Plastic People

 I recently attended a lesson at the clinical skills centre at Little France  – I wanted to see students working with simulation models – dummies, in other words. The point of clinical skills is to get some hands-on experience in a scenario as similar to life as design ingenuity and latex technology can get you. And these days, that’s startlingly close.

The room was the size of a small ward, even had curtains and rails to divide the space into a three bedded unit. That’s not what you notice first, though, since you’ve just stepped into what looks like a charnel house. There are single arms everywhere, resting on bloodstained pads (as a dog owner, I recognise these as ‘puppy pads’ a central but largely useless part of canine toilet training – I’m glad they've found another purpose).  In the old days, apparently, you practiced your syringe skills on oranges. Now we have disconcertingly lifelike arms with veins you can inject into or draw from. The blood is a jollier, more fluorescent red than the real stuff. Each arm has a bag of it attached by tubing, giving the impression that someone has just stepped away from trying to revive it.

Around the edge of the room, a selection of anatomically detailed lower torsos sit on the countertop. I wipe the unbidden image of an Amsterdam sex shop window from my mind. The class I'm attending is a speedy overview of pregnancy and childbirth given by the cool-headed Carol Brown, who has brought many of these female parts with her, some in a box branded with the name of Adam, Rouilly, who specialise in such things. The box is printed with the jaunty strapline Limbs and Things. A lone male bottom is incongruously stranded amongst the female parts, very obviously waiting to have his prostate felt. Carol puts him aside.

She props up an entire pregnant female torso, and with a whisk of her wrist pulls down the outer skin to reveal an amazing sight: a full-term baby inside a see-through sac with placenta attached. There is pump to control the inflation level inside the sac, so that manual examination of the belly will be as near life as possible. Some speakers are fitted to reproduce foetal heartbeat sounds. It is both ingenious and oddly beautiful.

The first year students and I practice internal examinations, then deliver the model of a baby through a skeletal pelvis, then a fleshed-out dummy. Between tries, students absentmindedly cuddle or rock the plastic newborn. I even learn something about neonatal resuscitation. Although the lesson is intended as an overview, so persuaded am I by the experience of hands on dummy-nursing, I go away with a delusional idea that if someone went into labour in the aisle of Sainsburys, I might be of some help. A little learning, as they say.

Adam, Rouilly’s website is absolutely fascinating, with an overlay of weirdness for the casual visitor. The list of simulation models makes it clear that this kind of virtual practice concentrates on the more intrusive tasks – injections, intubation, catherisation, internal examinations, suctioning.  Ideally, nursing and medical students can use them to come to terms with the basic mechanics of the thing, so that, when it comes to dealing with living patients (I was going to say breathing patients, but some of these models do breathe) they can focus on the person as much as the task.

But – and it’s not a huge but, because I can see the good of all this. But. Look at the picture below.  As the mannequins become more sophisticated, could it be that healthcare professionals might start to compare us unfavourably with these plastic people – uncomplaining, unopinionated, can’t use the internet, don’t mind waiting for hours, extremely high pain threshold. The students have time to discuss things amongst themselves as these attractive ladies wait in wistful silence, putting the patient back into patients.

All photographs courtesy of Adam, Rouilly

New Writing

I'm very happy to be publishing some more new writing on this blogsite, work that has arisen from workshops I gave within the School of Health in Social Science (of which Nursing Studies is a part) and also a poem sent to me by Denise Taylor, a nurse and writer based in the Borders. You can find Denise's poem along with a memoir piece by Marion Smith under the 'Writing by Nurses' tag above. 
Strictly speaking, it should read 'Writing by and about Nurses', as Marion's story deals with the patient's perspective, and a nurse you wouldn't choose to encounter.

In a similar vein, but a very different setting, Eliane Du's remarkable true story below, has at its heart our expectations about how healthcare professionals will treat us, and the painful shattering of those illusions.

The Doctor With A Gallon Of Water

By Eliane Du

We generally believe that doctors are meant to save lives within their power and ability, but from my experience that is not always the case.

Several years after the Vietnam War ended, my mother decided to leave the country taking her four children with her. It was a drastic decision, but like many Vietnamese “boat people”, we had to risk everything, including our lives, to find a new life. Our transport was a 19½ feet boat crowded with over 285 refugees.  I was about nine years old and was too young to understand how dangerous the journey was.

The night we left Vietnam, my mother dressed us in two layers of clothes and I was given a canteen of water to carry for the family. When we got on the boat, I was immediately separated from my family and was put to sit at the bow. My older brother and sister were pushed down to the lower deck.  My mother and youngest brother along with other children and mothers could remain on top.  

I was very seasick and the horrible smell from the diesel engine made me vomit. Terrified of moving around, I tried to lie still and go to sleep. I woke up with a terrible fever: I tried to look for my canteen of water but someone must have taken it while I was asleep. Our boat tossed and turned heavily in the strong winds and ferocious waves. A big storm was coming and everyone started to panic.

My mother was worried that I might fall overboard without anyone noticing, so she managed to persuade the people around to help and bring me over to her side. Right next to us sat a doctor and his wife. My mother asked him about my condition as I lay dehydrated. I could not take my eyes off the big gallon of water that was placed beside him. I whispered, “water”.   He looked at me and said that I had a high fever. Poor mother, she tried to beg him for a small cup of water but he refused to offer any. Eventually he poured out a little water using the tiny lid from the gallon and gave it to me to stop her from nagging. I was shocked by the amount of water provided, especially from a doctor whom I thought should be kind and helpful. I looked at him and tears were rolling down my face, but he was not bothered. I forced myself to sleep so that I would not think about the gallon of water.

I dreamed that I was happily playing in the sand with the neighbor kids. Suddenly, a big wave dashed in, knocked me down and carried me out into the ocean. I was waving my hands but no one paid attention. The waves kept pulling me under and I struggled to keep my head above the water.  I opened my eyes and felt terrified. It was only a dream but the thought of drowning made me shiver. Around the boat, dark fins loomed up through the water. My mother said softly, “sharks” and told me to pray hard and I again drifted into unconsciousness.

I was woken by something cold going down my throat. My mother was trying to squeeze some lemon juice into my mouth. Someone had thrown us a few lemons and that was how I survived for the next four days before we were saved by an oil tanker. I remember how much I enjoyed those lemons: every single piece that I could get from the little fruit. There was no sour or bitter taste in them but only juiciness and deliciousness and they were far better than the doctor’s gallon of water.

Photos from the journey:

This was the boat on which we left Vietnam. It was 19 and a half feet long and carried  more than 285 people

The rescue by oil tanker. Passenger had to board by ropes and a net.  I remember my mother was almost crushed between the two boats when trying to climb over. Fortunately, someone saw what happened and helped to lift her up!

Eliane Du is originally from VietNam. She has lived in Malaysia, the United States, and the United Kingdom. She received her BA degree from California State University Northridge and an MSc degree from the London School of Economics. She is currently doing her PhD at University of Edinburgh in the department of Clinical Psychology, School of Health in Social Science. Her research interests are in E-Mental Health and Human-Computer Interaction. Before starting her PhD, she had worked as a Software Quality Assurance Engineer for Autodesk Incorporations: an inventor of AutoCAD application and their 3D visual effects, media and entertainment software were used in Avatar movie

Story workshops with nurses

If you scrutinise the photograph (left), you may notice that an essential part of running a writing workshop for nurses is baiting the trap with a selection of finger food. There is no better way to lure busy team members in the middle of their working day.

Along with Dr. Deborah Ritchie of Nursing Studies, I ran four lunchtime sessions for mental health nurses at the Royal Edinburgh Hospital, under the theme ‘Telling our Stories’. Our immediate aim was to generate fresh accounts of mental health nursing today. Not only for the pleasure and satisfaction of the exercise, but because the voices of nurses are so often missing in debates around healthcare. In the long term, we are interested in seeing how these kind of creatively generated stories could be used to inform research, planning and advocacy.

We were assisted by the wonderful arts organisation, Artlink, who run a range of creative activities for patients at the hospital. They kindly loaned the big kitchen at their Glasshouses base so that we could get away from the usual training room atmosphere and have a space that was more homey and informal.

A big thanks to all the nurses who took part, none of whom had done creative writing before, but who rose fearlessly to the challenge, producing work that was moving, funny, sometimes frightening and filled with a tough-hearted dedication.

The following was written by staff nurse Jo Dunlevie in response to a challenge to find metaphors or images that would capture the transition between work and home. It’s a fine piece of imaginative writing.

Work

Unfunny clowns in dangerous big shoes

Stomping animals growling in the dark

Bright lights, Loud horns

Blinking light to dark

High wire ooh's and Ahh's

A moment away from a fall

A Disaster, head off in the lions jaws

Home

Slow steady smiles

Big laughs and tiny giggles

Quiet steady light, and the smell of growing things

Friendly voice, nudging concern

Big sighs and lashes on sleeping cheeks

Soft fall of turning pages

And the Dum de dum of life in Ambridge