Intensive Care Unit - a change of pace

After my 8 week stint in A&E and a short period back in the School of Nursing, I went to my next placement which was the Intensive Care Unit (ICU). After the hustle and bustle in A&E, which in the end I had quite enjoyed, the relative stillness of the ITU patients was quite daunting. Suddenly the two-way chat had gone, to be replaced by the hushed shunts of ventilators and the quiet blips and peeps of life-saving machinery.

The pace of work in ITU was completely different. It was a small 6 bedded unit, very unsophisticated by today’s standards but still daunting to an inexperienced student. With only a few patients to concentrate on and 'afternoon only' visiting times strictly observed, there were fewer people in the Unit and everything seemed much calmer than in A&E. With a controlled entry system, everyone who entered the Unit had to have a reason for being there. If a patient hit a crisis the team would swarm around them, like bees in a hive, each person seeming to know their individual role. As students we were assigned to a member of staff who usually worked with just one patient throughout their shift; occasionally two if their dependency was slightly lower. Our patients were wholly dependent on the staff and the machines that surrounded them. Everything had to be monitored and recorded from urine output, to oxygen saturation to cardiac rhythm. We still had oxygen in tanks in those days and even the supply display had to be checked regularly to ensure the porters replaced the tank before it emptied completely. No running supply of air or oxygen from a valve in the wall! 

Nursing ITU patients felt like a very one-way kind of nursing, much more technical and far less patient-nurse interaction than in the wards. Lots of communication through other means though and for many nurses the relationships with patients and family through these very intense periods of illness were very rewarding. For me though, the ITU experience was less than satisfying and I couldn’t wait to go back to the hustle of a ward placement area, not least because I could stop worrying about what was coming through the doors next. It was not until years later, as a Tissue Viability Nurse visiting ITU regularly, that I suddenly understood why some people enjoyed ITU nursing so much. What had seemed so daunting as a student became fascinating as an experienced qualified nurse and as is often the way with nursing, I started learning all over again.

Next week: Compassion -  a dying art.

The thrill of A&E: armchairs, fleas and pressure ulcers

In my first year of nurse training I was placed for 8 weeks in the Accident and Emergency (A&E) department which was housed in a separate, single level building on a steep slope just down from the main hospital (St.Albans City Hospital) . It was old, shabby and poorly equipped. The small waiting room was frequently overcrowded with people sitting on narrow wooden chairs, waiting their turn. Patients requiring x-ray or admission had to leave the department and walk, or be wheeled, up the slope to the main hospital. As this required being out in the open, patients on trolleys were covered with plastic sheeting if it was raining!

The department was run by a senior sister, called Sister Plum* and a junior sister called Sister Elton. Sister Plum was small and fierce with an enormous bosom that left little room for anyone else in the tiny department office. What Sister Plum lacked in humour, Sister Elton made up for. She was approachable and cheerful, a good teacher and an active Union member. On one occasion when I reported sick with a sore throat, I was asked by the Nursing Officer in charge to provide a throat swab to send to the pathology lab for culturing as proof of illness. Outraged at what I saw as a basic lack of trust between employee and student nurse as well as an abuse of position on the part of the hospital management, I wrote to a well known nursing journal to give vent to my feelings. Then, not really wanting to rock any boats, I signed the letter ‘anonymous’ and posted it off, not expecting to hear anything more about it. The next I knew of it was that it was pinned to the Union section of the department information board in black and white print, torn from the journal's weekly letters page. Although Sister Elton pointed it out to all the staff she never mentioned it to me directly; however, I was sure she knew who the letter had originated from. This might not have mattered had I not, to my ever-lasting shame, actually had a sore throat but two tickets to see the Rolling Stones at Wembley Stadium in London. My indignation at the challenge to my integrity was so intense that I had all but forgotten that I was actually completely in the wrong. So, 30 years on I would like to say here and now that it was atrocious behaviour on

my part and I am sorry to all concerned. Guilt is a powerful emotion and rest assured the guilt I felt was enough to ensure I never ever, ever played 'hookey' again, throughout my career. Students beware, nurse tutors were young too once and we know the kinds of temptations you face!

I had been worried about my A&E placement expecting to see lots of cardiac arrests and road traffic accidents. However, my enduring memories of A&E were of more mundane things. There were lots of finger injuries (as common then as they are now) and I quickly learned how to trephine a nail bed heamatoma using a spirit lamp and paper clip and then to apply a neat and firm finger stall to keep the dressing on. There were also plenty of fractures, typically clavicles, scaphoids, tibias, fibulas and Colles (wrist) and lots of near misses in the form of sprains. Bandaging was still quite an art form at that time and we spent hours in the classroom practicing how to apply crepe bandages in the spiral, figure of eight, reverse figure of eight, ‘toothache style’ and spica methods on each-other. Fortunately, the more old fashioned many tailed bandage had been dropped by then (it looked like it needed many nurses to apply it) but we still re-rolled bandages and gauze ribbon for re-use as long they were clean. I had very particular experience of those long narrow pieces of gauze as I had been a patient myself in this same A&E as a child. We only lived two roads away from the hospital and when I tripped over a long-handled garden fork on our concrete garden path and my nose wouldn’t stop bleeding, my Mum whipped me over to the A&E to see the doctor. It must have been bad because I was a regular ‘nose bleeder’ and generally it just trickled to a halt in its own time. However, on this occasion it wouldn’t stop so the doctor packed it with what felt like yards and yards of ribbon gauze. It was pushed up and up into my nasal passages until it made my head throb and my eyes sting. I’m surprised it didn’t just start again when it was taken out a few days later. My Dad wasn’t very pleased about the whole episode because I’d bled on my new brown duffel coat and stained the new concrete path dark red as well.

More serious injuries and illnesses were few and far between but one case sticks in my mind. He was a frail, elderly man with multiple pressure ulcers around his sacral and buttock areas. The ambulance team brought him in sitting in his armchair where he’d been quietly decaying for weeks into the soft upholstery beneath him. They had to carry him through the small department waiting room before settling him into treatment room, so every head in  the place watched him being carried through. When the door was shut, we literally had to cut him out of the chair, after which we washed him as best we could. All this whilst wearing surgical gowns aprons, hats, masks and gloves because of the fleas jumping off him. He eventually ended up in theatre for a full surgical debridement to remove not only the dead skin from the ulcer bed but the remnants of the chintz cushion cover as well. I don't know what happened to him after leaving A&E, one of the down sides of working in the most transient of all hospital settings.


Trephining the old fashioned way - a bit before my time

Another of my worries about A&E was seeing a fatality following some kind of major trauma. Although I had seen a couple of dead people at Napsbury, they were elderly and died peacefully, whereas death by crash, crush, burn or whatever other means, I imagined to be very distressing for all concerned. So when a person who was BID (bought in dead) arrived outside the department in an ambulance, I asked to go and see the body. I thought it would help dispel my fears of not being able to cope although I didn’t explain this to Sister Plum who thought my request  very strange. She said I could go in on my own if I was ‘that interested’, so caught between feeling rather silly to have asked and not wanting to back down, I went out to the waiting ambulance and opened the back doors and stepped up and in. The BID (horrible term), was on the trolley with a red blanket over him (red was used to mask any signs of blood). He was an elderly man, lying on his back, eyes closed and looking very peaceful. No trauma, no blood, no ghastly re-arrangement of the limbs. I returned to the department none the wiser about major traumas and remained wary of any emergency arrivals to A&E but mindful of Sister Plum's evident disdain, I did not ask to see any more BIDs. 

Next week: all change for ITU

*Names changed

1980's elderly care: Australian lift and the coming of Roper

During my three years I was fortunate to see a wide variety of specialties and experience a wide range of nursing challenges. My first placement was in an elderly care ward where I worked for 12 weeks. The ward was in a one storey building, a modern addition to the old Mid Herts. site on Church Crescent close to our accommodation (St.Albans City Hospital if you haven't been on this journey before!). The ward was set out in a traditional nightingale style, with beds lining the walls either side of the ward and ancillary rooms such as the kitchen, bathroom, treatment and sluice rooms situated at either end. All of the patients were female and over the age of 65 with a high prevalence of conditions such as stroke and cancer and chronic disorders such as Parkinson’s disease, diabetes, chronic obstructive airways disease, emphysema, rheumatoid and osteoarthritis and heart disease. Patients with multiple pathologies were as common then as now in elderly care wards often requiring complex treatment programmes from a range of professionals such as nurses, dieticians, physiotherapists, pharmacists, speech and language and occupational therapists and of course the physicians.

Work in elderly care was physically demanding and then, as now, space in each bed area tended to be limited making it hard to work efficiently; equipment aids were also in relatively poor supply when compared with today’s NHS hospitals. We had a bathroom hoist with a couple of slings to accommodate different sized patients (one often in the wash or on loan to our counterparts in the male elderly care ward), monkey poles above the beds and pump up variable height beds. Some patients were issued with turning or sliding boards to aid transfer but for most patients manual handling was the norm with lifting techniques such as the Australian lift in common use. This lift entailed two people standing one either side of the upright, bed-bound patient. Each person would then put their shoulder beneath the axilla of the patient, link their hands beneath the patient’s upper thighs and together lift the patient up the bed. This lift required co-ordination, strength and a fair amount of trust on the part of the patient. Unfortunately for the nurse it was highly likely to put a strain on the neck or spine and thankfully, in the UK at least, it is now recognised as an unsafe lift for both nurse and patient (shoulder injuries, skin damage through shearing) and should therefore never be used. Back then though, most of our patients were highly dependent and there were many occasions when nurses were at risk of back injury because of poor equipment, training, staffing and/or awareness.

The Australian Lift - not as funny as they seem to think!

Working in an elderly care ward was hard but it gave us an opportunity to develop core nursing skills which stood us in good stead throughout our nursing careers. The ‘back-round’ system of care ensured that every patient was visited on a regular basis, re-positioned if necessary, toileted and given a drink or fed. Mouth, hair and skin care were routinely carried out along with general hygiene care and mobility support  (today's use of Intentional Rounding is not as innovative as some would make out).

However, the regulated, task-oriented approach which had been in use for so many years fell out of favour as the profession moved in the 1980’s to adopt a more individualized approach to care. The work of nurse theorists such as Nancy Roper, the UK born nurse who defined nursing in the context of a model of daily living, provided a framework for care which allowed the nurse to adopt an individualised, holistic approach to care which encompassed all the patient’s needs from eating and drinking to sleeping, working and playing, breathing, maintaining a safe environment through to expressing sexuality, controlling temperature, elimination, mobilization, communication and dying. When used effectively the model, which is in widespread use around the world today, ensures important elements of care are not overlooked. The work of others such as Dorothea Orem and Virginia Henderson was equally influential, although it was usually the case that there were many years between the development of the theory and the implementation in practice.

However, delivering individualised care in the way Roper and others envisaged it is difficult in a modern healthcare environment. The pressures of time, staffing, targets and the complexity of patient’s needs often reduce nursing to a list of key priorities, the things that must be done rather than the things that should be done. The modern dilemma (in the UK anyway) is how to keep to an indivudalised approach to nursing and still ensure essential care for all is carried. 

Next week: Fleas and more in A+E

Being assessed in practice - 1983!

In 1983, assessment of clinical practice took the form of four practical examinations spread over the three year training period (I know it sounds antiquated but remember this is pre-project 2000 and the concept of continuous assessment hadn't quite crept in yet!). The practical exams were nerve wracking because they took place in the clinical area in front of everyone and also because, like the written exams, they had to be passed to progress to the next stage of training (so maybe not so antiquated after all).

I remember being worried about my total patient care exam because I was working in paediatrics (St.Julian's ward) for three months and there weren’t many suitable children to provide total care for. The exam required us to demonstrate skill in supporting nutrition and toileting needs and performing general hygiene and mouth care. However, the children were often in for relatively minor surgery (such as circumcision or inguinal hernia repair). They would be self-caring on admission, briefly incapacitated by an anaesthetic then quickly up and running about again before heading straight out through the exit at full speed. Children in for other reasons such as orthopaedic correction would often be fixed to some kind of metal frame for weeks on end but were still perfectly able to eat, clean their teeth and make mischief. In the end the ward sister took pity on me and said she would do my assessment with a little boy who was recovering from a pyrexia of unknown origin (PUO). He was fully independent, if a little weak, and about to go home. With his mother’s consent, I went through the motions of helping him into the big ward bath, preparing his lunch, encouraging him to clean his teeth and standing outside the toilet door asking him if he needed any help. Everything was very straight forward and the Sister duly marked me as passed but it hardly stretched my skills in the way someone who was assessed whilst working in elderly care would have been. This was the chief limitation of having to do the assessment at a certain point in time, it meant it could be more tick box than meaningful.
 As well the 'total patient care' assessment, there was drugs, aseptic technique and  ward manangement (always the grand finale). All I remember about the drugs one was that we had to undertake a drug round with our assessor, perform various calculations and memorise two drugs in detail to be tested on orally (tested not taken I hasten to add), My chosen drugs were paracetamol and digoxin. Educationalists, including myself, question the benefit of these very superficial approaches to learning (memorise - recall - recite) but to do this day I remember more about those two drugs than any other.

The aseptic technique assessment was a joy to behold and a horror to complete. At the time we used disposable dressing packs with forceps, gloves, solutions tray, apron and gauze. We used a non-touch technique, had 'clean' and 'dirty' hands and worked in a positive air flow treatment room wherever possible. The assessment started with trolley preparation which we had to clean from top to bottom making sure the wheels were last. For my assessment I chose  to do a partial removal of a corrugated drain from a surgical wound. This procedure involved the removal of a safety pin from the drain (this secured the drain in position, presumably this would now be stiched into place), the adjustment of the drain position and the re-insertion and closure of the safety pin. The wound area would also be cleaned and a sterile pad applied. All of this would be done with a pair of forceps and no-direct hand contact (not even with gloves on). Truly a challenge. I passed first time so perhaps an early indication of my eventual career path.

It all sounds very labour intensive now but the assessments for total patient care and aseptic technique did thoroughly test the ability to apply a procedure correctly and taught us a lot about doing things the right way. I think that learning the right way to do something in totality and then assessing it formally, with a bit of pressure in the mix,  fixes it in your mind for a long time. Habits when formed are hard to break (bad driving habits spring to  mind), so getting the right habit formed in the first place is very important, it then becomes routine, ordinary, the norm. It is from this secure position that nurses can make informed decisions about modifying practice where necessary e.g. the patient who is in their own home with an infected wound and not a dressing trolley in sight.

My ward management assessment took place on an acute medical/cardiac ward. It was a ward that I spent most of my time being in a state of stressful high alert because I had managed to go through my three years with very little experience of cardiac arrest; I was convinced that this placement would render me a 'rabbit in the headlights' in the event of a patient collapsing pulseless. I do remember the  lovely staff nurse who helped prepare me for the assessment (no qualified mentors then, just willing qaulified staff). I was working with her one morning and it was very busy indeed. I noticed she had a long written list of things to do such as booking appointments, arranging discharges and talking to relatives and I asked if this was ok to do for the assessment. Absolutely she said, how else would you remember it all? I had honestly thought it would necessary to have it all memorised much as we had to do for the drugs assessment, Having said that we were expected to know our patients extremely well and whilst notes about patients were permitted, we would be expected to give a  no-reference-to- notes verbal report about them to the ward sister, night sister or clinical tutor on demand (standing up straight, no cardigan and no coffee cup in sight).

Today, the problem of assessing the right skills, in the right place and at the right time remains a thorny one for nurse education. There is a real challenge in finding enough clinical placements to ensure all students have the same kind of exposure to the same kind of experiences as well as the same opportunities to develop a common set of core skills. One advantage of nurse training in the 1980’s was the commonality of experience with every student having a placement in theatres, midwifery, intensive care, general surgery and medicine, elderly care, Accident & Emergency (A&E), paediatrics, gynaecology, orthopaedics and the community.  The clinical teachers came out to the wards regularly to work with the students. They were highly visible and clinically credible, something which is difficult to achieve now with nurse educationalists being located in University buildings, the majority of which are far removed from the clinical placements they serve. Whilst there are echoes of the past in today’s link tutor roles, the context is quite different not least because the partnership between clinical placement and higher education is now based on a contractual obligation rather than the ‘in-house’ partnership of old. All in all a very different environment for today's student to work in, not necessarily better or worse but different.

Next week: Elderly care, my first ward at last.

Getting our nursing uniforms and meeting the teachers

This week we settle into our new home, get our uniforms (at last!) and meet the teachers...

In the early days of these nurses residences (before my time as a student), a ‘Home Sister’ would stay onsite and ensure the rules and regulations of the Hospital were upheld, including the moral conduct of its nurses. Homes were strictly single sex and there was no staying out late at night and certainly no sneaking in boyfriends. Even in my day there was a Home Warden who kept an eye on us although fortunately (given how close we were to St.Albans’ plentiful choice of 53 pubs) there was no late night curfew.
 

Slightly before my time..

We had to keep our rooms clean and were responsible for laundering and ironing our own clothes, which usually meant several ironing boards cluttering up the corridors. Each room had a single window and a deep window sill inside and out and it was common to see pairs of shoes on the outer sill, being given a much needed airing after a long run of shifts.
The Church Crescent site also housed two elderly care wards and a canteen. We congregated in this canteen on the next day for breakfast but I don’t remember ever going back afterward. Despite the fact that breakfast was very cheap, it was also very early and awkward shift patterns soon made us value every spare minute in bed. We didn’t turn down the free meals on night duty though, left over from the day shift they were left in the chiller cabinet in the big canteen on the main hospital site on Normandy Road. First come first served, so early break on a night shift was very popular. Like most students we didn’t waste a chance to turn down a free meal often.                 

Over the next few days we were issued with our uniforms; pale blue check dresses (standard NHS wear), mid-blue nylon webbing belts (called Petersham belts) and dark blue thick wool cloaks with a red lining. One of the last groups ever to be issued them, I was to regret ever letting mine go at the end of the training although we were told we could keep them if wanted. The ladies in the sewing room (yes, there used to be a sewing room in all hospitals) did alterations as necessary, fitted the belts individually and gave us our caps; stiff card with a thin blue strip around the top to denote our status as first year students, held in place with white Kirby grips. We had been told to bring flat black shoes and pale brown tights to complete the look. When everyone was properly uniformed, a class photograph was taken outside on the lawn by the School and at last the May 1983 set was ready to go.

The School of Nursing was situated in its own building on the main hospital premises at the Normandy Road site. It was a single storey building staffed by nurse tutors and clinical nurse teachers. The two nurse tutors, Mrs. M. and Mrs. Lewin dressed in white uniforms and taught us the theoretical aspects of nursing care such as anatomy and physiology, diseases and conditions and the function of different body systems.
They also taught us clinical skills such as how to pass a naso-gastric tube correctly. This we did on each-other in the mock ward area, withdrawing gastric fluid to test for hydrochloric acid with a strip of litmus paper and puffing small amounts of air into the stomach (we hoped) with a syringe whilst we listened with a stethoscope for the tell-tale gurgle of stomach contents. There were no guide-wires or positional check x-rays as became the norm later. Naso-gastric tubes  (Ryle’s tubes were used for feeding as well as drainage) then were uncomfortable and inflexible, making us cough and gag as they went down, so practicing on each-other made us much more careful when we passed them on real patients, knowing full well how unpleasant it was. Fortunately we weren’t required to try out urinary catheters on each-other.

Ouch!

Mrs. M. was the more senior of the two tutors and was rather scatterbrained and accident prone. She often fell over things in the classroom and although very kind she did seem to lack the kind of everyday common sense required to make an efficient and effective nurse. She once instructed us in ‘washing the bed bound patient’s hair’ using the resuscitation model (known by students everywhere as Resusci Annie) as the surrogate patient. When Annie’s blond nylon hair was shampooed it became badly knotted so Mrs. M told us to remove her head and bring her into the class to dry her hair with the hair dryer whilst she carried on with the next lecture. Annie’s head was sat on the front desk and the hair dryer set to warm. Within minutes the nylon hair meshed together in a melted clump and the smell of burnt plastic filled the room. Poor Annie never did recover her looks nor Mrs. M her composure.                                                                                                                                     

The clinical nurse teachers were Ita Blakey, Laureen Hemming and Peggy Morris (of course they were not known by their first names any more than school children call their teachers by their first names now) . They dressed in dark green nurses’ uniforms and taught us on the wards, focusing on the more practical aspects of nursing care such as how to perform a bed bath and how to set up a sterile field for a wound dressing. They also oversaw the four practical exams we each had to do as students; total patient care, aseptic technique, medicines round and ward management. These were nerve wracking and necessary, each successful one marking another step toward the final exams and (hopefully) qualification.                         

Next week: being assessed in practice!

Starting my training - 30 years ago!

During my time as a nursing assistant in paediatrics at the QEII in Welwyn Garden City, I started applying to become a student nurse. At the time most nurses were trained in a School of Nursing attached to an acute hospital. Training was delivered by the nurse tutors who taught nursing theory in the classroom and clinical teachers who taught practical skills on the wards. It led to the qualification of either State Enrolled Nurse (2 years) or State Registered Nurse (3 years), a two tier system bought in when nurse training was standardised as part of the NHS formation in 1948. Once qualified the SEN worked at a mainly practical level and always under the supervision of the more SRN nurse. Opportunities for promotion were limited although many enrolled nurses were highly experienced and skilled at what they did. The State Registered Nurse worked as the more senior of the two and was able to progress to senior staff nurse, ward sister, nursing officer, matron etc. As a registered nurse, she or he was able to make decisions about patient care including the management of wound care, drains, drips and sutures, administer a wide range of drugs including controlled and intra-venous drugs, accompany the doctors on ward rounds and lead the nursing team as required.

 



As the training for SRN was more demanding that of SEN, Nursing Schools required their SRN applicants to have a minimum of 5 O’levels. The more popular Schools could demand A levels as well. Some training places were highly sought after, a relic of the times when training schools around the country offered vastly different types of nurse training programmes. The best of these (includng of course Florence Nightingale's own school at St.Thomas') would only select well-educated young women from 'good' families.  Living close to London, I was within easy reach of Barts (St.Batholomew’s Hospital) and Guys and St. Thomas’s (before the merger), three top Schools which were still taking their pick of well qualified school leavers. However, as I was not an overly well qualified school leaver I decided to apply to the slightly less prestigious (although still very sought after) Hammersmith Hospital in West London, on the basis it was in London and therefore I would have a good social life. Although Hammersmith did accept O’level applicants they made it clear that A level applicants would have priority unless the O’level candidate was of exceptional quality. I was lucky then to get called for interview, probably on the basis of my nursing assistant  experience rather than my rather paltry collection of hard-earned O’levels.

The grand old Hammersmith Hospital in 1984                                                                                                                                                                             All I remember about the interview was that the hospital interior was beautiful. All varnished wood and tiled floors, with big heavy doors and tall windows. It looked grandly old-fashioned and seemed full of important people but sadly I was not to become one of them. After sitting through an interview paneled by three stern faces, they very nicely said good try but no can do. I didn’t really mind, I had been offered a training place in my home town at St.Albans City Hospital (SACH) and was happy enough to go there. With a full social life and a lot of friends in the area, a nursing life on the doorstep of my childhood home suited me fine. There would be time enough later for moving further afield.

I started my nurse training in May 1983. Our group of 18 were partnered with a similar sized cohort who were based at my previous hospital the QEII Hospital. Our first and the third years would be spent at SACH and the second year at the QEII, whilst the partner cohort would spend their first and second years at the QEII and their middle year at SACH. Our group was all female, all Caucasian and all 18 years old bar two, another girl and myself. Both of us were just 19. We were a very typical nursing student group of the time, predominantly Caucasian, boys a rarity and English our first language. The age, cultural and academic diversity brought about by the NHS’s widening participation initiative was still some way off.

The class of 1983, I am back row 7 from the left!

On our first day we arrived as directed at the School of Nursing for our welcome talk. Most students were accompanied by either one or both of their parents. There were girls there from Somerset, Corby, Cambridgshire, Bedfordshire and Wales, each with a stack of luggage ready to move into the nurses’ home. Only I was without luggage because I lived so close to the hospital it was easier to move all my stuff straight into my room from home. I was glad in the end to have stayed in my home town, less adventurous than some perhaps but I had no home sickness or nerves to contend with either. I was already used to working shifts, I was familiar with hospital environments and routines and I couldn’t wait to have my own space away from home. Close enough to see all my friends, but far enough away to have some privacy.

Like most hospitals at the time, SACH had its own student accommodation (perhaps one reason nurse training was popular). This was housed in two ‘homes’; Church Crescent and Osyter Hills. We were given rooms in the Church Crescent Home, which was just a short walk from the hospital’s main site via the Folly Lane allotments (creepy in the dark). The Church Crescent site had been in use for medical purpose since 1887 when it was bought for £750 in-order to re-house the St.Albans and Mid-Herts Hospital and Dispensary which was then situated close to Holywell Hill, some short distance away. The new Hospital and Dispensary accommodation was built for just £3,750 with the aid of various donations, bequests and subscriptions.

 

The Oyster Hills Home at the top of Waverley Road was built originally on the land known as Oster Hills. Initially a privately owned eight bedroom family house sitting on the brow of a hill surrounded by orchards and paddocks, it then became a registered asylum in 1834, licensed to receive ‘no more than 15 lunatics at one time’. By 1851 the census records show it as family residence again, albeit lying alongside the St.Albans Workhouse which was built just down the hill on corner of Waverley Road and Normandy Road (then called Union Lane) in 1836-7. 

The Church Crescent, Oster Hills and Normandy Road sites were three parts of the four piece jigsaw that made up St.Albans City Hospital by the time I went there as a student nurse. The missing fourth piece originated as The Sisters’ Hospital, built by Sir John Blundell Maple and handed to the City in 1893 for ‘the benefit of the inhabitants of the city and the immediate neighborhood who might be suffering from infectious disease’.

 

The Maple Block, built by Sir John Blundell Maple

 
These four jigsaw pieces became one at some point and the resulting hospital a jumble of styles from the once grand house Oyster Hills House, to the sturdy red brick of the Church Crescent and Normandy Road buildings and the single storey ‘bungalow’ style infectious diseases ward, St.Stephens. More recently a multiple storey high rise building called the Moynihan Block was built to house the growing city population; it opened in 1970's (exact date proving elusive). The wards in the new block boasted a modern layout known as the ‘racetrack’. Unlike the traditional nightingale wards with beds arranged linear fashion down the length of each wall, the racetrack wards were shaped like a chunky number eight with beds arranged in 6 ‘bays’ of 4 beds each plus a number of individual side rooms. Sluice, linen store and treatment rooms were centrally located and therefore easily accessible from wherever the nurses were working. It sounds pretty standard now but in those days it was considered a very 'modern' build.

The Church Crescent nurses’ home was a two storey block with single rooms on each floor, shared bathroom areas and a communal kitchen on the ground floor. There was a television room downstairs and the only way to make or receive a call was to use the pay phone on the landing. Each room had a wash basin, a single bed and a small wardrobe, a chair and a chest of drawers. There was not a lot of room in the room but we could add our own things including a TV if wanted. My TV sat on a small table at the end of the bed and could be turned on and off with a carefully maneuvered snooker cue (I did not actually play snooker I hasten to add). There was of course no remote control. We brought our own kettles, saucepans, plates etc. and some girls even had small fridges. For the rest of us it was a question of leaving provisions in the communal fridge and hoping they would not be raided by someone else.

After being there a while I bought a Tower slow cooker and would sometimes make a casserole or minced beef, leaving the dish to cook slowly on my bedside table whilst I was on shift. I also perfected the art of cooking eggs in a boiling kettle (half-fill with cold water, flick switch and bring to boil, turn off straight away, leave for 5 minutes, remove and eat). When I eventually obtained a mini second-hand fridge, there was so little of nutritional value to put in it I hardly ever opened it. Also, I was smoking at this time (yes, I am suitably ashamed), usually packs of 10 John Player (10 because it was all I could afford and JPs because I misguidedly thought the black packet was cool). On one memorable occasion I lost my cigarette packet and a Mars bar having just bought them in a nearby shop in Folly Lane. I hunted high and low in the room then walked back up the hill searching the ground all the way and even asking in the shop to see if I had dropped them there. So rarely did I look in the fridge it was days before I thought to and found both Mars and cigarette packet nestling side beside in the otherwise empty fridge. I have to say my flirtation with smoking was relatively brief, my love of chocolate lasted decidedly longer.

 Next week: Getting started.. 

The case of the disappearing baby

Working as a nursing assistant on a paediatric ward 30 (long) years ago...

One baby I nursed on the ward was Iain. He suffered a brain trauma at birth which left him mentally and physically disabled. He required a lot of help with feeding and took a painfully long time to take his bottle; barely did he finish one feed than it would be time to start another. As Iain’s parents didn’t come often it usually fell to one of the ward staff to sit and coax him through each feed and whilst I had no aspirations to become a children’s nurse, I never minded landing this particular job; sitting quietly with Iain in his little side-room day, feeding and day-dreaming, the hours just sliding by from one meal to the next. Iain was with us for months and when I left he even 'came' to my leaving tea on the ward.

Another group of children who demanded a lot of emotional resource were the non- accidental injuries or ‘NAIs’. Periodically, a child would come in with unexplained bruising, a greenstick fracture of the forearm (twisted and snapped under a force such as when a child is swung around by the arm, for fun or in anger) or worse. Wherever intentional injury was suspected the social workers and police became involved and the child would be put under close observation. The procedures then were clearly focused on the child’s well-being and safety but the processes for ensuring these are much more rigorous now and suspicions more readily aroused. That aside, when a ten month old baby came in with a badly scalded bottom, the consultant paediatrician immediately suspected NAI. The little boy’s buttocks were bright red and the skin was blistered and raw; he cried constantly with the pain. His mother was from a traveler family who lived locally and she said she had accidently run the bath water too hot and his bottom had scalded as she sat him in the water. The consultant pointed out the perfectly round nature of the burn, the exact contour and size, he said, of a cooking ring on an electric hob, right down to the blistering concentric rings. He said it looked to him as though somebody had sat the baby straight on a hot hob and that, he said, was unlikely to have been an accident. The Mother looked sullen but did not deny it.  The baby's burn was dressed with paraffin gauze and he was given a strong analgesic for the pain. Eventually he settled with the help of some warm milk and was put in a cot in a side-room to rest.
 

At that time security in general hospitals was relatively low key and on the children’s ward the main concern was to prevent children leaving rather than to stop anyone coming in. Handles were placed high on the entrance doors to prevent any ambitious youngster reaching them and the doors were locked at night. Parents were allowed fairly free access particularly those of the very young or very sick children but other visitors were expected to adhere to the fixed times of the afternoon and evening visiting times. Parents of babies (usually the mother) often stayed overnight in the side-room on a z-bed, not very comfortable but it enabled them to be close by which was important for the well-being of both parent and child.

Several days later, as I sat on my supper break in the ground floor waiting area near the hospital shop, I noticed two members of this little baby’s family entering the ward. It was visiting time and there was a certain amount of movement in and out of the ward but I happened to notice the same two people leaving again not long afterward and remember thinking what a quick visit. When I returned to the ward shortly afterward it was to find that the baby had gone missing. I recalled that one of the baby’s visitors was carrying a blue hold-all and I realised with a sick feeling that I had watched them carry the baby out of the ward and right past where I was sitting. Security in those days may have been low key but the alert went out swiftly and the porters (who doubled as security) were out in the front car park in minutes. The family was just minutes away from driving off, the baby still in the zipped up hold-all but fortunately uninjured. He was put under a formal protection order and the family cautioned.

I often wonder what happened to that little boy. Nowadays of course access to paediatric wards is strictly controlled but what a field day the papers would have had with that one had they known………….

 Next week: At last, applying to be a student nurse