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A patient was telling me yesterday how he'd managed to get a phone number that repeated the same three digits twice. He was quite pleased about this because it was easy to remember. Now, whenever he has to give someone his number verbally the conversation goes like this:

Him: Eight three zero eight three zero
Them: Okay, 8-3-0....and then what?
Him: Eight three zero.
Them: Yea, I got that part. What's the second half? 
Him: eight three zero
Them: What?

"I wish I hadn't bothered now" he told me. 

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Filipino healthcare workers and supporters protesting against derogatory xenophobic articles published by the Daily mail. Outside the Daily Mail's HQ, Northcliffe House, London.

I joined Filipino healthcare workers yesterday protesting outside the London HQ of the Daily Mail, after that newspaper published a derogatory, xenophobic article about Filipino nurse recruitment to the UK.
Read more... )
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My colleague tells me she once worked with a nurse who suffered a fear of buttons. I'm not making this up. I didn't ask how she managed to help patients put their shirts on. She couldn't even stand to hear the word 'button'. Once, someone at work jokingly started to sing the theme song to button moon (above) and she ran from the room screaming. This fear is apparently called koumpounophobia. It seems that sufferers are particularly nauseated by buttons hanging by a thread. I wonder if there is an evolutionary cause for this kind of bizarre phobia. Are they the unwilling puppets of some atavistic subconscious mechanism which misidentifies buttons as repellant parasitic insects? 
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Sanity

26/1/11 06:37
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The opening lines in a card sent by a patient who was with us recently......

"If someone had told me two weeks ago that I would spend over a week in the intensive care unit, and then be a little sorry to leave, I would have questioned their sanity. But this is the case."
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Photobucket

Some photos from my mother's collection of the Vietnamese refuge camp where she worked as a nurse, operating a clinic/hostel with a rather broad baby, women's shelter, psychiatric and geriatric remit. She took me to work with her a couple of times.
More photos here...... )
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Some doctors at work recommended that I Google this clip :)
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During a break at work I started flicking through this old dog-eared dermatology guide, which was written by a certain J.L. Burton at Bristol University back in the 80s. I found it so hilarious that I spent the rest of the shift reading sections of it aloud for the amusement of our bored patients stuck on ventilators.

Here is a taste of it:

On hand, foot and mouth disease…….

“It is important to realise that this disease is not related to foot and mouth disease in cattle, and it is therefore not necessary to shoot patients and bury them in a pit of quick-lime”

Read more gems here..... )
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Photobucket


Last night a 95-year-old patient told me that he remembered being a small child in the first world war, and rushing with his parents to the window to watch searchlight beams over London trying to pick out a German zeppelin.
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I looked around at myself and my colleagues at work today. There we all were in our identical uniforms around our central 'nursing station' with its computer screens displaying real-time patient data. There was one burly Scottish nurse. There was one black African. There were several pretty young women. There was one bloke, a bit of an odd-ball, who finds paternal and romantic love alien concepts.

I work in an episode of Star Trek.
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I had this conversation with a colleague at 5am the other morning, as we were wrapping up a dead body together.........

Her: Do you believe in creation?
Me: No, I do not.
Her: What do you believe in then?
Me: In something far bigger than gods, in Nature.
Her: But who created nature?
Me: Nobody did.
Her: What about her [the dead patient]? Will she be come back as a tree or something?
Me: Her atoms will almost certainly end up in a plant at some point, yes.
Her: But what about her soul?
Me: Souls do not exist.
Her: They do!
Me: No. They are a religious fantasy.
Her: But what about ghosts?
Me: So are they.
Her: No, no, they are real!
Me: How can all these ghosts, elves, goblins, voodoo spirits and Buddhas be real?
Her: Ach! That Buddha is the worst of them. That terrible fat man......
Me: No more absurd than your religion.
Her: Haha.
Me: Anyway, thanks. It's been nice working with you.
Her: And with you too.


I do find myself liking fundamentalists more and more. They're the only people who dare to raise this sort of subject at work. It makes life so much more interesting.

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Spent another long night shift working with my entertaining maniac Mauritian colleague who enjoys addressing me as 'darling' all the time. Occasionally he would laugh nervously and wonder aloud "what if people could hear me calling you darling? They would think I am a gay or something!" He continuously and severely criticises my sloppy workmanship while trying to keep a straight face. "You gotta learn how to iron your patients, darling" he insists. 'Ironing' is surprisingly effective at making unconscious patients look comfortable and neat, and involves pulling sheets tight underneath them and folding away any loose cloth, a bit like wrapping a parcel. I'm getting better at it now. Still, I had the last laugh, because he got stuck looking after the 135kg patient, hoho.

Waking up this afternoon I noticed that an old Hong Kong classmate of mine was on-line. She moved to Mauritius some years ago when her husband's bank relocated him there. I started quizzing her about life on the island. I work with dozens of Mauritians but they rarely discuss life 'back home'. It doesn't seem to interest them much. "Well, my husband loves it here" she told me "because he can play golf every day, but I do so much pine to be anywhere in ASIA again". It's a small-town sort of place, she explained. Like being trapped on holiday in Bali all the time. "Nice beaches, but just how many T-shirts can you buy before you get bored with them?" Poverty and petty thieving are rife. The grass is always greener, I suppose.

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I was somewhat bemused to discover than many of my colleagues believe the changing room in the Intensive Care Unit to be haunted by an aggressive ghost. This turned to scorn when I heard that they'd even persuaded the hospital chaplain to try and exorcise it. I felt that the chaplain should be looking after our patients, not catering to the superstitious hysteria of perfectly healthy employees. However, given the the formidable intelligence of that man and his strong service ethos I imagine that he saw it as his duty to do whatever was necessary to help keep the peace, literally as well as supernaturally, no matter how bizarre.

Now, even if you do believe in ghosts, why on earth would there be one in a small changing room, in a building built in 1993? Nobody has ever died in that room. I guarantee that.

I don't believe in the supernatural, particularly not the religious variety. I would say on principle that I don't believe in ghosts. The problem is I'm English. Yes, I was brought up on a diet of ghost stories and, despite tiny church attendance figures, we English do love to believe in ghosts. So, I am soaked in it. Ghost stories genuinely scare me, though I try to deny it.

I wanted to gather witness evidence. What had this ghost been doing? There's a folding bed in the changing room which we used to sleep on during our breaks on the night shifts. Nobody will sleep on it now. Two of the nurses I was working with last night had had 'experiences' while sleeping on that bed. One said it took the form of  'something' touching his face. Now, I found this fairly lame. Hardly a grey apparition dragging chains (or IV lines). But my other colleague, a sensible woman, had a more dramatic story. She said she had been woken up by something slapping her around the head quite hard. I was incredulous. "How hard?" I asked. And so she slapped me around the head, to the amusement of everybody present. My ear was still glowing ten minutes later. She said she was sorry. "Was it really that hard?" I asked.

"Yes, it was" she confirmed.

So now I'm scared of the changing room too. Damn it.
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Today at work I confessed to my colleague that I'd spent at least two days gloating over and scanning a collection of 19th century photographs I'd found in a junk shop. She thought this was hilarious and mocked me as a sad obsessive. I felt aggrieved and defended my hobby as humane and erudite. This entire conversation took place over a bed-ridden patient. So, decided to resolve our argument by asking him to act as judge. He was on a ventilator and unable to speak, but signalled his loyalty by grimacing comically at my colleague and then shaking me warmly by the hand.
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I was intrigued by the little story they always tell student nurses about the resuscitation training dummies we use. They are popularly known as 'Anne' or Annie'. The face on these mannequins is more or less the same on every model, regardless of manufacturer or gender; that of a serene, young, northern European woman with well defined cheekbones. The legend goes that the face is based on that of the drowned daughter of the doctor who invented these devices.

Apparently not, though. It actually has a much longer history than the resus dummy. It is the face of 'l'inconnue', a girl who was allegedly found floating drowned in the Seine in Paris in the 1880s. Unable to identify her, the police put her on display for a while and her sad beauty caught the public imagination. A deathmask was made from her (see above), copies of which then became a popular inspiration and talking point for several writers and artists of the day. Nabokov wrote a poem about her. Wikipedia pours cold water on this version of events, however, citing sources which claim that this deathmask was most likely taken from a living model in Germany, as a faked-up money spinner, and not the dead 'inconnue' at. It makes a nice tale though.
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I applaud this article written by a Financial Times journalist. She examines the concept of job satisfaction and concludes, as I have, that there is simply none to be had by looking for it in the job itself.

I was amused to see that she mentions nursing several times and also psychologist Abraham Maslow's heirarchy of needs , a model much quoted at us during nurse training. I remember working with an exasperated Indian nurse who had been lumped with 12 patients and was running around like his hair was on fire. At one point he suddenly stopped and shouted at me across the ward "Where is Maslow? Where is he?!" Haha.

Interestingly, if you look at Maslow's pyramid of needs, "acceptance of facts" is in the top section. This is something you have to do if you want to be a happy healthy person. The fact is that employment is an inherently antagonistic power relationship, even in its most benign manifestations. There's nothing wrong with this. It can even be fun if you play it right. However, to seek personal meaning within this framework of exploitation-by-consent is a fool's game.

But it's not all doom and gloom. Job satisfaction does exist, obliquely. My job gets me out of the house and allows me to walk around and talk to people and cheer them up. In some of the clerical jobs I used to do this was called 'shirking'. Now I get paid to do it. I'm secure too. The satisfaction of not being unemployed, of even having to worry about being unemployed, is deep indeed. Then there's my commute. A ten minute walk. Satisfyingly short. Of course none of these things are the job itself, which consists primarily of doling out drugs and creating mind-numbingly boring paperwork, but that doesn't matter.
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I’ve been caring for dementia sufferers for some years now and have come to recognise something curious about the delusional symptoms of this pernicious disease.

Firstly, that the damaged brain possesses an extraordinary creative power to create entirely imaginary scenery and scenarios for the patients to inhabit. I’m sure that neurologists have studied this in more detail than me, but I suppose that these detailed delusions occur as a sort of automatic sense-making mechanism when the brain loses its ability to grasp the present and is forced to dredge the memory banks instead.

Secondly, that these detailed delusions are surprisingly unoriginal. Time and time again the same ones crop up. I’ve made a list of them………

  • At Home. The patient believes they are at home, either their present home or a past one. They can clearly see their house and all their furniture. The nurses and the other patients are either invisible or intruders. Their spouses or other relatives (sometimes dead ones) are just out of sight in another room, but can’t hear them calling.
  • The Holiday Camp. The patient believes they are guests in some sort of recreational camp. It is quite a regimented affair with timetabled activities, sports and music. They are unsure whether they’re supposed to make their own beds or not. They are pleased that the food is included in the price. They wait patiently to be told what to do next.
  • The Prison Camp. The patient believes they have been interned for a crime they didn't commit. The other patients are criminals or fellow-victims and the nurses are guards.
  • The Railway Station. The patient believes they are waiting at a railway station. They are trying to get somewhere but are unsure when the train is coming. They ask for timetable information. Sometimes they believe that they are already on the train and that the scenery beyond the window is moving slowly by them.
  • The Airport. A less common variant on the above. Seen in younger patients.
  • The Cruise Ship. The patient believes they are on a cruise ship. The beds are deck loungers and the nurses are stewards. They are having a nice time. They look forward to the next stopover. They worry that they may have accidentally left a book or item of clothing behind in the last port.

What’s at the root of these? The first one is perhaps easy to explain. Memories of home and family are the most deeply imprinted. The others must be partially based on experience too. Nearly everybody in Britain has travelled on a train and many of our patients would have commuted on them daily. I have a patient at the moment who alternates between the railway and airport delusions. His family tell me he spent a lot of time travelling by both modes. Other patients may have spent time on cruise ships or at holiday camps. Some might have been POWs in the war. But that isn’t always the case. My own grandfather spent years living the ‘holiday camp’ delusion though, to the best of our knowledge, he never attended any such establishment.

The mechanisms at work here are more subtle and, in some ways, impressive and beautiful. The one thing all the patients have in common is that they are placed in the same situation; an anonymous hospital ward with lines of beds, strange faces and people in uniform. Their brains are unable to process the visual information presented as ‘a hospital’, even if they are told that that’s where they are. So, they do one of two things, either they blank it entirely and mentally repaint their surroundings with the intimately familiar, or they confabulate based on present information. The process draws on certain elements of the hospital ward: its anonymity, regimentation, uniforms, an apparent leisure or lack of anything to do, and the fact that they are looked after, albeit by busy strangers; it then combines these with an understanding of transient, regimented places of leisure or clock-watching, gained either from experience or second hand. And so we see, repeatedly, delusions of organised, transient public places of enforced or enjoyed leisure; large ships, transport nodes or temporary camps.

So, I wonder how today’s youth will cope with dementia. Finding themselves on hospital wards in 40 or 50 years time how will their brains compensate? I think railway stations and airports will still feature. Maybe there will be new ones, based on common contemporary experiences. Shopping malls or Spanish hotels perhaps. We’ll see. 
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Children have been running around impersonating emergency vehicle sirens probably for as long as emergency vehicle sirens have existed.

The ward where I work overlooks the playground of the hospital crèche. Sure enough, I hear the children there running around impersonating the 'woooooeeeeeooooooeeeeee!' of ambulance sirens. However, I can't help noticing that they do it with an uncanny accuracy which is surely not characteristic of 'normal' children.  

I suppose Mum taking me to work with her in a refugee camp clinic wasn't a 'normal' childhood either. Haha.
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Sirens

21/2/08 18:02
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At work on the hospital ward for the last few mornings I've been baffled by the faint sound of a strange siren. It isn't an emergency alarm or an ambulance, or a fire alarm. It sounds as if it's in another ward. I just couldn't work out what it was.

Then today I realised. It was coming from the patients' bedside televisions. It is the theme tune to 'Ironsides'.
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My mother is a nurse too and such a sensible, calm sort. Not emotionally incontinent like me (although, I might add, that I've got a steel rod up my arse compared to my labile in-laws).

However, I've just discovered that even Mum once made a drugs error. Quite a painful one as it turned out. She gave an oral drug as an intramuscular injection and her patient one hell of a boil on the bottom. Hohoho! God, I'd get a bit roasted for that, even protected by the 'no blame' policies of my employer.

In her defence, Mum points out that she was inexperienced, all the drug bottles were in French and she was working in a very makeshift clinic on the edge of the Sahara desert in 1960s Algeria. Okay, Mum, I'll let you off.
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