Nursing in the 70s Part 7 - Bloody Motorists

It became obvious when we started our clinical placements that we were a key part of the nursing workforce. We were counted in the numbers staffing wards, departments and clinics. Our contribution was crucial and any fluctuation in students numbers had a direct impact on front line staffing levels. We were required to work both days and nights and the more senior students were often left in charge of wards during off peak periods. Trained nurse support was usually pretty thin on the ground at times and it's easy with hindsight to dismiss this as exploitation, as running the service on the 'cheap' but no one could deny that learning took place here, sometimes in the mayhem of a short staffed medical ward or in the orderly organised surgical ward.

I remember one particular night. It was my first night duty placement and I was working on on Cuckmere ward at St Marys. It was a typical post op night with several patients recovering from surgery carried out earlier in the day. Post op care was rather less sophisticated in those days. General anesthesia was equivalent to hitting someone with a ten pound sledgehammer as apposed to today's light tap on the head. With no Recovery room in those days, if patients were able to demonstrate the 'gag' reflex (meaning they were awake enough to be able to cough) they were swiftly transported back to the ward with porter and and nurse escort.with a plastic airway in place as well as the usual assortment of drainage tubes and dressings. Any patient who was vaguely conscious during this journey would assume that the crossing of a busy road between theatres and the surgical wards was just another hallucination brought about by the anesthesia. The reality was that a road really did exist between theatres and the surgical wards at St Marys and I even remember a car sounding its horn when I was escorting a patient back from a prostatectomy. Bloody motorists.

Post op night was always going to be a fun time especially when you were on your own. It was mostly about making sure the patients were not bleeding to death and pain free. I learnt a lot from that placement. Worryingly though, especially after that memorable first one, it seemed that every time my Staff Nurse colleague stepped out of the ward door for a break, I was confronted by what today would be described as a 'challenge'. A patients blood transfusion line would come apart, someone would suddenly shout out in the midst of a nightmare, the old chap at the end of ward would think the man in the next bed was his wife and try and get into bed with him. Were the patients doing it on purpose I wondered?

Another time (and this is not for the faint hearted - so skip this bit if you are) I was checking on latest bunch of post op patients when one told me he felt sick. Now as most nurses know we deal with every type of bodily fluid (well nearly every type) at some time in our careers and vomit is one of the most common. I reassured him and held a vomit bowl at the ready. It was now dark in the ward apart from the light from my torch. He began to retch and the fluid shot into the bowl. Even with my inexperienced eyes I could see that it wasn't your usual vomit, it was blood and there was almost a full bowl of it by the time he had finished. The patient settled back down and I rang the canteen to ask the Staff Nurse to come back to the ward pronto.

She came back still eating her sandwich and calmly assessed the situation. "What colour is it?" she asked "Err its red" I muttered. "Of course its red you clot, it's blood but you need to look at the hue, its dark red, its partially digested, you can smell it on the patients breath. Its quite normal after a partial gastrectomy you always get some minor bleeding inside the stomach within the first few hours. We'll check his blood pressure and pulse half hourly and keep a close eye on his fluid balance." And that was that.

Its easy to criticise this type of training for all sorts of reasons, the lack of structured learning, the placing of students in a vulnerable position but there is no doubt that I learnt so much often simply by watching someone who could teach you by example, without fuss and not make you feel like an idiot. I met many such people during this period.

Part 8