Nell Holland: Patient 41

2022

The nurse changed my bed linen at lunchtime. It should have happened hours before, but a patient had demanded to be discharged and then changed his mind. This had doubled her paperwork and she found herself hopelessly behind schedule.

 She’d sighed an explanation, ’Paperwork is the worst thing, ever, for a nurse.’

Paperwork? Really? I don’t think so.

Decades ago in England

I was 19, Barbara 20 when we walked onto the ward for our ninth nightshift in a row. With Sammy, the elderly ward orderly, we looked after 40 male medical patients in an open ward; beds lining each side of the room.

The night began normally. Evening beverages, injections, tablets, two-hourly patient-turning, four-hourly observations, gastric feeds, reassuring patients, checking intravenous fluids, issuing then cleaning up urinals and bedpans. The three of us worked non-stop, but before Night Sister’s rounds at 11.30pm everything was completed.

At midnight, Sammy had his meal-break. While I prepared clinical trolleys for morning, Barbara brought paperwork up to date.

A telephone call from Casualty told us to assemble another bed in the middle of the ward, for a 39-year-old suffering from Delirium Tremens. He arrived, enormous and unconscious on a trolley, accompanied by a porter and two policemen who bundled him into bed, promising he’d be quiet as he was heavily sedated with Largactil.

As they left, one policeman looked at Barbara and me and shook his head. ‘If he wakes, you two won’t hold him.’ Neither of us weighed much over 50 kilograms at the time. Ten minutes after they’d departed DT-man woke and started punching imagined objects and screaming more swear words than I’d ever imagined existed. Barbara phoned the houseman to come and assess the situation but when Ahmed arrived DT-man was already sitting up, laughing maniacally, and cursing loudly. Paraldehyde was ordered, but Ahmed immediately ran for the door, watching DT-man leap out of bed bellowing new profanities. I shouted to Ahmed, ‘Call the porters. We need help!’

By now, the whole ward was awake, with patients watching in shocked terror.

Then Sammy returned, and DT-man’s bloodcurdling uproar included Satanic descriptions of Sammy’s Nigerian face. He grabbed and threw containers from a nearby trolley before kicking it over. Barbara was hit on the jaw with a pot of iodine, and I got hit on the temple, methylated spirits flooding my eye. Sammy grabbed a nearby beaker and threw water into my face, probably saving my sight, though the pain from the methylated spirits was excruciating.

DT-man, in full flight, screamed bloodcurdling blasphemies to accompany his rampage while we tried to shield patients who were mostly helplessly confined to their beds. The urinal stand was first to go, glass urinals shattering. Then the bedpan trolley was kicked over; metal bedpans clattering and skidding. The noise was ear-shattering and the broken glass and scattered bedpans combined to create a vision of devastation more often seen in a war zone.  He’d begun shaking beds, randomly grabbing patient’s notes, and kicking them around the ward, when two policeman and four porters arrived. The fight to get him into bed was monumental; DT-man really did possess the strength of ten men and believed he was fighting for his life. All six men plus Ahmed, Sammy and I were needed to hold him while Barbara injected the Paraldehyde, then to constrain him (mostly lying on him) until he’d quietened, and we could put up cot sides. The policemen insisted we add a restraining net over the bed, and we were more than happy to comply.

By now it was almost 3 am and Barbara and I had last eaten at 8 pm the previous evening. We cleared up glass, papers, and debris, calmed patients and gave out cups of tea. Then standard procedures kept us in perpetual motion until daylight. We didn’t dare to sit down as there was so much to achieve before we handed over to the day staff. Whatever happened during the night would never be allowed as an excuse for not having achieved our workload, before the day staff came on duty at 7.30 am.

When Day Sister arrived for the hand-over at 8 am her eyes narrowed on seeing us. Barbara’s jaw was bruised, an iodine stain running down her neck and uniform. I wore an eye-pad; my hat, collar and apron crumpled from water ruining the starch. But the ward looked pristine, and DT-man was oblivious and snoring loudly in his Paraldehyde miasma.

The night report was delivered in the unemotional and factual way that was expected. The drama of the night was reduced to clinical words on paper and Sister accepted the report without offering comment or praise for what had happened – or how we’d coped.   

However, she did say we should get cleaned up as fast as possible, as Matron wouldn’t want us to be seen in such a dishevelled state by any member of the public. Her cool, impassive approach was in stark contrast to that of the grateful patients who were only too aware of the drama, and how much worse it could have been.  They wolf-whistled, cheered and clapped as we departed, ignoring the furious Day Sister’s orders for it to stop. Their tribute created enough adrenaline to get us to our rooms. We’d eaten nothing all night but were past hunger and with great relief, tumbled unwashed into our beds. Then in the evening we woke; found fresh uniforms and walked back on duty to begin another shift.