The Long Slow Fall

‘Coo, that’s gone quick’.




Almost everyone I know has said a version of those words, commenting about the ending of my eight week student nursing placement in a dementia care home. Most of the time I’ve nodded and changed the subject while inside I’ve been screaming, ‘No it hasn’t, it’s been one of the longest and toughest periods of my life’. I had understood that having completed this elderly care placement, I wouldn’t be required to do another one, but last night, my friend informed me that it’s one a year. I almost choked on my bombay mix.



I still don’t understand why dementia care is not for me. I liked the people I was nursing. My mentor said that most students start off frightened by the strange noises, odd behaviour and personal care. I explained I was positive I could work with all staff groups (ouch that’s more a groan than a laugh). I was confident though. Because dementia is a type of mental impairment, the overlap with working with people with learning disabilities is extensive so all of my old skills kicked in. Naturally, my distaste for the model of care that involves getting 42 strangers all with their own problems to live together in someone else’s house kicked in as well. Especially as the someone else happened to own an extensive collection of vintage cars. I believe in Person Centred Planning, I cried, Get Me Out Of Here.



The staff were mostly kind to me, and they do their best in under-resourced circumstances. The shift pattern was convivial (early starts not too early). I had some time off to hit the library. There were tea breaks. I got used to having to wear the uniform. My mentor was intelligent and experienced, happy to engage in discussion. It should have been a breeze, and yet I never got comfortable.



Student nurses are implored to value even the difficult placements as learning opportunities. I went all in on this, and I’m much better informed than when I started. Practical skills (dressings for pressure ulcers, suctioning, injections...) buzz along in my head with assessment and care planning frameworks (Continuing Healthcare Funding, Oxford Care Pathway, Gold Standard Framework) circled by issues of nursing ethos (own training, management of staff, where responsibility rests and the gaps left between). Then there are the different forms of dementia, including Korsokoffs – alcohol related – the kids are tired of me telling them not to drink. I’m far more familiar with the musical The King and I than I ever expected to be. I wonder if Tom Kitwood, father of person centredness realised that his work would be so taken up by learning disability workers while being underutilised in Dementia where he developed it.



There have been beautiful and moving times. A woman asking me ‘Look, you say this is my home? Well why are all these people here? I can’t afford to cook for them and clean for them.’ A lady waking suddenly from sleep, frightening us both ‘I don’t know you’, and me apologising and agreeing with her although she had seen me around ‘But you’re nice’ she said, rolling over, curling back into slumber. A man obsessing over the work he had to do, lifting and breaking things beyond his strength, yet holding my hand gently, telling me about his father. A woman screaming and fighting, calming with a few words reminding her of who she was. A bath, another bath. Weetabix. A discussion about Scottish nationalism another about education and another about curry. Elvis, Abide With Me, and the discs they used to give away with Sunday supplements. My own soundtrack to it all, Chris T-T’s Tall Woman, and the metaphor of the ‘long, slow fall’.



Boiling it all down to the last week, when I’d got used to the place and started to think I enjoyed being there was this: my work in caring for people so far has been all about life. Living the best life in spite of the bad hand that has been dealt. Helping people live well. This placement has been about the opposite – about how to die well, and about waiting for death...in slippers...eating mashed potato...enjoying Tom Jones until finally, after a year or ten comes morphine and a CD of ‘Angel Music’.



I admire the people who work every day helping people to do this, but I’m forced to own, it isn’t for me. It’s taken 43 years to come to the infuriating conclusion that I can’t do everything. No wonder I’ve spent 8 weeks sad, frustrated and annoyed. Like it is when all relationships fail: Dearest Dementia, it’s not you, it’s me (and a bit you to be honest).

Old

Out of touch for a while, but here I am. Exhausted from my latest nursing placement with older adults and from quick visit to Nan. She recently gave up climbing the stairs and seemed much more frail with failing hips and failed sight. She has been falling out with the religious ladies who visit her. 'It's all rubbish about dead people coming back', she told me 'I want to live'. And then she said, 'mind you I must have someone looking after me'. We fixed her up a headboard and bought sweets. Life goes on and Coventry was calling.

I've been asked to contribute a funny story for the Mental Health Nursing Newsletter. I wrote this old story up, and thought I'd post it here too.

Alfred (born 8.8. 1915) was my Great Uncle.  He did watercolour painting, made me a brilliant swing, mended clocks, tamed wild animals, rode a Triumph Acclaim motorbike, kept receipts and saved coppers, polished furniture, and knew the virtue of iodine. He studied signwriting until the outbreak of the Second World War when he was called up fighting with Monty’s Desert Rats in North Africa. He held all kinds of job, including coffin maker, but mostly worked with his brother mending shoes and horse harnesses, retiring in his eighties. Oh, and he had Asburgers Syndrome.

It was cold, dark and raining the night he came down the lane, walking right in to his sister’s kitchen, already shouting. His voice had a particular tone that carried, his words repeated, often with varied pronunciation. Nan was used to him but couldn’t at first work out what had happened. ‘Alfred, Alfred sit down here’. He wouldn’t though, and demanded to call the police (he had no phone of his own, too expensive). Was he sure he needed to? Yes. He took the phone and the call was made. We lived in a rural area and they would be some time. He phoned again to make sure they were coming. Tea was offered and having taken over the precise measurement of the leaf tea (too much was wasteful) he became more coherent.

Some boys had come to his house. Not boys, youth. In a gang. They had demanded money and threatened to do damage if they weren’t satisfied. He had sent them packing but they might come back.

‘What did they say exactly?’ My Nan questioned him cautiously. Alfred was still angry. ‘They demanded money with menaces’. He told her how they had knocked the door and said something he couldn’t catch. They were dressed up in coats and scarves over their faces. He asked them again and they said something about treacle. When he had asked what they meant by it they had threatened to do something to his house if he didn’t give them money. ‘Treacle, are you sure?’ He was sure.

The police officer arrived and Alfred retold the story. ‘It was definitely about treacle’, Alfred said, ‘treacle..treacle.. treat’. The officer folded his notebook. ‘Sir it is the thirty first of October’.  There was a long pause. ‘Could it have been Trick or Treat?’

Joining the Dance

In tough times, isn’t it a comfort that there are loads of wise sayings out there to help me get through. No, it isn’t. Wise sayings are just one line fairytales designed to keep us from rebellion. I’m a woman on the edge – but wait – ‘What does not kill us makes us stronger’. Oh, that’s fine then.

In employment, in addition to company slogans that are wise sayings in disguise (see above), we are offered comfort from codes of behaviour. Elaborate dances to the tune of authority structures, customs, and values. Few of these are explicit, and a new team member is pretty much set up to trip over and get bruised. The jobs that I’ve lasted in have been the ones I’ve been able to pitch in quickly and prance about laughing until I’ve worked out what everyone else is up to and where I fit in. In those jobs I’ve enjoyed the rhythm, so not knowing the dance hasn’t mattered. I shared in my colleagues’ common joys and trials. This is the way I felt about my first job in Mr Leatherbrother’s (Mr Lee to staff) chippie when I was thirteen. I had a sixth sense about when the teapot was about to run dry, could squeeze between the summer crowds with a pile of crocks in one hand and a rag in the other. I loved the boss and he loved me, especially when I burned the meal of pigs’ trotters that his ex-wife had set on the boil in the back kitchen.  I loved washing up with the boss’s son to Dexy’s Midnight Runners. He was the only black child I knew in Cornwall that was as white as Princess Diana’s wedding dress in 1981, and the only adopted child too. We compared notes about life and disagreed in a good-natured way on everything bar Genome. Most of all, I loved the women who served in the shop, their humour, their hard work, their pragmatism, the way they made allowances for my age but not many and not for long. I loved their stories about their husbands, gossip about their children, their moral values, the liveliness and life in them. One day when I was away at college, Mr Lee did what he had always talked of doing and sold up to retire. I returned to find a clothes shop in place of the chippie over the road from the museum. It was as though I had come home to find that my family had been wiped out by the ravages of an earthquake. I grieved until I found them. The women had set up a refugee camp working at the bakery on the front street, Mr Lee had gone back to Yorkshire after his son had run away having robbed the old man by climbing in over the roof at night. It was a scandal over a saffron bun.

If I fitted in at Mr Lee’s, I did the opposite at the supermarket. Aged sixteen, I had been tempted by the better pay and hours (I was developing a cider-based social life). I was on the checkouts covering the breaks of the other girls. In the time before scanning checkouts, tills were a beige coated cast iron calculator. The task was to find the price label on the item then copy it into the machine by pressing the heavy square keys. After finishing the number it was necessary to depress a bar at the side of the keypad with the edge of the hand, making the till add up. It was all set up for right handed people, and this made me slower and clumsier than average. I never got to know anybody in the subsidised canteen where people chatted and smoked, looking at me with suspicion as I sat alone. Neither did I learn the numerous rules of conduct. I felt bullied by the supervisors who seemed to catch me out in the transgressions routinely overlooked in everyone else. The other checkout girls (the manager had his own policy of employing only pretty young girls, he told us so on our first day along with the fire drill was ‘wear make-up but not too much, tie your hear up nicely and smile’) were all a bit older than me, and wouldn’t let me adjust their seats while they were on their breaks so I was always uncomfortable and sore. I bit back the tears threatening to smudge my blue eyeshadow as the supers ostentatiously re-calculated the value of a trolley of shopping that I had put through, finding me 2p in the wrong. During afternoon tea-break on my sixth day, I walked out, telling no one that I wouldn’t be back, and leaving my overalls by the door of the personnel office. I never went back for my 98p per hour wages and no one ever called to check that I hadn’t been abducted by aliens.

When I fell into learning disability work, mostly by accident, I felt like I already knew the dance of the job. Falling out of it was more about tiredness and ill health than any disenchantment with the tune. Last year, I began mental health nursing with caution about how I would find it. It went well on the last placement, like coming home. It was imperfect, and there were trips and bruises, but I never wanted to walk away. They warn students every placement is different, and that some are difficult. Student nurses have to be exposed to a range of experience so the placements are allocated by a mysterious process to which I’m not privy. Given this, I was certain to be given at least one placement that I wouldn’t have selected. I’m all grown up now though, experienced in the ways of the staffroom, powerful in the way that I thought those middle aged women at Mr Lee’s to be. I ought to be able to join the dance anywhere. And yet, it’s the end of the first week and I have the same feelings of the sixteen year old who dumped the uniform and made a break for the fresh air.

Don’t get me wrong, it is as one of the nurses so aptly put it, a good-hearted place. Adequate or more than so in every respect. It turns out (and why would it not) that people with dementia act in the style of people with severe to profound learning disabilities with life limiting conditions. The staff are people of kindly and efficient nature, doing all they can for people with warmth and affection. There’s a good staffroom, rest breaks and tolerable hours. People have been pleasant to me. It should feel right but something is amiss in the dance between me and this place. I have the wrong shoes, the well worn trainers that encourage people to learn to do all they can, to battle their disabilities, find new pleasures, live to the full. The footwear to compliment this placement’s tune might be slippers in which to sleep out the long last afternoons. I came unprepared by my Nan, now one hundred and a half, who said this last week after telling me her age as she says every time ‘and I want to live’. She has moved into her living room now, unable to manage the stairs but otherwise unchanged. On my first day of placement, a member staff introduced the service by explaining that she thought of it as offering mainly terminal care. This was echoed by a service user who seemed cheerful as she said she was here waiting to die. She laughed at my shock and changed the topic for me. And so I learned a little more about kindness.

One week down, seven to go. There’s no Mr Lee to go back to, so I’m going to have to make it to the end of the tune all be it with bruises. After all, ‘what can’t be cured must be endured’. Oh.

Dyspeptic Toad

Me and my chest infection braved the spring sunshine to make it into Uni today. The pressure was on as last Friday I had received an email asking to see me about my attendance. I’d have gone in anyway because I was no longer likely to expectorate over the row in front, and also I’m committed enough not to want to miss this term’s lectures which have been good so far. The email added to the pressure though, and being still ill, I’m over-sensitive and could have done without the anxiety of having to go and explain the only two days sickness I’ve had since going back to uni in September.

I knocked at the lecturer’s door on time and was kept standing in the corridor while he finished a phone call. Wheezy from walking along the corridors, chest itching to cough but worried about my bladder’s ability to take the strain, I thanked him for the seat. Then I squatted like a hungry but dyspeptic toad required to wait for the courtier to get on and read the proclamation. It came to me that I was behaving quite strangely. I said ‘shit’ at one point and although I love a swear, I wouldn’t normally in that situation. I also apologised immediately for it, which is far worse because swears are only powerful if they’re confident.  I tried to bring the conversation round. The damage was done though and I can only say in my defence that I wasn’t the only one not making much attempt to listen. It was a painful meeting of strangers in the presence of the two other lecturers who share the same office. Thank heavens I only needed to talk about a chest infection – that and my shit maths test. Although, it might have been fun to wax on in the presence of three male nurses about some glamorous pelvic discharge.

Afterwards, I was annoyed with myself and with the situation. I don’t particularly like talking about my health with complete strangers and I don’t see why after just two days sickness I should have to. In the days when I was the courtier speaking to the toad, I used to have to ask about people’s illness because that was the king’s law. There’s plenty of business research that conducting sickness/fitness interviews reduces the number of sick days, especially odd days. I agree that checking how people are doing and offering a bit of help should be a nice thing to do. It’s a strange thing how good intentions go awry though:

‘Were you sick?’

‘yes’

‘really sick’

‘yes’

‘how sick’

‘this sick’

‘and you couldn’t come in because....’

‘I was sick’

‘and you know it’s not good to be off sick?’

‘yup’

‘and what action did you take about your sickness’

‘I did what I thought I needed to do given the state of my health and the NHS, I’m not a fuckwhit’

‘and what support do you need’

‘do you provide miracle cures for the norwalk virus? Only I thought you just sell drills and stuff?’

‘good, no support needed, so just to check the paperwork.. you were sick?’

And so on. 

The Learning Process

My first nursing placement now has two weeks left to run. I’ve just about got used to the early starts, the long days, and having to wear clothes that need ironing. Nick’s job is also due to finish in a few weeks, so the future feels uncertain. We’re trying to stay positive, but if positivity isn’t coming naturally, it’s a fragile concept. Home late last night, having not eaten for twelve hours, we went out for a takeaway. Both of us wanted to vent, neither of us felt like listening, so out voices ebbed away into a mutually dissatisfied silence. Fried food fixed it of course. What doesn’t a kebab improve. Heart disease? Oh.


It was inevitable that I would make a gigantic cock-up on this placement. Last week, it happened. Although I regret it, and curse my bad behaviour, I’m sort of relieved. Whilst I have no belief in fate or any spooky goings on, and certainly didn’t intend to do anything wrong, I had felt it coming. What now? Mistakes, especially as a student are viewed as learning experiences ,and everybody has been very kind to me in this respect. I’m less generous with myself though, because, I should have known better, and in particular, known to trust my instincts. Ah well, what’s done is done.

I’m glad I picked mental health nursing, although the shadows of my former career are appearing all the time. In a break between meetings, I was asked about my background. When I said Learning Disabilities there was a pause and then, from the dashing young consultant and his older junior ‘LD? Oohh’. Another silence followed. I had no idea what it meant. They asked a few more questions, and assumed I had been a support worker, which I encouraged. The NHS is all about status, and I find it easier to play down my background. It saves my explaining myself and people seem to feel easier. I sense that some of the people who have been told have gone on to have felt judged. While there have been some things I haven’t liked, I respect everyone I’ve been working with, so that hasn’t been my intention. I had an odd moment outside of the hospital. Someone with a person with learning disabilities stopped me. I did not recognise him, but he was excited to see me. ‘Oh, you’re working in mental health now?’ His eyes on the badge and then to the person I was accompanying. Luckily, the car pulled up an we had to go.

So much is the same that I’m caught out by the differences. Patients tell me their stories, and I listen. These are versions of the horror stories I enjoyed as a teenager, but they are real, lived out by the person before me once in the flesh and then often in their mind, the damage extending through years and generations. Astonished, not knowing how to help, I am not speaking because I don’t know what to say. They go on, sometimes angry, often weeping and then apologise to me. Inept, I tell them that they are brave and strong, that things will get better. Once their crisis has passed, I make a them hot drink, or fold laundry, I offer clean sheets, small comforts. They thank me. I feel bad, because that’s the gratifying bit. When nursing is described as ‘rewarding’, that’s what is meant. Because I find it a terrible thing to leave a person with tears still drying alone, I deposit them in the lounge, hoping that they may be cheered up by an antiques programme and the company of others. There is always an antiques programme.

Everything has to be reported and recorded so I retreat to the office where the phone is always ringing and there’s a lot of paper. I write down the gist of the conversation, but it’s hard to know what’s important from the nursing perspective and much of it doesn’t translate to the page. I pretend composure, pass it on to the nurses. They spot the things that affect the treatment plans and the risk assessments, embodying the saying about changing what can be changed, accepting what can’t be and having the wisdom to know the difference. I have much to learn.

Morrissey Would Be Proud

I'm still tring to learn medications. Someone suggested I put them to music. Nothing ventured... I've been humming Jeane by The Smiths all the way round the ward, and given the downbeat nature of the original lyrics, it seem obvious to link it to antidpressants. It doesn't really fit, but I've had a fun three hours playing with it. Perhaps a kind person will make it into a karaoke video?


Jeane

The low-life has lost its appeal
And I’ve tried walking these streets
And I’m eating five a day (and offered talking therapy)

Jeane
I'm not sure what SSRI means
But I know there’s fluoxetine
And I know seratonin gets a boost
(If you don’t mind nausea and no sex)

We tried citalopram and we failed
We tried fluvoxamine and we failed
We tried paroxetine and we failed
We tried certraline and we failed

We tried venlaflaxine, (SNRI) we failed

We tried duloxetine (SNRI) and we failed
(We tried for 6 weeks and if we saw results kept going for 6 months)

Jeane
There's tricyclics on the sink where we bathe
So how can we manage a home
With drowsiness and sleep problems?

(but you’ve got a drink for the dry mouth so never mind the nausea, weight gain and no sex) We need the noradrenaline Jean as well as the seratonin

But you still hold a TCA
As you take amitriptyline
But don’t overdose
Jeane

We tried mirtazipine (TeCA), and we failed (we were fat, tired but didn’t need the sink)

We tried and we failed
We tried

Oh ...
Cash on the nail
Tryptophan’s just a fairytale
Oh ...
You got to try the MAOIs first
Jeane

But I think you know
I really think you know
Oh ...
I think you know to avoid cheese meat and beer (it’s the tyramine)
Jeane

Oh ...

No heavenly sleep
Not for me and not for you
Because I think you’re fat
And maybe nauseous and dry mouthed
I think you know the MAOIs
Oh ... (To stop breakdown of seratonin and noradrenaline)
Jeane

That we tried phenelzine, and we failed
That we tried tranylcypromine, and we failed
We tried isocarboxazid and we failed
We tried moclobemide and we failed (though we could feast)
Oh ...
Oh ...now we’ve got discontinuation syndrome
Jeane

 
If you're not open mouthed with astonishment, I give you permission to laugh.

Half Way

Haven’t been so busy for years, and it’s taking its toll. I had anticipated the aching knees, but not the tiredness, or the consequential inability to think clearly. I’m glad I decided to try to eat healthy during this placement because I’m hungry all the time, so it’s just as well I’m eating more fruit than cake. The placement has just passed the half-way point. I’ve got a grip on the skills grid (list of things I need to be able to show I can do), and I’ve had much of it signed off. I’m still enjoying the ward, although there had been harrowing conversations I didn’t expect to come across so early on. Whilst it’s flattering that people have felt able to confide in me, I haven’t yet developed the coping mechanisms to deal with it in myself, nor the expertise to help them. I’m unsure if as a mature student I’ve heard more than the average. If younger people are having these conversations, then I hope they’re finding support, because I don’t think I could have managed as a young woman fresh from A’levels. Here's to 'em, and to the inspirational young nurse I worked with the other day (and patronised unintentionally as I seem to have a knack for doing however hard I try to avoid it).


In my hours off, I’ve tried to skill up, spending the week attempting to learn about medications. Unfortunately, the details slip against my memory like butter off a hot knife. I woke at six this morning, half dreaming of the characteristics of a drug I couldn’t name. I lay awake for a long time mouthing the names of drugs beginning with C, thinking ‘I know this, I know it…’ Only on the way back from the bathroom intending to look it up did it come to me. Sadly, it’s the only one I know really well. Now, I’m a bit scared about the forthcoming exam, not to mention the maths exam I haven’t yet prepared for. Having enjoyed the ward so much, it would be a blow to get chucked off because of my inability to distinguish Clobazam (the benzodiazepine) from Clozapine (the antipsychotic) from Carbamazepine (the antiepileptic).

All manner of small things have been happening on the home front. I made some Craftivism kits to take to the WI, and had a nice time meeting people there. It’s the kind of thing I would have loved to have been doing last year, but just don’t have the energy to go regularly. People bought all the kits, and I think it went Ok though, so I’m glad to have done it. Nick, with redundancy looming, is busy applying for jobs and mourning the loss of the work that he has put his heart and soul into. Somehow, I remain optimistic in spite of the economic situation that he‘ll find something he likes.

My Mum rang to say that my brother W was getting married this April. He has been engaged for some time, and I got in touch to say ‘congratulations’. Embarrassingly, it transpired that they have no intention of getting married before next year. I was a little relieved. How on earth was I going to get a double quilt made by Easter?

It's Only Natural, Or Vocational, Or Something

One time, when I was half way recovered from depression, a former colleague told me she was changing profession. She was qualified, experienced, kind and clear headed but had been through a difficult year and wanted to do something new. I was saddened because I thought she had lots to offer a field that needed people with principles who weren’t afraid to get close to its customers, but that at that time was suffering from an overdose of  management by process. I said as much, and she replied that my absence was the same loss. At that time, I thought that it wasn’t, and that I had spent my time working with people with learning disabilities pretending to be someone else. I don’t identify myself as naturally patient, or a good listener, or anything very people centred yet I’d somehow managed to make a career of it, until, unmasked,  I fell apart. Now, I’m back to a caring job. The comic, Al Murray in his character The Pub Landlord identifies all women as either ‘secretary’ or ‘nurse’. I couldn’t warm up to the ‘secretary’ option.

I was tentative about going back to college to study nursing. I doubted that I had ever been competent, and thought that even if I had, I was a different person now. I told myself I’d see if I could get through the first term. After Christmas, I told myself I’d see if I could get through my first placement. Now, I’m almost half way through that. I got placed on a fast paced acute ward, so I guess it was always going to be make or break, that it might bring back memories of my own illness, or be lost and confused, or unable to settle walk out one lunch time and not go back.

Did you see it coming? I absolutely love this placement. It’s very much like working with people with learning disabilities, only better because I’m fresh to it. Much to my surprise, I find my old skills reappearing, and because I no longer take them for granted, I enjoy them. Best of all, the people I try to help recover and get to go home. It’s confusing, overwhelming at times. Some things I don’t understand, some things I don’t agree with, and some things I’d like to get done but can’t. I can’t get used to the early starts, and the long days leave me with puffy ankles. I’m wrestling with the Practise Grids which seem to have been devised by a personnel officer who reads Puzzler magazine (for the absence of doubt, I don‘t consider either of those to be good things). The staff and patients have been brilliant and have taught me loads already. In spite of tiredness that made me sleep through my day off today, and tears because some things I hear and see in this field, I never came across in learning disabilities, I feel like I’m home.

I’ve kept my background a secret for the most part. I had been undecided about mentioning my medical history and planned to see how it went. As it has turned out, I’ve outed myself to one patient so far, because I felt it would be helpful to her at that moment. I’ve been even more reluctant to own my career history. I don’t want to come across as arrogant and put people off me before I start. Plus I wasn’t sure how much was going to be transferable, or had gone out of date. I had to put a brief account into my practise grid for my mentor though, which he looked at two weeks after I started. He talked about the relevance of my previous employment and asked me to be willing to learn. I said I hadn’t told anyone else anyway. ’You should’, he said. ’everyone can tell by the way you work’.  I haven’t though because hard on its heels is the question of why I’m now a student and not a service manager. Even if I was ready to answer that, I’m still not sure that I know the answer.

My mentor sat about the office tired one afternoon, telling me about a taxing management situation (sharing no secrets though). I told him I had done some of those. He smiled, ‘Yes‘, he said, ‘it’s why I’m telling you’. So I exchanged sympathy for answers to inane student questions until he went away to write up notes and I went to the lounge where patients smiled at me and we had a laugh about what was on TV. He has a lovely smart phone, but I wouldn’t change places with him. Do you think they’ll let me stay a student forever?

Breaking the Silence

Hello. I’ve been a bit quiet lately, haven’t I? Time for the fun to recommence.


I’m now two weeks into my first nursing placement, and I’m zapped. The work feels all consuming at the moment, and there’s lots I would like to write about. The big snag (aside from lack of energy) is the rule around confidentiality . I’m unable to write about patients for all of the obvious good reasons, and also unable to write about the placement provider. The reasons for this are a lot less clear to me and I suppose that’s why I feel reluctant to write anything at all for fear of crossing an invisible but deadly confidentiality line. At some point, I’ll talk to someone and clarify the position, but I don’t know who to talk to and feel that it’s an obscure thing to address given that I can’t exactly explain my reasons, vanity aside, for blogging.

At times like this, trivia‘s the thing. It turned out that smart-casual was more smart than casual and so I had to get some new clothes. Then I realised I would have to iron them because wrinkly is not smart. I gave up ironing six years ago with my last office job, and it has been quite a shock to go back to it. I’d forgotten how oppressive it feels to stand there passing a hot implement over wrinkled fabric for an hour at a time, struggling with where to put the seams, noticing the bits I missed only when the garment is on the hanger. I’m aware that some people like this sort of thing, but they must be masochists, and that’s not me being judgemental, it’s just true. The whole smart effect is ruined by the by the necessary nursing shoes. In spite of this, I’m developing a fondness for the super wide, super comfy foot enveloping lace-ups with the squishy insoles. They are guardians of my twelve and a half hour days. My feet haven’t hurt, but the lino corridors are hard on the hips.

If you change jobs regularly, you’ll be familiar with the problem of lunch. Every workplace has its own facilities, customs, cheats, temptations, obstacles and comforts. There’s never a way of anticipating them, and it’s necessary to feel foolish on breaks at least a couple of times during the first weeks, as a right of passage. My new workplace has a lovely staff canteen, serving cooked breakfasts and hot lunches. It also has vending machines. There are three breaks in the twelve and a half hours.
The availability of food presents all manner of dilemmas for a fat woman on the edge of huge. I find it very hard to resist grease, but there is bacon before me, at 9am when I’m tired and vulnerable. The scent of it reaches out along the corridors to the wards. Sometimes patients ask us to fetch some. Being a creature of habit, I dare not approach the counter. Eight weeks of bacon sandwich every morning and I’ll be a size up for sure. Ditto the vending machines which feel like gambling, but with a sure sweet win. I’d never stop at the occasional treat, at 5pm with over two hours to go, it would be a mars bar and crisps. So, for this employer, and as a kind of commitment to nursing (also because I’m copying a fellow student who’s lunchbox I admire) I’m embracing the healthy packed lunch. I take fruit, nuts, a cereal bar and a sandwich. I drink water. I am seriously considering a short walk at the teatime break, for the benefits of fresh air and sunlight. Don’t worry, I’m not about to do meditation, I’m not sick. Although…….



By the way, I’m on the local radio tomorrow at 11am. Don’t worry, the fame won’t change me.

and...Rest. (exam time and beyond).

It’s been a fraught week. Like so much in life, there was a laboured build up, satisfactory climax, dreary come-down, and now other difficulties present themselves. Thus the cycle is renewed.

As I said the other time, I do want to write a bit about my studies. This week was the OSCEs. That’s Objective Structured Clinical Examinations. Every profession has its common understandings, and for nursing, this is one. It has its purpose and in common with ugly shoes, brings anxieties. I’ve done a few practical tests over my lifetime. During my first Degree, I had to produce and serve food. I was a disaster, clumsy, incompetent in spite of my best efforts. I was a liability in the midst of the thirty or so others sharing the kitchen slopping stuff over, burning the rest, having forgotten the final egg wash. Promising starts turned into 45% passes. Looking back, I think the lecturers felt sorry for me, ‘There is no culin’ry term for liquid bouncing about in t’ pan.’ said one Yorkshire-woman as she rubbed at a small scald.

I passed the most common of all practicals, the driving test, at second attempt. That time, I fought off my nerves by taking off my coat. The single action, recommended by my fourth caviar-munching driving instructor was enough to put me in control. How he must have missed me. I got 100% in a first aid course the same week the Twin Towers came down. It seemed of similar magnitude to me, I had practised obsessively, unwilling to look a fool in front of my more dexterous junior colleagues. My sling was origami in perfection.

Coming to the OSCEs then, I had a little to draw upon in as much as I was aware that confidence is King. Therein lay the problem. If there’s one thing that the memory of a mental health problem does, it’s to strip away self confidence like a heavy duty steamer through woodchip wallpaper. The mess was daunting. I took my crib sheets to bed every night, reading them while imagining the steps from greeting the pretend patient to scooping the faeces. I imposed on people in labs, too anxious to do more than give everything one good go, trying not to listen to rumours of alternative techniques yet clinging to smarter friends. It was all coming together. The day before, I calculated that barring accident I could comfortably pass whatever came up, even the most difficult. Just so long as I kept my head. I was keeping it too. Someone asked me how and I said that I thought it wasn’t the most difficult thing I’d ever done, or the most final.

I felt too self conscious to tell my fellow students about the cheat that was going to put me up there with the best. It was more sure than notes on the wrist that would have washed off during the Ayliffe Eight Step anyway. It was also, crucially, within the rules. I was pretending to be the boss. In the time when I was the boss who knew nothing, I learned to do it. Act like you’re the expert in whatever it is you’re unsure of. Talk the person you’re trying to impress through what you’re doing step by step as though you’re giving them the benefits of your expertise. Take your time.

I’m not allowed to write about the exam. I signed a confidentiality agreement. Ah well. I'll leave you to enjoy the suspense.

After the OSCE, I wrote an essay. True to form from the first time at uni, and from my A’levels, O’levels, all the way back to spelling and cycling proficiency tests, I was finishing the work begun weeks ago well into the early hours of the due date. I had resolved that it would be different this time, but we don’t change, we just develop a little. My rubbish A’levels had taught me to read some books before boredom bites, and they were all stored up ready for when panic set in 22 hours ahead of the deadline.

In other news (the only news on the TV), it’s snowing. Nina struggled home from Swansea, H is marooned in Manchester. I’m ready for Christmas. When I was a fat, a-rhythmic five year old, I used to dress in a flesh coloured leotard and go for ballet lessons. I overheard my Mum say she ‘thought it would help’. Anyway, the teacher would count down the end of the dance ‘five six seven eight and........rest’. Brilliant advice.

Acts for Today

If this was a proper diary, there might be a round-up of my day here. I used to do it that way, but I was getting bored with it, so I went all topic focussed. That generally works OK because I quite often obsess and move on, but mow I’m missing the round-up pages. I want to record that today I: overslept, learned how to give an orange an injection, bought H and I cheese pasties, found a mobile phone in the snow and rang the owner’s mum, read an e-book on asylum and cried a bit, talked to Nina on facebook about Christmas, listened to Frank Turner, Chris T-T and Billy Bragg on Spotify, roasted chicken and potatoes, finished off an on-line assignment, donated some money to Education for Choice and thought of Elsie, read some blogs including lovely Richard Herring's, remembered World Aids Day and forgot to call the GP surgery for H.

I think that’s quite a mixed bag. I’m not sure what kind of a snapshot of my life it is. I don’t even remember yesterday, so it may have to act as a memento of the year. It certainly picks up of some of the 2010 themes quite nicely.

Coming back to the topic approach, I want to write a bit about the nursing. I’m still a bit scared of putting the wrong thing and getting into trouble though. Uni is taking up more of my time and attention these days, and if I get through the three years to qualification it’ll seem a shame not to have written anything about it. What to do? You will tell me if I go too far won’t you? I’m not even sure that student nurse blogs will be any more interesting than quilting ones. Probably better than that cringe-worthy poem the other day though.

The uncontroversial student scoops are that injecting an orange with water is unsurprisingly easy (they keep still and don’t complain at all), whereas taking blood-pressure is harder than filleting plaice was 25 years ago in a former life but might be a bit more important to get right.

UPDATE: the man who lost the phone came round and gave us £20 which we’ll give to the homeless sanctuary seekers. The love is spreading.

Bad Poem Contains Swears

Oh fuck

The guilt

The shame

I came in here

Switched on the computer

A stack of books ten high

A pile of paper

A pen

‘I’ll just..’I said

And I chatted on line

And I did a bit of the wrong kind of work

And I perused

And I commented

And it was 18.26

But when it was 12.04

It was OK

Fuck, I’m a student nurse.

Not meant to say F, C or S.

Meant to be an organised angel

‘Arse’, OK?

Maybe?

Oh dear. Sorry about that. Yes, this is the reason I don’t write poetry

The procrastination fairy has been all teeth and claws today.

A Time to Keep Silence and a Time to Speak

There is a Christian prayer or poem with a line about deciding when to speak and when to be silent. I don’t know where it’s from, the history of it, or the context. It’s there though in my subconscious, ready for use as the need arises, even though I’m not religious. That’s culture for you, and school assemblies.

Twice yesterday, there were choices to be made. To speak, or not to speak. First off, in a class about feeding and mouth care. I was feeling slightly unwell, which contributed to me failing to raise a paw. The lecturer explained how she had been told that bibs are not used in learning disabilities services due to the childish appearance. Frankly, this is far from accurate (although I’d agree they are avoided in the same way that spooning food into people is if it can be). Later, I wondered about why, given decades of learning disability experience, I had kept quiet. After all, it is a small but important issue and relates to situations which are wrestled with by many of the professions of people who care, irrespective of who they care for. It had come down to not wanting to show off, and to wanting to give others to the chance. I’m aware that’s patronising, but I only do honesty here. In the end, I dropped an email to the lecturer concerned, and she replied very graciously. I wasn’t sure how it would be received, thinking I might be wasting her time, but I’m glad I did because it got it off my chest. Each trade develops its cultures and customs, even if there's no logic there's usually a reason. In case you're interested, here's what I wrote:

Although I'm studying mental health nursing now, I worked in learning disabilities services for twenty years and saw the progress away from bibs (although I never worked anywhere where there was an absolute ban).

 In the long stay hospitals it was part of the culture that most people were put into bibs irrespective of need. The practice continued into the early 1990's when people were transferred into the community, it was challenged under the new values of normalisation and choice. A further problem was that people were often put in bibs at breakfast and left in them all day. As many people who need help to eat also often produce excessive saliva (or fail to manage it) they would become soaked in drule as the day progressed, becoming sore around the neck and getting skin infections. The appearence and smell were, indeed, quite offensive.

 I've certainly worked with people who lived with their families who used bibs comfortably, and used bibs for some people as the need arose. I was surprised to hear of the rigid attitude but I wonder if it is a local issue brought on by perhaps over-rigid, if well meaning management.

 

Later in the evening, I responded to an ‘emergency’ facebook appeal for an opinion about reality TV from a woman 40+. Ahh, irony. It is so easy to speak about something that don’t care about that I offered immediately, wrote something, found out I had needed to comment on the impact on children, and then wrote a bit more. I was genuinely happy to help, and it might be in the paper. If not though, here’s my almost midnight thoughts on the impact of reality TV on children:

My teenage daughters got me hooked. Talking about reality tv is one of the things we can discuss without treading on each-other's toes. In some ways it has brought us together, not quite as a family though as my husband feels excluded. 

The ones with a focus on music and dance may well influence some young people growing up to think about a career in the media, but I'm not sure that's a bad thing. My eldest used to like the Supernanny programmes, qualified in childcare and is now at university intending to be a social worker. She might have achieved this without Jo Frost, but I have a feeling that Supernanny was a force for good.

3 in 1 Socially Motivated Post

As with busses, you wait for a blogging opportunity and then three come along at once. And here the analogy ends because, I can tap all three into the keyboard. Not much of a common theme, but hang with it because there’s going to be a call-back.


The Mental Health Nursing studies have started to go quite well. I’m getting to grips with the timetable, haven’t been in trouble at the library for a week, and have got myself some people I sit next to in lessons. So far there have been basic practical skills like hospital corners and bed-baths, some social theory around oppression, and more specific Mental Health Nursing discussions on history, roles and the user movement. Today was an introduction on law relating to mental health. I wasn’t expecting to be troubled. The little-bit –dull lecture had been going almost an hour when it happened. The exposition on treatment without consent. The lecturer, in a matter of fact way described several people holding down a patient so that they could be forcibly injected with medication lasting anything from six hours to six weeks. There was an aura of suppressed glee in some areas of the room, lots of questions and comments on the need for people to be made to have the treatment that was good for them, lots of enthusiastic nodding that people who have committed no crime can be detained for up to a year at a time. I should add that there are measures of balance as decisions can be appealed.
Walking home in the near dark afternoon, I thought about my career in learning disabilities. I have been trained several times in the art of ‘restraint’ (the restraint of others, not the self). To build a career quickly, I worked with people regarded as the most challenging, the ones known to assault staff. As a manager, I was called in to help people in crisis. Here’s a confession then: I have never restrained anyone. There were times when I had the option, even times when doing so would have met with the agreed care plan. I never did. I distracted people, placated them, persuaded them, gave them space and gave them time. Sometimes people ran off and were brought back by the police, the sight of the uniform having a calming effect. Why did I opt for personal restraint rather than restraining? Partly because I saw an incident early in my career where a member of staff took issue with a service user over a cabbage (yes, you read right CABBAGE, I’ll tell you about it someday) and I thought her actions distasteful and counterproductive. Partly because I found my other tricks were effective enough. Here’s a confession though: I think it was mostly because I’m a coward.
So now I’m left to question. Could I ever hold someone down so they can be injected? Could I ever give the injection? Answers on a postcard please.....

On a different topic, I’ve fallen heavily for the music of Chris T-T. He strikes me from Twitter and his blog as a clever man who knows his politics so much better than my wishy-washy leftwingyness. Anyway, he has made a remarkable playlist of protest songs on Spotify. A real treat with loads of stuff I haven’t heard before, and stuff that reminded me of former times. In the grim circumstances of anti-social reform in which we find ourselves I find protest songs heartening somehow. They provide a bit of a ‘you’re not alone’ feeling if nothing else.

And finally.......following the Craftivist patch, some of you have asked me about the homeless people who Nina works for and who I sometimes give stuff to. I’m trying to get some things together to make up a little Christmas Parcel for each man (at the moment there are no women coming in). Nothing fancy, just hats, gloves, socks, toothpaste, shower gel, shaving things, biscuits and sweets. The pound-shops have some useful things at the moment. About twenty people are supported so I can’t do this alone. If you would like to offer anything, this would be appreciated. If you want to give money, I will pass this on to the centre so that it will be spent on things people need. Warm used clothing in small to medium men’s sizes, blankets (not duvets thanks due to washability), and serviceable shoes/trainers are always welcome too. I can collect from the Coventry area. Please get in touch if you are able to offer anything. Giving feels good.

Did I mention a call-back? Oh bugger.

With A Little Help From A Yoghurt Pyjama

After three weeks of unbearable stress, with me weeping and saying I couldn’t go on, Friday arrived. It takes time to adjust to new situations, and perhaps it’s middle age, or just too many aborted life-changing projects, but I’ve struggled to get used to being a student. During a difficult moment between the stacks a couple of weeks ago I stopped still, recognising that I ached for any kind of familiarity. I shouldn't have said it out loud, I was in the silent section with the would-be engineers. The streets all seem to be uphill, the crowds, the maze of corridors, wearing the right clothes, reading from textbooks, getting on the internet, talking to strangers – these things have felt too big and too much.


Prompted by I know not what, I’ve stuck at the homework. I’ve been reading ahead, learning how to print things off, and visiting the library. Every day last week, Nick has arrived home to find me at the dining room table making notes and muttering about microbiology, inclusion, and asylums. He has a new wife, and I’m not sure how much he likes it. He’s been doing way more cooking.

On Friday morning, I walked up to the University. It didn’t seem quite so far. I found my seminar group, a new mix of students from all four kinds of nursing plus some occupational therapists. One of the young women on my course came up to talk to me, and we sat together with another of our cohort who, although in my group, I hadn’t yet met. We shared small-talk and sweets. All of a sudden there was a feeling of happy belonging.

There were mixer exercises, and I found myself for the first time in weeks, being jovial and open. A little later, I was getting on well with someone on the Adult Nursing course when she remarked, “You’re bubbly aren’t you”. I told her I was actually quite shy. It was nice to be likeable. We were asked to say something unique about ourselves. I went for saying that I was a Richard Herring fan. There was a squeak from the woman next to me. She was a fan too. It was a magic moment, as expected, no one else in the room had even heard of Richard Herring. It made the group laugh, and we embraced, enjoying being a little disruptive, quoting from the Someone Likes Yoghurt show.....'yoghurt pyjama....cat....' You had to be there but trust me, it was delightful.

The seminar was fun, and I felt free to contribute properly. I had held back because of my lack of experience in the field of mental health, but decided to let go of that and talk about my time in social care. In valuing my own skills, I was valued. The Herring induced pixie dust didn’t end. I went off down to the library and emailed two lecturers for more information (I had hitherto been reluctant). Then I got talking to the librarian who offered me all kinds of help. The stairs of the library became shallower under my feet, and people seemed to be smiling at me. Especially the young student who offered to get my tea from the machine.

I think that, as they say of five year old children entering school, ‘she is settled and is beginning to make friends’. About time too, some might say. I’m saying ‘thanks’. Richard Herring you’re my lucky charmer.

(student) Nurse!

I am back to University. It is nineteen years since I got my first degree and I’m doing it all over again. It’s all different of course, and I am different too. I’ve spent some time thinking about whether continuing with the blog is a good idea, and in particular if keeping an honest blog from which I can be identified is the right thing. The nursing profession is particular about confidentiality and what I can only describe as seemly behaviour. When the tutor said that we need to give up biting our nails and that she never wanted to hear us swear in public, I knew I was in trouble. F**k me if they’re not two of my favourite things.

See, I only just got my library card and things are already starting to look dicey (talking of the library, I was asked to leave it within five minutes of setting foot, it appears that talking is allowed as long as it’s not on the phone). Anyway, I’ve read the rules and decided that it’s business as usual, I would never talk about an identifiable service user anyway, which just leaves staff and fellow students to worry about. Keeping this blog is going to help me to be all angelic, just like a proper nurse.

When you think of a nurse, who do you think of? I think Hattie Jacques in Carry on Doctor. From now on, when you think of a student nurse, you may think of me. Student Mental Health Nurse, that is. I’m getting nursing shoes and a fob watch and everything. It’s going to be A Journey. But not like Tony Blair’s.

Left in the Nest

As a younger woman, I commiserated with the older ones as their children left home for flats above shops, or for study bedrooms in University Halls. Inside though, I did not expect to share their pain when the time came. Every time my children have reached a milestone that meant I wasn’t needed, I’ve enjoyed it. The moment when they learned to take the straw off the juice carton and pierce a hole, I rejoiced (the moreso when they remembered not to squeeze). When they could run an errand to the corner shop, I made full use of the new skill, and hurray for turning 18 and being able to get matches and wine. I felt no sadness when they started school, or finished school. They’ve spent plenty of summers in Cornwall at their grandparents away from us. We’ve gone on holiday without them and it’s been lovely to have them take care of the dogs. We’ve never had place settings around the dining table so unlike what happened a poem I read once, I’m not about to notice an empty chair. I’m stalwart. Unsentimental. Yeah right.


Nina leaves for Swansea Uni on Saturday, and I’m a walking chiche of a middle aged mother with offspring about to fly the nest. Everything is packed, The Uni quilt made especially for the occasion but used over the summer has been washed and mended. I’ve passed on so much advice it’s become a joke. At the supermarket checkout, we were talking about financial arrangements. She asked why a parent would rather put money on an Asda student card than hand over a cheque. I made the cashier laugh, saying it would stop her spending it on booze and fags. ‘What?’ I said to Nina and the young man who might himself be a student. ‘I know all about your mieow-mieows and your alco-pops because I read about them in the Daily Mail’. I was only kidding. Although I wish I had taught her how to cook, and worry that she can be over sensitive and accident prone, my eldest is a non-smoker, non-toker, moderate drinker of Bacardi and heavy drinker of my Diet Coke.

Truth is she’ll do fine but I’ll miss her. She sings when she does chores, wakes up early and skips down the stairs, we talk social affairs and politics and friends. She knows the good places to go for lunch, comes with me to gigs and makes the best of what isn’t to her taste. We watch chick flicks and comedy together. She tells me about cool new trends in websites and introduces me to popular turns of phrase. Who’s going to do all that with me now? Ah ha, I have a backup, my youngest, two more years of hints on keeping young then. Phew.



In extra news; Nina’s latest recommendation is the delicious if over- filling 50 track Beans on Toast album Standing on a Chair. It’s on Spotify, but I still can’t work out how to link to it. Lefties will like it.

Hello England, this is Swansea Calling

Nothing on the planet has a cry so loud as a teenage girl. I will definitely have to get those windows replaced. Nina has an offer of a place at Swansea University (conditional on getting the portfolio verified by 31st August. It has been a hard road, and such a relief as she really wanted and deserved this.

A couple of nights ago, I dreamed that Holly failed all of her GCSEs and couldn’t go to college, I was quite disturbed by it. My thoughts are full of study plans as if all goes to plan, I start back at Uni at the same year as Nina. Holly starts at college at the same time. My little Bro may even be returning to China for his MA. No wonder I’m a bundle of anxiety. Just think of how smart we shall be in three years time. Ideally, we will work together for a unique organisation specialising in improving the mental health of Chinese children and youth by means of photographic-linguistic therapy. That’ll work. I expect there’s grants for that type of thing. I hope the work turns out to be well paid. It’s going to be an expensive three years.

Air Punch

I got an unconditional offer from Coventry University today for a place to study mental health nursing. It seems that I didn't mis-hear the admission tutor's phone call of a few weeks ago after all. Clearly, it was worth buying a new cardi, and wearing foundation. I would like to be leaping about in glee, but what with concern for Nina and the thought of signing away three years of my life, and then the rest of my working life to a new profession, I'm playing Zoo World on facebook. Where is there a walrus? Just tell me me that, then I'll be punching the air.

Success

'Just to let you know, your interview was successful'. That's the kind of thing I like to hear. The punchline of this entry is up-front, subject to the usual CRB, references and medical, I'm going to be a student again. If I still want to be, come September.



As usual, I got to sleep at around the time of that the first of the morning traffic circuits the ring-road. That's around 3.45. Adrenalin woke me up at 7, that, Nick's calling me and the smell of bacon under the grill. I was uncharacteristically prepared with all of the paperwork packed, trousers ironed, and clean pants at the ready. I think I may have been too tired to be nervous. Nick had taken the day off, and walked me into town early. We sat in Browns restaurant which is a regular bar/coffee shop/eatery for council workers, Nick included. It was quiet enough in the morning for me to swap my trainers for dolly pumps and pop socks. It was then I realised I was serious about this interview. The pop socks and the tightness of my face, coated as it was with makeup, the foundation drying. It's very rare that my grooming reaches those sartorial planes.



I was one of a group of 'matures', no sixth-formers were invited. There was a presentation, the collection of certificates, and a written test. I wasn't brim full of confidence, but I was in the zone where I was able to making a convincing stab at seeming so. The written task was to summarise a short paper and say what it contributed to mental health nursing. Aside from not having worn a watch and so being unable to tine the half hour, I found myself enjoying it. This may have been relief brought on by the realisation that there was to be no maths test.

I got chatting to some other people while we waited for the interviews. They were all working in the field, I tried not to feel intimidated. Then came the interview. It was in the panel of three, six question style. I talked too much, much too fast, with some inappropriate emphasis on learning disabilities. I was told off for this. After that, I kept my answers short. The panel nodded and continued to move me on. I came out horribly disappointed, angry that I had let myself down in what should have been an easy interview. I had been able to predict all but one of the questions (but not 'What are your strengths and weaknesses?' which I consider a question unworthy of an interview and always want to answer with 'stem stitch and ballroom dancing, respectively' because how can the response ever be objectively measured?). I had the impression that they had liked the application, my writing, and the reference, but that they hadn't liked me because I had inadequately conveyed my motivation. I've interviewed enough people to know this is always a fail.

I went marching around town with no coat, waiting for Nick to meet me. I had that sickly, punched in the side of the head feeling, and was reflecting that I had let everyone down again. Nick turned up and took me to lunch, where I had a little cry over, but not into, the Chinese buffet. Then, he took me home, to wait for the outcome. The call came. They're letting me in. I'm not sure what that says about them. I will be taking up the place. I think I'll be quite good at it and will be interested for the most part. It's time I got myself out there. I need to have a job that comes with a pension by the end of the decade, and that's no joke, that's motivation.

Now the interview is done, this blog is going public again. Regular readers may be interested, or appalled to know what I will be studying: Mental Health Nursing.