BELLS, BEDPANS & BURNOUT

The reality of working bedside in the NHS

Tag: nursing

  • Emily

    [05/09/2019]

    Emily is quietly dying. My experience tells me that it is not the kind of dying you recover from. Yellow and puffy, she is exhausted from just staying alive. She lies in her bed at the entrance to the last bay (where the most stable/independent patients are usually put) and I see her every time I pass by: Lying flat with her dark hair spread in waves across her shoulders, its red colouring contrasting with her sallow skin. At 35 she is just a couple of years older than me and the calmness with which she faces both the struggle of her present circumstances and the loss of her future speaks volumes about her overall character. She is unquestionably one of the most kind and considerate people I have ever had the privilege to look after. Always patient, always polite, staff talk about her with a fond sadness that reflects the fact we all know she won’t be with us much longer, even if it is not openly discussed.

    [08/09/2019]

    Emily is catheterised now. They had wondered if she was retaining urine, but she wasn’t producing any. Her renal system has started shutting down. There is lots of discussion about how much of her deterioration was due to disease progression, and how much was due to her treatment. After administrating what was supposed to be the first bag in a final round of chemo, Emily rapidly deteriorated. So much so that they decided to not continue. It was never going to be curative, but if the cancer had responded, either slowed or stopped growing, it could have given her more time. The chemo nurse tells me that she regrets administering that final dose, “but who wants to tell a 35-year-old that she’s no longer appropriate for treatment”.

    [10/09/2019]

    Emily has been moved, brought to a bay in the middle of the ward so she is closer to the nurses’ station. She lies awkwardly, never comfortable. Her limbs heavy with fluid, skin stretched taught. At this point care staff are assisting with all her personal care needs as she is just too weak to do much of anything for herself anymore. Helping her reposition in bed, I am shocked to see the blackened skin of her sacrum when she rolls over. Necrotic damage to deeper layers of skin a clear indicator that her body is breaking down, unable to heal. The cancer specialist nurse has been discussing the reality of Emily’s prognosis with her. She seems receptive to this – very aware that her body is failing her and too tired to fight it. It is documented that she confirmed that she understood that nothing more that could be done to treat her cancer, that priorities now are keeping her comfortable and meeting her wishes of being able to spend time at home before going to her preferred place of death which is the hospice.

    [11/09/2019]

    Emily seemed brighter this morning – the blood transfusion overnight must’ve helped. After being practically bed bound, she was up and walking when we arrived on shift. Making the most of this, I offered her a shower. I made sure to take my time, knowing that there is no guarantee she will be able to get back in there again. I massage my fingers into her scalp, building up a lather of shampoo as hot water rains down. I comb coconut conditioner through her hair and, once she’s dry, cover her in body butter. She talks to me throughout it, telling me about her family and the pets she had growing up. Having exerted herself from this, she stays in bed for most of the rest of the day, getting increasingly uncomfortable as the evening drew on.

    This is hard to deal with. Whilst acute pain is horrible, and its management complicated, employing medication for its relief is well established and staff are usually in agreement about appropriate usage. The chemical management of discomfort, restlessness, and agitation on the other hand, is less readily employed as its sedating effects make it seem an extreme measure. Emily has made it clear that she would rather be alert and uncomfortable than so doped up that she cannot be awake and experiencing the world for the remaining time she has in it. We are doing all we can to keep her comfortable – endlessly adjusting pillows, limbs, bedding, heat pads, the electric bed, and taking blankets off and on. But nothing seems to bring any relief for more than a very short amount of time.

    [13/09/2019]

    Emily asked for me today. She asked yesterday too, but it was my day off and she said she would wait until I am back to have another shower. The team accommodates, working out patient allocation to ensure I have adequate time with her. Its only two days since we last did this, but this time she struggles every step of the way.  I must help her with everything – sitting up, moving to the edge of the bed, putting on her slippers, standing up – and she is exhausted by the time we get to the bathroom. I carry on but am inwardly worried we won’t be able to make it back without using a hoist. She doesn’t talk much this time. Just sits slumped in a plastic chair, her eyes closed, as hot water runs over her hair and puffy, swollen body. I gently pass the soapy flannel across her skin which, along with the whites of her eyes, is now an almost illuminous yellow and stretched so tight that I’m scared it will split if I’m too rough. Her long, thick, dark red hair, still so soft, seems to be the only part of her left unchanged from this disease.

    The complexity of her care needs means that her original wish of spending time at home is no longer feasible and we are now organising her discharge to hospice. I am sorry that going home isn’t possible but glad that she is leaving the hospital for somewhere more suited to what she needs, where she can have her own room and her parents can stay. “They can even bring the dog”, she tells me smiling.

    [14/09/2019]

    Emily left us today. A hospice bed became available overnight and she was taken there by ambulance this afternoon. Wrapped in blankets and strapped into a trolley, I walk with her as she is wheeled across the hospital forecourt. For the last 5 weeks that she has been with us, she has not been outside, has not been able to open a window, has not felt fresh air on her face. Its grey and drizzly, but she turns her face up into the rain, shrugging her arms free and holding them up to the sky, smiling and blinking in the light.

  • Bowels Open – Type 7.

    “Ready, steady, stand”

    With the flat of my hand resting at the base of her spine, I gently push to encourage Corrine as she moves from sitting at the edge of her bed into a standing position. Holding on to her zimmer frame with arthritic hands, she begins the slow shuffle towards the ensuite bathroom of her private room. Corrine was moved to this room so that she could be isolated from other patients after testing positive for clostridium difficile or “c-diff”. Most commonly occurring is those taking broad-spectrum antibiotics, it is easily spread to others and can be life threatening, with profusive watery diarrhoea leading to dehydration, colon damage and even sepsis. Despite my best efforts to respond to her call bell, don the required PPE and assist her out of bed as fast as possible, I wasn’t quite quick enough. As we cross the room odorous brown-green liquid begins running down the inside of Corinnes legs, over her surgical stockings, and dripping across the floor. I look back at the bed she just got out of and see the trail leading from us to a small stain where she was just sitting.

    Neither of us mention it. When we get into the bathroom, I silently pull her nappy down before helping her lower herself onto the toilet. I say I’ll give her a few minutes and leave to strip the bed and wipe up the mess. Despite her frailty, Corrine is fiercely independent. Recovering from a broken hip after a fall, she has worked doggedly with the physios to complete her rehab to get back home as soon as possible. This infection has really set her back. Not just delaying her discharge, but sapping the strength she has built up and the energy she needs to recover. This is the third time I’ve taken her to the bathroom since the start of my shift and her legs are now trembling with the effort of it. Although she has been managing her hygiene needs pretty much independently, when I return to the bathroom it’s to suggest I help her with a wash. Exhausted she agrees, and shyly asks if I can help her shower – no matter how much she wipes herself she just doesn’t feel clean.

    Performing the required hand hygiene protocols on exit and entrance, and re-donning PPE, I return with pants, a nightdress, socks, towels and disposable flannels. I help her strip off and sit her in a plastic chair in the open shower area of the bathroom. The water runs hot and makes the air in the room feel cold. I have to stand holding the hose over her body to stop her from shivering as she lathers her hair. She leans her head back and I rinse out the suds. Proximity means the bottoms of my trousers, shoes and socks are quickly soaked. She manages to most of it herself, but I have to help her flannel her back and feet causing soapy water to run down my arms and fill the inside of my plastic gloves. Shakily she stands, holding on to a handrail, so that she can wash her bottom and between her legs. The effort of standing causes her bowels to open and the rising steam fills the room with the distinctive smell of clostridium difficile. The pooling water begins to discolour and I take a step back to avoid the spreading faecal matter from absorbing into my already soaked shoes.

    Its a small while before Corrine leaves the bathroom. Once dry, dressed and wrapped in a blanket, she sits waiting for me to make her bed. Looking small and grey, her eyes are closed before I finished pulling the blanket and sheets over her. By the time I leave, carrying bags of laundry and pulling the door closed behind me, it’s been almost an hour since I first answered Corrine’s call bell. And despite the time, energy and coordinated effort it took from both of us, anyone looking in would barely be able to notice anything had changed in that time, seeing only a tired and sick, but clean and comfortable looking woman lying in a freshly made bed in a silent room. Nappies and socks have been binned, faeces wiped, washed, and flushed away, and all soiled textiles anonymously bagged and shipped to an industrial launderers. In the end, the only visible trace of our activities will be found on her electronic health record, under her “Fluid Input and Output” chart, where I have selected a box marked “Bowels Open – Type 7”.