Post 3 The nurse knows best.

Thought for the day

‘Do you want to speak to the Doctor in Charge or to the nurse who really knows what’s going on?’                                               Author unknown

Scene    An emergency department 50 years ago.

Whilst working nervously in casualty at the City General Hospital during my first week as a doctor, I'd been completely unaware of the time but it was already one in the morning; I was tired and hungry. Seven long hours had passed since I last had anything decent to eat; I'd survived on cups of sweet tea and the occasional dry biscuit.

I also felt abused!  Although the nurses had started their shift at 8 pm, they were now able to have a forty-minute break and a cooked meal. I had worked since 9 am but there was no such facility for me or indeed for the other doctors who were on duty through the night.  Fortunately though, Bill, the night porter and Stan, the night security guard - an ex policeman - were happy to produce hot buttered toast on request.

“That’s a lovely smell,” said my next patient, in a soft Irish accent. His nose was held up in appreciation of the aroma, reminiscent of the boys in the well known gravy advert.  His appearance suggested that he was a tramp. 

He was dirty, unkempt and, as I discovered later, wore multiple layers of clothes underneath his old gabardine raincoat. He carried a woollen hat in his hand that I presumed to be responsible for the tidemark across his forehead. Below the line, his face was weather-beaten and brown; above it was strikingly pale. He obviously spent much of his life out of doors, wearing his hat most of the time.  He was carrying a mug of tea which struck me as being unusual. Patients were advised not to eat or drink before they saw the doctor, lest an anaesthetic be required subsequently. Notices to this effect were prominently displayed throughout the department.

My initial ‘foot of the bed’ impression was that he didn’t look particularly ill; in fact he looked both healthy and cheerful.  He also appeared to be pleased with himself and had quite a sparkle in his eyes.  I was surprised that he'd smelt the buttered toast, because the whiff that reached my nostrils was one of methylated spirits. 

“Top of the morning to you, Doctor,” he said, “to be sure ‘tis a nice clear cold night, is it not?”

“You’re Irish by the sound of it. Where exactly are you from?”

“I am indeed from Ireland,” he said. “The Emerald Isle. God’s own country.  I’m from a little fishing village called Killybegs.  It’s right up in the north in County Donegal. Lovely spot it is too. Have you ever been there Doctor?”

“Actually I have,” I replied, recalling a holiday that I’d enjoyed with my parents, many years previously, “and wild and beautiful it is. So what brought you to this country?”

“Tis a long story to be sure but I’m a priest.”

I must have looked surprised as I tried to reconcile his present appearance with his stated calling. Then he continued, now in a conspiratorial whisper.

“Well Doctor, to tell you the truth, I used to be a priest but I was a bit of a naughty boy. You see, I developed a taste for the communion wine; I helped myself a little too freely. The Bishop of Donegal disapproved and sent me packing; not that he didn’t partake of a little tipple himself, you understand!”

Certainly an interesting character I thought, a defrocked priest, down on his luck. It was tempting to delve a little deeper into his background but conscious of the time and hoping to get a little sleep  before morning, I thought it best to move the consultation along.

I asked him what the problem was.
“Tis my belly, Doctor. So it is.” he said. “I’ve got a terrible pain in my belly.”

He went on to describe his troubles in more detail but it was a story that was difficult to untangle.  The position of the pain he described suggested that it might be coming from the stomach or perhaps the duodenum but he insisted it troubled him when he moved his arms into certain positions and occasionally when he scratched his head. This was not a combination of symptoms with which I was familiar from my study of  textbooks! He also described a pain behind his left eye, “only my left eye mind Doctor”, when he passed water, again an amalgam of symptoms that I'd not encountered in five years of study at medical school!

 It took nearly ten minutes for him to undress to allow an examination of his abdomen because of the multiple layers of clothes he wore. When he had taken off his jacket, three ragged sweaters and an old waistcoat, I thought that we would soon be rewarded by the sight of flesh but the further removal of a shirt and a couple of vests was required before we finally reached his skin.

Having achieved this however, I discovered that the clinical signs in his abdomen were just as perplexing as his symptoms!  One minute the tenderness was on his left side causing him to leap from the couch in an alarming fashion. Later it seemed worse on the right, yet at other times he would allow deep palpation without any apparent discomfort whilst happily relating stories of his beloved homeland.  Half an hour later, the only conclusion I’d reached was that I didn’t have a clue what was the matter with him!

It was at this moment that sister walked through the door.

 She beamed at my patient, “Oh, it’s you Charlie, so you’ve decided to pay us another visit?”

“Sure I did Sister and can I say what a joy it is, to see your beautiful happy smiling face once again.” 

“Have you had a cup of tea Charlie?”

“Yes thank you, Sister, a nice big mug. Hot and sweet and lovely it was too, brewed by one of your little angels.”

“Would you like another drink before you go?”

“Would there be some nice buttered toast with that Sister?”

Sister smiled. “Yes, Charlie, there would, provided that you promise not to come back.”

Then rather more severely she added, “This is a hospital Charlie, a place for the sick and infirm, not a port of call for ex-naval sea captains down on their luck.”

Suddenly, it dawned on me that Charlie had succeeded in getting two free mugs of tea, some hot buttered toast and had spent a couple of hours in a nice warm environment whilst successfully pulling the wool over my eyes. However his plan to spend the night between freshly laundered hospital sheets and be served with a cooked breakfast in bed had  been thwarted. 

“He’s actually not an ex-navy captain tonight Sister,” I said. “He’s a defrocked priest.”

“Is that so,” she said, smiling. Then turning to the patient whom she obviously knew well, she added, “in that case, please say a couple of prayers for us Charlie whilst you are having that tea and toast and then be on your way.”

“I will, Sister. I will. And I’ll say one for the young doctor too. May the Good Lord bless you and keep you both safe and warm in His arms,” he said, “’til I pop in and see you both again”, he added with a wink.

Comment 

In the days when I was training it was by no means unusual for folk to attempt to spend a night or two in hospital, particularly in the days leading up to Christmas;  a short time in warmth and comfort being preferable to sleeping rough on the streets. Perhaps they still do!

On the rare occasions when someone did slip through the net and reach a bed on the ward it was usually difficult to dislodge them. However Sister’s ‘glycerine suppositories thrice daily’ treatment usually had the desired effect – not that such therapy could be administered these days without falling foul of clinical governance!!

  This tale is adapted from ‘The First Cut’, published in 2011.

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