Though Cowards Flinch

It 20-odd years ago now, but I still remember  exactly where his bed was – second on the right as you went in. 

 It must have been around 8.45pm.  I was in charge that day, it had been a pretty standard day, and I was just doing a last walk round the ward, checking on anyone I had particular concerns about, having a laugh with one or two of the regulars, making sure people were settled before the night shift nurses came on.

As I came to the bed of the gentleman who’d just been transferred over from A&E a few minutes before, it took me a second to work out something was wrong. 

His pyjama top was soaked and for a second I looked to see if he’d dropped the water jug as he fell asleep. 

But then it clicked.  I grabbed a lancet and the blood test strip tube from my pocket and stabbed for blood, but even before the blood was on the strip I knew there as no sugar in there to change the colour; the sudden drenching of sweat could only mean he was in hypoglycemic shock and heading swiftly for coma.

The efficient nurse-in-charge took over from the affable youngster having a banter with the oldies.  One nurse was sent to the phone to fast bleep the House Officer – a sign that there was an emergency one stop short of cardiac arrest and that he was needed NOW – and another to the ward downstairs where I happened to know they had the 50% glucose solution we didn’t have in stock. 

My job was to swing the curtains round, rip off the bed head in case arrest came and access was needed on all sides, and get a blood pressure cuff on to check the vital signs (he’d come in that afternoon for observations into ‘mini-strokes’, but I knew what the problem was now).

 The house officer was there is seconds.  It was his first few days, and it may have been his first fast bleep; he seemed dazed.  Within seconds I had the 50% glucose from the nurse runner and was bleeding it through the giving set.  Fortunately, there was already an intravenous catheter line in as he’d come through casualty.

 ‘Hypoglycemic shock’, BM’s zero, here the 50% glucose’ , I said (or some such), expecting him to give the verbal order for medication I needed as a staff nurse before I could legally administer -  I could bend the rules, and the signing could come later, seconds counted now as any delay meant possible neural deficits if and when we got the guy round; you can’t live for long without some sugar in your blood.

The House Officer hesitated, and said he wasn’t familiar with the IV solution I was holding, ready to plug into the line and rush into the blood stream.  He’d have to look it up, he said

 ‘There’s no time’ I shouted.  ‘It’s glucose! Just give the bloody order!’ 

I may have sworn, I don’t remember. The order was given, after a fashion.  I would have started the drip anyway.

The glucose poured in, and I explained where we were at; that the gentleman was a late transfer, that I’d not read his notes yet, but that he was clearly an insulin dependent diabetic whose control had been upset by the events of the day; that he’d probably simply not been fed in A&E, who’d focused on the possible stroke rather than the existing issues, and that what was needed in these circumstances was fast glucose, the faster the better.

We parted.  I handed over to the night staff and stayed on to write up the notes.  Next morning at 7am I entered the ward, and my first look was to the second bed on the right, where the gentleman sat upright, eating his cereal.  He was fine, and good enough to wave me over and thank me for saving his life; I assume the night staff had told him where he’d gone to the previous evening.

The House Officer arrived around 8am.  ‘Any deficits?’ was his first question.  He didn’t need to say who he was talking about.  ‘None’, I said, ‘he’s fine’.  We looked briefly at each other and got on with the day.

Why do I remember this little incident to this very day?  Why do I suddenly recount a personal tale on a leftwing political blog devoted to class-based analysis?

The reason I tell you this story is that, more deeply ingrained in my memory than the incident itself – just one of the many emergency episodes you get when you run a busy medical ward – is the reaction of the House Officer in the days and weeks that followed. 

I could sense, every time he was in my company, that he was uneasy.  He became more formal, more ‘doctor-like’ in his relations with me.  He was a lad not much older than me, maybe even the same age, but he needed to show – it seemed – that he was the doctor, and I was the nurse.  He was never rude, but he became just a ‘little bit off’, the whole time.

It didn’t bother me much, but I wondered what had happened, and I grew to realize that just for a second, in the heat of the emergency moment, class relationships had been overthrown, that I’d given the order, that I’d taken control, and that he now felt he needed to re-establish the proper hierarchy.   

 It didn’t matter that, in the cold light of day, there was no reason he should have known about 50% glucose, but that it was perfectly normal that I, as an experienced staff nurse, would do.  What mattered, it seemed, was the convenient fiction that (male) doctors had the scientific knowledge of drugs, while (generally female) nurses took the orders, however adept they might be at making clear what orders they expected to be given on their ward.

Cutting across that, I suspect, was the fact that as a male nurse, and that I’d also transgressed a different, less clear line; that an older, ‘motherly’ sister figure giving an order like that would have been OK, that this would have been within the ‘order of things’, but that by my very masculinity of approach (I’m a big bloke and in those days I was built like a  brick shithouse) I had denied him his dominant position, and that my continued presence around the ward continued to deny him that.

I’ve not thought of the little episode for years, but it sprang to mind the other day, when in a comment on my post about Ian Dale’s ill-informed reaction to the news that all nurse training will be in higher education, another male nurse (Gary) commented, saying that he disagreed with the (original) decision to move towards degree-based nurse training, and that many of the faults he currently sees in nursing care can be attributed to the pernicious role of the Royal College of Nursing in the development of nursing as a ‘profession’ where what both he and I grew up with as basic standards of care have largely been lost.

 In fact, while that wasn’t actually the focus of my original post, I actually agree with a lot of what Gary says. 

 What he doesn’t draw out, though, is the extent to which the Royal College of Nursing has been used (and has willingly played its part) as a mechanism to reinforce, under the pretext of the promotion of nursing as a profession (and thereby presumably a reduction in gender inequality), class-based inequalities within the NHS.  In so doing, I contend, standards of care in hospitals (and care home etc) have dropped in the last 20 years.

I’ll be looking in my next post about how this came about, starting with the way the NHS, at its very inception, had built into it a system of class inequality which stays with us some 60 years on, and which impacts negatively on the standard of care received by people benefiting from it; my point will be that the NHS is a great institution, a great concession wrung from capitalism by the working class, but that just as Labour MPs in the post-war government did, we should see it as a socialist project only just begun, not simply one to preserve in aspic.

 If I hadn’t, a quarter of a century ago, in the heat of the moment, cast aside the class-based distinctions, built into the NHS rules, which said I must wait upon a doctor’s order in spite of what we both knew or didn’t know, that diabetic gentleman slipping into coma would have suffered brain damage.  Perhaps he would have died.  Class could have killed him

Maybe, as a newer type of nurse goes through its newer type of training, challenging class rules is good for the NHS as a whole.