Michael Alexander: Confessions of a Male Nurse

Russell also had some experience working in the other areas. All doctors, in both New Zealand and the UK, have to spend some time in each of the main areas of specialisation. The common areas are surgery, paediatrics, obstetrics & gynaecology and orthopaedics. Of course, each of these general fields has many subcategories.

Russell had been working in our hospital for just over a year, six months in general surgery, six months in general medicine, and now the emergency department.

As entertaining as his remarks about wanting to sleep his way around the world were, I wanted a serious answer.

‘I’m glad you like the women here, Russ, but how do you like our department so far? How do you find the emergency room?’

‘Ach, it’s a bit worrying at times, but hey, I’ve always got you around to keep me out of trouble, eh?’ Russell said jokingly as he gave me a wink.

As Russell and I sat around sharing stories, Mrs Reid was brought through to the minor injuries area, clutching her left hand to her chest.

‘Can ya check that out for me, mate?’ Russell asked me. ‘It doesn’t look too serious.’

In the two weeks Russell had been in our department, I had discovered that he was the master of delegation, but no one seemed to mind, not even the person getting the instruction.

I sat Mrs Reid down on a bed, and began to undo the towel she had wrapped around her hand.

‘What happened?’ I asked.

‘The bloody kitchen knife,’ she replied, holding out her hand. She had a pretty nasty laceration running the length of her finger.

‘We bought one of those new ever-sharp kitchen knives; the ones that sharpen every time you put them away in their sleeves,’ Mrs Reid began to explain. ‘The damn thing has cut us all. My husband, my son and my daughter.’

I nodded my head in understanding. Generally we try not to suture up fingers. They can heal very well without stitches, often we can get by with paper strips to hold the wound together, but in Mrs Reid’s case it was too big a cut.

‘It looks like you’re going to need a few stitches; I’ll get the doctor to take a look.’

Russell didn’t mind dealing with anything to do with fingers and toes; they were usually easy to treat.

‘Won’t take long, Mrs Reid,’ Russell began to explain, once he’d taken a look at her injury. ‘A few stitches and you’ll be on your way home. I’ll pop in a bit of local anaesthetic and you won’t feel a thing.’

With this, Russell began to get things ready.

I watched as Russell grabbed the wrong vial from a cupboard, and briefly debated whether I should say something. Just because I know how to fix a particular injury one way, doesn’t mean it’s the only way. I wanted to give him the benefit of the doubt because maybe he knew something I didn’t, and I also didn’t want to make him look incompetent in front of a patient.

However, I eventually had to step in.

‘Um, Russ, here’s some different anaesthetic,’ I said, opening a second cupboard, ‘without adrenaline. Which one do you want?’

If you use adrenaline-laced anaesthetic on a finger, it can cut off the blood supply. Russell took a second look at the vial he was holding, before quickly exchanging it for the right kind.

‘I think I’ll take the one without adrenaline this time, no need to go overboard,’ he said with a smile and a wink as if he had things completely under control, even though Mrs Reid could have lost her finger if he’d gone ahead.

‘Just a little sting, then you won’t feel a thing,’ Russell said to Mrs Reid. ‘It will go numb pretty quick.’

Russell held Mrs Reid’s hand in his, with her palm facing down, and began to inject the anaesthetic into the base of her finger.

‘Nearly done, Mrs Reid,’ Russ said. ‘Can you just turn your hand over and I’ll numb the other side of the finger?’

Like the good and trusting patient she was, Mrs Reid did as she was instructed. Russell began to inject the other side of the finger.

Something didn’t look right. Again, I wanted to say something, but hesitated because I didn’t want him to look foolish. Surely Russell couldn’t be that stupid. I felt it must have been a technique I didn’t know. I knew he’d be pissed if I interrupted again.

‘Interesting technique, Russ,’ I said, trying to prod him into explaining himself.

‘Ach, it’s nothing, pretty basic really,’ he explained. ‘It’s the sort of thing anyone could do. You can’t go wrong, laddie.’

He touched the tip of the third finger from the thumb.

‘You shouldn’t be feeling a thing, Mrs Reid,’ he said as if he had casually performed a small miracle.

‘Well, I don’t feel a thing, but what about my middle finger? It’s still pretty sore.’

The triumphant look faded from Russell’s face. He looked at me accusingly.

‘How could you let me do the wrong finger? You watched me do it and said nothing.’

There wasn’t a lot I could say. I should have spoken up, but it was his bloody fault, not mine.

‘I’m terribly sorry, Mrs Reid,’ Russell said. ‘I feel a bit of a fool. Give me a moment and I’ll fix it up.’ Luckily for Russell, Mrs Reid wasn’t upset, in fact she laughed. It was the Russell charm at work. No one could resist it.

Two days later, Russell still hadn’t completely forgiven me.

‘Ya stood and watched me fook things up. Fookin’ lot of good you were.’

He said it jokingly, but the Dr Russell McDonald charm was wearing a tad thin on me.

‘Get over it, Russ. You screwed up, not me.’

Later that afternoon, Miss Hope was brought in by ambulance.

‘She fell off her horse. She’s a race horse trainer. The horse stood on her thigh. It looks pretty bad,’ the paramedic explained to Russell as we all helped transfer her from the stretcher on to the emergency room trolley, ‘but I don’t think she’s ruptured an artery.’

Miss Hope chose that moment to scream out in pain.

‘Arrrgh, hell, oh bloody hell.’ She then began to weep.

‘We’ve given her ten milligrams of morphine, but when we move her she screams in agony,’ explained the paramedic.

There were muffled gasps of horror when the extent of Miss Hope’s injury was revealed. Her right thigh was most definitely U-shaped. I glanced briefly at Russell to gauge how he was coping. I’ll give him credit, he looked calm and in control.

‘What next?’ I asked Russell.

I knew what to do, as did the nurses around me, so we got to work monitoring her pulse and blood pressure. Someone put in another IV line and took blood for a cross-match, another got a bag of fluids ready.

‘Let’s leave her leg briefly. I need to check her out,’ Russell said as he began at Miss Hope’s head and worked his way down, checking for any other injury.

Thank goodness he said the right thing, because after his last screw-up, I needed to be reassured that he knew what he was doing.

Whenever a serious admission comes into hospital with an obvious injury, it’s easy to focus on that one injury because it’s so glaringly obvious. But what mustn’t be forgotten is a check of the rest of the body, to make sure there are no other injuries. For all we knew, Miss Hope could have been briefly knocked unconscious when she fell. It would be pretty awful if we fixed her leg up, and missed a small but lethal bleed in the brain.

Once Russell was satisfied that Miss Hope had no other injury, he began to deal with her pain.

‘What do you think, Dr McDonald?’ I asked, not really sure what would be best for Miss Hope as the intravenous morphine wasn’t as effective as I had hoped.

‘Femoral block, that’ll do the trick, then off to theatre.’

A femoral block is an injection of pain killer into the groin on the affected side. The anaesthetic is extremely effective as it completely blocks the pain. It’s short lasting, only an hour or two, but it would be enough to keep Miss Hope comfortable until she was taken to theatre.