A week

Nurses care for all sorts of people, often those we’d never dream of interacting with outside the job.

“Unconditional positive regard” is the aim but that can be severly tested, is not always deserved, not always able to be given.

Some days there’s no better job than this. Other days it’s cooked, it’s a lot. You’ve no idea.

I had a week (not that long ago) of caring for the violent, the floridly mentally unwell, the sexually inappropriate (well only one of them thank god)

I’d been overdue, too many ‘nice’ shifts, too calm for too long.

First up, angry impatient woman, spitting her racial abuse at my delightful colleague. Outraged I calmly gave the speech, “Not acceptable…” “Here to help.….” “Do NOT speak to us like that….”

Great start.

Moving on, chatty, twitchy, shambolic woman (boyfriend in toe) disinhibited, appears in the corridor stark naked, “Oops, in you go, shut this door while you change.”

He, the moment I laid eyes on, my gut told me ‘NOPE’ loud and clear.

Too jumpy, too in-your-face, too chatty, “yes miss, no miss”, fawning but with an undercurrent, a potential to go mental.

A memory surfaces from years ago, tiny nurse, similar crazy (Glaswegian) bloke, a punch, a black-eye.

Not having that here today. All staff on alert.

As predicted his behaviour did escalate when calmly told “no, sorry you can’t stay” “I’M NOT LEAVING HER, I’M STAYING RIGHT HERE!!”

Aah, nope, no yer not.

Plan already in place quickly actioned, security called (low bar these days)

They arrive, calm, ready for anything, their bulky presence always a relief, “you nurses don’t need to be dealing with this.”

That’s right, we don’t.

Next day, a young woman, pacing up and down, shouty, swearing, demanding, desperate. Quick risk- assessment made, genuine distress evident underneath the ranting. De- escalation works, quiet room, warm blankets, listening ear. “Hate hospitals …” “Brother died …” Sympathy for her little-girl self.

Then onto inappropriate, IV drug user bloke, bones broken, in need of our help. Uncovered, (mistake?) uncaring, boldly continues eye-contact while touching himself. Skin crawls. Immediate removal, curtains shut. What the ….

No male nurses on shift, plan going forward, two attending at all times, quickly, no eye contact. Shudder. Next shift will be warned.

Next day, different place, an instant tsunami of competing issues on handover ….

Dangerously high blood sugar. New covid +ve diagnosis. Pain crisis. Some agitation. Hints of verbal abuse to come. A blocked picc. A blocked iv cannula (drugs due now, of course)

Predicting a morally injurious shift, I actually planned to leave. I didn’t. It was. Sigh.

Later ‘workload concern’ form submitted, all events shared, in detail, every F word, every C word, all deranged behaviour directed our way.

Finally, rounding off the week, in the midst of a ‘how many pairs of hands do they think I have?’ kind of a shift. Patients all elderly ❤️, no one can walk, leg ulcer dressings, seventy billion meds to dispense, charts to decipher, pharmacists to chase.

Then amidst it all, a wee moment of grace. Intellectually disabled man, sat in his chair, waiting patiently, poor sight, poor hearing, HOOTS with laughter as comedian nurse helps him stand then wheels him, dances him, SWIRLS him across the floor to the shower.

His day brightened, mine too.

Later, driving home, nose-to-tail traffic in little shitbox car, back in ma garden thinking, it’s all good, everything’s perfect. There’s nothing to complain about here.

A Shift On Women’s Surgical Ward

Shift begins with bedside handover from outgoing nurse, introductions made, ID’s checked, we smile, we say hi, we scan, noting the patients skin colour, affect, facial expression, position in the bed, are they moving, scared to move?

First patient has a zip-like vertical incision in her abdomen (large ovarian cancer removed the previous day) neatly sutured closed, covered with see-through dressing.

Drip stand, four pumps attached sits alongside. Above the 1st pump a bag of lethal pain killer hangs. Is it labelled correctly, is the line labelled, pump programmed accurately, drug matching the order, IV cannula dressing secure, any sign of infection, kink in the line?✔️

2nd and 3rd pumps give a micro dose of numbing local anaesthetic into skin near the wound, check them too, are dressings secure, no leaking✔️

The 4th pump gives an hourly volume of saline and antibiotics at the same time. Check ✔️

Drain in the wound, is it unclamped, is the squeezy chamber vacuumed, is the volume of blood/fluid in bag ok? Mark it, record, check dressing✔️

Abdominal dressing, is it intact, any bleeding, ooze, gape in the stitches?✔️

Urinary catheter, is it fixed securely to the inner thigh (stops pulling at the urethra, ouch) check volume and colour of urine draining?✔️

BP machine, is it available, ready to go?✔️

Is everything plugged in, battery loss painful at critical moments 😩✔️

Untangling as we go, thinking ahead to moving the patient out of bed when the dance begins of unhooking drains and catheters, unplugging pumps, unwinding lines, round and round, threading this way, threading that (it’s an art!)

Handover received for remaining seven patients then off we go into the fray to a chorus of alarms and call bells, to pain relief needed urgently, to someone retching into a vomit bag, to a new admission wheeling up the corridor from emergency.

Immediate fires tended we start proper, expecting to be on our feet most of the shift treading a path between bed, treatment room, nurses station, linen trolley and pan room. Feels like exercise but in reality just a lot of walking ( doesn’t that count🤔) heart rate elevated only in emergencies.

Space is limited so every inch is grabbed back, surfaces cleared, patient belongings put away, equipment returned, unused blankets folded, extra pillows removed , all making clinical care easier.

If there IS an emergency valuable time can be lost untangling lines, moving shit from the floor to let relevant teams in. Sicker the patient, tidier it needs to be

* * The aim by end of shift is for all patients to be clinically stable, pain free, clean, cocooned in fresh sheets and blankets, curtains pushed back to let natural light come in. Takes a lot of work.

Observations first, blood pressure, heart rate and oxygen saturations reveal all. Temperature check too, looking for signs of infection.

Next medication administration, a huge responsibility, focused concentration needed every single time, no short cuts, ever. Patience too, often scrutinising multiple charts.

Physios help sicker patients take the first lung expanding, leg pumping walk, the brave promenades up the corridor, hospital gowns flapping, legs in compression stockings, trampoline socks gripping the floor.

Some are keen for a shower so we go for it, multiple drips, drains and catheters in tow, a major physical manoeuvre for both patient and nurse. Quick is key.

Peering at their abdomen in the mirror the sight often too much, “don’t look!” Cannulas and wounds waterproofed , then gently, sweat, blood and pink antiseptic stripes are hosed off.

Drying backs, lower legs, feet. Nurses don’t bat an eyelid at the sight of naked flesh but we scan, skin detectives looking for problems, rash, bruise, sore, a dressing undone.

Then, patient adorned in clean hospital gown, the final push, back across the floor to a freshly made bed, to opioid pain control, to sleep.

Scan again, quick recce, is everything in place before moving on. One episode of care for one patient, the two nurses responsible for seven others.

Things can and do go wrong.

Drugs often not available when needed. Equipment malfunctions. Doctors difficult to contact. Crashing BP’s. Soaring temps. Sudden rivers of blood. And the human factor, patients needing extra time and attention, a pain crisis, a heightened emotional response (crying, raging, acute anxiety) Overwrought relatives.

Nurses who need or like plans to work out in a linear way find this all frustrating. It IS frustrating!

End of shift, we look at each other, hopefully satisfied, patients exactly as planned ** or we commiserate, feel bad, stretched too thin, patients fine but our perfect, lofty goals for them not quite achieved.

We learn not to blame ourselves, it’s a 24/7 job, we work in a system, within a team so handover is given to the next shift, it’s our turn to go home, rest, re-energise, ready for the next .

Lindsey Crossan Registered Nurse/Midwife

Chapter 2. Learning To Be A Nurse Glasgow 1983

I’m from a family of nurses going way back.

Great auntie Evelyn nursed in London during WW2.

Great Auntie Jean was a “Call The Midwife” helping women birth at home, day and night, in 1950’s Greenock in Scotland.

Three of dads’ sisters were nurses and my own mum was a district nurse in the community. Watching her leave home of a morning in navy uniform dress, hat and coat with the big nylon bag over her shoulder full of mysterious dressings and paraphernalia, I knew I wanted to keep up the family tradition.

Continue reading “Chapter 2. Learning To Be A Nurse Glasgow 1983”

The Night Shift

Glasgow Royal Infirmary, 1988, a drunk lad is pinned down by police and porters, “get tae fk, get aff me ya bastards!” face slashed (bottle/knife?) skin flapping, his blood spray up the curtains, on the docs white coat. “Keep still!!”

My job, apply pressure (try not to get stitched to mental boy in the process) fingers scarily close to needle, thick black silk, no plastic surgeon, no operating theatre. Finally, the doc finished, another ‘Glasgow kiss’ done.

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Chapter 12. Womens Theatre

We take modern surgery for granted. Anaesthetists safely render us unconscious, surgeons make deft incisions, cauterise, snip, scrape, biopsy, repair then we wake without remembering a thing. A miracle of modern medicine.

Not a miracle of course but the result of many highly qualified individuals coming together, an array of pharmaceuticals, specialized equipment and instruments

I often work in a women’s operating theatre prepping them for surgery, minor, major or life-saving specific to their female sex.

In this theatre, babies are born by caesarean, haemorrhaging is stopped, prolapsing organs replaced, cancers removed, contraceptive devices placed, pregnancies ended, tiny fragments of tissue gently removed after miscarriage

Our job in admissions is to make women feel safe, respected and cared for, give them our full attention, instill confidence.

We see women across the spectrum

Elderly, Girls with mature bodies, Indigenous, Neurodivergent, (aspergers, autism, dyspraxia) Disabled physically or intellectually, With mental illness, With history of sexual abuse and resulting PTSD, With gender dysphoria, Refugees, Non – English Speaking.

All humans, all worthy of dignity, respect and equal healthcare. Negative stereotyping is deadly. Nurses know this. We don’t assume anything.

Quiet hijab wearing woman might be confident, articulate, questioning everything

Exquisitely dressed woman with the frosty demeanour and clipped communication style may be on the verge of a panic attack, just holding it all together

The woman with english as second language, relaxed in our presence, reveals a significant health issue, till now untold. Surgery is delayed.

Vague , delightful elderly woman may not understand exactly what’s about to happen, surgery can’t go ahead without appropriate consent

The next elderly woman spirited, spritely, sharp as a tack, gives accurate answers and cheek!

Shouty angry woman might just be terrified, missing her usual self medicating drugs, anger turning to tears

Woman clasping emotional support teddy, own pillow , headphones, eye mask and fidget spinner is autistic with sensory issues.

We accomodate, we manage, advocate, gate-keep, check lists, mitigate risk, tend fragile mental health, keep everyone safe. Nothing surprises us, humans are complex

Questions, questions, so many questions

Why are you here? What surgery are you expecting ? When did you last eat? Did you take any drugs today? Do you need any drugs? Any jewellery on your body, any sneaky piercings?

Some women are scared, facing a lengthy surgery for cancer, pre-chemotherapy.

Some are having minor surgery, seem glad of the anaesthetic escape, from the relentless parenting of small children

Some mortified, hating the need for surgery in their most intimate parts

Some barely conscious, rushed through from emergency, actively bleeding, blood drip, drip, dripping into a vein

We swoop, urgency, speed, focus, No words needed

Many heartbroken having miscarried a pregnancy, still bleeding, need a curette

Some having an abortion, feel shame , embarrassed, many are not, aware of their right to reproductive autonomy, no matter the opinion of others.

She’s been raped, maybe a child herself, abused by a family member, her life a train wreck, she’s vulnerable, she is septic, she is bleeding, at risk of dying if the pregnancy implanted in her fallopian tube ruptures.

She is beyond heartbroken, devastated, carrying a baby with abnormalities who won’t survive, has made the brave decision to end the pregnancy

Can you even begin to put yourself in her shoes?

No matter your feelings, thoughts, opinions, this decision is never taken lightly, is frankly no one else’s business, should not be up for public debate , certainly not by old white male politicians of the patriarchy. Photos of the Supreme Court judges in the USA abhorrent, make my blood boil

The idea of a woman not being able to have this safe procedure in a hospital is unthinkable, medieval.

In my hospital, in this theatre if you need us, you’ll be in safe hands.

Hope we don’t see you anytime soon

Lindsey Crossan. Registered Nurse/Midwife

Another Day At The Office

Recently had the delightful task in the postnatal ward of weighing the newborn babies going home

Wheeling them to the scales one at a time in fish bowl hospital cots

Quickly, gently, wrangling them out of clothes and nappy

Talking to them , shushing them, apologising for ma cold hands

Placing them atop the scales on the blanket nest, tiny bums in the air, so cute!

Just as quick, dress em up again, straight back to mum’s arms

Next day a shift in emergency, seeing the polar opposite example of human

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