(The Nomadic Nurse Series Book 1)
By author Sarah Jane Butfield
About The Book‘Ooh Matron!’ is the first book in The Nomadic Nurse Series. Each book in the series takes you on a journey through medical specialisms and environments that formed part of Sarah Jane’s nursing career. Throughout the series Sarah Jane uses her trademark honest and entertaining writing style to share insights into her thoughts, reflections and the changes in her personal life and circumstances as she moves forward in her career.
I am not sure what Florence Nightingale would have made of Sarah Jane! The story starts with a sixteen-year-old country girl who, for no apparent reason at the time, suddenly decided that she wanted to be a nurse.
Sarah Jane was entering adulthood with no obvious career path in sight. She had planned a traditional, some would say old fashioned, future. Her vision was to leave school, find a job in a local store, get married and eventually have children. Then everything changed, as she embarked on a journey which would help to map out her future by offering opportunities in a variety of places and healthcare settings. Find out how Sarah Jane deals with births, deaths and everything in between with laughter, tears and humility in this touching, sometimes heartrending, superbly written memoir.
Read An Excerpt
Chapter seven: Do I really want to be a nurse?
The second year as a student nurse saw the workload, assessments and study increase to become a testing time. Our tutors had joked about the ‘two stripe blues’ in our first year, but as a keen and eager beginner I convinced myself that it would never happen to me. I would call it a mid-point crisis, a bit like a midlife crisis now that I have experienced both and can compare notes. Things started to change and at the time I didn’t realise how easily little pieces of my life veered off uncontrollably in different directions. From a professional viewpoint I had moved into a year of specialist ward placements which included ophthalmic surgery, gynaecology, obstetrics and psychiatry. Written down like that it looks like an even stranger mix than I perceived it at the time. I had no interest in eye care whatsoever. I struggled to administer my own chloramphenicol ointment when I had conjunctivitis and so the thought of touching and being responsible for the eye care of children and adults at Myland Hospital hung over me like a dark cloud. My time in the ophthalmic specialist unit was a surgical allocation and would form part of my 760 hours of surgical practical experience during my three years training. It would include working in the operating theatres, out-patient clinic, day-case surgery and ward based pre and post-operative care. In the two weeks before I started, when we did our introduction to ophthalmic nursing in the classroom, I struggled to take it all in. I think I was so nervous about the placement my brain just would not acknowledge any further information about eyes. The eye is such a delicate, crucial organ and I became consumed by self-doubt and low confidence. I loved nursing, but I suddenly felt inadequate and I hadn’t even started yet. After studying the history of nursing on my pre nursing course, the history of Myland Hospital fascinated me. In the late 1800s, as a farm, it formed part of the Severalls estate at the end of Mill Road. Its location made it an ideal location for conversion into an isolation hospital as part of an initiative driven by the Contagious Diseases Act 1867. This conversion was part of an attempt across England to contain the spread of venereal diseases in Army towns such as Colchester. The plan aimed to administer compulsory treatment to infected prostitutes. The isolation unit started out as a cluster of small, four bedded wards with the addition of temporary structures for periods of high demand. Years later with the onset of smallpox a further 20 bed extension was added and over the years it became the smallpox centre for the north of Essex. After 1910 more blocks needed to be added to treat the First World War troops. The building and site, taken over by the newly formed National Health Service (NHS) in 1948, was renamed Myland Hospital. As the need for infectious diseases beds reduced, the smallpox ward underwent conversion into a ward for ophthalmic patients and the other wards took general medical and surgical cases. In 1952 a rise in tuberculous patients called for another increase in beds, but within two years the demand decreased again and these beds were reallocated to chronically sick adults who needed respite care. In the 1970s Myland Hospital had 181 beds, including a geriatric ward. I worked at Myland Hospital in late 1984 and downsize planning had started as the building of the new Colchester General Hospital in nearby Turner Road neared completion. By 1988, with only seventy-seven ophthalmic, geriatric, young chronically sick, and infectious diseases beds open and staffed, the end of its functioning years approached. It finally closed and was demolished in 1989. Whilst working there I often walked through the grounds to the various wards and storage areas, and the locations of the additional wards over the years could easily be spotted. The variety of building materials and their erection style, which included wood, corrugated iron and brick, were a clear give away. The architecture was the only thing I loved about Myland Hospital. The working conditions there formed a depressing and subdued workplace. We often worked with below the recommended staffing levels, meaning that student nurses and auxiliaries picked up the slack. This caused anger and frustration for the doctors and medical professionals who needed experienced staff to support them. As students we wanted to learn, but it was hard with insufficient qualified staff to mentor us. That said, although I didn’t enjoy it I did consider myself fortunate to work with a couple of senior enrolled nurses who took me under their wings. Without them I would not have completed my nurse training. One of them called Pam caught me applying for an office job at a local double glazing factory. She was a large woman with the biggest bust I had ever seen. She put her arms, which appeared short due to her oversized chest, around me in a big motherly maternal hug. “We need to put a stop to this nonsense Sarah.” she said, amongst other things, and from then on things seem to get better. I am not sure if anything really changed or whether she gave me the psychological boost of having a mother figure looking out for me. In the meantime I had got as far as going for an interview at the factory, but luckily they rejected me and suggested I stick to nursing. It turned out to be a lucky escape because my whole life would have been so different if I had not qualified as a nurse. Before heading into my next hospital-based placement, I was allocated a secondment to the district nursing team to experience their role find and out first-hand how this service links in with pre and post hospital admission care plans. Imagine my surprise and initial horror when the team I became allocated to was not the Colchester based team of district nurses, but the Dovercourt and Harwich team. Harwich is 20 miles from Colchester and had been home to an international working port since the late 1800s, operating freight and passenger ferries. Harwich developed a salubrious past in the 1970s and 80s when the local Warner’s Holiday Camp was used as a filming location for the popular television comedy series ‘Hi De Hi!’ which starred Sue Pollard. The show, about life in a fictional holiday camp called Maplins after its owner Joe Maplin, was set in a fictional seaside town called Crimpton-on-Sea, Essex. The storylines mimicked the then successful holiday camp company called Butlin’s, owned by Billy Butlin. At the time of this placement I still lived in the hospital house in Colchester and so was offered accommodation at the Dovercourt Cottage Hospital for the days when I would be working there. When I say accommodation I use that term very loosely. This offer was obviously not one taken up very often by student nurses, because the place allocated to me looked uninviting and resembled a temporary storage shed. It was dark, and the metal framed single bed looked like it had come from a ward that Florence Nightingale would have worked on. From the moment I arrived I did not want to stay there, but for the meantime at least I had no choice. There was no opportunity to telephone anyone to try and arrange something else or organise daily transport in line with the shift times. The district nursing team was small but very friendly, and the first thing I noticed, which they seemed to accept, was that they had far too many patients scheduled in each day to attend within the times allocated. The morning round had to start before 7am to be able to visit all the diabetic patients who needed their insulin injections before breakfast and who were unable to administer it themselves or had no family members to assist them. Some visits which were time-crucial were marked in bold in the diary. This well-used A5 sized diary, with its pages curling up and with some folded over at the corners as reminders looked disorganised, but was used with precision. It contained numerous scraps of paper with telephone numbers, names, addresses, internal memos, etc. stuffed in the back. The first time I was asked to write in it I made sure to write very small, as each page previously was crammed with written notes, appointments, etc. I didn’t want to take up too much space on the page. We would set out at 7am and had four insulin injection visits to make. Some of these patients we would see again later in the day. Then there were personal care visits for bathing or get ups and there were wound care visits, I loved the post-operative surgical wound care because I was familiar with that but there were oh so many leg ulcers being dressed once a week. Harwich and Dovercourt, like many areas on the Essex coast line, were highly populated with retired older people. Often our patients lived in houses that would now not be considered fit for purpose, with their owners suffering from mobility and physical deterioration which compromised their ability to be independent. Many of the houses had been built in the Victorian era and when I saw the first one a tidemark on the side like dirty bath ring, I had to find out how that appeared.
The story goes that during the night of 31 January 1953 the unfortunate combination of a severe storm with a spring high tide resulted in a tidal surge. Property was devastated along the east coast and 120 people were killed in Essex. In Harwich a two metre high wave rolled through the main street and eight people drowned. The houses of elderly residents who survived and remained in Harwich wore the tide marks like a symbol of respect. Many of the elderly patients we visited delighted in recounting the tale to a new face visiting. One of the worst tasks I encountered on this placement was the various bowel treatments we were required to undertake. Many of these measures are no longer in use as clinical evidence now dictates that the risk of internal damage was too high and advancements in medicinal treatments has made these antiquated methods redundant. But at that time it was common place on our rounds to be inserting rectal tubes to assist bedridden constipated patients pass their faeces or stools. The administering of enemas and suppositories every 3rd day, or worse still performing a weekly manual evacuation with only gloves for protection, all fell into my remit as a student. I had never performed a manual evacuation until now. Neither had I inserted rectal tubes, although during my time on Ashley ward I had regularly given suppositories or an enema as preparation for patients needing bowel surgery. Once I had been shown these two procedures, and demonstrated my ability to perform them they became my responsibility. What do I remember of this new responsibility that I was given? Firstly the smell: it was horrendous and made worse by being in someone’s bedroom, surrounded by their personal belongings whilst performing such an invasive, highly embarrassing procedure. This was extremely difficult for a young student nurse to get used to. Secondly, the noise when you insert the rectal tube and the gas exits fast and loud, causing embarrassment for me and the patient. Where do you look? What do you say? Then worse still when the tube is removed what follows is unreal. The first time I removed a rectal tube I thought I had pulled the lining of the patient’s large intestine out with the tube. I had to manoeuvre the longest piece of formed stool (poo) I had ever seen into a curly shape to keep it from leaving the bed! Fortunately there were other more nurse-like tasks that I was given responsibility for during this placement, otherwise I am not sure that I would have made it through. I enjoyed taking down the post-operative dressings from patients discharged after routine operations, and I loved the feeling of satisfaction after removing sutures or clips and being able to observe and record that the wound was ‘clean and dry, healing well no signs of infection.’ The scariest set of clips I removed in the community setting was from a woman who had a hysterectomy, (the removal of her uterus or womb as most women refer to it), to treat her fibroids. These are tumours which form and grow in the womb, causing excessive bleeding and painful periods. She was a large woman and even when laying on the bed on her back it took two of us to manipulate her skin folds to expose the wound we needed to remove the clips from, which was on her bikini line. However, I suspected that she had not worn a bikini in many years as it would have got lost. With Sally the district nurse holding the skin away from the wound, I set out my dressing pack and clip remover. As discussed and agreed beforehand, because of the risk of the wound re-opening due to the pressure from the surrounding skin, we were going to remove alternate clips today and then remove the remaining clips 48 hours later. The first two clips came out with no problems; all looked healthy and healing well. However when the third clip released from the skin as I squeezed the slip removers in the palm of my hand, the whole wound started to open. I froze for a second before grabbing a dressing pad and placing it on the wound, firmly over the exposed fatty tissue. Sally calmly said, ‘Pop another pack in there Sarah.’ Sally carefully lowered the skin fold down covering the packs I had applied and she indicated that we needed to swap sides and roles. I was now on skin holding duty and she would expose the wound and assess the next action that was needed. After a closer examination Sally very gently said to our patient, “I’m really sorry love, but the wound is not healing as we had hoped and I think it would be best if we got you back to the hospital for the surgical team to take a look. It’s nothing to worry about.” ‘Nothing to worry about!’ I would be horrified if my abdominal tissue was exposed like that, but thankfully the patient was in fact unable to see it from any angle. We later found out that the patient had to return to theatre and have her wound re-sutured, no clips this time, and when we returned to remove them all went well.
As my time working in the community drew to an end, I had developed a deep admiration for the work of the district nursing team who, in all weathers and often in unpaid time, worked tirelessly to ensure a high standard of care was provided to their patients. The sense of community in this Essex town and the surrounding areas which we visited was definitely enhanced by the local cottage hospital and the district nurses who helped many people remain in their own homes with family and friends around them. I became an avid fan of the television series ‘The District Nurse’ which starred Nerys Hughes as nurse Megan Roberts. Although set in a Welsh mining town in 1920s the ethos and community setting in the series was not dissimilar, in many ways, to Harwich and Dovercourt. It was time to move on professionally and personally, as other changes started to occur during my second year. In my personal life, my mum’s health was deteriorating, and I felt guilty pursuing a career and living away from home. At the same time my relationship with Keith struggled, not just because of the travelling distance, but due to the pressures caused by me living in the house share with a reputation for being a haven for party animals. We decided that the answer was to get our own place and move in together. Within a few months we had bought a house in the 1980s property boom in a village on the outskirts of Colchester called Wivenhoe. A small one bedroom Barratt’s starter home. The time had come to move out and move on to a new episode in my life and before long we planned to get married. We married in March 1985 in Stowmarket, Suffolk at the registry office, with a small wedding reception and evening disco in the village hall at Stonham Aspal, the village where I had lived and attended primary school as a child, and where we became regulars at the pub, The Ten Bells, when I stayed at Keith’s house on my rest days and holidays. None of my student nurse friends attended, just family and our friends from my life outside of my career.
Glass Half Full: Our Australian Adventure, her debut travel memoir, and the award-winning sequel Two dogs and a suitcase: Clueless in Charente, are regularly found high in the Amazon rankings in categories including; Parenting, Grief, Christian faith, Step-parenting, Travel and France. Her culinary memoir, Our Frugal Summer in Charente was recently voted as one of the 'Top 50 self-published books worth reading in 2015'.
Author Sarah Jane Butfield was born in Ipswich and raised in rural Suffolk, UK. Sarah Jane is a wife, mother, ex-qualified nurse and now an international best-selling author. Married three times with four children, three stepchildren and two playful Australian Cattle dogs she an experienced modern day mum to her 'Brady bunch', but she loves every minute of their convoluted lives.
Sarah Jane loves to interact with her readers so feel free to connect on social media:
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