it's never enough until your heart stops beating

Somebody wrote me a suicide note today.

He left it, folded in half, in his bedroom on top of his chest of drawers.
On the outside he'd written my first name, my job title, and an 'x'.

This note was handed to me about ten minutes after he'd kicked open a fire door and jumped a fence and absconded from the ward. As some of my colleagues chased after him, I called the police to report him missing and explain that he was considered a high risk of suicide.

It was only after I'd completed this call that a colleague passed me the note. It was one sheet of A4, completely filled on one side with his reasons for doing what he was doing, an apology to his three children (all aged under 7), to his ex-partner who he described as "a good person, a strong person, stronger than me" and an apology to me, with thanks for all I'd tried to do for him.

He's safe. The police found him in less than half an hour, brought him back to the hospital and I immediately transferred him to a ward that's more secure than my own. So tonight he's safe and that's all that counts.

But I'm really, really pissed off with him that he chose to address his suicide note to me.
Why me? Why not his ex-partner, or his kids, or his dad, or any number of people other than me. I'm not his named nurse, I'm just another member of staff on the ward. Just someone that spends time with him and listens to him and dishes out his medication and tries and tries and tries -unsuccessfully, apparently- to try and make him realise that he has a lot to give, a lot to live for, a future if he chooses to live rather than die.

I like him. As a person, I mean. On a human level, he seems like a decent bloke.

He has no idea how addressing his suicide note to me has impacted upon me. But I haven't been able to get it out of my head all day and he has no idea how angry I am with him. This is a human reaction, not a professional one. We're trained to be non-judgemental and empathetic and professional and emotionless-drones pretty much.

But we're not. And now I'm left to reflect on this whole situation and why he chose to address his note to me. Then I move on, back to the next shift, to the next patient, to the next challenge, with my emotions firmly in check and my work-face on. Just like that. If only it were that easy.

Nurses are humans too, y'all.

RMJ

mud is a barrier, right?

It's a few minutes before 5am. I've been on shift since 8:15pm and still have another two and half hours to go before my shift ends and I can go home. It's my third of four night shifts and I'm flagging.

We have 21 patients on the ward, most of whom are asleep. One is awake and this one, aside from his mental health needs, has flu. Not man-flu, proper-flu. The kind that kills people.

Because he has flu, he's being barrier nursed so that he doesn't share his germs with everyone else on the ward. So he's in a room alone, with a big sign on the door telling people not to go in and any time we have to go in, we look like we're dressed to enter a crime scene.

Gloves, apron and mask are the bare minimum. I've also made sure I've had the short straw on this run of nights. There are three staff on duty but whenever anyone has had to enter his room, I've made sure it's me. It seems daft to risk infecting three separate members of staff, so I've seen to him on each occasion.
I'm just angling for a week off really. ;)

So, just before 5am, I realise that we've run out of masks. I've hunted the ward and can't find any and I have the cup of tea he's asked for, but now I can't take it to him. I decided to call the ward next door and see if I could borrow some, so I picked up the phone and:

"Ward 10, Ben speaking."
"Hiya Ben, it's RMJ from Nines."
"Oh hiya mate. How's it going?"
"Not bad, love. I'm on the scrounge though."
"Go on..."
"Have you got any face masks?"

At this point there's a pause of maybe two or three seconds. But two or three seconds of silence can seem like a long time. Finally:

"Ohhhh a face mask! You know, for a minute I thought you meant, like, a face peel. A mud pack. That kind of mask. How gay am I?"
"So, so gay, Ben. You big poof."

He is, for the record.

"I know, I thought 'Why does she need a peel at five o'clock!'"
"No mate, I mean a surgical mask. A face mask. But if you've got any mud packs and a couple of slices of cucumber for my eyes, that'll do in a pinch. I'm sure my patient won't shit himself when I walk into his room wearing that instead."

He didn't have any. I got some from Ward 16 in the end, one of the Older Persons wards where the staff are apparently straight and infinitely more professional than us two gayers on Acute.

Two and half hours to go.


RMJ

If it isn't written down it didn't happen

I often hear myself telling people that when people are unwell, they sometimes say and do things that they wouldn't dream of if they were well. This is true.

Unfortunately, as a nurse and therefore the person most often delivering bad news / not permitting the patient to leave / administering the unwanted medication / countless other examples, I'm often the person who bears the brunt of this out of character behaviour. 

In just the past week I've been told "Fuck off", "stay the fuck away from me", "I'll fucking have you, you lesbian bitch", "stick it up your fucking arse", "what the fuck are you gonna do about it?" and "I'm going to sue you for every fucking penny, you fucking bitch".

That last one's more common than people think.

The best I've had though, is when I was recently called a "stupid fucking bitch-faced cunt".

Less of the "stupid", thank you.

That one was impressive. I don't think I've ever been called anything that compares with that. The person who called me that went on to tell me that they knew which car I drove and I should watch my back because they were going to cut my brakes.

You know what's the best bit? It wasn't even a patient. It was a patient's relative, annoyed that I wouldn't tell him anything about the patient because the patient hadn't consented to information sharing. I was very polite and even apologetic as I tried to explain this to the gentleman on the telephone, but apparently he wasn't happy, as demonstrated above.

The Health and Safety Executive (HSE) defines violence at work as “any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work.” [link] So when we're subjected to things like this, or overhear abuse directed to others - patient to patient, for example - we're encouraged to complete an incident form on the Trust intranet.

Leaving aside the amount of time it takes to physically complete the incident form, a lot of staff think it's pointless anyway because "nobody reads them" and "nothing gets done". Well, I can't argue with the latter because I'm yet to see any changes, but I know that they do get read.

I know this because having completed incident forms over the past month or so that variously included the words/phrases "nigger", "fucking paki" and of course "stupid fucking bitch-faced cunt" I received an email that contained the following:

At this week’s incident monitoring group we picked up on the fact that staff are writing verbatim the abusive language that patients are using when an incident has occurred [...]

...it is not necessary to write verbatim the abusive language or expletives that a patient has used during the incident, nor is it appropriate to reference the  expletives using asterisks as an alternative .  It is more than sufficient for staff to refer to the patient as using abusive language or swearing. 

So there we have it. The members of senior management who attend the meeting where all of the incident forms are read and discussed have ears so delicate that we're no longer allowed to put the actual language used in the incident forms.

I am of the opinion that detailing the exact words spoken carries considerably more weight than just saying that the patient used abusive language. Offensive language is of course offensive every time, but there are different degrees of this and I don’t think this can be accurately reflected if we are unable to detail what was said.  I said this in an email to my ward manager and was told that I was right and I could and should continue to detail the exact words spoken when I'm putting an entry in the patient's notes, but I must refrain from doing so in the incident form.

So what exactly is the point of completing an incident form if I can't state exactly what was said? Saying that the patient "directed homophobic abuse" at me doesn't quite have the same effect as if I say I was called a "lesbian bitch" or a "fucking dyke", as has previously happened.

Saying that the patient's relative "became verbally abusive" in no way conveys the seriousness of the incident when I was actually called a "stupid fucking bitch-faced cunt". 

But hey, I'm front line staff. It's okay for me to be subjected to this abuse, it's just not okay for the management upstairs to have to read about it. It's just like we were told over and over and over again in the School of Nursing: if it isn't written down, it didn't happen.

RMJ

How I saved the leader of the free world

"You okay John*?"
"Yeah, I'm errr... just talking. To my voices, like."
"Ah okay. What're they saying to you tonight?"
"They errr, they're telling me to... errr, like, kill." *pause* "The president."
"The President."
"Yeah."
"The American one? Barack Obama?"
"Yeah."
" ... "
"It'll be one of them, errr, what're they called? It'll be a... errr... a suicide killing. That's it."
"Okay. Do you think that's realistic?"
"What do you mean?"
"Well he's in America isn't he."
"Yeah, that's a good point. And I don't really like flying."
"Ah."
"Is there any other way of getting there?"
"Well there's a boat. But that takes about two weeks I think."
"Two weeks?"
"Yeah."
"That's a bit long."
"Yeah."
"Mmm. What errr, what do you think I should do?"
"Well honestly, I think you might be better off ignoring your voices and not doing it."
"Do you think so?"
"Yeah mate. I do."
"Oh okay then. I'll do that then. Thanks for that, nurse."
"Anytime, John."

Stand down, Mr Obama.
I gave him his meds and sent him to bed. You can sleep easy again tonight.

*Not his real name.

RMJ

Standard Phrases

The title of this blog is directly copied from a line I read time and time again in patients notes.

X has been settled and appropriate throughout the shift...

X has demonstrated settled and appropriate behaviour whilst on the ward...

...initially unsettled, X responded well to PRN medication and has been settled and appropriate for the rest of the shift...

Poor X.

What the staff member actually means when writing the term "settled and appropriate" is usually something like:

Patient X has kept his/her head down all day and hasn't done anything to create a fuss or cause me to notice them. In fact, I only really know Patient X is here because the healthcare support workers have marked him as present on the hourly fire checks. For all I know, patient X may not even exist.

Settled and appropriate indeed.

RMJ

Settled and Appropriate

I am a nurse, of the psychiatric variety rather than the "real" variety.

The "real nurses" (RN) think my job entails drinking tea, eating cake and biscuits and chatting to people. I do occasionally drink tea, I admit. I have even been known to use a cup of tea as a tool to help form a therapeutic relationship. I'm not too fond of cake though and I learned very early on in my career never to eat any gift of cake that has been prepared in the OT department by a patient.

I am a Registered Mental Nurse. RMN. 

I work on an inpatient ward caring for adults of working-age with a mental illness. My patients are, for the most part, acutely unwell. I like my job. I like my patients. I wouldn't ever want to work in any other area of nursing, because the care I deliver is person-centred rather than task orientated.

I can take a pulse, I can measure blood pressure and temperature. I can clean and dress wounds. I can even inject stuff into patients and take blood from their veins. In short, I can do everything a RN can do but I can do something extra too: I can create time to talk to my patients and treat them as individuals.

It's why I'm a RMN and not a RN.

Mine's a bourbon biscuit, please. Thank you. 

RMJ