Part three of the previous series can wait until another time, if ever. I can’t write about it right now. In my own life I can’t seem to move far from fairytale expectations and disappointingly not very grown up ways of thinking about love – ha, the irony.
I do try to capture a bit of each rotation. As in capture something beyond I-don’t-like-hospital-work sentiments. Earlier this year I was “fixing broken hearts”. Not really. We don’t even have the facilities for PCI (stenting), let alone bypass surgery to fix blocked heart vessels.
Anyway, one story I remember quite well from that rotation happened during the Easter weekend ward round, where an Indigenous lady whose heart had the tendency to go into loooooong pauses insisted that she wanted to leave coronary care to attend the service held that morning by the hospital chaplain. Her English was rather limited but she was also adamant that she didn’t need to consent to a pacemaker insertion. “I want to pray for healing. God will heal me. I won’t need surgery.” she insisted. The consultant was sympathetic and explained whilst it wasn’t safe for her to leave, perhaps the chaplain could come to pray for her at her bedside. I wasn’t sure what to make of it – to commence her for her faith or to convince her that she needed a pacemaker. Maybe I would have done both.
Our best quitter
One hectic day, a few patients from the morning arrived more than half an hour late, just before the clinic closed for lunch. I thought it was a bit ridiculous that they still expected to be seen when they had clearly missed their appointments and the rest of the afternoon was already booked out. So I wasn’t impressed with the teen who sat before me, until I heard about what he came in for.
He had been smoking for a few years and was serious about quitting. On the several occasions that he tried, what stopped him from stopping altogether was not peer pressure from his mates, or a lack of motivation. It was the withdrawal symptoms that he had, including headaches and nicotine cravings. He wondered if patches could help. I don’t know how he did in the end, but this teenage boy was the most self determined quitter I’ve met in all of my smoking cessation discussions – he was clear that he wanted to quit, knew why he wanted to quit, recognised what stopped him from doing so successfully, and forthcoming with asking for help to overcome the barriers. Grown ups certainly have something to learn from him!
Life is a gift
Sometimes you resent patients for simply being complex (which is unfair of course), because you know it will take a long time to dig through their history, see what’s been done so far, get your head around the current problems, and work out a sensible plan. Especially if when there are communication barriers. I had such a patient, who was profoundly deaf even with hearing aids. He had been going in circles between surgical, endocrine, and renal outpatients for essentially the same problems and couldn’t tell me much about it. It took a long time to make sense of the letters that seemed to be bouncing referrals from one specialty to another with no clear conclusions.
Apart from that, there were also some concerns about mild cognitive decline. We got talking about his mood because his family were concerned. Amongst other things I asked about whether he felt that life was not worth living sometimes. He beamed and said, “No! Life is a gift from God.” I smiled back and thought I should take the reminder to heart.
Working in rural places you meet some interesting staff. T-shirts and shorts seem to be the standard dress code for nurses. Flip flops aren’t uncommon either. Nor are tattoos and multiple piercings. Not that I particularly mind but I just didn’t see much of that in the old school hospital I worked in last year.
I shut off a bit at work and rarely have much emotional attachment to colleagues – but maybe less so in the cosier clinic setting. This time there was a nurse I liked and connected with. Whilst I was thinking about my career goals and applications, she said that she too was thinking about what to do in terms of further training or studies. She had done Masters in midwifery just a few years back but now doesn’t know where she wanted to take that, or do something else. She shared my frustrations in working out where to go, and finding something that was interesting, challenging and fulfilling at the same time. Except, well, she is possibly in her sixties or thereabouts. Now, some of the clinic staff are permanent residents of the region, but many including her are on short contracts from one rural clinic to another, each separated by many thousand kilometres. When we asked her where her permanent home was she said “I really don’t know”, and the other nurse nodded knowingly and said, “ah, so you’re permanently moving around.” I felt I could relate to that oxymoronic description of home. Though, I don’t know what drives people to move from place to place without ever settling. I don’t know if it gets lonely. Yet often I too feel the itch to keep moving. My dad says “you want to go here one day, and move there another. I think you will be more settled when you find someone.” Haha, I guess so.
The loveable couple
He had vulgar language, she had mental health issues, they were previously homelessness and seemed to have drug and alcohol issues in the mix too. At handover I heard about how he had attempted to strangle her over the weekend. Later the same day, she turns up for something unrelated with the same partner. Again, communication was difficult because she was deaf – not only that, she had been deaf since childhood and her speech was also fragmented and difficult to understand. I can’t recall what her issue was with hearing aids. We did some pen and paper talking but he also offered to come in and interpret via sign language. I was wary, but she wanted him to too, so in the end he came in with her. As I mentioned, I resent complexity (medical or otherwise) but I guess they grew on me in the subsequent visit.
This time she was using the external amplifier we had at the clinic. He gleefully told me how she can now pronounce “babe”, as in “bayyyybe” not “bub” with the amplifier on. She was delighted about this too. We got talking about how she came to be deaf. I had assumed it was either congenital or a result of recurrent middle ear infections, given that she was Indigenous and it was so prevalent within Indigenous populations. But it was an unfortunate story of her having sustained significant injuries from being hit or shaken as a baby. He encouraged her to seek help about her other worries and she told me about her abusive father interstate and how she felt unsafe every time she went back home to visit. I sort of asked whether she felt safe where she is now and she replied that she did, because he protected and looked after her. He piped in, “she looks after me too, we look after each other. Love you babe.” They embraced at that point and I thought aww… though I had mixed feelings too, not forgetting the dysfunctional elements of their relationship.