Post 20 A Nurse's 'Very Special' Patient.

As a part of my paediatric nursing training in 1963 at Great Ormond Street Hospital in London, I was required to undertake a ‘patient study’.  It involved studying the care of an individual patient in detail.  I chose a particularly ill baby called ‘James’ (not his real name) who had a severe chest infection.   He was just twelve months old.   He had a collection of pus both within his lung and in the cavity around the lung, a life threatening condition known as an empyema.

His father was a major in the army, so he was flown to London from Germany, where his father was stationed, leaving his mother and three sisters behind.   Because he was separated from his mother, all the nurses on the ward gave him a little extra attention.   I certainly did!   In all he spent 6 weeks with us and in that time I got to know him especially well.   He was treated with antibiotics, spending much of the time being nursed in an oxygen tent.   He also went to the operating theatre to have the collections …

Post 19 My Most Memorable Medical Moment

Jimmy was 28 years old when I first met him.He was good looking, 5 feet 10 inches tall, slightly built, a keen football fan but also a violent criminal with severe mental health problems.Arrested, tried and found guilty of causing grievous bodily harm, he received a custodial sentence. Later he was referred to a secure mental health unit to avoid risk to the public while attempts were made to treat his aggressive behaviour.I was tasked with working with him and during one of our sessions I asked what he would most like to do? His reply surprised me. “Run a marathon,” he said.

“Yes, that’s possible,” I replied, “but I would have to come with you while you trained.” Jimmy was really excited that his dream was possible.

I suggested that instead of a marathon, a local 10 kilometre run would be an acceptable first step. Jimmy agreed and soon training started in earnest. It was hoped that sport and exercise would enable him to channel his aggression in a positive way,

His enthusiasm to run a …

Post 18 A pregnant pig helps me make a stunning diagnosis!

One definition of serendipity is ‘Looking for a needle in a haystack and finding the farmer’s daughter’.   Perhaps that’s a bit ‘Non PC’ these days, a bit sexist but no matter!    For me, serendipity was having a pregnant pig help me make a stunning diagnosis – let me tell you more.....

Ihad taken the written papers and my bedside competence in matters medical had been assessed by an evil physician, who had derived great pleasure from laying bare the paucity of my knowledge(described in Post 10).The final part of the examination to determine whether I was fit to become a doctor was a test of my knowledge of surgical matters.

My examiner was Sir William Warrender, the most senior surgeon at the City General Hospital, for whom I had a great deal of respect. I had undertaken part of my training on his 'firm' and found him to be a ‘fatherly figure of the old school’.He was patient with students, a good teacher with the wisdom of long experience; I had every confidence that his asses…

Post 17 A traumatic experience for a student doctor

“Let’s get you to see another patient and see if you can do a little better with her,” my examiner said, smiling; clearly enjoying my distress. He asked me to listen to the heart of an extremely breathless lady who was lying on a nearby couch. My spirits rose slightly. In the previous three months I had regularly attended the cardiology clinic. I’d listened to the heart sounds of hundreds of different patients and considered myself to be something of an expert.I rarely had any difficulty in identifying the heart sounds and the various murmurs that could be heard and was usually able to make the correct diagnosis.

A chance to show that I’m not a complete muppet,’ I thought as I applied my stethoscope to the patient’s chest. Once again though I discovered that my confidence was entirely misplaced. The noise I heard was unlike anything I had ever heard before.It sounded as if there was a concrete mixer churning continuously inside her chest. It was rasping and grinding and was so loud t…

Post 16 Understanding the patient's pain

We had all heard of high flying students, some the best in their Medical School year who had come a cropper in the final exam. To succeed, you not only had to know your stuff, be quick witted and keep a rein on your nerves; you also had to be lucky. The previous year my brother, twelve months my senior, had the grave misfortune to be examined by a senior dyspeptic surgeon who purged his disagreeable symptoms by failing 90% of the students he examined, sadly my brother amongst them.Despite an appeal by the University, the examiner’s decisions were upheld thereby condemning the unfortunate ‘failed’ students to six long months of revision and the stress of re-examination.

Now it was my turn to face this ordeal and as I waited in a small anxious group for the assessment to begin, my heart was in my mouth.I was hoping and praying that I would be allocated a patient who was literate, had an uncomplicated medical history and easily recognisable physical signs – preferably one who knew their d…