Nursing in the 70s Part 8 - Merry Christmas

During my three years nurse training I worked every Christmas day. Twice on days and once on nights. If anything could remind you that patient care was a twenty four hour, three hundred and sixty five day service it was Christmas.

Surgeons had the right idea. As most of their patients were booked, beds could be closed over the Christmas period. This left only the very poorly and those unlucky to have a burst appendix in the middle of the festivities.

On Cuckmere it meant only about six patients out of twenty five. The ward was decked out in Christmas decorations and a very fine tree was placed in the main ward area just in front of the toilets. On Christmas day the more poorly of our patients were made as comfortable and presentable as possible.

As well as the patent's families a host of local VIPs would descend upon us including the Mayor and his wife. Even more important was the local photographer. Pictures would be taken of the Mayor shaking hands with everyone, grateful patients, admiring nurses and anyone else with a hand.

Disaster did strike once during one one of these visits when the Mayor spotted one of our more elderly patients at the far end of the ward. Smiling he marched with wife towards old Jack

"No Mayor, please don't" Sister spluttered. It was too late. The Mayors outstretched hand was already reaching out to smiling Jack.

"Merry Christmas, old chap, I hope they are looking after you here."

Both of Jack's hands were under the sheets which had been hurriedly changed before the visit. The photographer stood by as Jack reached out from under the sheet and met the Mayors hand with his own but with the surprising addition of a large amount of faeces

"Merry Christmas to you too, sir, bless you" whispered Jack.

The commotion that followed was predicable and involved profuse apologies hot soapy water and smelling salts for the Mayoress. It was a long time before the Mayor would darken Cuckmere Ward again.

As for Christmas lunch this was served on the ward with the patients and staff together nurses, doctors, domestic staff and anyone else who was working that day. One of the Consultant surgeons would carve the turkey and like any other Christmas occasion gifts would be exchanged. It sounds like another world now and yet this was not that long ago. Occasions like this brought us closer as a team and I wonder if that is still the case now. Ah the mystery of Christmas.
Part 9

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

Nursing in the 70s Part 6 - Enter the Grim Reaper

The very first patient I ever touched died. Not a brilliant start to my nursing career you might think. The circumstances around this were simple. I had been asked to take an elderly patient to the toilet. He was a few days post - op following a relatively minor procedure. It was my first clinical allocation, working one evening on a surgical ward.

It was a quiet evening and the Staff Nurse in charge suggested that I escort the patient to the toilet. We walked together down the ward arm in arm, me feeling useful, he desperate to use a proper toilet at last after all those commodes. When we arrived at the cubicle I made sure he was sitting comfortably and waited a discrete distance outside with the door slightly ajar. I remember clearly how quiet it was, no tell tale sounds from the cubicle and more worryingly no response to my repeated 'Are you OK?' I gave him a few more seconds and then gently pushed the door open. He was slumped against the cistern and I assumed he had fallen asleep. It became increasingly obvious that he was not asleep. I called to the Staff Nurse and managed to lift him onto the floor 'Get the bloody oxygen!' someone yelled. I hadn't a clue where that was but luckily someone else did. More people arrived and I was told to screen the beds in the main ward. It was my first resuscitation and unfortunately my first death.

Nothing prepares you for something like that I was 20 years old and had never seen death up close before and all through a career which lasted over 25 years I never 'got used to it' as some observers might say - all you do is learn to adjust to dealing with it.

Nurses always pick up the pieces after everyone has gone and I was asked to help with the 'last offices' for the patient. 'You don't have to now, but you will have to some time' said the Staff Nurse.

I agreed with her and assisted.

People die in hospital. Sometimes slowly, sometimes quickly - in a twinkling of an eye they're gone and as I went through my nursing career I saw this many times. I can't actually remember if we had been given tutorials covering bereavement during PTS, it was an area that was and to some extent still is taboo. Dealing with death as a nurse was something you learnt, like many things in life 'as you go along'. The experienced nurses I worked with had all cared for dying patients.. All had performed 'last offices' for the patient and all had comforted relatives. But these were all practical things, things that nurses are good at and besides how and what could you teach to someone sitting with a dying patient or comforting a distraught relative?

The very essence of caring is often just about being there, someone to listen, someone 's hand to hold, just that.

Part 7

Nursing in the 70s Part 5 - PTS & Uniforms

September seemed to arrive quickly and I remember sitting in a chilly portacabin classroom at Princess Alice Hospital with my colleagues to be. 25 fresh faces - some fresher than others.

We were all dressed in our uniforms despite the fact we would not lay hands on a patient for at least another 6 weeks. The thinking behind this was that we needed to get used to wearing them. The girls wore hats, blue dresses & white aprons. The boys (there were 3 of us) the infamous 'dental coat' & trousers.
Male nurses always were difficult to dress. If you gave them a white coat they could hide their nurse name badge, put a stethoscope around their necks & pretend to be doctors. This was useful when trying to impress the ladies. The answer to this problem was the 'dentist' uniform. This consisted of a short white 'top' with an array of buttons or studs which ran up the side from the waist to just below the L ear lobe. The coat had a breast pocket which also displayed your rank in the form of a sewn flash. (White 1st year Red 2nd Year Blue 3rd Year etc). It also had a sort of kangaroo pouch at the front to complete the display. How could this be made more ridiculous? Add some white see through trousers of course.

These were usually either too small or too large but by the time they had been washed a few times ones 'nether' regions were available to view by all.

Welcome to the world of PTS (Preliminary Training School). Our tutor was Miss Maltby - an ex army nurse who had that world weary look of someone could not be surprised by anything, perfect for dealing with a bunch like us. We were a real mixture of ages and experiences. The heart of the group I guess were the four Irish girls who would provide so much energy, fun and headaches throughout the coming weeks.

PTS was effectively an 8 week study block which tried to cram just about everything we needed to know to at least sound like nurses at the end of it.

The 8 weeks were full and demanding with classroom tutorials of basic anatomy & physiology, disease management and treatments, plus mind boggling program of visits to departments and visits by clinical experts in countless areas of care. The final two weeks would include placements to the wards where we would start our clinical experience with real patients.

For me personally this would be a significant moment for many reasons.

Part 6

Nursing in the 70s Part 4 - You'll need to cut that hair

I had a total of 12 weeks off work. Plenty of time to think about how my life was panning out. I had no real career aspirations at that time despite reasonable grades at school. The family had moved to Eastbourne from London 3 years earlier and I hadn't really settled on a career. Nursing had now become a real option. I had chatted to the student nurses on Alfriston Ward and had observed how interesting and rewarding their work appeared to be. I knew that it was time for a hard to look at my life and what I wanted from it and after much soul searching decided to apply for nurse training.

During the 1970s nurse training was provided by local hospitals and organised nationally through the General Nursing Council. There were a number of different training courses available depending on the hospital location and specialities available. Two levels of nursing training existed that time SEN (State Enrolled Nurse ) and SRN (State Registered Nurse). The SEN training was a 2 year course intended to focus on the practical side of patient care, whilst the SRN training 3 year course was regarded as a more academic route. I guess what none of us realised though, was the extent to which the NHS relied on nursing students to provide its nursing service.

Within a matter of weeks I was sitting in a gloomy room at Princess Alice Hospital with a group of similarly nervous folk waiting to be interviewed. We were a very mixed group mainly female all about the same age, many Irish some West Indian and a couple of blokes. Some sat quietly not speaking, others particularly the Irish girls were all talking at the same time. Little did I know this would be one of my soundtracks for next 3 years.

My interview went surprisingly well. The Head of Nurse Education & Senior Tutor seemed to be reasonably impressed with my application, maybe they used Southdown buses a lot. I was then sent to another even gloomier room and asked to sit a general entrance test. Once this was done I rejoined the Irish lot for a good old listen as I couldn't get a word in anyway.

After coffee we were called back in one by one for a final interview. When my turn came I was told that the school of nursing were pleased to offer me a place in their September 1972 intake. I was both suprised and flattered. My conductor skills had obviously won them over. I joined the other candidates outside and it seemed that we had all been offerred places

We would become very much part of the nursing workforce and exposed to all that which came with it. The joys, the sadness the relentless tiredness and the gradual realisation that demand for care often exceeds the capacity to provide it.

There was one thing though. "You will of course, need to cut that hair, Mr Harden"

Part 5

Nursing in the 70s Part 3 - A Shave Sir?

'Have you had a shave yet?' asked the cheerful chap hovering over my bed. 'Yesh thanks I think I had one yish morning' I slurred. still feeling stoned out of my head after yet another injection.

'I'm sure it wasnt nipple to knee though was it, sir? smiled my barber friend. This completed the truly surreal situation my brain was trying to make sense of. I was dressed in what seemed to be a white shroud, with some kind of hat and white thigh length stockings. People had drifted in and out of my awareness but I had no sense of time 'That's the pre-med, don't worry' someone told me. I wasnt worried, I was too spaced out to care. From here on in I really don't remember a thing. I woke up in the ward the next morning with a large dressing on the lower part of my right abdomen. Not only was I an appendix short I also had no pubic hair. It hadn't all been a dream then.

In those days post op patients tended to be in hospital a lot longer than today. Post op appendicectomy patients were usually kept in about 7 days. Alfriston ward was a general surgical ward with about 20 beds. One of the 2 consultants specialised in genito -urinary surgery so many of the patients sported urinary drainage bags which they carried around like handbags. I'd vaguely heard of the prostate gland but never realised how much trouble it could cause if it swelled up. I'd never seen so many men interested in each other's urine. Groups would sit in the day room and discuss the colour, volume and yesterdays output. I assumed there was so much time to kill it got you like that.

The ward was staffed by a mixture of trained and untrained nurses with nursing auxillaries providing much of the backbone. I suspect my 'barber' friend was one of the latter.

These were the days of caps aprons and cloaks. It was easy to tell who was who. Sisters wore blue dresses, staff nurses wore a pink check and enrolled nurses wore green. They all wore aprons which could be changed each day. Students wore white with coloured belts to denote the year. Male students wore a dentist style uniform. (more about this horror later). I hadn't really thought much about male nurses up until that time. I'd heard some of the old jokes but nursing appeared to be a good career option wether you were male or female.

I got on pretty well with the student nurses who were working on Alfriston at that time. Maybe it was because I was probably the youngest patient on the ward or that I didn't have a urine bag to check. After a few days I was allowed to walk about and even help with the evening drinks. This honour was only bequeathed to those patients who were fit enough to push the drinks trolly and have a steady hand. 'Tea, coffee, Horlicks, Bovril?' Some patients couldn't use a regular cup and needed one with a spout. Others needed help with drinking and it struck me how illness effects even the very the basic things in life. Even the simple pleasure of drinking a nice cup of tea. Mostly though it was witnessing for the first time how courageous people can be when facing overwhelming odds. This was something I would see many times over the next 30 years.

As soon as I had mastered the drinks round I was deemed cured and ready to be discharged.

Part 4

Nursing in the 70s Part 2 - A Pain in the Guts

The pain in my stomach had got increasingly worse and by the time I got home it was almost unbearable. I was working as a bus conductor on Southdown buses as a summer job and had just finished a late shift. The company provided a mini bus to take the late shift home and I had just been dropped off at my parents house at Langney Point at about 1130pm. I have some vague memory of getting up to my room & my worried mother asking me what was wrong. She must have thought I'd been to the pub or eaten a dodgy curry or both.

The doctor was duly called and in amoungst the mutterings downstairs after he'd examined me I heard the words 'hospital', 'operation,' 'probably appendicitis'

These words would eventually form a significant part of my vocabulary in the years to come but at that time they just frightend the life out of me. I was 19 had never been in hospital before and didn't want to start now. Nevertheless I was carted off to St Marys hospital in the middle of the night and admitted to Alfriston Ward.

Part 3

Nursing in the 70s Part 1 - Introduction

I've been feeling a bit nostalgic recently. I was moved to recall some of my experiences in nursing particularly doing the period when I was a student nurse in Eastbourne during the 70's.

Nursing like everything else has changed with the times . Radical educational and organisational reforms within the NHS have resulted in many significant changes over the past 20 years. It would be easier and lazier to say that things were better then, that nurses cared more, that the NHS was better organised, that nurse education was more relevant. I'll try not to do that. All I offer in this account is some of my experiences of that time, the people I met, the situations I found myself in and some insights into the world as I remember it. It was generally an amazing experience and changed my life forever.

Part 2