“Out of the mouths of babes…” How often we quote this when a truth is made manifest by an innocent. We so often become caught up in the detail of a situation or problem when the salient and defining issue remains obscured by our own ruminations.
At a family gathering recently the TV was on in the background and a rather astute young grandson saw Donald Trump resolutely refuse to shake hands with Angela Merkal at a recent meeting between the two.
“That man‘s rude Mummy” he said in a stage whisper. Laughter all around…no need to pontificate about policy differences… rude is rude.
Similarly, inexperience and a junior status can sometimes mean that comments or insights can be brushed aside in a “….what would you know anyway?” kind of arrogance. I will never forget, well over 30 years ago a young nursing student—just a month into her course and working the odd shift for pocket money—coming to me with a meal tray. “Mrs Jones has this on her plate”, pointing to her meal at which sat three broad beans on a side salad, “and she‘s on a MAO diet”. I praised her diligence and wondered if other much more experienced staff would have stopped to take this in.
(You probably never see people on MAO drugs now; useful for depression they worked utilizing a pathway which suppressed a certain enzyme necessary for the synthesis of a number of food stuffs including broad beans. A ‘reaction’ could occur if such foods were ingested).
Probably because of her very junior status she was cautious, following the rules, yet to learn the breezy confidence of “she‘ll by right…” often an unfortunate consequence of far too much to do and far too little time to do it in—a real trap and a hazard to guard against by effective protocols and policies [where was the kitchen in all this….? Damn broad beans should not have been on the plate in the first place. I hope my 30 year younger self checked this out!]
In the second year of my nursing training at Prince Henry‘s I trembled somewhat as the charge Nurse informed me that the senior (3rd year) nurse was too busy to do a below knee post-amputation dressing on an elderly French lady, Mrs Jeanette Latour. The happy combo of me not long attending surgical lectures and being determined to become Florence Nightingale‘s stunt double saw me examine this wound intently.
As I swabbed gently with forceps and a swab soaked in disinfectant it seemed to be ‘telling’ me something. Now a wound like this is unforgettable anyway, and every time I buy meat at the supermarket or butcher‘s shop the pale-skinned pieces of pork with netting and elasticized ties holding flaps together always take me back to this day…
I continued to swab again. One movement left to right; discard swab, another movement left to right; discard swab. Yes…it was a suggestion of bubbles and with a little pressure I could feel a sponginess, my heart raced…I pulled my mask aside to smell the exudate…yes!! That‘s it—but further palpitations—could I as a lowly second year make the proclamation? What if I was wrong? Would they scornfully scoff at my insolence? Could I withstand their judgement?
“Bugger that!” thought junior Ms Nightingale and utilizing what I thought was the best approach i.e. Whitesides Surgical Nursing text book lingo I approached the Charge Nurse bent over at her desk. “Excuse me sister, Mrs Latour‘s wound has surgical crepitus and a mouse-like odour. I believe she could have Gas Gangrene.”
There were few truly memorable times where I could be said to have created a melee during my nursing training. One was catastrophically overflowing the bath in the nurses Home — on the sixth floor with Matron visible to the sentinel on watch, about to go up the lift to the end of the sixth floor where the sisters had their own quarters. Every nurse on my floor “aqua-planed” with towels, sheets etc to clear the waterway and by the time Matron Jeffries disembarked and walked up the corridor the linoleum was dry and spotless. (Betty Jeffries was one of the survivors of World War 2‘s atrocity involving nurses either shot in the back or imprisoned by the Japanese so I doubt it would have undone her greatly).
Anyway after my diagnostic declaration it appeared that the ward erupted into turmoil. Doctors ran, curtains were swished closed, Sister‘s high pitched voice issued orders, pathology staff were summoned, the surgeon, bow-tie askew, rushed in also.
I was due off duty and washed my hands wondering what the outcome would be.
After two days off I returned and Mrs Latour had been operated upon again—this time a drastically higher further amputation had been required as the clostridium perfrigens (a bacteria producing “gas” in wounds) had coursed its way far too dangerously up her leg and despite heroics and heaps of intravenous gentamycin she died five days later.
Thousands have stories like this—we all learn from books and lectures but real life is uncompromising and demands action. Two things are needed vigilant observation and courage to speak up—even if you feel a fool!
Gas Gangrene rare even then, would be a curiosity in our times, but this does not mean infection has taken a bow from the surgical stage. Our over-riding concerns are now with Resistant Staph (MRSA) and other bugs happily developing defences against many current antibiotics.
Wound care has become a very sophisticated and advanced science and dressings and techniques are enormous in range and diversity. Hyperbaric oxygen treatment, negative pressure devices and different surgical techniques have all combined to in-crease healing potential. Our nursing staff attend ongoing education about wound management and advances in the biological understanding of wound healing and the influences which impact this (genetic factors, poor circulation, chronic ill health and disease e.g. diabetes, poor nutrition and hygiene etc etc) have meant huge changes in approach to care; working with the bodies healing forces rather than against them. Each wound is as individual as the patient.
When you see Frank or Karen, or any of our other senior nurses wheeling along the dressing trolley think of it as a little storage chest of miracles. In amongst the lyo foams, duoderms, tegaderms, intrasite, opsite, alginates and silver dressings is the potential to proliferate trillions of cells, coaxing them to do what Nature has as their destiny; healing and making whole a damaged part. Would that we could so expertly fix all other ills!
Cheers for now
(Patient‘s name changed for privacy)