Wednesday, June 25, 2008

The Curious Incident of the Student Nurse and the Polish Man with Back Pain.

Names, locations and facts have been changed to maintain a lack of research funds. Comissioning editors for "Scrubs" and "House" are denied intelectual property rights on this script.

‘A Wooden Die (Zbigniew Herbert.)

A WOODEN die can be described only from without. We are therefore condemned to eternal ignorance of its essence. Even if it is cut in two, immediately its inside becomes a wall and there occurs the lightning-swift transformation of a mystery into a skin.

For this reason it is impossible to lay foundations for the psychology of a stone ball, of an iron bar, of a wooden cube.’

Of course a man in need of food with excruciating back pain is not a wooden cube. However, on a ward dedicated to old people of many different cultures, there are many different communication issues that arise. They have a wide range of caring needs, whether they are physical, circumstantial, mental or a combination of the above. There are people in the last stages of cancer in beds next to people with severe Bi-polar disorder, next to people who have little to no home help who have simply fallen over. They have one thing in common. They are old and unable to work.

As we live in a society based around competition and profit, they are often marginalized. Their families may have moved to follow work and their pensions may be inadequate to support them. Not all of the patients on my ward suffer from these situations, many have caring families on hand to support them, but these factors cannot be ignored. The alienation that they suffer can manifest itself in many forms that can make a nurses life miserable. Aggresion, paranio, neediness. They need a decent life, hospitals are not equipped to provide this.

A wooden die is simply a wooden cube with spots from one to six painted onto its side. When you roll it, you transfer your hopes to win a game onto the outcome of that roll, thus giving it a personality. If you roll a one when you want a six, you may say that that the die is a complete bastard, when really, it’s just a piece of wood. The next time you roll that die, you will be more wary.

Montmarcey Brown is still studying nursing, and spent the grand total of ten hours on a hospital ward just last week. This gives him special "observational" powers, but doesn't knock the life out of him to such an extent that he wouldn't have the energy to write a blog, or do a bit of study for that matter. Study requires beer, cigarettes, a healthy determination, high hopes and an ability to piss in strong winds.

There are times on a ward when you have the chance to see further into the minds and situations of the patients. Feeding someone is one of these times, even if it is only through a glance or gesture. At mealtimes patients are given food appropriate to their culture and dietary requirements. The meals are put on a trolley at the end of the ward with the bay and bed number written on a piece of paper laid on the tray next to them. I got bay forty, bed twelve (Which I reached by means of a Matter Transporter), an elderly polish man who was sitting upright in a specialist wheelchair that looked like a seat from a sports car on wheels. He got an approximation of shepherds pie, broccoli, peas, chicken soup and custard. It didn’t look very appetising, but I described to him what he had on his plate and pointed to each piece in turn, asking him what he would like first. Although he didn’t seem to be able to speak English, we negotiated that he should have the broccoli first as it looked tastier than the peas and the shepherds pie was still too hot to eat. It took five minutes for him to eat two pieces of broccoli. After fifteen minutes he’d had about half of what was on his plate and looked satisfied. He’d thanked me after each mouthful and seemed to enjoy his food, which was extremely satisfying for me. I wiped his mouth, told him I’d be back to see if he wanted more later on and went off to twiddle my thumbs beside the nurses’ station.

I live in Acton, where there is a large Polish population. During the Second World War many Poles moved to London, fleeing the invasion of Soviet and German forces, they were allies to the British forces and had a positive image amongst the population.

More recently, with the expansion of the European Union, many more Polish workers have immigrated into London. Fear of job losses, fuelled by right-wing papers such as the Daily Express and organisations like ‘migration watch’, as well as employment laws that make it more likely for the workers to be employed in low paid casual work, with little to no rights, makes life hard for these immigrants. Because I am white and fair-haired, I often get seen as Polish. I have learned to point at myself and say ‘Polski?’ whilst waving my hands in a manner that says ‘I am not.’ They usually gesture back with a rolling motion of their fingers that says ‘I’m gasping for a cigarette’ to which I reply with pinch of Drum tobacco and a blue rizla. I can say 'Suck my cock' in Polish, but the chances to use this term
during polite discourse are limited. I learned the term in an innocent and culturally appropriate manner whilst working in a drinking establishment. Oh, and I can say 'Solidarnosk' and know a little bit about it being a socialist and all. Not a lot, but a little. Like Jimmy Saville.

Luckily, the other nurses on my ward are from many different backgrounds, and racism doesn’t seem to be a problem, but there isn’t a single member of staff I know of who is Polish, and there don’t seem to be many Poles on my course either. This should really be addressed because there were at least three Polish patients on the ward the last time I was there.

After lunch the ward settles down as the patients digest their food, have a nap and wait for their relatives. The qualified nurses and health care assistants generally retire into the staff room for the long break they’ve been waiting for since 7.30am, leaving the student nurses free to sit at the various nursing stations and harass any qualified staff who happen to pass by. I was wandering about the ward looking for someone to talk to when I noticed my Polish man reaching for his custard. He was trying to drag it towards him, past the half full plate of shepherds pie still on his tray. I walked over and offered to feed him again. It was at this point that he started to talk to me in Polish, none of which I understood, but I didn't bother him with that because he was eating, and this was tremendously satisfying for me. Old people in hospitals generally lose their appetites. At the time I thought that maybe he was confused and thought I was Polish. I have since learned that many patients will talk to you in their mother tongue, even if they know you don’t understand. It’s one of those things that people do.

After he'd had enough custardI did my wavy hands ‘Polski? I am not’ several times, but he didn’t seem to take it in the first few times. Eventually he beckoned me closer and said, in a plumy phrasebook English ‘I am suffering the most excruciating back pain.’ I said, ‘I’ll see what I can do.’

When you start on a ward, the first thing you should do is get to know the roles of the various different nurses, care assistants, social workers and doctors who are there. I never did this, preferring to hassle the least busy, most affable looking people. The trouble with this approach was that the least busy, most affable people were having their breaks or trying to do their paper work. There was no one about, so I asked a nurse sat at the nurses’ station if she could help. She had to write reports on five patients before her shift finished. I decided to approach the head sister, who was having a hushed argument with one of her colleagues. For some reason I wasn't too worried about interupting them, they're good at responding to a pannicked face. ‘Daljit is in charge of that bay, go and find him’ I didn’t know who Daljit was, but she had resumed her argument, so I decided I’d have to guess. Luckily there was only one other male nurse on the ward at that time, and he turned out to be Daljit.

‘He’s had painkillers an hour ago, so we can’t give him more. We’ll move him to his bed so he can lie down.’ I was a little surprised that Daljit knew what to do without seeing the man, but when we arrived at his bed with the hoist, he seemed relieved. ‘Do you want us to move you?’ I asked. He nodded, seeing the hoist and hearing my questioning tone he had put two and two together.

First we moved his table out of the way and closed the curtain around his bed, then Daljit asked me to hold him forward as he positioned the sling behind his back, tucking it down so that we could pull the other ends of the sling up between his legs. The sling attached to the hoist by means of plastic clips, which we had to pull up from between his legs. It was quite a struggle to attach the plastic clips to the hoist and we had to lower the hoist a few times and reposition it around the chair to get the best fit. Eventually we had the hoist in position, so I plugged it into the wall socket and raised the man so that he was above the bed. We then had to swing him around so he could lie on the bed, which proved difficult as his legs were rather stiff and the main trunk of the hoist got in the way. Eventually Daljit had to apply some force and squeeze his legs past the trunk. (Knowing how much force you can apply when carrying out a clinical procedure is something that you can only learn with time. You've got to do it without causing harm, but sometimes you've got to use a bit of elbow grease.) We gently lowered him onto the bed, making sure that he was comfortable, before rolling him onto his side to ease the sling out from underneath him. This required us to stand either side of the bed, then I rolled him towards me by gripping his shoulder and thigh, while Daljit rolled the sling up underneath him, then Daljit did the same, while I eased the rest of the sling out from my side. At this point he became a little panicked as he was close to the side of the bed, so we had to make reassuring noises. ‘It’s ok, we’ve got you.’

Mission accomplished, Polish man moved from chair to bed and relatively comfortable.
I am a student nurse; therefore, legally, I am not able to do anything without supervision. This can become difficult when people need assistance and I am close to them.
Understanding does not require a common language. People throw dice, thinking that they understand the dice, when really they have a one in six chance of getting what they want. When elderly people are on a hospital ward, often they may regard the various professionals that they meet as die that they can cast. Is it worth the effort trying to make them understand? Maybe the back pain is easier to endure than the humiliation of being reduced to symptoms, none of which Montmarcey has really experienced.
In this way, the role of a student is valid but unpredictable. We come on to the ward with no routine and no preconceptions. We do not know that the Primary Care Trust will deny certain patients the right to die in comfort because it will cost the hospital too much. We do not know that the patient was discharged, only to be re-admitted later, not because they are ill, but because their family cannot cope. We have no concept of how casualisation and low bursaries are eroding the ability of nurses to develope professionally. This makes us slightly amusing, and a little human. Contact, in the last days of your life, is all that you can hope for.


Blogger Montmarcey Brown said...

Sorry, I forgot to mention Solidarnosk. But perhpas people could elaborate.

9:25 PM  
Blogger Montmarcey Brown said...

I have now remedied it to mention solidarnosk. Thankyou for your patience.

9:52 PM  
Blogger Renegade Eye said...

When you become a nurse, it becomes harder. You don't have the security of practicing under someone else's license.

The healthcare system in Poland, is schizophrenic, combining Stalinist rule, with open capitalism.

2:52 PM  
Blogger Montmarcey Brown said...

Yeah, that's why they ease us in gently.

The health system in England appears the same at such a broad definition, once a fairly decent service, now a steady breaking free market.

3:14 PM  
Anonymous Anonymous said...

Really good blog. Close-up sociology type stuff and historical context. How d'you find the time?! Keep your spirits up.

steve, France

5:05 AM  
Anonymous Vanessa said...

Good words.

11:40 AM  
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8:05 PM  
Anonymous Anonymous said...

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4:48 PM  

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