Most people will have heard of the Hippocratic Oath at some time or another. Issues of ethics and medicine are pretty tightly bound together, wherever you are. I have encountered similar moral dilemmas in both New Zealand and the UK, particularly when it comes down to the right to confidentiality. Sometimes it can be rather riling that medical staff cannot discuss patients, but they are free to discuss us. But then again, everyone needs to have someone they can turn to in complete privacy, when they may have no one else, and I’m happy to be able to be that person.
Things are rarely black and white, take these occasions for example:
The woman in question had been a psychiatric patient in my care. She was a very unstable schizophrenic and spent the majority of her life in and out of the psychiatric unit. This was a real tough one for me. I strongly believed in her right to be treated like a normal person, and in this respect, I should have let my friends chat her up. But at the same time, she was a genuinely troubled soul and I couldn’t let a friend walk blind into a complicated situation. In some of her lucid moments, I’d heard her refer to her psychiatric medications as rape drugs. Ultimately, I refused, and my friends were pissed. But I left the pub and my friends followed me, none of them any the wiser.
Nursing boards in both New Zealand and the UK insist that we spend so many hours each year updating our skills. This generally includes things like basic CPR and correct lifting practice, as well as anything else that a nurse is particularly interested in. These hours can be fulfilled on an individual basis, or sometimes hospitals put on special conferences where guest speakers come to speak to the assembled nurses.
I hate to say it, but as a rule these mass education sessions can be a bit boring, particularly when you’re learning about things you already know. But for me there is one major exception, which is when we’re discussing ethical issues like confidentiality. As challenging and complex as these sorts of issues can be to deal with in real life, in the classroom, I enjoy them. I’ve always enjoyed a good debate – although my wife would say ‘argument’.
On one particular occasion, as part of our ongoing education, I was one of about a hundred nurses receiving a lecture on patient care ethics. The union rep caused quite a stir. She said that ‘Nurses should be discouraged from marrying their patients.’ There was a loud murmur of disapproval around the room, which surprised me. I didn’t think this was such a big deal. In fact, I assumed that most nurses would realise this, but I guessed from comments I overheard – which ranged from ‘That’s bullshit’ to ‘Who the fuck do they think they are?’ – that more of my colleagues than I’d imagined had married people they’d looked after.
The speaker also seemed surprised by the hum of displeasure, and although she didn’t back-pedal, she did become slightly more conciliatory: ‘Well, of course, we can’t stop you, and, of course, nothing would happen regarding your registration, but we do recommend that you do not enter into relationships with your patients.’
The rep then asked for a show of hands of nurses who had married patients. I got quite a surprise when I saw that nearly a third of nurses put up their hands.
To be honest, I think this is fine. Hell, most male patients, of all ages, flirt with the nurses. So I’ve seen many of them make the first tentative moves.
On the other hand, things are a little different when the nurse is a male. Friendly as I endeavour to be, I would not want to be seen to be genuinely flirting with a patient. Nor have I often experienced female patients making the first moves on me.
That said, sometimes it’s different outside of the hospital. I was at a bar one Friday night when a woman came up to me and with no warning, kissed me on the lips. She was very attractive and I naturally responded.
‘You don’t remember me, do you?’ she finally said when our lips parted.
I was racking my brain, desperately trying to recall who she was. My future sex life might depend on me remembering where I’d met this woman before.
She just smiled. ‘Don’t worry, I’ve changed a lot. You looked after me when I had my surgery. I just wanted to say thank you for being such a great nurse.’
I suddenly remembered who she was. Not her name, damn it, but at least the circumstances. She had had Crohn’s disease (inflammation of the bowel) and had needed an operation. She was obviously doing well as she’d put on some healthy weight, and looked positively gorgeous . . . My hopes remained high. Until: ‘I have to go, my boyfriend will be here soon, but I just had to say thank you.’ She gave me another kiss on the lips, then disappeared into the night.
That’s about as close as I ever came.
About a year into my time in the emergency room, I began to feel competent – if competent meant knowing when and where to get help. Every day was a learning curve, and if it wasn’t a new disease or a bizarre accident that kept me on my toes, then it was something psychological or emotional.
The hospital environment is a place where we meet the good, the bad and the just plain messed up. On any given day you will see the wealthy sick, the poor sick, the rude sick and the bad sick. And then there are the children. Infants are my one true weakness, I turn into a bumbling, useless idiot; they are so small, so fragile, so completely dependent on you.
It was three o’clock on a Friday afternoon the day I met baby Alice. Things were just starting to get busy; it was only a matter of time before the usual Friday night alcohol-related injuries began trickling in: assaults, car accidents, comatose intoxicated.
Beeeeeeeeep!
I still always jumped when the blue phone rang. It was so loud, the whole department could hear it. It wouldn’t have surprised me if one day it gave a patient a heart attack. The blue phone is the phone used by paramedics to give us advance warning of a particularly sick patient that’s coming in. So, as ever, I picked it up expecting the worst.
‘Ambulance 13 to hospital; do you read me? Over.’
‘Hospital receiving; go ahead, ambulance 13,’ I replied.
‘We have on board a 27-year-old woman and a three-month-old infant. Please have security waiting when we arrive.’
I was a bit surprised; they would usually say what was actually wrong with the patients; they didn’t even say which, or both, needed to be seen. That got the alarm bells ringing. Why didn’t they tell us anything? It probably meant that the mother was causing trouble.
I went to stand in the ambulance bay beside the hospital security guard, Jamie, the world’s
smallest
security guard. It’s a strange phenomenon, but most hospital security guards I’ve met tend to be either a bit undersized or look near retirement age.
‘Give me back my baby, you bastard.’
The woman wasn’t even in through the hospital doors yet, but she could be heard by everyone.
‘She’s my baby, fuck you. Fuck you all! Give her fucking back.’
The woman made a grab for her child, but tripped over her own feet, landing on the ground with an audible thump.
I’m not picking her up, was the first thought that went through my head. I didn’t move from my spot but glanced down at Jamie.
‘Looks like you’ve got your hands full there, Jamie. Don’t take any crap from her,’ I said.
Jamie, a veteran, had dealt with situations like this before and prudently made a call to the police.
I then saw Alice, she was cradled in the arms of Tim, our gentle-giant of a paramedic. Alice was beyond tiny; she was the littlest human being that I can remember seeing. She was gorgeous, even while crying at the top of her lungs.
‘She hasn’t stopped howling since I’ve had her,’ said Tim, as he handed baby Alice to me.
Even howling didn’t feel like a good enough word. This was a scream, a high-pitched wailing noise that sent shivers down my spine.
Tim must have read my mind. ‘I’ve never heard a scream like it. It gives me goosebumps.’
As I carried Alice through to the treatment room, I briefly ran my eyes over her. I could see no sign of obvious injury. There were no deformed limbs, no bruises, lacerations, not even any bleeding. But that scream was triggering a memory deep down inside of me. I couldn’t quite place my finger on it yet, but I knew it was something important.
‘We were called to the supermarket at 1400 hours by the manager of the store,’ Tim explained. ‘Mrs Lawrence was on the escalator. Witnesses say she tripped and landed on top of her baby.’
The more Tim said, the more rapidly the memory found its way up from the depths.
‘Mrs Lawrence claims she has only had a few drinks but as you can see she is very intoxicated. She was refusing to come to hospital to get Alice checked out but soon changed her mind when I threatened to call the police.’
At that moment the memory surfaced and I knew, without a doubt, what was wrong with Alice.
I glanced back out into the ambulance bay, to see Jamie picking Mrs Lawrence up off the concrete.
‘Get your fucking hands off me, you bastard.’
Mrs Lawrence wasn’t letting up with her verbal assault.
She was heading towards Tim and me, all the time continuing with a non-stop barrage of abuse that would make the most weather-beaten sailor blanch. By this time, Jamie had the help of two of my colleagues and, between the three of them, they herded Mrs Lawrence into a side room.
‘I swear if she comes near me I’ll lose it,’ I told Tim.
I gently laid Alice down on the bed. That was a mistake. Just when I thought I had heard the worst that baby Alice’s lungs had to offer, her screams jumped up several octaves, so I quickly picked her back up and with Alice held close I carefully made my way next door to find the consultant on duty.
Dr Nelson wasn’t exactly a consultant; he never got around to sitting his final exams, but he was the backbone of our department. After 20 years of service, he had seen it all.
‘I think you’ve got a sick one there,’ he remarked calmly to me. ‘Let’s have a look, shall we.’
I wished I was as calm as Dr Nelson, instead I blurted out the obvious, ‘The screaming is really bad, doc; it gets even worse when I lie her down.’
I didn’t want to appear like a drama queen, and I didn’t want to sound stupid if my diagnosis was wrong, but I had to speak my mind. One of my nursing tutors had told me about a special type of cry a baby makes, a cry that sets your teeth on edge. She had no other words to describe it, but she’d said we’d know it when we heard it.
‘I’m worried she has a fractured skull.’
Dr Nelson calmly began to examine the baby.
‘I think you’re right, well done for bringing her to me straight away.’
The plan of action was to arrange a head CT as soon as possible. This is a pretty serious test to carry out on an infant, not only does it expose the baby’s brain to potentially damaging X-rays, but you can’t ask a baby to keep still, so they need to be put to sleep, and putting an infant to sleep with a head injury is really a big deal.
As we made arrangements with the anaesthetic consultant and his registrar, we heard a male voice bellow from reception: ‘Where’s my fucking baby? I want to see my baby now.’
Judging from the language being used I guessed this must be Dad. The poor receptionist didn’t get a chance to respond as Dad came charging into the department. I really shouldn’t judge people by appearances, but I’ve found in the emergency room that often first impressions are worth something. Dad was skinny, pale, goateed, tattooed and shaven-headed. He was also drunk. He reeked of heavy spirits and was at least as intoxicated as his wife.
‘I’m sorry, Jay. I’m so fucking sorry, so sorry,’ sobbed Mrs Lawrence, as she ran in, trailed by Jamie. ‘They won’t let me see her. The fucking arseholes won’t let me near her.’
‘Get them out of here now,’ Dr Nelson said in the kind of tone that makes people bolt into action.
Jamie took hold of Mrs Lawrence.
‘Get your hands off my fucking wife, you little bastard,’ yelled Jay.
Thankfully, Tim the paramedic was still there, and moved to physically remove Jay from the department.
‘I’ll fucking sue the lot of you,’ Jay said as he was led away. But he wasn’t resisting; he was sensible enough not to push his luck any further. He tried a new tactic; one which I have seen many times.
‘Look, I’m really sorry, guys. I’m just worried about my baby. Please, I’m really sorry.’ He knew he had gone too far, realised he could end up being led away in handcuffs, and now he was trying the oh-so-caring-dad routine. ‘Please, just tell me what is going on.’
‘Your daughter is seriously unwell, Mr Lawrence. It looks like she has a fractured skull. She will be put to sleep and a scan will be done of her head,’ Dr Nelson said. ‘Depending on the scan, there is a possibility she will be transferred to another hospital in another city, where they have a specialist intensive care unit for infants.’
When Dr Nelson talked everyone listened, it was those years of experience and the accumulation of knowledge filtering through every word he said. I actually thought he was getting through to Mr Lawrence.
‘What did my wife do?’
Dr Nelson told him the full story – and Mr Lawrence turned his rage on to his wife.
She was standing in the doorway of her cubicle with the door half closed, ready to slam it shut if her husband made a sudden move towards her.
‘Not your fucking fault!’ Mr Lawrence said incredulously as Mrs Lawrence attempted to defend herself. ‘You got pissed and fell on my baby. How the fuck isn’t it your fault?’
‘If you spent any time at home, you’d know just how it’s your fault. Instead you’re always at the pub, pissed.’
Mrs Lawrence looked directly at me.
‘Do you know he can’t get a job? We have no money and he pisses it all away. I married a fucking loser.’
Before we had time to react, Mr Lawrence charged towards his wife. She tried to slam the door shut, but he easily forced it open. In the seconds it took us to catch him, Mr Lawrence managed to deliver two hard fists to his wife’s face. After making sure she was going to be okay, Mrs Lawrence went home with a social worker and Mr Lawrence went away in handcuffs after all.
Baby Alice did have a skull fracture but that was the last I saw of her; she was wheeled into the intensive care unit, to await transport to another hospital, in another city.
It wasn’t until three months later that I eventually heard that she had made a full recovery. I also discovered she was back with her parents. This is sometimes the most frustrating part of the job, knowing that you can only fix a small (sometimes temporary) part of an often greater problem. All I can do is have faith that the powers that make this sort of decision are making the best choice for the child.