Mopping Up

Many years ago when I was at work, a funny thing happened that still to this day brings a smile to my face. I was working in a major city teaching hospital in the operating theatre suite. It was a particularly busy day. We had at the time, a number of student nurses on their theatre rotations and on "observation duties only”, and one of them was assigned to me.

My student nurse was a lovely, well spoke and gentle young thing, not a common attribute to those in the theatre environment. Most of us who had been working in this part of the hospital were a hardened bunch. You had to be to survive the trials and the tribulations that went with the job. Working in a teaching hospital’s operating suite, everything and anything in the way of trauma presented to us. From serious cuts and broken bones, right through to multiple trauma, sickening injuries and mangled torsos, that had somehow previously resembled a human being. We got it all. Along with this trauma came the personalities of the orderlies, the nurses, the surgeons and the consultants. Each and every one of them ever so different, but all hardened to the type of work that we did.

So here was this timid, shy student nurse, in awe of her surroundings and hesitant to do anything in fear of getting in the way. After formal introductions from her preceptor, I gathered her under my wing and off we went to face the forever growing theatre list. I had been allocated the orthopaedic list for this shift. The list had scheduled operations on it like knee replacements, arthroscopies, hip replacements and other minor operations. It was a great list to observe and learn from, and I relayed this to my subservient student who was both excited and appreciative of my willingness to make her feel welcome. After some basic instructions on how the day was to run, what the routine was, what to do and where to stand, our day began.

The first job for me was to find this student something to do. It had to be something that would not involve too much of my time as I was required to assist the scrub nurse and the surgeon during the operation. I introduced my student nurse to both the consulting surgeon and the anesthetist as they entered the operating room. They warmly welcomed her and asked the usual polite questions while setting up for the morning’s list. I then instructed our student nurse to assist the consultant surgeon as he scrubbed up, explaining what to do and how to do it. This was the safest task for her to do as she was out of the way and, somewhere where I could keep an eye on her. In the scrub room she would be able to ask the appropriate questions regarding the upcoming operation, and get it from the horses mouth, so to speak. The consultant surgeon seemed to have taken a shine to this young girl as he rambled on and on about the procedure he was about to perform and the technique he was going to use. I think he was in his element as someone was actually listening to him and interested in what he was saying. As we theatre nurses have worked with this consultant for many years, we had heard it all before. So I was comfortable that my student was in her element, and my surgeon was in his. I continued with my preparation of our patient who was now on the theatre table, and the equipment required for this operation. Finally we were underway.

The operation was well into its second hour. It was a difficult case but it was progressing along smoothly. My student nurse was stiff and silent, watching in amazement, just as I had done when I saw my first knee replacement. Although I couldn’t see her mouth (because she had a mask on, covering her face), I am sure it would have been agape in awe of what was taking place in front of her. The buzzing of reciprocating and oscillating saws, of drilling and reaming holes, of tapping and counter-sinking screws and then the sudden hiss of compressed air. The noise and sounds of a workshop, a different kind of workshop.

After the main part of the operation had been completed, our surgeon had worked up a bit of a sweat. Replacing joints is quite physically demanding job, especially if the patient is on the larger side. Also, unconscious patient’s limbs really are a “dead” weight making lifting and repositioning them a challenging task. During such joint replacement surgery, our consultant surgeon usually wore a head band to capture any sweat that he may produce during these cases. This particular day he had either forgotten or chose not to wear one. Personally I think he was just too busy chatting up this young student nurse before the case started in the scrub room, that he forgot to put it on. Or maybe he thought it didn’t look too cool, especially for his new and keen young surgical admirer.

So here we are close to the end of the case and becoming obvious that the sweat was beginning to annoy our surgeon. Soon it became too much and at this point he turned to the young student nurse and said, “Mop nurse please” indicating that he wanted the sweat removed to avoid stinging his eyes as it rolled down his brow and behind his protective clear glasses. Suddenly, the young student nurse walked off and out of the theatre room, as quickly as she could. We all stood stunned and silent, looking at each other wondering what had happened and where she had gone. The surgeon looked up at me and raised an eyebrow in question. I started to make a move towards the door to see if I could find our student nurse and answer all of these questions. Just as I neared the main door, suddenly it swung open. In came our student nurse, briskly moving towards the theatre table with a spring in her step and happy that she had finally been asked to do something constructive. She boldly came forward and looked at the surgeon, and produced a well used floor mop. The mop she had collected from the utility room that was down the corridor. It was one that used after each each case to mop out the theatre floors. Holding it in her hands in front of her she asked “ Where would you like me to mop sir?”. It wasn’t quite the type of “mop” he wanted!

I looked at my collegues with trust in my eyes that they would not to burst out laughing. I so much wanted to protect this young and dedicated nurse from any humiliation. Thankfully, the surgeon spoke before anyone else. He looked at her and said, “Thank you nurse but I wont be needing the mop anymore, I have stopped sweating now.” She was oblivious to it all, and walked out of the theatre to return the mop to the utility room, just as happily as she had when she brought it in.

Often we will say one thing and mean something else. The most important lesson to take from this story is that we should never assume that everyone knows what we are talking about. Making assumptions on ones understanding of situations may not have positive outcomes. So where possible always be clear on what it is you want and get confirmation that your instructions have been understood. Never assume anything. Always ensure clarity in what you say and what you expect.

First days

The year was 1979 and I had just completed my nursing training. I was working in a country hospital where I had just been employed as a "full timer", and was so excited to finally be a "real"nurse. Back in those days nurses wore caps that were adorned with various numbers of stripes, some different in colours. These were to indicate to others your level of experience. I always thought that we should have just had a green stripe to begin with, as we were so green to the job. As it was, my stripe was dark blue. The caps were starched, held together with a button and clip and then pinned in place to your head with hair clips. They were cumbersome to wear, always slipped to one side and got in the way, especially when showering or lifting patients. Nevertheless they encompassed the symbol of Florence Nightingale, and I was proud to have earned my final stripe.

Today, my first day, was special. I slipped on my uniform, stockings and white flat shoes, and pinned on my first fob watch, a present from my ever so proud parents. I paused, stepped back and looked at myself in the mirror with some degree of pride as I donned the final piece of attire - the white starched cap that had a single stripe on the side. I turned my head from side to side, looking at myself. I think I must have repositioned my cap about ten times before realising that I might possibly be late for my first day on the job. This was it, the day begins.

After a morning of nerves, realising that I could no longer hide behind the "student nurse" front, and that I now carried huge responsibilities, I settled into some sort of basic routine, probably one I copied from the senior nurse assigned to me. From the morning pill round, followed by breakfast, then the commencement of showering and washing patients, I started to feel some confidence creeping in. All of a sudden this was shattered when I was directed to do my first patient rounds with the General Practitioners (GP's) who had patients on my wing. You see in this hospital there were no resident doctors, no specialists, no registrars within ones beckoned call. No, just the local GP's who did their rounds with their frowns, before heading back to their rooms to see awaiting patients.

To do a doctor's round, you were required to escort the GP (sometimes in tow with the hospital matron), through the ward to see his patients. You were lead to believe that it was a privilege to walk alongside a doctor during his rounds and, it was done so in a subservient manner as well. During the rounds, you were expected to be able to recite every single patient's diagnosis, historical events (since the GP's last rounds), results from investigative tests, observations (blood pressure, temperature and respirations), operations, dressings and current medications. Heaven help you if you forgot anything or were unfamiliar with the patient's condition. To be honest, heaven couldn't have helped you, in fact no-one could have!

So there I was, racking my brains to deliver all the necessary information and to impress. However, impress I did not, fail I did. I struggled to remember patient names let alone remember what the results of their blood tests were. And of all times to do the rounds, who had to accompany me but the hospital matron! She was short, stocky and stern. Not the caring sharing nursing image that comes to mind that is for sure. After an initial build up of confidence at the start of the morning shift, it all came crashing down in one foul swoop which took all of five minutes. I was left standing in the corridor having failed my initiation to conducting a perfect doctor's round and told to go back to the staff office to review all of my patients notes. In addition to this, matron looked up at me over the rim of her round glasses and said "I will deal with you later nurse".... I was a blubbering mess for the rest of the shift telling my senior nurse that I would never be able to do it all, I was just not as good as she was. She looked at me with pity and said "In a few weeks you will wonder what all the fuss was about. You will be fine. Trust me, it wont take you long to get the hang of it".

She was right too. I survived and it didn’t take me long to get the hang of it all, and I never looked back.

Never underestimate your ability to do well. It may take a bit longer than others and you may not do it perfect the first time around. But if you believe in your intentions and ability, you will succeed. We often place too much pressure on ourselves to be perfect and correct first time up. Trust in your own ability and believe that what ever you do, is the best you possibly can. Learn from your downfalls, pick yourself up and you will be better next time around.

Reaching out

I had only just started working in the operating theatres of a major city hospital, so I was still in the "green" mode as to how to do things and where to find everything. I was working a late shift on a Sunday evening when we had a patient come back to theatre from one of the day lists. He had had a couple of heart bypass grafts done earlier that day which were leaking and needed to be re-sutured. Unfortunately, once the gentleman was opened up again in theatre, it was found that he had had a massive bleed and could not be repaired. Consequently he died on the operating table about 10.30pm.

Being my first "coroners case" I requested to stay and see it through, to see what was needed to be done, who to call, the paperwork and so on. Once the preliminaries were dealt with I was asked to check a few things in the operating theatre. The coroner's representative had not yet viewed the case so the gentleman was still lying on the table, a sheet over his body to indicate no signs of life.

By now, it was late at night, and we did not have any other cases in progress in the adjoining theatre suite, and the main lights had been turned off. The only light in the room was that of the scrub area (where the doctors and nurses wash their hands before a case). It was unusually quiet, with only the hum of the hospitals air-conditioning in the background. As I checked the area around the table where our expired gentleman lay, I noticed that one of the suction bottles under the table was near full and had yet to be recorded in the case notes. I bent down to move it away from under the table. As I did, I suddenly felt the weight of something on my back. I froze, wondering what or who was in the room with me. As I slowly moved away from the table, still crouched down I could feel this weight moving with me. Startled, I swung round to see the patient's arm sliding off the small of my back. I flew out of that theatre room as quickly as my little legs would carry me, calling out "he is alive, still alive" as I ran down the corridor. I can still feel the weight of that arm on my back to this day. After creating a commotion, waking half the hospital, and working myself up into a state I was assisted by the theatre charge nurse to show her what the problem was. I gulped as we came to the solid theatre operating door. There was a small oblong glass window in the middle upper third of the door that just begged any passer by to look in. Not me... I knew what was in there. I had already conjured up visions of this person sitting on the edge of the operating table, intravenous lines and monitor wiring tangled around his body, alive and kicking. After all, he touched me on the back to tell me this, didn't he?

As we opened the door, my superior said "Trust me Berni, there is nothing in here for you to worry about". Ok for her to say that, she didn’t have an arm reaching out, holding you down, wanting you to know he was there. As we entered, the main lights turned on flooded the area and lit up the operating room. There in the middle of the room lay the deceased, his right arm by his side. Not a breath, not a single movement came from him. I stood and stared, heart beat racing, knowing she was right. He wasn’t alive. The charge nurse explained what probably had happened, that his arm had slid away from the side support, which was why it had fallen across my back. I now felt embarrassed at my naivety.

On reflection, maybe I was really hoping that he would still be alive, reacting as I did through helplessness of not really being able to do any more than what had already been done.

Sometimes we are faced with confronting situations where fear can take over our rational thought processes. Facing difficult situations and trusting the guidance of others will enable you to learn skills to cope with these challenging circumstances.

What is Trust?

What is Trust? How would you define it? Trust means so many things depending upon the context in which it is used. There are over 30 different definitions for the single word TRUST (http://ardictionary.com/Trust/7936), each conjuring a different meaning depending on the situation of use. What does it mean to you?

I ask the question to a couple of National Speaking buddies the other night, as to why is it that people will often pour out their heart to me, after they find out that I am a nurse? What is it in the title of "nurse" that implies trust?

I would be curious to hear some comments.

How far we trust

Anna was a patient in a country hospital who was in her last stages of a terminal illness that had stolen the last years of her life. She was initially diagnosed some five years earlier with a kidney tumour that had been removed. It had unfortunately, infected the major vessels in and around the tumour area, spreading cancerous cells to other parts of her body and thereby forming secondary cancers. Her breastbone, spine and hips were riddled with secondary cancerous deposits that had eaten away at what was once healthy bone. I was nursing Anna one afternoon, washing her hair and trying to make her as comfortable as I could. We spoke of many things, her family, her life in general and her short future that lay ahead. She suddenly sat still for a while, just staring at me. I asked her what she was thinking about. Anna looked at me, with pain in her eyes, her suffering obvious. She said that she had had enough of her suffering and wanted me to help her end it all. She asked me if it would be any different if she was an old dog, saying that the RSPCA would have put her down months before. I smiled thinking she was trying to put some humour into a somber moment, but my smile faded quickly when I saw the seriousness in her gaze. I asked her what she thought it was that I could do for her, thinking that maybe I could get a softer mattress, or more pillows or maybe even some essential oils to help relax her fractured body and maybe too, her fracture will to live. She took my hand and held it for quite a while without saying a word. She then took a long deep breath, looked pleadingly at me and said "just help me to go now, give me an injection. I am ready and dont want to have anymore pain. I know I can trust you to help me finish all this suffering. Please let me die."

Sometimes we cannot always carry out requests, no matter how much trust is placed on an individual to be able to do so. Morals, judgements and beliefs will always create an ethical dilemma between what is best and what is right.

Anna was my mother, and died two days after this trusting request she made to me, her nurse.

Trust Me

It never ceases to amaze me how trustworthy people are - especially when I say that I am a nurse. Just the word itself "nurse" conjures images of an innocent and trusting soul! Nurses are one of the most trusted professions in society. Almost everyone who has come in contact with a nurse will often share their innermost secrets and problems with them.

I can remember working on a remote mine site in the northwest region of Western Australia. I had just stepped off the plane when I was greeted by one of the workers who asked whether I was the administration "sheila"(Australian word for girl). I said that I wasn't. We walked across the tarmac in silence until he asked "Well what are ya here for? That is what do you do for a crust love?"I smiled and said that I was a consultant nurse, here to look at some of the workplace health standards. By the time it took to walk from the tarmac to the accommodation check-in area (about a ten minute walk) he had explained to me about how he had a few problems in his groin area, which had turned out to be a hernia. He continued to explain to me about his recent hernia operation, and how he had had an infection, which they (the doctors) now think may have been related to his diabetes. He went on to tell me that his mum and dad both had diabetes, but his dad died of a heart-attack some years ago. There was a pause in this one sided conversation, just a short one, from which followed a long winded description of how his wife of 15 years had left him for his best mate. By now we were close to the steps of the administration block, where he stopped and reached across to touch my arm, and we paused. He rolled up the leg of his work pants to show me a scar on his right knee. Proudly he told me of his knee reconstruction some years back, and that it was as "good as gold" as he flexed and straightened his leg as if to prove a point to me. He left me standing there at the entrance of the administration block, turned and headed towards his quarters where he said looking straight ahead "have a good swing love, catch ya" and walked off. I stood there staring at him as he disappeared, leaving only a puff of red pilbara dust behind him. I never even knew his name, but that was OK, because I was a nurse, and he trusted me.