Shit Happens! Death on an NHS Toilet.
When life gets heavy and you feel as though you would just like the ground to open up and swallow you up; knowing that you will eventually be able to laugh about it is a true gift to your heart. This does not always happen quickly or with every situation that ever challenges you, though it can get easier the more that you do it.
We are all shaped by our past. During 3 years of training as a student nurse, there had always been someone around who was more senior and experienced than me on the ward. If something potentially serious happened, I could always let someone else lead the call. I felt safe.
After 3 weeks of being qualified, I was working on a busy medical ward. When the two most senior nurses decided to go for a morning coffee break together and leave the ward, I was faced with my first ever instance of being the most senior nurse. Leaving a newly qualified nurse in charge would generally be considered less than ideal practice but it was not my decision.
Phones were ringing, patients were demanding my attention, people needed washing, drugs needed to be administered, relatives were demanding updates on patients that I had not even met, and porters were arriving to take patients away for tests, without even letting me know.
This was my life as a newly qualified nurse.
I felt under-qualified, unready and very apprehensive at this prospect. I had never been present for a life or death situation that didn’t have someone around who had led a similar situation before. Yes, I had been given all of the theory and attended resuscitation workshops but I’d never had to do the real thing. I had looked on as a student but that was miles from what was about to happen to me.
When a cleaner strolled over to me and casually mentioned that there was a patient on the toilet who didn’t look too well, I went straight to the cubicle. The cleaner was clearly a master of the understatement.
There was a patient dead on the toilet.
Unless you have been in this situation, it is difficult to describe what happened next. It started with a whirlwind of terror, shock, panic and adrenaline. In this, my first ever cardiac arrest situation that I was in charge of, the man was clearly very dead and any attempt to change that would be futile. However, panic and hospital procedure can be a funny thing.
I asked a Care Assistant to call the resuscitation team and lifted the dead man from the toilet to his bed, on the other side of the ward, with the other Care Assistant. All of the other patients on the ward and their visiting relatives could see us carry him, as it was an open-plan ward. It must have been a surreal sight for them, watching two nurses run across the ward with a dead man but I didn’t have time to think about anything else at that point in time. All I knew was that the handover I received did not give me any reason to believe that the man wasn’t alive and relatively well.
The man was cold, white, stiff and very dead.
He had died on the toilet with a huge, anal bleed. What made it worse was that he must have been there, undetected, since the shift before. I know this as he had riga-mortis, which takes at least 4 hours, usually longer, to set in. I had been on the ward for about an hour and a half. I did not get a full handover because I started an hour later than the rest of the staff that shift. This was part of an initiative to save the hospital money. They saved less than £10 that day on my wages. This was clearly worth the saving for me not getting a proper handover on that particular occasion.
As the resuscitation team arrived, imagine their surprise and my horror to find that we could not lay this man flat because he had riga-mortis.
He had stiffened so that his legs were at a ninety-degree angle. The fact that I had placed an airway in his mouth, an oxygen mask on him and had started the resuscitation process must have looked utterly ridiculous to the team as they rushed through the curtains and looked on in bewilderment. The dead man’s knees narrowly missed my head as he rocked during my cardiac compressions on his chest. I swiftly realised that this must have looked ludicrous, as the aghast resuscitation team stared at me.
I was filled with panic. Hospital procedure stated that if someone is for resuscitation then an emergency call MUST go out when a patient’s heart ceases to beat. It is not usually expected that there will be at least a 4-hour delay for this to happen.
I felt utterly humiliated.
I was subjected to some cutting questions from the doctor in the resuscitation team. My friends laughed at me, as did the senior nurses. I was devastated and terrified to go back to work after this incident. At first, I perceived this as insensitive. However, I eventually saw the funny side, knowing that the night staff should have realised that he was dead before they left the ward, and the rest of the staff on the shift with me had failed to identify that he was dead during the hour before I arrived. Nothing that I could have done would change these facts.
I learned several key lessons very fast.
1. Locate ALL of your patients at the beginning of each shift.
2. Treat all handovers with at least a hint of caution.
3. Shit happens; and for some it’s much worse for some than others.
4. Dealing with death is easier when you learn to see the funny side of things.
5. When you start at the deep end, it gets easier from that point onwards.
Afterwards some of my colleagues would call me over, to clearly dead patients and ask if I wanted to attempt resuscitation before they sent them to the mortuary. There were many laughs at my expense as a result of that incident. Allied with my experience of a psychiatric patient exploding diarrhoea on my foot a day earlier, as I lifted him out of the bath; and the time that my colleague forgot to unhook a patient’s catheter before we rolled them over, flicking infected urine all over my face and chest as the catheter disconnected from it’s bag; I provided many laughs.
By accepting that my colleagues would laugh at me ruthlessly, I was able to laugh at them and the numerous ridiculous episodes that I witnessed as a nurse. This made the job better and cheered me up in many situations that may have caused others to break down.
Humour is an essential tool in the NHS and life in general.
When you realise that you can laugh at yourself and others, life will most certainly get easier for you.