Stuck In The Middle
I was never one for early mornings, and to this extent I simply don’t know how I have survived thirty years of nursing. Having stared into the face of the dawn of day through the prisms of morning and night shifts, I am familiar with the gravity from the beckoning of a bed to a sleep deprived nurse. In my youth I awoke on so many mornings after obscenely late nights regretting the rampant use of my social freedom, aware only of the grit under my eyelids and the fearful lack of energy required to sustain me through oncoming shifts. I have always detested the sound of alarm clocks screeching at me as though that dreadful waking noise has true authority over my behaviour. I hate the realisation that waking at ungodly hours as a nurse is not just a dream gone badly, but a reality to face. In my novice nursing days, I lay in my bed for several seconds after the alarm’s warning peeled, thinking of my non nursing counterparts who rose at 7.30am to prepare their days of work in offices, with painted faces, glued hair, fashionable clothes and plans to meet girlfriends or newly found lovers for lunch. Why was I nursing? I could never recall any convincing reasons in the pre 6a.m. hour before a morning shift.
This particular morning was autumn. I was far too young to appreciate the crispness of the air and the wonderful sensations that autumn no brings to my senses. The crisp air was a cruel reminder that my body was no longer hosting slumber and fantastic dreams of adventuring life on a wage greater than a first year student nurse. Trying to rouse myself into enough consciousness to feign a competence as a nursing professional, I attempted to cast aside the lingering dreamy memories of trekking the mountains in Nepal I had enjoyed that morning before the attack of the killer alarm. As I was automatically dawdling towards the Renal Unit where I was currently working, I summoned my mind to focus on the order of my mandatory 7a.m. activities. My uncomfortable uniform assisted this process. The belt was tight and the severity of the starch in my uniform, I realised, served a secret purpose. It transformed my relaxed and sleeping posture into an involuntary, alert and tortured carriage ready for action as a result of its unyielding rigidity. Bodies could not entertain anything that resembled recreation or leisure in this outfit!
“Ughhh, here I go again” my thoughts hissed as I entered the unit. The night staff were mulling around the office, in preparation for handing over the medical and surgical responsibilities of the patients to the nurses on the day shift. I was usually one of the last to get to my wards, and generally arrived there with little or no time to spare. To assist my own completion of the shift from unconsciousness to consciousness I greeted whichever patients sighted me as I entered their domains of recuperation on my way to the nursing station where morning handover took place. This particular morning did not provide me with any such prospect and my consciousness was abruptly confronted and assaulted by the situation I walked into. One young woman was sitting up in bed looking stunned and I witnessed her in a similar struggle with the new day as I had experienced only 30 minutes before. Her name was Marilyn and she was about 18 or 19, just a little older than me. She had just had major surgery but this had resulted in a scandalous debacle.
Marilyn had recently gone to her General Practitioner for a repeat prescription of the oral contraceptive pill. Apparently, he requested to examine her physically before prescribing this medication for her, and on palpating her abdomen, he detected an irregular mass. She was duly referred to a surgeon for further investigation. The surgeon recommended a laparotomy, which, in the 70s, was a major surgical procedure where a horizontal incision of up to twelve inches long was made along the outer abdominal wall. This opening provides a view into the abdominal and / or pelvic cavity. So off to hospital Marilyn went. The surgeon found a huge abnormal looking mass in her abdominal cavity so he removed it.
Marilyn returned to the female surgical unit and was slow to return to a full state of consciousness. She complained of pain, as was an expected part of the post operative condition. It was our job to listen for bowel sounds before commencing someone on any type of diet and to report when a person had passed urine. Marilyn had no appetite and did not pass urine post operatively. She had no urge to empty her bladder at all. Her blood pressure began increasing, as did her pulse, her face began to look bloated and she complained of nausea. Investigations into her post operative condition were undertaken; blood was collected and analysed. The results informed us Marilyn had gone into acute renal failure. Further investigation into Marilyn’s state revealed that the mass the surgeon removed was her one and only kidney, abnormal in appearance, but functioned effectively. Marilyn had no prior knowledge of her renal status prior to this hospitalization and the surgeon did not check the mass before removing it.
“Poor lady” I thought as I entered the ward. “Hi Marilyn, how are you this morning?” I asked sincerely as I walked towards the nursing station. I approached her and looked inquisitively at the dressing on her wound. I noticed it was stained with tide marks of old leakage and fresh blood. She sat up to respond to my greeting and as she did she coughed feebly. I looked closely at the pad, and this pink sausage like thing was peeking out at me from the side of the pad. I asked her to sit back and I placed my hand over the pad, trying to avoid the messy serous discharge that was becoming increasingly evident on the pad. I lifted the corner of the pad and thought for a split second she had some unusual looking raw sausages sitting beneath her dressing. What had really happened though, was I had come face to face with her small intestine. Her wound had broken down, and when she coughed it sort of unzipped itself and the contents of her abdomen thought they would have an excursion to the outside world.
“Sister!! Sister!! Hey, HEY, SISTER!! Bed 13, quickly, Nurse Long here, just on day duty, help needed now.” What was the bloody use of not panicking? No one ever responded to calm signals of distress, but you could move the entire medical and nursing entourage if you announced crises at a specific decibel range.