By Big M

Geoffrey had drawn the short straw, again. Night shift over the New Year weekend. He’d settled into ‘walking wounded’ area at the back of the Emergency Department. New Year’s Eve was, naturally, busy to the point of chaos. He’d ended up with some patients who’s level of illness was beyond his abilities, and above the level of acuity for his area, yet, he’d held it together, at the expense of, even, getting one short break each night.

Even Sister Kent had come down to help. She relieved as the night supervisor over Christmas and New Year to allow ‘the girls’ with ‘littlies’ to take a break. She was in her element, suturing cut faces, inserting IVs, taking blood, and lending plenty of shoulders on which to cry.  At one stage it was complete mayhem, a couple of car accidents generated five adults and two small children, with injuries, there were two victims of separate glassings, who would need plastic surgery, and a bikie, who’d been admitted unconscious, had woken up thinking he was Cassius Clay. Sister Kent walked in, and barked some commands at some junior doctors and nurses. The bikie collapsed as soon as the injection hit his thigh. He was soon in the recovery position, on a bed with some very pleasant medicine coursing through his veins. Everything seemed more manageable at this stage.

Uva tried to exit via the back of ER, when she ran into Geoffrey, who was trying to admit an elderly lady. “Want a hand, Geoffrey?”

“Well, no-one else will, so, yes.” Geoffrey and the ambulance officer had just transferred her onto the bed, and were still trying to assess her.

“What’s your diagnosis?”

“She’s got a deficit in global awareness…”

“Not mumbo jumbo uni talk, what’s wrong with her.” Uva had no time for any bullshit.

“Well, she’s disorientated, and may be in pain.”

They both quickly assessed poor old Mrs MacDonald. She couldn’t answer any questions coherently, and moaned. The reason for her moans was pretty obvious. “What do you think is wrong with that leg, Geoffrey?”

“Broken?”

Yes, it’s bloody broken, but where! Here’s a clue. Old lady, probable osteoporosis, externally rotated right thigh, must be a fractured NOF.”

Geoffrey had never heard of a bone called a nof. “I don’t think there’s such a thing.” He thought himself rather clever, what with his university training, and Sister Kent probably hadn’t finished high school.

“Neck of Femur, you dill! Why do you think she’s disorientated?”

“Dementia?”

“No, the ambulance picked her up from her home, where she’s probably been lying on the floor for hours. Uva was getting exasperated. There was no doctor available, so Uva helped Geoffrey immobilize the leg, then inserted an IV cannula, through which, she took various blood tests. She then started some IV fluid to slowly re-hydrate the patient in preparation for her operation.

Geoffrey was amazed. He’d always been taught to model himself on nurses with degrees and qualifications; yet, old Sister Kent could out-perform the lot of them. She went to harass a doctor to write up the request forms, X-Ray form, IV fluid and order some pain relief whilst Geoffrey did another set of observations on his other patients. He narrowly missed being vomited over, then rushed out to get mop and bucket. At least he’d learnt to duck.

Uva rushed off to counsel a family about organ donation, from their daughter, whilst Geoffrey assembled the notes o his new patient. He’d barely sat down when a wards man appeared with a post-op patient on a trolley. The nurse in charge was loudly remonstrating with him about the fact that ER wasn’t a recovery ward. His response was that he only pushed patients from recovery to the wards, and, as far as he was concerned, this was her ward. The nurse was then heard to say, rather loudly, that she’d ‘only’ had a D and C; so silly, bloody Geoffrey could look after her. Whist Geoffrey was personally insulted; he thought it terrible that a patient should be spoken about like that. He stepped forward, and pushed the trolley into the end of his little ward, whilst the recovery nurse quickly handed over. “ Ten weeks… miscarriage…D and C…obs have been stable.” Then disappeared.

Geoffrey didn’t have much idea about ‘D and C’, as he’d fallen asleep during his gynaecology lectures (he hadn’t really, he just couldn’t bring himself to look at the pictures), but thought to himself they probably need the usual observations, plus some check on the level of bleeding, ‘down there’. He pulled the curtains around the bed, introduced himself then started on the usual blood pressure, pulse, and temperature. He didn’t know how to go about checking ‘down there’, so decided to go for it. “Mrs Jones, I’m really, really sorry, but I have to check ‘down there’!” He blurted.

Mrs Jones promptly started to cry. The sobs were interspersed with snatches of words. “Second miscarriage…my little baby…Tom doesn’t even know…that nurse was so rude, only a D and C.”

Geoffrey had no idea of what to do with crying women, or, for that matter, men. He held her hand and said. “ I’m really sorry about the baby. I can’t imagine how you must feel, but my Mum always said she had lots of miscarriages, before she had me. Anyway, if I can just check for bleeding we can call Tom and take it from there.” Geoffrey finished his observations, brought a phone over, plugged it in, and called Mr Jones, who was working over in WA. He explained what had happened, then handed the phone to Mrs Jones. As he turned to leave he slipped in another patch of vomit from one of his patients.

Geoffrey turned to rush to the change room when his little old lady called out. “Porter, porter. Hurry up and get my bags onto the flyer. There’s tuppence in for you!”

“Hello Mrs MacDonald, do you know where you are?”

Mrs MacDonald looked around, suddenly less sure that she was standing on a train platform, in 1961, and more sure that something had happened to her, that had landed her in some alien place. Geoffrey could feel the vomit wet against his skin. “Mrs MacDonald, you’ve had a fall, and hurt your leg, you’re in hospital waiting for an operation.”

Mrs MacDonald looked at her hand, with the IV, then down at her leg.  She suddenly seemed to take it all in, then looked at Geoffrey. “Then why are you covered in filth, young man? Go on, clean yourself up! “She ordered.

Geoffrey returned to Emergency to do another round of observations and found that two of the drunks wanted to discharge themselves against medical advice, which the Resident Medical Officer was quite happy to allow. Geoffrey then called a friend for Mrs Jones, who came promptly to collect her. He’d offered to take her to the shower, but she declined, just quickly dressing in her friend’s spare clothes. She made a point of shaking Geoffrey’s hand, as she left, her eyes still red and puffy.

Mrs MacDonald lay in bed. “You look a bit better now, Porter.” She had a twinkle in her eye. You can call me Peg, what am I supposed to call you?”

“Mr…er…no…Geoffrey.” He smiled. “I’m the nurse who’s been looking after you. We’ve been trying to contact your daughter, but her mobile’s switched off. I guess it is New Year’s Eve…sorry…day.”

“You mean I missed the fireworks, love, must’ve been out of it for a while.” Peg seemed amused by this, but she had a fair dose of morphine, earlier.

Two big bleary-eyed men in theatre scrubs marched in. “Peg MacDonald?”

“Over here.” Geoffrey indicated. “Fractured right NOF.”

It was just on five, and Uva sat at her desk, her head in her hands. It was like this every holiday. Wards and clinics closed, staff given leave, theatres and radiology barely staffed, at the busiest time of the year. There were still ten patients in the Emergency Department with no hospital beds to go to, plus four in the recovery ward. This would be partially remedied by the next shift, when she’d opened a half ward staffed by casuals or full timers on overtime. This would cost a bundle. No doubt bean counters like Dr James would claim to have saved the hospital money, by shuffling costs around. Plus she’d fielded various complaints from patients, or their relatives. She shook her head, and then finished her tepid black coffee in one gulp.

Geoffrey was nervous as he knocked on Sister Kent’s office door. “Come.” She rasped from too many cigarettes.

“Geoffrey, sit down…coffee?”

Geoffrey glanced at the coffee pot, which had clearly sat at low tide for many hours, from the telltale stain three centimetres up from the base. “Er…ah…no thanks.” He mumbled, thinking that coffee was to butter him up for the bad news.

“Geoffrey, I’ve had a very serious complaint from one of your patients, overnight.”

Geoffrey’s throat went dry, and his heart rate shot up to about one hundred and ten.

“The patient was intending to take her complaint to the Area Health Service, as well as State Health. She said that the reason that she was going to leave the complaint at hospital level, was the excellent care and compassion she received from the male nurse who cared for her in Emergency.”

Geoffrey blinked and didn’t know what to say. “So, who is this male nurse?”

“You, you dill.” Uva Kent’s eyes crinkled at the corners, then she smiled. “Mrs Jones said that you were the only person who offered to ring her husband, or even recognise that she had lost a baby!”

Geoffrey’s heart rate dropped back to normal. “Thanks, I didn’t really know what to do, so I held her hand and said that I was sorry. Thanks, by the way, for helping me with old Peg. You showed me that even you old, hospital trained nurses know some stuff.”

“Geoffrey, I know that the uni tries to inculcate you younguns with the idea that us ‘old’ hospital trained RNs are stupid, but just open your eyes and look at what some of us old RNs have achieved. By the way, most of us have been to uni, albeit, late in life, I have two Master’s degrees, and am thinking about enrolling in a PhD. Tess, I mean Sister Tickle is half way through a degree in engineering. There are nurses around the hospital who are published authors of crime, biographies, history, and so on.”

Geoffrey was gob smacked. “You’re right, we were told from day one to watch out for the old RNs who knew nothing. I’m sorry Sister Kent.”

“There’s nothing to be sorry for, Geoffrey, you’ve worked hard these last two weeks, and, by the way, if you ditch the strangely worded ‘nursing diagnoses’ and think about what’s actually wrong with the patient, you can easily plan your care from there, now, off you go”. Uva already had another Camel in the corner of her mouth, a one eye half closed as she lit it with a disposable lighter. It was clear that the interview was over.