medical and social implications. Is it sad that I do things like that?
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