Thursday, 14 August 2008

On the ward

I've just checked - the library's open until 8pm tonight, so you get a blog post, even though I've just finished my three days on Fitzwilliam Ward and haven't eaten since 10 am. See how much I care. By the way, dear family, this means I won't be speaking to you on the phone today, I've had enough of hanging out of the window or sitting on the bench outside the residences just to get a mobile signal.

I can't say that I'm enjoying it yet, although I'm much less pathetic and miserable now. Obviously, my time outside work is particularly dull, but working on the ward isn't that interesting either. I think it's the frustration at the lack of control anyone has over what's going on. Three or four people are messing with each patient at any time: Health Care Assistants (or Nursing Auxiliaries) wash them, dress them and look after food and meal service; nurses do all the routine medical stuff like adjusting drips and oxygen and tube feeds, and handing out medication. Physios visit every day, Occupational Therapists, Social Workers, Dietitians and Speech and Language Therapists drop in now and again, and of course there are the doctors. Something can go wrong at any stage, from missing medications to food not turning up to someone falling over or weeing on the floor. All you can do is deal with it when it happens, there's no way to prevent any of it.

Everyone can be recognised by the colour of their uniforms, except the doctors, who don't wear uniforms apart from the mandatory stethoscope (not just in Carry On Doctor, then). Phlebotomist - white with light green trim. HCA - thin blue stripe with blue flashes. Student Dietitian - stupid white dress, and, let's see, is she wearing trousers with it? How ridiculous.

I'm not qualified in any way so I'm not allowed to touch the patients or have anything to do with their clinical care. Occupational Health very nearly prohibited me from the ward because of a sore patch on my hand - not for their safety, but for mine. I have remained very aware that two of the patients have MRSA and one has scabies.

I am allowed to talk to them, but actually only two or three are a) conscious, b) sentient and c) intelligible. And that includes the Yorkshire accent; I'm starting to say 'owt' when I mean 'anything', which sounds really silly from someone brought up in Essex. It's a Care of the Elderly ward, once known as Geriatric, which may explain the lack of sparkling conversation.

I'm also allowed to get involved in the meal service, so I've been serving meals and clearing up afterwards, and even helping to feed a couple of patients. One lady with dementia insisted on holding my hand at the same time, which made things very difficult indeed, but I only dropped one spoonful down her front.

Most of the time, though, I just latch on to someone who looks like they're doing something interesting. I've watched wound cleaning and dressing, a tracheotomy being cleaned out, the phlebotomist taking blood, a PEG feed being set up that goes straight from a bag into the stomach through a tube, and lots more. I have learned a very large number of abbreviations, of which my favourite is 'TTO', which means the medications and stuff that a patient takes away on discharge. It stands for 'To Take 'Ome'.

Today I sat in on a review between representatives from the health and social services sectors to decide whether a woman's care needs were health or social, which is what determines who pays. She's got Parkinson's and dementia, she has hardly any swallow reflex and isn't suitable for feeding through a tube. She can eat five teaspoons of double cream consistency at a time. I don't think anyone will be paying for her care for very long. Another lady was admitted to the ward at the start of August with a chest infection, but otherwise she was feeling OK. The tests showed that she has cancer of the lung, stomach and bowel, and the Macmillan nurse told me yesterday that she reckoned another 72 hours would be as much as she would expect. She arranged a transfer to a hospice and phoned the lady's son. That would have been a difficult phone call.

I asked the nurses whether all this frailty and imminent death starts to get them down. One said that she can manage perfectly well because it's a ward for the elderly and that's what happens when you're old. She has more difficulty coping when she's looking after young people.

It has been an interesting experience on the ward, but I'm glad it's over. One nice thing about it has been that it's a refreshing change to be encouraging people to eat as much high protein and high energy food as possible, rather than in real life when everyone's trying to eat less and lose weight.

I'm going home tomorrow for the weekend, and on Sunday night I'll be returning with the car, which will do a lot to reduce the isolation of having to live in this godforsaken backwater. Don't expect me to waste time on blogging! Although, actually, I do have a couple of posts that I've written and not published, so I might treat you to those if you're lucky.


aims said...

Wow! At least you find it interesting. I would be unable to cope.

Jay said...

It is interesting, and yet it must also be stressful. I'm assuming you're doing something medical at university? Nursing? Or a medical degree to become a doctor?

Lola said...

Jay: I'm studying to be a Dietitian - a four year Masters degree course leading to registration with the British Dietetic Association. This placement comes between the first and second years at university.

Jay said...

Ah - I'll be asking your advice when you're done, then! I can't work out how I'm supposed to get all the nutrients I'll supposed to eat, while keeping my calorie intake down below 1500. If I eat more, I balloon. If I eat less, I can't make the baseline five fruits/veg a day plus roughage, plus all the vits and minerals and omega thingies I'm supposed to need! LOL!