Nella Martin

an appointment with a nurse in practice

Category: Nursing

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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Chicken Pie

It’s another cool but gloriously bright and bird chirpy spring day! Twin girls from further down our lane, came here this morning to walk to school with D2, their three little faces were all sunny and chatty to match the day. They didn’t want me to walk with them, so three little red and grey dressed nine-year olds set off to school, calling for another along the way. I want to record these moments, they are so fleeting. She is my last, before I know it there will be no little youthful face to wave off to school.

I have an annual leave week, however I’m going into a care home to do some outstanding health checks this morning. It’s a lovely home. You only get to read about the bad ones in the press, yet all around us are care homes with hard-working staff, working for minimum wage doing their very best and with real affection for the people that they care for.

I roasted a chicken yesterday, I paid extra to try to ensure that it had been a happy chicken. I’ve salvaged enough of it to make chicken and mushroom pie for dinner tonight. I cyber spoke with a friend of mine last night about pastry making, To me it’s one of the quickest and easiest things to do, I’ve never bought ready-made. I think that’s from all those early years spent with my Grandmother and helping her bake, I don’t have to look at a recipe, the amounts and hows have been etched in my brain alongside my first words. If I ever develop Alzheimer’s, I will remember how to make pastry right up to the very end. I do meet many disadvantaged families through work and It always saddens me that so many people do not know how to cook even the simplest of meals from scratch, to them cooking is switching on the oven to heat up oven ready prepared foods. It’s such a very important part of life and living healthily. I believe that there is a real need for schools to include food and nutrition with some cookery classes on the curriculum. It will probably do many people more good than some of the other subjects that will be instantly forgotten and never used again. Some people will argue that those skills should be learnt at home, but sadly if the parents do not have the skills and many do not, there is nobody to teach the children.

Finance management is another important life skill, not one that I’ve ever been good at. Information on credit cards, APR, loans, mortgages and budgeting should also be taught in schools because again if many parents struggle with this themselves how can they help their children. They are my thoughts this morning!! I need to go to do those health checks now.

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!