Nella Martin

an appointment with a nurse in practice

Category: Nursing In Practice

Delightful Dawn Discoveries before a Working Day.

This morning I awoke at 04.30, I briefly considered going back to sleep before effortlessly slipping out of bed, grabbing some clothes without disturbing a snoring husband and deciding to go out to meet the day while it was brand new, fresh and dewy.
My first memorable encounter was on a narrow nettle lined footpath with an industrious Mistle Thrush, her beak was full of worms, we both stopped and looked at each other with interest, each of us waiting for the other to hop out-of-the-way. She reluctantly hopped a few paces forward not wanting to be the one to give way, claiming her superior right to be there when clearly I had very little, it being far too early for humans to be up and about.
When I reached the end of that footpath and turned into the lane that leads down to the Marina I stumbled upon a Muntjac deer, he was large and strong for his breed, he didn’t immediately bounce away, we surveyed each other with equal curiosity from a respectable distance before he leapt into the safety of dense foliage. I didn’t have time to muse over Mr Muntjac before spotting my greatest prize of early morning delights, two Little Owls, companionably sitting on a low fence by a barn. I’ve never seen them so near in the wild before and so definitely themselves. We all three paused as we took stock of each other before one flew away having decided that I was too much of a threat to remain, the other stayed put, boldly staring until I moved, half hopeful of photographing him or her with my mobile. I’ll go back there to see if I can see them again. I continued my walk along the sea wall coastal path, flanked by creeks and mud flats on one side and long grasses with rabbits that could barely be bothered to move away from me on the other side, it was just me with the furry and feathered creatures, caterpillars unfurling themselves to munch on nettles, and poppies and daisies opening up to greet the rising sun.
I arrived back home at 6.20, I was amused to see our Cat sitting in the middle of the road staring at our house intently, he was obviously awaiting the first sounds and sights of his humans being awake to let him in and feed him after his night-time adventures of shrew stalking. I took him by surprise and he meowed and mewled in no uncertain terms to tell me so. Husband was awake in bed and had noted my absence. Little daughter was still asleep under her duvet and didn’t even wake up when Cat settled himself down to sleep a purring on top of her.
Two hours later I was at the surgery ready to start a 9.5 hour day. My morning surgery was a mix of asthma and diabetes reviews, cervical smears and contraception checks. The morning ended with a home visit to a housebound elderly lady to give her a B12 injection. My knock on the door was greeted with a “Come in, it’s open” as I entered she said “Please help me with this dear, I’m in such a muddle and I can’t leave it.” She was leaning precariously on her Zimmer frame, trying to defrost her fridge freezer, the floor soggy, lumps of ice and bowls of water, frozen foods starting to defrost all around. I cleared up the floor and the water, collected up the last remaining stubborn chunks of ice, wiped it all out with a towel, put everything back in and switched it back on, that took about 20 minutes. Then I gave her injection!! “I’m so grateful nurse dear” she said several times over.
Lunch was very colourful today, I arranged it all on my plate to be so, tomatoes, avocado, orange, peppers, bread with cream cheese and watercress and yogurt. (Early morning walks make me extra hungry)
I started my afternoon surgery at 13.20, my most “challenging” patient was a 60-year-old Nepalese lady, she had received a letter for her first ever smear test. She came in with her husband and a male soldier translator friend. I had a Nepalese print out of smear test information but she couldn’t read in any language, I tried to establish if she knew why she had the appointment and they all pointed at the letter, when I explained to the interpreter friend in very basic details of what a smear test was and he explained to my patient, she looked aghast and gesticulated that the men leave the room, I nodded and showed them out! We communicated with body and sign language, we told each other that we both had three children, she two boys and one girl and I, two girls and one boy, I demonstrated how we would do the smear and she giggled like a young girl. Afterwards when it was all finished and I said that she could go, she gave me an unexpected big hug and a kiss on each cheek, we both laughed. Despite neither of us being able to speak a comprehensible word to the other we had connected and understood each other in many ways.
Straight from work I had to go to collect three little Brownie children from the scout hut. I dropped two off to the penultimate house in my lane and kept one for myself.
The little Brownie and I made stir fry veg with some noodles with a piece of baked salmon for dinner.
She is back in bed asleep and I think I will now go to bed also.

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All Bodies Great and Small.

In the beginning I was mostly interested in the bodies of small creatures, spiders, frogs, worms, snails, caterpillars, chicks that had fallen from nests. When we are very small, we are much closer to nature and wildlife, or did it just feel that way? I would once sit,  delighted and thoroughly entertained at watching little red spider mites crawling all over hot paving slabs or a stone wall. I now can’t remember the last time that I saw any. Are they still about but I have failed to notice them?
Do children still have funerals for dead butterflies and beautifully ugly, bald, dead blackbirds chicks? I can remember taking one with me to a Girl Guide camp, hopeful that I would be able to raise him after our cat ate his parents. He did of course die and I sadly gave him a grand little funeral with a decorated grave, then I dug him up again a few days later, eager to know how his little body was decomposing.
As I became older, human bodies began to hold a similar fascination, inside and out. Women’s bodies have always been the most interesting because they can grow and feed babies, men’s seem rather boring in comparison, a penis alone a poor consolation prize. A part of me has always felt a little bit sorry for men because of that. I’ve never met a man who laments not having this ability though, yet, somehow in many places all over the world Men even feel that they are better and more powerful than women. I’ve never understood this when they can’t even grow their own babies. I can remember having these thoughts at three to four years of age when my mother was pregnant with my sister and they have persisted over the years.
I’ve been nursing for many years now and have seen the bodies of many men, women and children. I cannot remember a man or a child ever apologising to me for their body, like the frogs and the spiders they mostly just unconsciously are, as they are, but it often saddens me that women almost always apologise for their bodies. They are sorry for their body hair, for stretch marks, for how fat or thin they are, if they might smell a tiny bit of anything other than perfume or deodorant. They are sorry that I have to do something as awful as a cervical cytology/smear test.
Bodies are meant to have hair, a cervix is a cervix, just a part of the body but tucked a way, to me and other doctors and nurses no different from looking into an ear or down a throat for tonsils.  Bodily secretions really don’t bother me, I used to play with frogs and snails and dig up dead birds. I still find it all interesting. Little babies chubby hands or the wrinkled veiny ones of a 90 year old are both as equally delightful, they are alive and working and pretty amazing as every single living creature is, when you look, think, notice and wonder.

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Of Men and Cakes.

It’s very hard to go sugar-free when your work place resembles ‘The Great British Bake Off’. M is something of a feeder and frequently tries to fatten up all her colleagues with yummy baked goodies. J however isn’t, or rather hasn’t been to date. He came to work with a ginormous and very marvellous German Marble Pound Cake. He said it took him all day to bake, I can believe this, if J is going to do something he does do it properly. At his first attempt he used granulated sugar instead of caster sugar, on realising his mistake and doing a little research which stated that it might alter the texture slightly, he discarded the mix. It would have been fine and I was rather a little dismayed to hear this. In my own very personal experience with men and baking or cooking, they like to stick to the very exact letter of any recipe or cooking instructions, where as women folk, probably out of necessity, will improvise, alter and  experiment with happy abandon. I do of course know that many men cook out of necessity also, but traditionally and still even in this day, women do the majority of baking and cooking to feed their families. With men like J and my husband, when they decide to do something special, it’s more for entertainment, a hobby, art and they don’t want to fail in that endeavor.
Anyway, what I’m trying to say is, that I had to eat two lots of cake yesterday before attending the Elvis V Jackson curry night and it’s so very hard to keep within ones daily calorie limits when one has to work and socialise with people!

Splinters V QOF

I saw twenty-one patients yesterday, this morning I have fourteen in total booked in. February and March are always busy times for GPs and practice nurses as they try to complete as many QOF (Quality Outcome Framework) targets/points for the practice as possible. Which is why, if you come to see me with a splinter but you have an asthma diagnosis and haven’t been for an asthma review this year, the computer screams, sings even does a dance to tell me that. In fact, eventually, I reckon GPs and PMs will make our doors unopenable until every missing QOF point possible has been extracted from a patient before they are allowed to leave the surgery. Points do mean prizes, so your splinter will be secondary, I won’t be worried about it, if I am and decide to operate with a needle, as I do it, I will be asking how many times this week have you used your blue inhaler, do you get wheezy at night? when you walk up the stairs? I have just removed a splinter, wedged full length under somebody’s fingernail, it even made me feel a bit queasy poking about with needle, scissors, scalpel and tweezers until I managed to grab it, VERY triumphantly!

Babies and Parents in Practice- part 2- experienced mum

My favourite is the third or fourth time mother, she balances a toddler with the new baby on her lap as she admonishes an errant older pre schooler jumping up and down on my scales. Deftly, she undoes the poppers one handed. Seeking informed consent I begin to tell her what immunisations we are going to give today, she interrupts with “don’t worry about all that nurse, just give ‘im what ‘e’s gotta  r’af, I don’t understand these mums who don’t wan ’em to ‘ave nuffink, ‘jections are important, we don’t want no diseases”. I agree with her as I immunise baby. She has baby dressed in a flash, laughs affectionately at his little red, bawling, angry face and stuffs him back in his pram with a cursory kiss, not bothering with safety straps. As I fill in the red book she gives the older jumping child a small slap for being naughty, then reaches into her bag to find sweets, previously promised for being ‘good’.  She exits the room, appearing to be unaware of the grizzling toddler clinging to her leg.

 

Babies with Parents in Practice

I had three lots of babies for first immunisations today. I can tell a first time mum as soon as she enters the room, new pram, dad and gran hovering nervously behind her, baby carefully cradled. I explain the immunisation schedule and possible common side effects. Mum exclaims that she cannot possibly hold baby while she has her injections, however as she clutches baby to her it’s obvious that she doesn’t quite trust baby with anybody else either. Time’s ticking by, I assure mum that baby will be fine and urge her to sit down, she hands baby to dad and steps slightly away. I pounce, “lets get those little legs out”. Dad holds baby all awkwardly, I undo the babygro poppers and before baby has finished filling her lungs with air to enable an indignant wail, I’m done. I do up the poppers, as watching a new dad trying to align them, all nervous and flustered is always a sight too painful to witness. Mum snatches baby from dad, she and baby sob together, I hear the usual faint mutterings of “nasty, nurse, needles”. I fill in the red book, hand it back and remind them to book back in for four weeks time.  As the door shuts behind them and I enter batch numbers etc on the computer, I try to recall if I remembered to smile and coo at baby…..