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

Good Nurse, Bad Nurse - read it here

I have just posted the text and photos from my public talk here (just click the Good, Nurse, Bad Nurse tag, above). It's quite a chunk of text to read onscreen, so those of you with fatigued eyes might wait for the audio version that we're planning to put online at Nursing Studies if the gods of technology allow it.

Above is one of the illustrations from the talk that I came across during my research. It was a campaign based in Oregon to shift perceptions of male nurses. Hmmm....

Other Voices, Other Blogs

One of the many undone tasks that I carry around with me like so many virtual baglady encumbrances is the assembling of a blogroll for this site. Look to the right hand column and you’ll see that today my load is lighter.

These blogs and sites cover a wealth of ideas– from the ever-changing and ever-stimulating blog of Durham’s Medical Humanities department to the individuals who have set up blogs to reflect their personal interests and opinions (or vent a little spleen as in the case of The Grumpy RN) .

I’ve been putting out calls for nurses who write, not only through this blog, but also through guest posts at The Scottish Book Trust and writer’s magazine Mslexia. As I hoped, plenty of people have got in touch to alleviate my ignorance and point me to nurses who do write or sites that reflect the nursing experience.

I especially enjoyed Dovegreyreader, a blog by part-time community nurse Lynne Hatwell which has become very influential among publishers for its thoughtful book reviews, but also contains entertaining accounts of her nursing career. Annie Coops, both a nurse and a diabetes patient, uses her site to reflect on her experiences of caring received and caring given, while Nursing Writing, set up the University of Connecticut school of nursing is home to a range ‘scholarly and professional’ writing by nurses.

These and more riches – available at a click of the finger.

Sometimes, when I think of all the voices, all the opinions the web allows us to access, I have to go and lie down in the dark. Other times, it’s a giddy thrill.

Good Nurse, Bad Nurse

Just to let you all know that I'll be giving a public talk at Edinburgh University on October 2nd. It's an occasion to mark the residency and to talk about the different and often distorted ways that nursing is reflected in our culture.

Here's the blurb:

‘Good Nurse, Bad Nurse’

Featuring a cast of drunkards ,saints, harridans, angels, sexpots, wimps  and mavericks, Nicola White, Leverhulme Writer in Residence at Nursing Studies Edinburgh, explores how nursing  has been portrayed in literature, film and popular culture and asks what part nurses play in their own stereotyping.

Hope that you get the chance to come along - it's free but ticketed and you can book HERE

Public talk, October 2^nd.  Doors open 6.30pm, talk starts 7.00pm, Teviot Lecture Theatre, Doorway 5, Medical School, Teviot Place, Edinburgh, EH8 9AG 

Story: Cecilia

This new story, Cecilia, is a companion piece to my previous story here, The Nurse My Father Loved 

The wife brought me chocolates. She didn’t just leave them at the desk; she came right up to me in the ward.

‘Harry wanted to get you something,’ like she didn’t have a part in it, was just a means of getting the chocolates from him to me.

They were fancy, in a box like a gold brick with a little cardboard tag tied on the ribbon. Her sulky-looking daughter hung back at the doors of the unit, wanting to be away. I knew her name the other day, but I’ve forgotten now. She’s like a lot of teenagers that visit here, resenting having to look at so much illness and dying, and I’d probably feel the same in her shoes. Harry’s being moved to a general ward tonight, things are on the up for them. I search my head for the wife’s name.

‘You didn’t need to do that, Valerie,’ I say, but it comes out more harsh than I meant. I meant it like a thank you, not a brush off. Now I’m annoyed.

‘But I did,’ says Valerie, holding my eye, and I’m embarrassed, a bit, even though I’ve nothing to be embarrassed for.

He’s been with us for five days, out of it most of the time, a little delirious. When we removed his breathing tube yesterday he kept staring at me with eyes big as a boy’s, his cracked lips moving, trying to tell me something. I gave him sips of water, told him to take it easy. His hand in mine.

He started to cry then and I held on, telling him where he was, that he was okay.

He said he’d been living under the sea. People say all kinds of things when they’ve been sedated. They have dreams they can’t wake up from, nightmares often.

‘There’s been someone with you all the time,’ I said.

‘I know,’ he said, ‘you were with me.’

‘Well, not every shift – ’

‘They were trying to catch us, but you swam so fast. Pulling me through the water. Your lovely tail.’ His eyes dropped to my hips, where my tunic meets my navy trousers. He frowned. ‘Your tail….’

‘You need to rest yourself now.’ I said, but I couldn’t help smiling.

I passed by Frances at the desk.

‘Bed five dreamed I was a mermaid. He said my tail was lovely.’

Her mouth twisted up on one side, but she didn’t lift her eyes from the computer. ‘I heard. Are you sure he meant mermaid? You could’ve just been a big fish. Like a tuna.’

By late afternoon he had his head on straight, but he was still looking at me in that way, you know, sentimental. We’d shared some adventure in his head, something that might have seemed like years to him. When I leaned near him to check his lines, he said.

‘I should have married a girl like you.’

There were a lot of things I could have said to that. Like how if he thinks this is what I’m like at home, he’s sorely mistaken. Like what about his perfectly good wife, breaking her heart over him in the visitors' room. Some men get the idea that it’s to do with them, not with your job.

I’m good at what I do. Give me the sickest person in Scotland and I can take care of them. You do get attached sometimes, but it’s often to ones you lose, and we lose people in intensive care, that’s just the way it is. I work here because you get to take care of one person, properly. On other wards you’re running around chasing your tail, things you haven’t done yet stacking up in your head, never getting to the end.

Harry’s a lucky one, out of the woods. Too many days I’ve drawn the curtains around a bed and unhooked a quiet body from all the gubbins. Line by line. Cannulae, electrode patches, nasogastric tubes, ventilator tubes, catheters, drains. I cast them off from the machines to be themselves again, just a person. I tell them what I’m doing, all through last offices, even though they are already gone. I like to do it this way. Some nurses get nervous and chat about what they’re having for their tea. I hate that. I prefer to do it on my own.

Harry's wife is still in with him when my shift ends. He’ll be gone tomorrow, but I skip saying goodbye in case he starts to get soppy again. I don’t want her seeing that. I go behind the desk and find that someone has opened the box of chocolates. I take two for the bus stop and stand a moment, scanning the ward as it quietens towards night. The whooshing of the ventilators comes to me like the sound of waves.