Quite often one hears how “this wouldn’t have happened years ago…” or “things were better back when I was a student nurse…” or “PACE (MET) criteria charts take away a nurse’s need to think………………….…”
Anecdotes of drama, gore, and disasters were flying thick and fast at the reunion of my mum and her nursing colleagues. I called them ‘the old reunionites’– I went along for the ride (and the free feed) just to see if any of those tall tales I had heard over the years actually had a milligramme of truth in them and could be verified. Especially the one about the politician – let’s call him the honourable Mr Etho. The patient my mum said she will NEVER forget.
The honourable Mr Etho was admitted to the surgical ward for a routine procedure – cholecystectomy. He was given the only private room attached to the surgical pavilion ward. This was the room always allocated to the wealthy or the dying – preference being in that order! It was situated at the farthest end of the ward so that noise emanating from the main area would not disturb the patient and privacy was optimal – just perfect for a famous politician wanting anonymity and probably post-operative medicinal assistance provided by his associates.
The honourable Mr Etho was described by the ‘reunionites’ as a charming, portly gentleman who admitted to “a bit too much of the good life” when he tipped the scales at 110 kg; his ruddy complexion and facial spider naevi supporting his comment.
Alarm bells should have started ringing right then – “Mum, grab the AWS chart stat!”
“But darling, he was so polite, and he was a famous politician, and when I admitted him I was an innocent 1st year nurse, and AWS charts hadn’t been invented.”
Anyway, pre-op assessment was within acceptable limits so he was shaved, starved, wrapped up and packed off to theatre.
It was two days later that my mum was re-assigned to care for the honourable Mr Etho. In his secluded, private room, the honourable Mr Etho was resting quietly – obs stable ( although slight tachycardia present), tick; abdominal suture line intact, tick; T-tube drain (they were quite large back in those days) secured, patent and draining, tick; nasogastric tube secure and patent, tick; IV therapy running to time, (no pumps back then), tick; mental status – mmmmm, a little bit agitated – probably just everything catching up with him……………..
Mum then carried on with the usual busy morning activities out in the main ward and left the honourable Mr Etho to recuperate.
“But mum, the ruddy complexion, the spider naevi and the ‘too much of the good life’”………………
The honourable Mr Etho was next checked about an hour later during which time he had managed to work himself up into a frenzied state of mania. And like a true politician he had the tenacity of a Bull Mastiff protecting a 3 week old ‘maturing’ chicken carcass – the growling jowls, gnashing teeth, and squinty eyes – definitely ’Mastifflike’.
The nurse call bell was way over the other side of the bed, and calling out was of no use owing to the geographical setting of the room – just perfect for a famous politician wanting anonymity and probably post-operative medicinal assistance provided by his associates.
What to do? Mum said it was the scariest moment of her career. Confronted by the honourable (now ‘Mastifflike’) Mr Etho with one fat leg stuck through the bedrails as he tried to escape, T-tube drain (they were quite large back in those days) being wrenched from its securing sutures, and IV line which had once been in his arm now being ripped out by his teeth. He hadn’t yet started on the nasogastric tube………
Mum couldn’t quite tell where most of the blood was coming from arm? abdominal region? or the enormous skin tear now developing on his leg as it sawed away on the bedrail.
The only way to get to the nurse call bell was to crawl under the bed while trying to avoid the pools of blood – Mum said she felt like a soldier on bivouac training crawling through the mud; and at the same time was wondering how long it would take for the cavalry to arrive. As she had indicated to her other colleagues on the shift that the honourable (now ‘Mastifflike’) Mr Etho was stable, albeit a little bit cranky, her colleagues would not be on the alert for a pending disastrous situation.
Mum’s thoughts: stay calm…….., someone please, please, please answer the call bell; the honourable (now ‘Mastifflike’) Mr Etho please don’t fall on me, and please don’t bleed to death; should I start screaming or will that make the honourable (now ‘Mastifflike’) Mr Etho even more agitated??
Next thing mum knew, the honourable (now ‘Mastifflike’) Mr Etho had managed to pull the IV pole over landing on top of her legs as she crawled out from under the bed. Someone please, please, please answer the call bell now!!!
There was no stopping the honourable (now ‘Mastifflike’) Mr Etho. The growling had now crescendoed into roars, and the honourable (now ‘Mastifflike’) Mr Etho decided that the nasogastric tube was next to go. No, not the nasogastric! Abdominal contents spilling into his lungs on the way up??????
Mum’s thoughts: stay calm…….., someone please, please, please answer the call bell; should I stay or should I go and get help???
Decision was made to stick her head out the door and yell – the honourable (now ‘Mastifflike’) Mr Etho couldn’t possibly get any worse………..
Mum’s thoughts: stay calm…….., someone please, please, please hear me! The situation is totally out of control, I think this is all my fault, I hope he doesn’t die.
As the honourable (now ‘Mastifflike’) Mr Etho was stuck with his blood soaked leg protruding through the bed rails, – at least he couldn’t fall over the top, one small mercy.
Help finally arrived in the form of the wardsman sauntering past after his tea break. The sauntering rapidly turned into a run when he heard the roaring and screaming and crashing of a falling IV pole. The wardsman was so stunned by what he saw that all he could do was gawk! Several times mum had to yell at him to go and get reinforcements – as many as possible! Meanwhile mum was left trying to hold down his arms, ducking to avoid punches, trying not to trip on the fallen IV pole and blood soaked floor, and trying to keep that NG tube in-situ. Mum said she learnt that rubber soled shoes become extremely slippery when they come into contact with a floor being rapidly covered in copious fresh blood, and “if it wasn’t for the adrenaline coursing through my veins I would have been a blubbering mess huddled in the corner” – that came later…….
Real help quickly arrived – two RNs, the RMO, and following on, the resusc team. But even trying to hold the honourable (now ‘Mastifflike”) Mr Etho down required four staff members with very big muscles – his level of anxiety, aggression, and probably fear, escalating the more we tried to restrain him. It is amazing just how much strength a person can acquire during a state of such mania!
Even with successful restraint, the resusc team had to try and find venous access to administer sedating medication. Long gone was his IV cannula, and with thrashing arms and legs and gnashing jowls, the team had to settle for intra muscular administration, and then wait until it took effect.
Twenty minutes passed and still the honourable (now ‘Mastifflike’) Mr Etho maintained his level of anxiety, aggression, and probably fear, thrashing and roaring. More IM medication administered – more waiting and restraining. Was the honourable (now ‘Mastifflike’) Mr Etho hypotensive? hypovolaemic? hypoxic? tachycardic? about to die? – No way of knowing as it was impossible to check his vitals and with no IV access, impossible to administer any fluids.
Mum’s thoughts: stay calm…….., the situation is totally still out of control, I think this is all my fault, I hope he doesn’t die, I hope my other patients don’t need anything because it’s just too bad if they do!
An hour after the arrival of the cavalry, the honourable (now not quite so ‘Mastifflike’) Mr Etho began to calm down and fifteen minutes later the resusc team had achieved a level of sedation adequate to transfer the honourable Mr Etho to high dependency for assessment, monitoring, and patching up.
Mum was left with clearing the devastation, and catching up on her other patients. She described the room as looking like one from a murder scene. The soiled blood soaked bed linen strewn across the floor mixed with blood covered IV pole, discarded IV infusion bag, mattress and bed rails covered in blood, discarded wound dressings where the team had attempted to stem the flow of the honourable Mr Etho’s haemorrhaging from arm, abdominal drain site (they were quite large back in those days) , and leg.
Mum didn’t even attempt to clean her shoes; she threw them out as soon as she could get them off her feet and the long shower she took couldn’t wash away her feelings of distress for the honourable Mr Etho, and her feelings of failure and guilt.
So the next time you have to make a PACE (MET) call for a slightly abnormal parameter, and perhaps thinking what a waste of time it is, remember Mr Etho being “a little bit agitated” with a “slight tachycardia”, and remember my mum.