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2007 - June 21st - Thursday

POSTOPERATIVE DAY TWO

JH thought that this was the day – when Lyn Headon was taking the minutes for the PCFCD on JH’s behalf!  JH was seen by the usual Personnel: first by the gentleman Registrar, and then by the lady Registrar, and then the SHO.  The lady Registrar did comment (firmly but in her usual calm, professional manner) to the Nursing Staff that she did expect her donor patients to get out of bed on the evening of operation: it was explained to her that there had been no Physiotherapists on duty on Tuesday, and yesterday JH had not had her catheter removed until the afternoon (although this could have been ‘got round’ with difficulty!).  One of the Clinicians said ‘Suppositories Stat’ but this did not happen until about one hour later.  JH’s chest was ascultated, and she was found to have crêps and diminished air entry on the lower left side (rattles, and inability to expand that bit of lung) which was the usual finding after nephrectomy.  After suppositories were inserted (by a Nurse, not self-administration) JH managed to retain them for +/- 15mins but then ‘returned’ only the suppositories: however, a bit of fidgeting about had the desired effect of releasing flatus explosively – eventually.  JH asked Amelie to bring back the commode after emptying it: however . . . Amelie brought back the commode with the message that there was no bedpan in the commode, because all the metal bedpans were in the washer.  So JH (with a certain amount of horrified amusement that she might ‘forget’ there was no bedpan in the commode) – ‘jumped to attention and rallied herself’ - to walk about a bit, and then sit on the commode seat while she had a wash and cleaned her teeth – during which ‘performance’ JH got tangled in her PCA line, and the tubing to her oxygen mask.  JH thought she heard a cup of coffee ‘arriving’ whilst she was behind the curtains, and so asked Amelie if she could pass JH a cup but, actually, it was not the ‘time for tea’ - or coffee - as there was no milk!


"Don't you worry"
 
 
The gentleman Registrar had told JH to continue inhaling oxygen via the mask; furthermore – in view of the continued absence of Physiotherapists - he asked JH to move her legs up and down, or press them against the end of the bed five times a day; also JH was to breathe deeply in and out – holding her breath to a count of three.  The previous day JH had been churlish enough to bemoan (to Mary) about Amelie’s constant replacement of the mask on JH’s face (after observing JH’s pO2 on the monitor), but of course this was unreasonable of this recalcitrant patient.  Furthermore, Mary and JH observed that Amelie was not the most ‘vitalised’ of people but Mary said that it might at times ‘be difficult’ for this young lady, who was from a different culture, and that probably English was not her native language.

JH was still using the PCA as the line had not been removed the previous day; however during the morning, the PCA pump rang continuously and the legend on the display said ‘reservoir empty’.  JH attracted the attention of a Nurse who was tied up doing something else; JH put up with the noise for 10 minutes or so and then asked again but was told that, as the PCA line contained a controlled drug, a Staff Nurse had to deal with the bleeping machine.  But JH persevered with asking for the noise to be ‘smothered’ somehow - JH could disregard all the other noises and bleeps in the Ward but found it very difficult to ‘put up’ with this machine being noisy right by her bed.  Eventually the machine was put on standby – which meant that it only bleeped intermittently, but JH felt ‘guilty’ as if she had ‘pulled her weight’ too strongly: the line was not finally disconnected until early in the afternoon.

JH was visited by a different pharmacist (from yesterday) whom JH reprimanded for calling this patient ‘Mrs’.  JH observes that, now, patients on a galaxy of drugs which they self-administrate orally, store all their medications in a bedside locker for which they hold the key: so the patients are considered responsible enough to be given back some of their autonomy (not like in ‘JH’s day’).   Ralph visited after Kathy had had her after-lunch nap.  During the afternoon and evening JH made sorties to the toilet (having finally relinquished the oxygen mask at some point) – clutching her Andrex moisturised toilet tissue; these sorties were also carried out, of necessity, during meals: in the evening ‘something worthwhile’ was produced.  During her ‘preoccupation’ with her bowels at suppertime, JH dripped un-minty gravy (ie supposed to be minty but JH could not taste any) down her nightie which she had put on in place of the vomit-stained hospital gown after the CPA was removed.  [Mary’s advice - about bringing lots of nighties into hospital for frequent changes - was good advice!  In addition JH applauded herself for having thought of bring disposable pants to wear - once mobile.] 

During one of JH’s necessary walkabouts, she was asked by Grace – who had sat herself down by another patient who was giving a sympathetic, attentive ear to Grace’s tales of woe – if JH could lift her up out of her chair: JH explained that she was really unable to help as she had a large surgical incision herself, and this was her first day out of bed.  Furthermore, she pointed out the puddle of water (nothing worse) by the door of the balcony (possibly to distract further importuning): JH mentioned the puddle to someone whom she felt sure could find a floor-mop.   Grace had mobility problems; her gait was shuffling at the best of times, and she usually wheeled herself about in her wheelchair; but Grace was a determined conversationalist, and so managed to reach a neighbour’s arm chair which was too low for her to get out of with ease; however, she quite understood JH’s reluctance to haul her up and, eventually, nabbed the next passing person to help – whom she did not detain for long with further tales.

The elderly lady (from the Indian Subcontinent JH opines), who was the occupant of the bed opposite, received a visit from her delightful extended family - two young women, a young man, and a little boy.  [Children who are under five visit the ward at the Senior Nurse’s discretion.]  Also a little girl, who had no speech, and a protruding tongue was visiting grandma (query great grandma): this little lass looked beautiful in her Sari and head shawl.  One of the young ladies untied grandma’s long, abundant, grey hair and brushed it tenderly for most of the family’s visit, and then re-plaited grandma’s crowning glory.  

[JH recollects that, when she was briefly a Student Nurse at St Bartholomew’s Hospital in 1959, a relative had asked permission(!), of the Ward Sister, to cut his relative’s finger and toe nails: at the lunchtime gathering round Sister’s desk, all the assembled company of Staff were told firmly by Sister that she was most concerned that the relative had felt moved to ask to cut his sick relative’s nails, as ‘this is a Nurse’s Job’ and should have been done before the relative had occasion to ask!  JH also recollects that Marjorie Watson, JH’s long-time friend who now lives in North Wales, had a similar experience – of both patient and a patient’s relative losing their personal autonomy in Hospital – when Gordon, Marjorie’s Husband, was hospitalised more recently than when JH did her Nursing Training.  And Angela Tilly also realises that ‘this is not a Nurse’s job’ following her experience in Hospital - when she had the operation on her back - of being completely unable to find a willing person to cut her toe nails: she now has a helpful friend who does it for her!]

JH continued to people-watch throughout her inpatient stay: this opportunity could not be missed!  JH observed that, out of the total of 16 beds in the Ward, that usually only a quarter of the occupants of said beds were white, at the most – and not necessarily truly ‘Caucasian’.  During Thursday, a lady was admitted, and she was accompanied by her husband, in other words a ‘white and ordinary’ couple (as written, at that moment, by JH in her diary).  As JH felt sure that she recognised them, she asked the gentleman if we had met before, to which he replied that it was probably here - in the RLH - as he had no recollection of meeting JH elsewhere.  A rather ‘different’ family visited Lilian (as well as her white and ordinary husband) in the evening: from the manner of the greetings it could be confidently ascertained that the family members were daughter, son-in-law, and two grandsons aged about 8 and 6.  Different – yes – from the Indian lady’s family, and from the distressed lady (wTS) who had occupied that corner of the Ward on Tuesday evening, and been visited by her understanding ‘family’ ie, ‘significant others’ as detailed on so many databases these days - in other words those carers to whom you are an important person.  People are of course from many different cultures and, perhaps, the white and ordinary people are from different English social classes?

Another Bedlam Night was preceded by a stout black lady refusing to take her tablets, but her attendant Nurse, Hussein, persevered with his usual professional determination, to kindly persuade her to take this essential medication.  This patient continued to weep and express her great distress throughout the evening.  JH had observed two young men who seemed to be ‘out of sorts’ with each other visiting this sad lady – possibly mum – and so this lady’s distress is a distress to all her family.  But JH observes, again, that everyone has different coping abilities, and that perhaps the stiffness of the upper lip – as reputedly maintained by the English – is because the English cannot allow themselves to express unrestrained emotion.  Grace, our determined conversationalist, nabbed JH successfully in the evening: when JH asked Grace ‘how it all started’, she launched into the tale about her disabilities, and how she ‘fell on her knees’ rather than elucidating how she had come to be on dialysis for three years.  JH observed that this lady appeared to have port-wine markings on her face – physical stigmata which in no way detracted from Grace’s courageous determination to be heard.   At about 7.30pm JH was speaking to Mary Andrews about her bowels (JH’s not Mary’s!), who had phoned the Ward - JH waved at Kathy in response to her wave from the 4-bedded bay where she was lying back watching TV on her Patientline console.  Then JH turned round to see Kathy’s face was obscured by an oxygen mask, and she was just about to be wheeled off to have an X-ray (which had actually been planned to take place earlier in the day).  Ralph was still there: was it Ralph, Kathy, or someone else that had mentioned ‘not panicking’?  JH went back to her bed: Amelie, who was helping to make up the bed next to JH’s, immediately noticed that JH seemed sad; JH explained that one minute Kathy had been waving at her, and the next minute she was breathing oxygen, and being wheeled off somewhere; Amelie reassured JH by saying that she had not seen anybody ‘rushing in and out’.  So a few minutes later JH peeped in and spoke to Ralph before he left: Kathy’s neck wound (where she had lines inserted for monitoring purposes) had bled, and she had been sick, and her blood pressure was fluctuating; apparently something had gone awry with her fluid balance and, regretfully, she had not been weighed on admission - so that her fluid balance could be accurately monitored. 



 
 
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