‘You’re a man,’ someone said to me when I explained that I was the agency nurse for the afternoon.
‘Last time I looked,’ I replied.
‘I can make good use of a man,’ she added, a thoughtful expression on her face.
The woman with the acute observation skills was Stephanie, the charge nurse for the afternoon. I took notes while she read off a list of patients, their problems, and divvied them up among the four other staff nurses. I waited for my names, but received none.
‘Um, Stephanie, you haven’t given me any patients.’
Stephanie smiled and nodded her head.
‘That’s right. I’ve got a very special patient, just for you.’
‘But, one patient?’ I added, wondering what exactly she meant by special.
‘Oh, don’t worry. We meant to cancel you, but never got around to it, so we’re one staff up. Don’t panic – we treat our agency staff well here.’
The patient Stephanie was going to give me was a young man who was away from home, alone, and had been in hospital for eight days. He had just turned 18.
Stephanie took me to his room and introduced him to me as Jan.
I immediately found myself unable to take my eyes off him –even though I had known what I was going to see. From the whites of his eyes to his bony ankles, Jan was yellow.
‘As you can see, he’s extremely jaundiced,’ Stephanie explained. ‘The doctor is very worried about him. We should be getting some test results today.’
I’d seen plenty of adults with Jan’s condition, whether due to liver disease, obstruction in the ducts to and from the gall bladder, or cancer, but I had never seen an 18-year-old boy with such discoloured skin.
The yellowish pigmentation you see in jaundice patients is a result of the liver’s inability to remove bilirubin. Bilirubin is made up of red blood cells which have naturally broken down. It combines with bile (which is produced in the liver) and is normally excreted in the bowel motion (it’s what gives a stool its yellowish/brown colour). If this process is impeded, the build-up makes the skin turn yellow.
‘Hello Jan,’ I said.
Jan looked at me with a smile on his face. ‘Dzien dobry, hello, hello,’ he replied.
‘How are you?’ I asked.
‘Dzien dobry, hello,’ he repeated.
I looked over at a sheepish looking Stephanie.
‘His English is not the best,’ she confessed. ‘I think he could do with some male company. He’s had nothing but women around since he’s been here.’
I knew some people who would pay good money to be surrounded by women all the time, but I suspected Stephanie had a point.
‘We have an interpreter coming in about half an hour. The doctor is going to give him the results of the tests he has had done,’ Stephanie said before leaving the room.
What does one say, or do, with a yellow-tinted Polish teenager who has very limited English? Speak slowly and loudly.
‘I.Am.From.Neeeew.Zeealllaaaand.’
Jan looked at me. His brow was knitted in concentration, but there was no sign of comprehension.
‘Do.You.Need.Anything?’
I still saw no indication that he understood, although he was smiling – obviously enjoying the entertainment. I was about to ask something different, when Jan interrupted me.
‘You are funny. When the doctor here?’
His English didn’t seem so bad after all.
Half an hour later, two women accompanied Stephanie into Jan’s room. One had the usual white doctor’s coat and was introduced as Dr Brown; the other was dressed in casual, but tidy clothes. Her name was Kasha and she was the Polish interpreter. No one was smiling; in a flash the mood changed from awkward and amusing, to sombre and serious.
‘We have the results back from your tests,’ Dr Brown said.
Everyone waited while Kasha translated.
Jan nodded his head.
‘I’m afraid it isn’t good news. You have cancer of your liver.’
After Kasha translated Jan sat there unmoving, silent, staring ahead.
‘Can you treat it?’ Jan asked through Kasha.
‘We can try. We want to begin treatment tomorrow. I can’t promise you anything. It’s looking very serious and I’m sorry to say, but there is a chance that treatment may not work.’
Rarely had I heard such blunt words from a doctor. Normally they were a bit more diplomatic, usually waiting until treatment had begun before talking about success or failure. For Dr Brown to be so frank the cancer must be well progressed. Jan seemed to come to a similar conclusion.
‘How long have I got?’ Jan finally asked Dr Brown.
There was no answer.
I looked at Stephanie, she was staring at the ground. The doctor sat on the bedside and clasped Jan’s hand.
‘We don’t know for sure. The sooner we get started, the better.’ The translator stumbled over her words and had to repeat herself. But the answer wasn’t good enough for Jan. He again asked how long he had.
I could see Dr Brown struggling with an answer, but Jan again insisted on a time frame.
‘Maybe a year. Maybe four months,’ Dr Brown finally said. ‘But we don’t know for sure. You could respond well to treatment. It’s just too early to tell.’
Jan’s calm exterior cracked and tears streamed down his face. I sat down at the foot of the bed, my legs weak. Stephanie and Kasha sat down as well and grasped Jan’s hands in their own. No one spoke.
Eventually Jan’s whispered voice filtered through: ‘Mum and Dad will be here in two days. Don’t tell them anything yet. I don’t want them to worry.’
Stephanie, Dr Brown and Kasha made to exit the room.
‘Is there anything you need before we go?’ Stephanie asked.
After Kasha translated, Jan shook his head. I got off the bed and looked at Stephanie, my eyes pleading don’t leave me here.
Ever-observant, Stephanie asked Jan if he wanted me to stay.
Jan looked at me.
‘Yes,’ Jan replied in English.
Just before Kasha left the room she pulled me aside.
‘He understands a lot more English than you think. Stay with him. He likes you, and he shouldn’t be alone right now.’
What does one do with a yellow-tinted, Polish teenager who knows a little English, and has just been told he may die within the year? You sit in silence because there is nothing to say. Even if there was, I couldn’t be sure exactly how much he would have understood. I got off the bed and turned on the television. I sat with my eyes glued to the screen, waiting for him to make the first move.
‘Do you have girlfriend?’ he asked me.
His question caught me off guard. ‘No. No one will have me.’
I guess he understood because he managed a small smile.
‘Do you have one?’ I asked in return. He shook his head and managed a small chuckle.
‘Not get girlfriend now. Not this colour.’
It was a clever remark, but I didn’t find it amusing. I pictured myself in his position, away from all my family, counting my life in months, weeks, days; I’m sure I would never laugh again. Maybe Jan was being brave for my sake. Maybe he needed to be alone after all, so he could let it all out: cry, howl, scream, punch, hit, slam something.
I considered leaving, but then wondered if it might have been me that had the problem?
I’d never been in this situation before. Until then everyone who had died or was expected to die had been old. It was always sad, often unfair and it could be heartbreaking, but it was more acceptable than this, and was easier to cope with.
‘It’s okay,’ Jan said to me. ‘It’s okay.’
What was he talking about? I got the feeling he was trying to reassure me. Was I being that transparent?
Jan turned his attention to his bedside cabinet; he pulled out a small stack of magazines, and handed me one from the top.
‘Good shit,’ he said.
I was holding a porn magazine.
The next hour was one of the most unusual of my life. A young Polish man with limited English and a New Zealander with a dreadful, drawling accent tried to rate the talent of each woman on display. When I eventually left I felt, if not exactly happy, at least a little more at peace with the world.
So far, in the few months that I’d been working in London, I had worked with people from all over the world. And, it didn’t matter whether people were from deepest Africa, Norway, South America, or any place in between, if a person had a sense of humour, it could make a bad day, good.
‘You won’t be having any patients,’ said a tall blonde nurse.
Her name was Susan and she seemed very serious. I suppose that wasn’t surprising considering the area she worked in.
‘It’s not that we don’t trust your abilities as a nurse, but we don’t know you and this is a very specialised area. We can’t afford to get things wrong here.’
I nodded my head, and kept a solemn expression on my face. Some nurses might have been offended by being told this, but I took a different view. In fact I couldn’t think of a better job; no patients and a full day’s pay. I made a mental note to thank Tracy back at the agency for setting me up with this one.
‘Fine with me, I’m just here to help out – but what exactly
do
you want me to do then?’
‘We need someone to regularly check everyone’s observations, their pulse, temp and blood pressure every hour. The patients here can become very unwell very quickly. Is this okay with you?’
I nodded my head.
‘Do you have any questions?’
I was worried about how ignorant I would sound, but I had a few that I felt I really did have to ask.
‘Susan, this is all very new to me. I mean I’ve heard of heart transplants, lung, liver and kidney transplants, but I don’t know the faintest thing about bone marrow transplants. I don’t even know what sort of things I need to watch out for.’
I was given a quick rundown of cancers of the blood, or in more medical terms, leukaemia. I was also reminded of how susceptible a leukaemia patient is to infection, because the body has very few white blood cells left to defend it.
‘Whatever you do, don’t be afraid to ask for help,’ were Susan’s last words.
‘I’ll be careful,’ I promised as I headed towards room 1 and cautiously opened the door leading into the first patient’s room.
‘STOP! Don’t use that door,’ a voice yelled out at me.
I turned around to see Susan gesturing to another door.
‘Never walk directly into a room, always use the side room. And always wash your hands and put on a gown.’
I had been wondering why all the rooms seemed to have so many doors.
‘Sorry, won’t happen again,’ I said. I hurriedly shut the door, then headed into the side room to prepare for entry.
By the time I had washed, gowned, gloved and masked up, I was becoming a little worried at what I would find in the room. Exactly how sick was the patient going to be? I peered in through the small window in the door to get a look at the occupant, Mr Tait.
I’d seen some terrible sights in the few short years I’d been nursing, but the sight of Mr Tait’s face made me panic – I was certain I was staring into the face of death. His cheeks were grossly sunken and hollowed, the bags under his closed eyes stretched down to his cheeks. His skull was emaciated and his skin was a greenish yellow. My eyes wandered down his body to his chest, where I was looking for movement. I eventually saw some, a very slight rise that told me he was still alive.
Mr Tait’s eyes opened and he briefly glanced in my direction then closed them again.
‘Water,’ he rasped.
There was a jug and an empty glass in front of him. He didn’t have the strength to pour for himself so I made myself useful. A thin arm reached out and clasped the glass, then slowly, almost painfully, brought it to his lips. He took his first sip.
‘Arrrgh.’ His sudden cry literally made me jump.
He glanced up at me again and grimaced . . . no, it wasn’t a grimace, he was smiling.
‘I look like shit and I feel even worse,’ he said to me. ‘I would give anything to take away the pain.’
My second lesson of the day: bone marrow transfusions are painful.
‘Where’s the pain?’ I asked, trying to figure out where it could possibly be. The whole body perhaps? Or maybe deep down in his bones?
‘My mouth,’ he answered.
‘Your mouth? What’s wrong with your mouth?’
He opened up as wide as he could, and I brought my face close to get a good look. His mouth was a mass of raw, red ulcers, some of which oozed. I pulled back suddenly, trying to make it look as casual as possible.
It seemed Mr Tait could read me like a book: ‘It’s a side effect of the treatment; they have special medicine for me. Go get me some,’ he ordered.
I didn’t question him and went in search of Susan. I caught up with her in the treatment room.
‘Everything okay?’ she asked.
‘Well, yeah, I suppose. But Mr Tait’s asking for something for his ulcers. He said there’s a special medicine?’ I explained.
‘Oh, that’s no problem. Here, take this. This is the mouthwash he’s talking about.’
I looked at the label on the bottle of liquid in my hand.
‘Ah Susan, are you sure this is right? You want me to give him this as a mouthwash?’
It was unlike any treatment I had ever used – or even heard of being used – in this way before.
‘Sure, it’s no problem. We use this all the time. We go through heaps of the stuff.’
Mr Tait wasted no time in ordering me to pour him a generous portion.
His drug chart said between five and ten mls, as often as required. He requested ten.
As I poured, I worried what sort of side effect he could experience.
‘Um, aren’t you supposed to spit it out?’ I asked Mr Tait as instead of spitting out the mouthwash he swallowed it.
‘No,’ was his monosyllabic reply. He then ordered me to pour another ten mls, which he again swallowed.
The next patient I saw was Mr Henry. He didn’t look anywhere near as ill as Mr Tait, but he too had some very nasty mouth ulcers.
‘Can you get me some of the mouthwash, they’re really bad today?’ he asked me as I sat there measuring his observations.
The scene with Mr Tait was repeated.
When I again questioned the swallowing of the medicine, he sounded a trifle offended: ‘Of course not. Don’t be ridiculous. If you ever end up like me, and I pray you never, you will understand.’
I quickly left the room.
‘I understand that your mouth ulcers are particularly painful today, Mr Johnson,’ I said.
‘Worst they’ve been for quite some time,’ he said, as he showed me just how bad they looked.
I was steadily becoming suspicious but I didn’t want to upset another patient and I repeated the cycle again, except this time I refrained from saying anything when he didn’t spit out the mouthwash.
The ward had a total of 12 patients and out of those 12, eight had requested mouthwash and five had swallowed it. An hour had gone by and I was back in Mr Tait’s room to check his observations again.
‘Good to see you again,’ said Mr Tait when I walked back in.
Well, he certainly seemed a bit brighter than before.
‘You’re new here. How you finding it?’ Mr Tait still sounded terrible, but he was definitely a bit brighter. I left Mr Tait’s room with a nagging feeling that I had messed up. I could only hope no one noticed.
Susan caught up with me before I had a chance to check on Mr Henry.
‘The patients seem very cheerful this morning,’ she said to me. I had a sinking feeling in my stomach.
‘I notice on the drug chart that quite a number of patients have had mouthwash; more than normal, in fact. Have you been making sure the patients spit out their mouthwash?’ she asked me. ‘After all it is hospital quality cocaine they’re using,’ she added.
I shook my head.
‘Don’t believe them, if they tell you they’re supposed to swallow it. They try it on with all the new staff.’
Susan left the matter at that, although I swear I could see a hint of a smile at the corners of her lips.
That was the first time I’d seen cocaine used in hospital. In this case, it was the best medicine for the terrible ulcers that are a common side effect of the treatment these patients receive. Apparently nothing works as well as cocaine mouthwash. The medicine is not to be swallowed, but the dosage is actually very small, so no harm done if they do.