I recently had to spend 5 days in ICU after having had an operation to remove a burst appendix. The route into hospital and the people who dealt with me and did my surgery were amazing, but I just met one of each of those people. In ICU I met a lot of nurses, one per day and one per night, plus those that covered for them while they had breaks and that meant it was really interesting to me to see how these different people did their jobs. I’m going to focus on the ones who were actually assigned to me rather than the extras although a few of them might come up.
I arrived just as a shift was changing so technically I was admitted to a nurse who looked after me for about 30 minutes, and I was pretty out of it, so the first person I really remember was Ted who was on the night shift…
Ted (Monday Night)
Ted was really great, he got me settled and was very clear on everything that was going to happen and when it was going to happen. He also had a feature for night work that none of the others had, which was kind of awesome. He wore a kind of neck mounted pair of torches that essentially pointed down his chest. This meant that he did everything with the main lights off… which was really handy for getting a better night’s sleep. Now I was still on a lot of drugs, and Ted explained again to me how the morphine button worked… you can’t overdose as if you press the button, you get morphine, but it disables the button for 5 minutes. So, you can kind of press it as much as you like and that’s fine. Ted said, “press it as much as you need… but don’t go crazy, I’ve seen people go loopy on that stuff”.
I had pressed it twice when I was first out of surgery when I was really thirsty and couldn’t have water yet, but hadn’t pressed it since and didn’t really feel like I needed to. I’m sure the anaesthetic was still wearing off and I had another drip giving me paracetamol and another thing called a rectus sheath (which despite its name is attached at the front) and was giving me a regular dose of local anaesthetic. It turned out that I only pressed for morphine 4 times in total, those first two times, once the first time I got out of bed and once the first time I got back into bed. The Morphine lady who came round almost seemed to tell me off for not using it. I wasn’t trying to be brave or anything it just really didn’t seem necessary on top of everything else.
The longest gap in terms of attention you get, or at least I did, was between blood test readings which were every 4 hours (ish). So, I got into a routine of thinking my main sleep would start around 12:30am and then I’d be woken up again around 5am. I would usually have had a little sleep before, and a little sleep again after, but by 7:30 you were changing over to the next nurses, so people were talking around you, and about you. So, the big chance for sleep was really those 4 to 5 hours.
Before I went to sleep Ted said, the main thing he was looking forward to was hearing me fart. Which seemed a little odd. “Yes,” he confirmed, “in most situations you might be worried about farting or burping in public, not here. That’s exactly what we want to hear to know you are getting better.” I immediately told my family about this groundbreaking development. The next morning, Katherine woke up Nina in bed, Nina greeted her mother with a giant fart… and proudly announced, “Ted said it was ok”! Nice one Ted, you will be long remembered in this family as the person who gave permission for this activity.
Ted was back on nights for the next two nights, and he came and said “Hi”. Even though he wasn’t looking after me, he made a beeline and said, “I can’t believe you’re still here”, as he hoped I would have been better enough to be moved to a ward. It was really nice to see him again each time.
But on Tuesday morning Ted handed over to Esther…
Esther (Tuesday Day)
Esther was a really lovely and sweet young nurse who was, full of kindness and constantly wanted to check if I was comfortable and things were ok. She was also very attentive to make sure that I could reach my phone, iPad and headphones, which doesn’t seem like much, and in fact I particularly noticed it in retrospect as sometimes wheely table was left just a bit out of reach and that was low level kind of annoying. I mean, you might be built differently, but it felt particularly bad to draw attention to myself just to get my entertainment moved slightly closer. I mean I was on the ICU and some people around were really in a very bad way, so it didn’t really seem the highest of priorities, but Esther would always check as she was leaving… “right so are you going to watch something, or listen to your book, here’s your water, here’s your headphones.” Just a simple thing, but really appreciated.
Esther was still studying alongside doing the nursing job, she was studying more advanced level nursing and mentioned that actually this was quite common with a lot of the nurses around. They start and get experience but then they want to keep studying to get more experience. She admitted that she noticed that versus other nurses who always seemed to know exactly what to do, or what a reading meant she was still learning. Her studying was to try and help make that more automatic.
There were two patients on either side of me, one, the lady, was Esther’s responsibility, the other, the man, was not, but obviously when the nurse for, the man, went on break Esther was also responsible for them. The man was somebody everyone found difficult to deal with, he was clearly very ill and had a pipe down his throat which made communication near impossible, and he didn’t want that pipe down his throat so had bandage mittens on his hands to try and stop him removing the pipe. At times, his main nurse would be on break and Esther would go in and try and soothe him and discourage him from removing his pipe, “why are you doing that [name], you don’t want to do that [name]”. She would talk to him like he was a slightly naughty child but she didn’t tell him off she seemed to be trying to reason with him, “you need that pipe, where are you going now [name]?” She found it much more difficult to deal with him than many of the other nurses who seemed to be much more likely to tell him clearly what was what.
With the lady who was in her charge, Esther was very happy with her, but there was one moment when the lady found that she wasn’t going to be able to go home after all. She had been in the ICU for a long time and really wanted to go home. The news that she would have to stay in hospital after all, despite being told earlier in the day that she would be going home, had clearly crushed her. She really was beside herself, and Esther got the brunt of it as though it was all her fault that this had happened (it had been a doctor who had told her that the lady was going home today, and yet had asked for one more test which turned out to mean she had to stay) so clearly the doctor had been the fault here (although it was clearly a bit of an outlier situation, it was his words that had built up the expectation). Esther found it very difficult to calm and soothe her, by trying to jolly her along in terms of things not being so bad, and that this was the best place for the lady, it was tough to hear from round the corner.
There were often a gaggle of other nurses around Esther, they seemed to come to her station for a bit of a chat and to check in. She was, despite being young, a bit of a mother hen to the other young nurses. She reminded them about their upcoming rotas. At one point while she was talking with two other nurses a third arrived, and said, “my sisters…” which is a reasonable way to start the sentence, all of the female nurses were called sister… but she said, “my sisters in Christ”… and I noticed there were further references, “if you take that shift you’ll miss church” etc.
Esther brought me a great dollop of Nigerian hospitality and care and seeing these sisters together at that moment I thought… I bet 50 years ago they would have been nuns. I have nothing to back that up, it was just how it felt.
Dorothy (Tuesday Night)
On Tuesday night I swapped to Dorothy, Esther’s handover to Dorothy was funny as they were clearly warm friends and so Esther chatted away about everything, however while Dorothy clearly enjoyed Esther’s company, she was comparatively, quite quiet. The first thing I noticed about Dorothy was she was very tall and moved like she might have been a dancer. There was a great deal of precision about what she did. In a way she was like Ted, but even more so, I thought this was probably a feature of the night nurses (they really call themselves night and day nurses)… less chatty and conversational… more let’s just get on with it, and get you sleeping. Dorothy really didn’t give anything away, she just got me on with all my meds and all the tests.
The next morning she had been worried that my heart rate had been too weak overnight so she stopped one of my meds until the doctor was around later and could check it – fair enough… I only mention it because this caused a great deal of confusion later in the week.
Tim (Wednesday Day)
Dorothy handed over to Tim. Tim was interesting because he was an agency nurse so he wasn’t really part of the gang if you like, he didn’t really know how all of the specific systems of this hospital worked etc (although he had been there before, he needed to be reminded etc.).
Right after he’d been handed over to by Dorothy he came over and discussed the meds situation, saying that Dorothy had mentioned that she was worried about one of them and had asked to wait until the doctor arrived, I said that sounded fine, and Tim said, sure but you take this medicine all the time at home so it is probably fine, but let’s get me out of bed to see if the problem is that I haven’t been active enough to get my pulse moving. Then the doctor would have something to properly test.
I asked him about being an agency nurse and why he’d taken that path. He said that he’d been a kind of classic student and left everything until the last minute, and then realised he had absolutely no chance of finishing everything he needed to do in time to pass his exams and work as a student nurse. So, he had quit a month ahead of his exams, crammed to get everything done and then passed, but that had meant that he didn’t have a normal job entry point, so had applied to become an Agency nurse. Something he had done ever since.
He said he’d mainly enjoyed it as it has brought variety, but that recently the NHS has finally tried to put an end to employing agency nurses, by getting a better handle on supply staff themselves and this has ended up meaning that you aren’t paid more for being an agency nurse… and you don’t have the guarantee of a particular number of hours which makes things tricky. Tim was saying that he was finally thinking that he would have to get a permanent job, at 56. He wasn’t quite sure what to do, either training junior nurses, but that would take him away from patients, or working in a paediatric ICU that he’d previously worked in as an agency worker, something he’d found particularly rewarding… but that if he went in for a proper job, the downside is that he would get night shifts. Something that he knew at his age he’d find particularly hard to keep doing. I wonder what he’ll end up choosing, I’ll never know.
Tim had to deal with the same two patients on either side of me, his approach was very different. With the man, he was just very firm on where the limits were, he explained why things were happening and said he wasn’t allowed to do certain things. Not, “why are you doing this?”, more “don’t do this, it will hurt you more.” With the lady his approach was also different, although to be fair to Esther, the news was also less new. The moment he took over she complained to him that she really wanted to go home, that she had been told that she could go home and now she was stuck here. Tim said to her, “of course it’s not a prison, you can go home whenever you want, in fact we don’t want you to be here really, because we want you to be better, we’re only keeping you here because of how ill you are and to make you better.” The lady said she felt a fraud, something I felt at times too, given how ill other people were… Tim said, “that happens more than you think in ICU, we have a high bar to let you in to ICU but we actually also have a high bar to let you out too, we really want to know for sure that you won’t be coming back as that is a real waste of everyone’s time and resources. So we test and test again, and sorry if somebody made you think you’d be going home yesterday when there were more tests to run, but in the end the right place to deal with this new issue was right here, if we sent you home, or if you send yourself home which you can do of course, right now I predict you’ll only be back here and more ill than you are now, meaning even more days in ICU which we all know you don’t want”. She accepted it and was later moved to a normal ward as part of her path to heading home.
When Tim took her down to the ward, something strange happened. The person who had had the freed up ward bed turned out to not want to go home, so as the lady was being settled in by Tim and her new nurse all of a sudden the previous resident in the bed appeared and started a massive row about how this was her bed and that this lady shouldn’t be in it. Tim apparently dealt with that person too and headed them off and got them on their way… seemingly between defending the lady from a returning patient and also, I’m sure, due to the way that he had assured her in the morning, the lady arranged to have Tim sent a box of biscuits later that day.
The doctor came around at some point and said I was good to have that medicine and also that I could move onto proper food (it had been soup with Esther, and with Tim it was pureed food which was particularly unappetising), but the message for the latter came after the food die was cast so I ate my pureed dinner knowing I probably could have had something better.
Sam (Wednesday Night)
Tim handed over to Sam. Sam was late 30s, and would be exactly the kind of person that would get cast as the cheeky younger sister or friend of the main female character in a romantic comedy. The first thing she said to me, while the kind of mild chaos of the handover was going on was, “has it been like this all day?” Like somehow, she and I were on the same side against all this.
Sam had a bit of an unusual demeaner of the nurses I had so far, as on the surface she didn’t seem overly kind and caring, although I was to discover she really was. Part of the difference with her was that she was the only nurse I dealt with all week who had changed jobs to become a nurse, everyone else had been a nurse for the whole of their career. Sam had been an insurance broker, then had had a lifechanging significant illness, which had seen her in and out of hospital multiple times and for long stretches and had been looked after so well that she decided that she needed to pay something back by becoming a nurse herself.
Because she had bucked the trend like this it was clear, from some comments from some other nurses, that she was a bit “confusing”. It seems that the usual way to read “how experienced is this colleague” is essentially “how old is this colleague”, whereas Sam was older but still quite junior.
The main thing from my perspective was that Sam was funny, and also maybe because of having been a patient so many times really had a strong empathy for what it was like to be in my position. Esther had said earlier in the week that she was scared of ever having surgery, something she’d never had, and not particularly that reassuring for somebody who sees lots of people post-surgery. Sam was like, “oh I bet that arterial canula is painful, they always are, let’s see if I can get the doctor to give me permission to remove it”. She’d been on the other side.
Despite Sam saying that she had become a nurse because of how amazing the nurses had been to her, she also had lots of stories about how she’d regularly discharged herself, and again a bit like Esther checking that the headphones were in the right place she paid attention to things like that. She said at one point, “yeah let me work out all the things that are going to beep, I remember a nurse who left me with a machine that was beeping for an hour, when she came back she asked who had been in to change the settings on the machine, I told her I had done it because I couldn’t stand the idea of a machine beeping at me for an hour, and she looked shocked… but don’t you mess with anything alright… but in exchange I won’t leave anything beeping that shouldn’t”.
It seems like such a minor thing, but man alive there were a lot of things that beep when it doesn’t seem that important to anyone… I mean there are clearly certain kinds of important beeping that are louder and rise above everything else… and when they happen somebody pretty quickly comes and checks on you… but there is a lot of low level beeping that everyone just ignores… well all the nurses do… but as a patient it’s a lot harder to ignore… first the beep is much closer to you… and second you have no way of knowing if this is or isn’t an important beep. Are the people not coming because it’s not important, or are they not coming because it is important but they are out of earshot?
Anyway, Sam sorted out the beeping, but she couldn’t convince the doctor to let her remove my arterial canula, but that was fine. She was pushing for trying to make me more comfortable in my stay and that was a nice feeling. At one point in the middle of the night I woke up to see Sam in the corridor, I guess she had just returned from being on a break, and she was wearing a giant woollen hat with a massive pompom on the top, it made me laugh. In the morning, Sam revealed that she was going on holiday that afternoon, which seemed like it would be particularly weird, so you do a night shift, then sleep during the day and then catch a 5pm flight to Spain. She was worried about oversleeping and missing her flight.
When Sam initiated the handover to Louise, I was slightly worried, Louise looked very intimidating. Then Sam explained something she had done with one of the other patients she had been dealing with, and Louise suggested that wasn’t right, and that something else would need to be done. Sam was adamant that it was the right thing. Her parting words before heading home to sleep and then go on holiday were, “good luck with Louise, it’s easy to piss her off, I’ve only been speaking to her for 5 minutes and I already have”.
Louise (Thursday Day)
Louise, did look a little intimidating. She was the oldest of the female nurses I saw, she actually turns out to be the same age as me (45), just younger by 7 days. Part of the seeming sternness was simply that she wore transparent plastic reading glasses, the ones you can get 10 for £10 on Amazon apparently, which sat on the end of her nose and kind of obscured her face. Louise came in to introduce herself and check my vitals, and I suppose to follow on from the point Sam had made. Louise said, “you see she looks older, but she’s not got that much experience, everyone makes mistakes, when you’ve made a mistake, it is better to learn from it not to double down. That’s why I was annoyed.”
Louise definitely gave off very different vibes than say Esther at the beginning of the week. She was not in that kind of default warm friendly mode, but she asked what I do for a job, and what Katherine did, and I thought I was about to tread into a difficult area as Katherine works for a minority rights charity, and she started talking about the recent protests. She said she really didn’t keep up with the news, but that her mum had been asking her about it and had said it was something to do with people wanting to fly flags, but she’d looked into it and as far as she could tell it was about bad people wanting to be horrible to unfortunate people and nothing to do with flags at all. Having talked about our jobs, we talked about hers, and she said, “it’s a funny kind of job really isn’t it, helping people who need help. You have to help people who need help, it’s always seemed to me, doesn’t seem like a job just something you have to do”.
She returned to the topic of minority rights, and said, she’s always said to her brothers that they are a minority of 3… well she said, how many people do you think are Armenian Indian? Her mother was from Armenia (I think, she really didn’t focus on it for long it could have been Greece, my memory on this is a little confused), her father from Bangalore. Having been to Bangalore many times I talked about that, and she mentioned that she had never been. No, she’d been too obsessed with skiing so any time she went on holiday it was either skiing or somewhere like Spain in the summer sometimes.
I was surprised by the Skiing so pressed on this aspect, she said it was her ADHD, she suddenly got into things. She had left home when she was 16, completely done with it, and then got into nursing and suddenly one day she’d seen somebody skiing on tv and thought, I reckon I could do that, and so she booked a skiing holiday for that weekend. She didn’t even have the money saved or time off really to take it, so she’d got special permission to take holiday in advance, and then went off and skiing. She said it was surprising to her that it hadn’t just left her again, skiing, but it was one that came back again and again, suddenly she’d just remember and think, “right I better go skiing again” and then realise it was summer.
Her ADHD was a big feature of our conversation, Nina has had her diagnosis and so we compared notes. She explained that she’d done really well with her floor in her flat which was engineered wood. She hadn’t liked it since she had moved in, but on the other hand didn’t want it to be carpet. She was pleased with herself that she hadn’t done anything about it for years, but then there had been something that looked like it might be a wet patch and she wondered what was underneath it and then had needed to know what was underneath it, so had started pulling it up, and now she knew what was underneath it (concrete) but as she’d started pulling it up she’d have to keep pulling it up. A job for the weekend.
She hadn’t done anything about it the day before because she’d been at her brother’s house cleaning his house. So, despite being a nurse, and having a day off, she used that to clean her brother’s house? Yes, she needed to, he’s married and they both work and they have 3 kids and two dogs, “so you can imagine”. It had been a thing she had really wanted to do for ages, but it’s difficult because “he’s my brother, but she’s not my sister if you know what I mean”. I wasn’t sure I really did know what she meant, but she explained, “well it’s different with brothers and sisters isn’t it, well I’d imagine with sisters as I don’t have one, but I have a cousin and it’s the same with her, with family you can say, ‘you need help cleaning your house, I can help, let me do that’ and it’s fine and understood that it doesn’t mean anything except you want to help and that’s why you’re helping, but with my brother’s wife it’s like I’m saying she can’t look after her house properly, and she can’t really but I’m not saying it like it’s something she can’t do, I’m saying it like it’s something that’s not happening that I can help with and will make them all feel better, but I didn’t want them to feel worse about it, so it’s taken a while for it to be ok. Same with the kids really, if I’m with my cousin’s kids she just lets me get on with it, but with my brother’s kids the mothers are hovering, it’s just not the same.”
I asked her if she was still studying too given she had explained she was more experienced than some of the more junior nurses. She said she wasn’t at the moment, because she was taking a break, but she probably would in the future, and I asked her what more of her studies she had to do, and she said there was lots more, but having finished her masters on Thomas Aquinus she was taking a break. I had, in my head been thinking she was studying nursing, so this was a bit of a surprise. “Yes,” she said, “it had been a surprise me too. I woke up one night in the middle of the night with an idea to study a course and I googled courses that started soon and one on theology was going to start that Saturday”. So, she’d written an email to the professor and asked if she could enrol, the professor wrote back to say she could but only if she could get the whole application in by the next day, so she did that and started on the Saturday. It had taken her 5 years to complete the course alongside working in nursing full time (and that was a year longer than it should have been because of Covid). But she was glad she had stuck with it. I mentioned that Nina often got whims like this, and started lots of things, but I was impressed that she’d been able to stick with her whims for 5 years. “Well yes I’m incredibly stubborn, that’s why, and once I’ve started something I hate to waste the effort I’ve already made”.
She did actually yawn at this point, so I asked her if using a day of leave up cleaning her brother’s house had tired her out, she said it might have, but probably what had more tired her out was joining a choir last night, which she had done for the first time. Just on the other end of the Lizzy line from where she lived, she mentioned it’s not a religious choir, but that it’s still ok. She’d had to quit the church choir because the person in charge of the choir let everyone sing at different paces and it was a nightmare, and because she had the strongest voice people would end up following her, except those that didn’t and it all sounded like a racket, so she had to leave that, but that it was good she’d found this other choir, but it did mean she’d got in late last night.
Louise was really brilliant for me, she got three pipes removed from me after consultation with the doctor (the doctor still wasn’t happy with removing the arterial canula), and I mentioned that that was actually the thing that hurt the most. Louise said, “well that’s not surprising is it… you’ve got a bit of plastic shoved in you and when you move you’re putting pressure on your wrist and that’s shoving the plastic in more. So, you shouldn’t be surprised.” She put a bandage on my hand which stopped things from freely moving, but also she said, “you’ll be surprised, but having that bandage will mean that when you look down at your hand before you use it to support yourself you’ll remember to be careful, I don’t know why it makes such a difference but it does.” She was right, I didn’t hurt myself with the canula from then on because you always end up looking where you are putting your hand before you put it somewhere, and this reminded me each time.
On the other pipes that she got removed, she really helped there too, the answer about removal came back really quite late from the doctors and quite close to the handover to the shift to the next nurse. She said she’d looked at the rota and the next nurse, given who she was looking after, wouldn’t have time to remove anything, so she said would I mind getting into bed, getting everything removed pretty quickly, and then getting back out of bed she’d do it now. She said that, while it was a bit of a pain for me getting in and out of bed, it would make for a much better night’s sleep. I was more than happy to oblige.
When she was removing one pipe from me, she apologised because she removed it without having warned me, she said, “it’s funny I spent years telling people I was going to do something that was going to hurt and they tensed up and I think it hurt them more, now I just do it and say sorry and it seems less bad for everyone”.
Also, and I will be eternally grateful for this, she questioned why on earth I was still being assigned pureed food, the doctor confirmed again that I didn’t need to be, but the notes hadn’t been updated. Thanks to Eugine (next door day nurse who asked this vital question of the doctor while Louise was away dealing with somebody else, Louise had impressed this upon him and Eugine came through). That night for dinner I was supposed to have my first “normal” meal… but more pureed food came. Quite the disappointment, clearly not as bad as my former neighbour thinking she was going home but having to stay, but these little things can be a little crushing. I said not to worry, I’ll have a go at this, and we’ll get it sorted for tomorrow, but Louise wasn’t having it. She went down to the kitchen and got me a chicken tikka masala, with onion bargees and rice. It was SO GOOD!
As you can probably tell Louise was my hero!
Davina (Thursday Night)
Because Louise had kind of done everything, Davina and I hardly needed to interact which was lucky because as Louise had predicted Davina was busy with other people in the ICU. This suited me because with now the only point of attachment to the machines being the two cannulas in my left arm, I was now able to finally get some decent sleep. She started her shift at 7:30pm and I was asleep by 8:15, woke for my meds at 12:30, slept until 5:30 for next tests and meds, asleep again until 7 when I was given my meds and handed over to Poilin.
Poilin (Friday Day)
Poilin was kind, lovely and sweet and was great at making sure I was as ready as I could be to be able to go home, but there was this one question about my medicine which suddenly they weren’t willing to give me. This was a hangover from the note Dorothy had made several days earlier, and that a doctor had checked and then said was ok, but clearly while that doctor’s correction had worked on the Thursday, it was suddenly not allowed today. Very strange. Anyway, the doctor arrived and fixed that and said he thought I would probably go home today… but that it would really depend on the consultant.
I then had tea, toast and marmalade for breakfast. The first proper breakfast I had had, and I really began to feel a bit more human. Then the surgeon arrived and said, “he should go home, but there’s one more test that I need him to do”… I can see how that other lady could have got confused, and then finally the consultant came round and said, “well if the surgeon doesn’t need him then I certainly don’t, especially as that final test is all good” and all of a sudden I was free. Well almost, I needed my bandages changing and to be told about what to do about the bandages and to be officially discharged, and in the meantime, I even got lunch which was a cheese sandwich! It might not seem much but after pureed food it was amazing. And finally, I was allowed to actually go home.
I was so well looked after by all of the nurses in the ICU, they were all so brilliant, and different and wonderful. I really enjoyed meeting them, but as Louise said to me, “I mean this in the best possible way, do us a favour and don’t come back”.
I’ll try my best Louise.
gamboling.co.uk 