My first “real” patient
When I first qualified, I worked supernumery for a number of weeks until my PIN Number arrived from the NMC. By this time, I had moved to a ward which worked slightly differently to the ward I was used to, in order to get my preceptorship. This ward used the “named nurse” principal of nursing, where one nurse was reponsible for a maximum of three patients, as opposed to the “team nursing” principal.
After a few shifts on that ward I took over the care of Mary, an 80 year old woman with chronic lung desease and who was at the end of the desease process.
After receiving handover I went into her side-room and introduced myself to her and her family. It was obvious from handover that this lady was very unwell, and on meeting her the extent of how unwell she was really hit home. She had an intercostal drain, although this was neither draining nor showing evidence of an air leak, and weighed approximately 6 stone.
I made sure she was comfortable, and left her with a pulse oximeter attached, and went to speak to the physio’s who had been working with her in the morning. They informed me that her target oxygen levels were to be 90% or above, due to her lung desease. The next time I went to check on Mary, her saturations were plumetting. 84%. 75%. 65%. 54% by the time I had a chance to call for help. I rushed around to the other side of her bed, where a resevoir mask was waiting, and after calling her name and shaking her shoulder with one hand (grabbing the mask with the other!) her sats returned to 80% before I even had chance to put the mask on her. As I got the mask on, her sats were 92% - I have to admit I was tempted to go and find myself an oxygen mask as well at this point!
Over the next few shifts, I got to know Mary very well. She required assistance with all aspects of her Activities of Daily Living (ADL) but she was able to transfer from bed to chair with minimal assistance, and was full continent. She was, however, constantly tired and emotional. Her family had all made the effort to leave their homes and travel the hundreds of miles to be with her, which was a comfort to her. Her husband had died a decade ago, but she took great pride in telling me who he was, and who he had played professional football for just after the war.
In handover for my fourth shift with Mary, it was handed over that her chest drain had “come out” over night. Great. It hadn’t been re-inserted, and a chest x-ray showed her lung had collapsed. Her consultant came to see her within an hour of my shift starting. Mary was lucky in that her consultant was a lovely man, with an excellent manner with his patients, although like most he spoke in a very medical manner. A manner she didn’t fully understand. He discussed the pro’s and con’s of putting another chest drain in, and Mary decided she didn’t want another drain inserted, as she hadn’t particularly enjoyed the first two!
The consultant left and was satisfied that Mary understood what was going to happen without a chest drain. She didn’t. Yet.
This is where the nurse comes in. As a nurse we are told that we are the patient’s advocate, and that we are often the bridge between consultant and patient. It was down to me explain to her. I tried to do this in a way which meant Mary came to her own realisation of the consequences, rather than me saying it coldly. I said “You know you have bad lungs don’t you?” and she answered yes. “You know that you have trouble breathing with both your lungs don’t you?” again she answered yes. “And now you only have one lung inflated. It’s going to be harder to breathe isn’t it?” “Yes.” “Without a drain it’s never going to get easier to breathe is it?” “No.” “And you know what will happen if you can’t breathe don’t you?”
“I’ll die, I suppose.”
She continued to tell me how she had lived a full life. She had experienced everything she wanted to experience, and that all she could see from now on is pain - she felt the drain would only extend the pain.
A meeting was called with Mary’s daughters and her consultant, and it was agreed to move Mary to a hospice to die in comfort and dignity. I worked with the MacMillan nurses and we found a hospice for Mary to go to the next day, which was my day off.
At the end of my shift that day, Mary buzzed for assistance and I went in to see her. She handed me a card from her and her daughters which said :
Thank you for all the care you have given me, you have made my life so much easier.
Her daughters had added :
Thank you for all you have done for our mum. Your professionalism and caring nature have been wonderful and we don’t know what we would have done without you.
That card has seen me through some pretty tricky times as a nurse, which I’m sure I’ll discuss at some point on the blog. Just reading what Mary wrote reminds me why I chose this career.
As it transpired, Mary was still on the ward on my next shift, but she was transferred to her hospice in the afternoon, and she died two days later, peacefully, and with her family around her.
Mary taught me a great deal about why being a nurse is a privelege, and the experience of working with her will stay with me throughout my career, may she rest in peace.
