Location: South Wales
Two weeks I’d been back nursing, after two years away. Before I’d left, working in London, I could expect to look after 9 patients per shift at the most, usually 6 or 7, on a good night 4 or 5.
In my first two weeks back to the job, I’d been looking after 12 patients each night, which had blown me away, so when I turned up at this particular hospital, an old Sanitarium-like building in the middle of the Welsh countryside, and was told I had 16 patients to care for… I could barely hide my shock and anger.
We’ll ignore the first four hours in which I struggled to come to terms with how much I had to do that night and simply struggled on for hours, having to ignore patient requests for help to the toilet to instead prioritise caring for my post-op (recently back from theatre) patients. We’ll ignore those ridiculous moral dilemma’s that no person should be placed in, for I know there will be time and other shifts upon which to elaborate them. For now, for this tale, I’d like to concentrate on one event.
This was an orthopaedic ward. That meant, and I have come to find this throughout my career on these wards, that I was looking after, for the greater part, ‘little old ladies’ who had fallen and broken their hip, sometimes leg.
The ‘little old lady’ of the night, of this tale, is Iris (pseudonym’d of course). Iris had broken her leg, had had surgery performed to fix the bone in place two days ago, and now had a HALO cage around her leg. Picture metal spikes sticking out of the leg from foot to knee and all held together in an external metal frame. Iris was to stay in bed because of this – ahh you can guess where the story is heading, I was lucky in a sense, Iris was pleasant enough for the start of my shift, she had a cheeky sense of humour, a little cackle escaped her lips whenever she made a comment she found funny. I liked her. I was lucky because she remained so until I had begun to get my shift under control.. and then.. at midnight…
‘Can I have help please!’ I heard the desperate plea coming from a few bays down. I was sat at the nurses station, no, not sat, I was about to sit, mid-sitting you could say, my knees were bent, my arse about to touch the chair – for the first time that night, a fresh cup of coffee in my hand…
…I placed the coffee down on the desk, straightened my legs and strode off down the corridor..
…I came into the bay and found two of the nursing assistants there struggling with Iris.
‘Get your bloody hands off me!’ she hissed from behind clenched teeth (dentures), while shuffling her bum down the bed, eyes, hands, bum, feet, spirit, all desperately edging for the gap in the bedrails towards the foot of the bed…
‘Iris you can’t get up, you will fall!’ and other such protests and pleas from the staff.. and from myself
‘Iris, Iris’ her eyes, lit with desperate madness now swivelled to look at me ‘Iris what’s wrong? You cant get out of bed at the moment, your leg is broken.’ she ignored me and pushed into the hands of the staff who tried gently to hold her in place, if she reached the foot of the bed and got a leg out, she’d be on the floor and potentially back in surgery the next day…
‘Iris do you need a wee?’ I asked, all delicate charm but…
‘get me out of this blOODY BED! POLLLICE!! POLICE!! screaming the last words.
The familiar sound of patients shuffling in bed, a few grumbles of ‘bloody hell’ from the next bay.. people were waking up.. chaos yawned.
The other nurse, Jane, came into the bay.
Iris thrashed her arms and began swinging at the staff around her, thats Gill and Sarah. Gill dodged a right hook and Sarah took the opportunity to move the bedside table away. Noticing this Iris snatched her handbag close to her and sat huffing, out of breath, refusing to look at us or answer Jane’s pleas of ‘Iris what’s wrong my love?’
This back and forth continued for another 10 minutes.
‘It’s probably a UTI’ (urine infection) I muttered to the others and they ‘hmmm’d’ back in reply and then…
‘arggghhhhhhh!!!!’ a loud scream and Iris renewed her violent bum shuffling towards the foot of the bed.
It’s worth pointing out here the true dilemma we were in. You see, we cant really manhandle patients, restrain them with force, pin them to the bed, and yet… this lady had a shattered leg in a metal cage, if she made it to that gap in the bedrails she’d be on the floor and… and yes you’d be right to be picturing a skinny woman in her late 70’s… but wrong to think that would mean she was easy to restrain, especially carefully, with tender nursing love… no… the smallest of enraged and delirious elderly people can fight like a tiger… tooth and claw…
‘Ahh ahh ahh!’ Sarah shouted as Iris struck out her face and bared her teeth (dentures) towards Sarahs hand, which tried to hold Iris’ left arm down, and as Sarah snatched her hand away, and Gill stood back too and Iris seemed to calm for a second I also stepped back thinking if we gave her some space she might calm down but instead she had her phone in her hand, a little flip phone with giant numbers on the dial pad. A little click as she flipped it open, still huffing and puffing, and then… beep beep beep.
She held the phone to her ear ‘Police! Police! They’re trying to kill me! They’re killing me!’ and then a little more calmly, I guess in response to an unheard question ‘Yes it’s Iris Cleverly’.
Jane had left, after declaring ‘I’ll have to ring security’ and as she left I asked ‘Can you bleep the doctor too?’. Only security could restrain patients, and I wanted some medication prescribing for her. Christ how bloody ridiculous this was. The bum shuffling began again. We each reached out our hands reluctantly and tried to stop her climbing over the rails.
A voice was coming from the mobile, a woman’s patiently asking.. ‘Iris are you okay?’
Jane was back ‘Security are coming up’ she muttered to us and then ‘is she still on the phone?’
‘Can’t get it off her one’ Gill said. I’d tried myself, any reaching towards it and Iris snatched her hand away and bared her teeth (dentures).
‘Hello, hello?’ coming from the phone. Iris seemed to have given up on her 999 call.
Jane began shouting from where she stood ‘Hello, this is Jane ———— I’m a nurse at ————- Hospital. Iris is a patient here, she’s quite confused… the conversation continued…
I had the drug chart in my hand by now. Re-scanning to check if she had any mediations prescribed that would help and then I heard the phone ringing, hopefully the Doctor. Answered, explained situation, Doctor promised to come, I went back to the bay.
More arm flinging, fist swinging, leg thrashing until… the ineveitable.. Iris pulled her cannula from her upper wrist. Blood, at first dribbled, and then streamed, down her arm, and flicked across the bed until I realised what had happened, and (luckily Sarah had though ahead and thrown us all gloves a while ago) clamped my hand down over Iris’s wrist where the blood pumped out.
Amidst the chaos of flicking blood Iris had wrestled her hands free and… clamped one deep into my upper arm. And so, in a mirror image of madness, I held a hand clamped to iris’s wrist – trying to stop the blood flowing from her cannula site, and she clamped a hand to my arm – her nails digging so deep she began to draw blood. Art first, all the adrenaline and shuffling I couldn’t feel much but eventually… a collection a sharp piercings that I would later discover were four nails shaped puncture marks.. that a year later remain a scarring reminder of the night.
Cut scene to 20 minutes later.
The Doctor, a young Asian girl, despite a brilliant manner with patients, had also failed to elicit any sense from Iris. She’d prescribed (reluctantly) 1mg of Lorazepam (sedation) to give IM (intra muscularly).
God I hated giving things IM, that meant injecting a drug deep into the patients muscle, on a skinny patient like Iris it meant that sometimes – in ensuring the needle had reached deep enough to hit muscle, you hit bone, and felt a little crunching grind of metal needle on solid bone. Only a couple of times I’d felt it, but it sent a shiver through me, and IM injections hurt. I hated hurting people.
So I came towards Iris with the needle in a tray held behind my back now. She was fighting still. About an hour she’d been at it now. And now it was Gil, Jane, Sarah and… two burly security guards holding her in place. Ridiculous.
‘Get your bloody hands off me!!!’ Catch phrase of the night.
And then from the bed opposite ‘Is that my handbag?’ we all turned to look. Mabel was sat up in bed, looking across at Iris’s bed, and all the commotion, with bemused and friendly curiosity before repeating again ‘Is that my handbag?’
‘No Mabel, go back to sleep’ said Jane, and Mabel diligently laid her head back down on the bed. We caught each others eyes grinning. Oh christ the madness.
I felt around Iris’ upper arm while the others held her steady but there was so little muscle there it would be like injecting a skeleton. ‘I’ll give it in the leg’ I said and Jane shuffled aside so I could get at Iris’ thigh and, as quick as I could… needle in – sharp scream from Iris, plunged the syringe – continued screaming from Iris, needle out – swearing from Iris.
Renewed bum shuffling, violent but less vigorous, she was getting tired now, the drug hadn’t hit yet, but exhaustion seemed to be.
‘Iriiiis’ Jane said, all sugar sweet from the end of the bed, she leant forward and rested a hand on iris’s foot ’do you have any pets Iris?’
Okay, I understood the idea. I did it myself a lot. Asked an out of the blue question about their life, trying to suddenly switch the topic, get them thinking about something nice and familiar to them, like a partner, children, grandchildren, where they’re from, any pets… it worked at times… calming.. friendly conversation.
Iris stopped her thrashing. Calm? Friendly? She looked up from her lap where she’d been fumbling with her handbag. Fixed her eyes on Jane and…
said in a tone of pure acid…
‘No… but I had a rat once… and it looked just like you.’
We all erupted in laughter, staff, security and Betty in the next bed too.
The night did not end there. After another hour of delirium and violence we eventually had to give a second dose of Lorazepam, another jab – scratch – scream and slur. By morning we had a diagnosis. UTI. That was it. One urine infection can cause this much madness. Two hours of most of the ward staff’s time. All four of us. With 31 other patients requiring care in between, imagine all the care delayed – turns, hygiene needs, even checking observations and fluids, all pushed back due to a lack off staff – because any night something like this can happen, most nights it will, something that makes the minimum staff-to-patient ratio seem pathetically inadequate and scarily dangerous.