Post 31. Battling with the Nursing Sister- an uneasy truce

 It promised to be a busy day – there were three new patients to be seen and it seemed unlikely that I should have time to examine them all before the boss arrived for his ward round.   But I got off
to a bad start for no sooner had I introduced myself to the first patient when I was ‘bleeped’ and told that there was a problem with Mr Quigley.   Apparently Sister Ashbrook, my nemesis, was already in attendance. I had already crossed this fierce nursing sister twice in the two days since I took up this, my first job since I qualified as a doctor ( see previous two posts).
  My heart sank.   Mr Quigley had already bled once after his gastric operation, the most likely explanation was he was bleeding again.   Did all newly qualified doctors have doubts about their ability to cope or was it just me?
Arriving on the ward, the screens were indeed drawn around Mr Quigley’s bed and there was considerable activity within. Fortunately it  quickly became apparent that the patient had not suffered any major haemorrhage.   He was sitting upright in the bed, he look reasonably alert and even had a bit of colour in his cheeks.   It was reassuring to see that the observation chart at the foot of the bed showed that blood pressure and pulse were entirely stable.    I relaxed a little.  Sister Ashbrook was at the bedside with one of the staff nurses.   She looked displeased. 
“Why you junior doctors can’t anchor  drips securely I will never know,” she exclaimed in a voice loud enough to be heard by every patient on the ward.   “Does no one ever teach you  that the cannula should be secured with adhesive tape, the forearm should be splinted and the splint should be held in place with at least two rolls of three-inch crepe bandage?  When my nurses do the job it’s done once and done properly; the drips never come adrift.”
 It was clear that the remark was aimed at me!   It was on the tip of my tongue to point out that the consultant anaesthetist in theatre had inserted this particular drip, not me, but with the relationship between us already strained, I thought better of it.
“The nasogastric tube seems to have come adrift as well,” I said,
knowing that inserting these tubes was usually a nursing task and hinting that perhaps the nurses were not quite as perfect as she would wish to believe.  Too late, I realised that this played straight into her hands, for Sister remembered when the tube had been inserted.
“Yes,” she replied pointedly, “but the nurses didn’t put this particular tube in place, did they?   The anaesthetist did that in theatre”.
“Probably at the same time that he inserted the cannula in the arm, Sister,” I said, innocently.
My remark was greeted by a long cold stare but there was no verbal response.   At least it was comforting to know that senior anaesthetists, as well as house officers, could be held responsible for mishaps.
Sister barked out her instructions.
“Well Doctor, set up a new drip, pass a clean nasogastric tube and rewrite the intravenous infusion regime. Mr Quigley needs to catch up with the fluid that he should have received in the last couple of hours.”
 She turned on her heels and marched off, snatching the screens shut behind her. We were back with the ‘I am the senior sister, and you are a junior doctor’ routine that I had encountered when I first arrived on the ward.   Mr Quigley looked at me, sympathy written large on his face.
 “She can be quite a tartar when she wants to be, can’t she, Doctor?”
“She certainly can!”

I am pleased to say that the overwhelming majority of the nurses it has been my pleasure to work with have been exceedingly helpful colleagues!
Thought for the day
Advice is seldom welcome, and those who need it most, always like it least.
Lord Chesterfield  1694 – 1773  (In letters to his son)

This story is adapted from The First Cut which tells the story of an introspective young man who is thrown, bewildered and unprepared, onto a busy surgical unit as a newly qualified doctor.Through his eyes numerous ‘patient episodes’ are told, many amusing, some serious, others poignant, but all very ‘human’. 
It is available from Amazon as a paperback or ebook.
Extract from doctor’s letter: Patient is alive - but without my permission!!

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