After my rotation on general medical I moved to the surgical wards, and arriving to find the cleaners hard at it made me think it may be a slight step up from general medical. While the wards were still pretty basic on surgical, they were somehow cleaner and a little more orderly than those on general medicine. The surgical wards are over two floors in two buildings with a grassy area between, where the patients were relaxing in the early morning warmth. I soon discovered that this was not by patient choice and in fact the cleaners had turfed them out for this daily ritual as the floors were cleaned, with only the very, very sick or immobile permitted to remain. One morning I walked on to find one small boy from the paediatrics’ ward pushing the bed of a young girl in traction off the ward – cleaners ruled here!
On the adult block, the four wards were split male and female – (which is impressive as mixed wards continue to exist in Manchester, in Nightingale arrangements) with a further split between general surgical and orthopaedics. The smell of festering wounds is pretty pungent around the surgical wards, and it is very common to find poor stitching and wound care post-surgery has left the patient with gaping, oozing wounds that MRSA wouldn’t stand a chance in.
During ward round one Tuesday morning, we were accompanied by Tegan a radiographer in the house from Brisbane who was expertly showing us the x-ray films of the patients on the orthopaedic ward. Most of the patients had two sets of x-rays, a before and after. I cannot really begin to describe my shock at noticing the dates on several patients’ x-rays which clearly showed a marked difference in the bone setting process, where after 4 weeks in cast, the bones were further displaced than the original injury had caused. No explanation was offered for this almost horrific phenomenon, but our assumption was that little explanation and education had been offered to the patients once in their casts and perhaps financial pressure had led them to continue with manual labour after their initial discharge in their plaster cast.
On the orthopaedic wards, many of the lower limb injuries warranted traction which was a simplified version of home, where a screw would be protruding at the appropriate point attached to a length of string which was weighted at the end of the patients’ bed with a carrier bag containing rocks. During one ward round on the paediatric ward the Dr realised the small child with the fractured femur was able to wriggle free from her traction, and so he instructed the mother to gather more rocks for the carrier bag, and she was wedged into position with this.
While the fascinating insight into wound care and orthopaedic care was good, the greatest draw for me came from the two paediatric wards on the ground floor. One ward with 10 beds saw children with a variety of surgical and some medical complaints, ranging from hernias, injury sustained when thrown from a moving vehicle in road traffic accidents, to fractures sustained “playing”, and rather grimly, injury caused by sexual abuse and other forms of neglect. Each bed contained at least one child and their parent, but at busy times it was common to see two children with their respective parents sharing a single bed. On the other side of the nurses’ office was the burns unit, with its 12 beds containing mainly very young children with mainly severe burns to large areas of their bodies, caused by falls into open fires, hot porridge or hot water being toppled onto them. A glance in the report book told me that some of the burns sustained caused wounds susceptible to infection that their small bodies just couldn’t fight, and infant death rate from injuries caused by burns is high here.
I have studied to be an adult nurse, and so many of the illnesses and ailments facing these children surprised me, as I couldn’t believe that children could be struck with such a cruel blow so young. But as nit was explained to me, however big or small, the human body can make the impossible possible and I should never discount the unimaginable.
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