Michael Alexander: Confessions of a Male Nurse

‘How bad is the pain now?’

I didn’t get a chance to hear how the pain was, because the call bell in Mr Simpson’s room went off, and continued to go off. It wasn’t stopping. I ran to his room.

‘Oh shit, it’s agony,’ Mr Simpson said as soon as he saw me.

I looked at his thigh and knee and placed my hands on them. I could feel something hard in his thigh. It wasn’t swollen to the naked eye, but I could definitely feel a lump that wasn’t there before. It was also hot. By the time I went to feel for a pulse in his foot, the other nurses on duty that shift were in the room.

Katie took charge, and within minutes had the doctor at the bedside. Katie told a terrified Mr Simpson that his graft wasn’t working, and that he needed to go back to theatre.

The head surgeon was urgently called back into hospital. During the next hour, myself, the junior doctor and the registrar made what preparations we could to get him to theatre. That hour was probably the most terrifying in Mr Simpson’s life. There was a chance that he would not only never play golf again, but possibly lose the leg altogether.

When he finally left for the operating room, the last of the adrenaline left my body and I felt physically and emotionally drained. It was also at that moment that I remembered Mr Dexter and his chest pain, as well as my other four patients that I hadn’t seen in all that time. I ran to Mr Dexter’s room, expecting to find him either clutching his chest in agony or dead.

He was sitting up reading his book. ‘Are you okay?’

‘Why shouldn’t I be?’ he replied.

I briefly felt relieved, but I rushed to check on my other four patients. Their medications were late…

… but they’d all had their meds. They were comfortable. All their needs had been taken care of.

Katie and the other nurses had seen to every one of my other patients.

This kind of generosity was not to be unique. Over the next two years I learnt that, in this ward at least, it was normal; the nurses worked as a team, and always watched out for each other.

Part 1: Who is Mr Groom?

Feeling part of a team was what made nursing truly enjoyable for me. I no longer dreaded going to work each day. I didn’t have that nauseous feeling in my stomach whenever I had to approach a senior member of staff. The biggest improvement was in the confidence I felt about looking after more challenging types of patients, which was fortunate because I was about to encounter one of my biggest challenges yet.

‘Are you okay having Mr Groom again?’ asked Carol, the nurse in charge.

What could I say? No, I’m worn out, he’s too heavy, too much work?

I had been looking after Mr Groom for what felt like forever and was hoping for a bit of a break, but whenever it came time to allocate his nurse there was always a silence in the office.

My adventures with Mr Groom had begun four days ago. I had just returned from my days off. The problem with coming back from time off is that you are at the bottom of the priority list when it comes to picking and choosing patients. To be fair, everyone is generally pretty reasonable when allocating patients, everyone takes their share of the demanding ones, but every now and then there comes along one patient whom no one really wants to be responsible for.

The first time I had met Mr Groom, I couldn’t believe my eyes; before me lay a sweating, rippling, heaving mass of flesh, covered almost head to toe in traditional Maori tattoos. He was one of the most obese men that I have ever had to look after. He must have been at least 180 kilograms.

Carol tried to be encouraging. ‘He needs someone strong and you’ve done so much for him; you’re good for him.’

I didn’t see exactly how I was good for him. We were too different. I come from an average white family, from an average white part of town. Mr Groom is an ex-member of Black Power, a gang with offices throughout New Zealand. Not a group to cross – even an ex-member – they eat boys like me for lunch.

‘Good morning, how are you?’ I asked Mr Groom.

At the sound of my voice he rolled over towards me, the bed springs protesting beneath him, and greeted me with a huge, gap-toothed grin.

‘Morning,’ he replied, then, after pausing to catch his breath, ‘Could be better, bro.’

Poor Mr Groom, he was only 35 years old, but he looked ten years older and had all the problems you would expect in someone twice his age. I could tell just from looking at his swollen legs, that it wasn’t all fat – there was fluid in them, a sure sign of a failing heart. Just to prove myself right, I poked my index finger into his ankle and left an indentation that faded away very slowly. Mr Groom’s joints also looked swollen and I wondered how much longer they would put up with being abused, before giving out completely.

Mr Groom had never been in hospital before, but he’d developed a bad case of pneumonia. In most 35-year-old men, a case of pneumonia would probably not need hospitalisation, but because of his weight he needed to be with us, especially now, because it looked like his condition was deteriorating.

With someone as big as Mr Groom, it’s never really just a simple case of pneumonia. He already had a diagnosis of heart failure. His joints always ached, and it was an effort to walk, even when well.

Mr Groom was drenched in a cold sweat, his hands were shaking, and as I clasped his wrist, I could feel his pulse racing. His eyes had a glazed look about them, as if he was in a world of his own. But it was his laboured breathing that caused me most concern.

‘How long has your breathing been this bad?’ I asked him.

Surely he hadn’t been struggling for breath all night? I knew the night staff would have done something.

‘It just got bad in the last hour’ – he paused to get his breath – ‘started about six this morning’ – pause – ‘came on really quick.’

He smiled again at me.

‘Why didn’t you call the nurse sooner?’

A rather pointless question, it wasn’t going to help, but I just had to know.

‘They had a busy night’ – pause – ‘didn’t want to bother them.’

Not the answer I was expecting.

There was no time to waste; I grabbed Carol who took one look at Mr Groom and immediately came to the same conclusion as I did. We went into the corridor to discuss our plan of action.

‘We need to get Dr Grey down here right away,’ Carol said.

‘Are you sure?’ I replied. ‘Why don’t we get the registrar instead?’

Dr Grey was the new junior doctor and had only qualified in the last few months. It’s an unfortunate truth that some junior doctors don’t listen to the nursing staff, and it looked like Dr Grey was turning into one of them. Just the other day we’d pointed out to him that one of his patients normally took his blood pressure medications in the evening before bed, because the patient said if he took them in the morning, he fainted. Dr Grey had disagreed and prescribed them for the morning, and sure enough the patient collapsed because of low blood pressure. The nurses were there to catch him. They also suggested perhaps reducing his dose, but this never happened either.

Carol thought over my suggestion for a moment or two.

‘You may be right, but we’ve got to give Dr Grey a chance.’

Fortunately, today Dr Grey surprised us all. He too took one look at our patient and did the wisest thing I had seen him do in three months. He called his registrar. Registrars usually have a minimum of four or five years of experience, and can usually be relied upon when complications arise.

The registrar took Mr Groom’s pulse. It was weak, but pumping along at 110 beats per minute. His breathing was rapid and shallow; he also had a high fever. Mr Groom had developed a sepsis – meaning the infection had got into his bloodstream – and a sudden worsening of his heart failure on top of his pneumonia.