My daughter said to me recently "When I grow up Mummy, I don't want to be a doctor, I want to be a nurse, so I can pass things to the doctor". Even my four year old thinks our role is on the side-lines.
I have been a Registered Nurse in the NHS for nearly fifteen years. For fourteen of those years I have worked with cancer patients, most recently specialising in the surgical insertion of central venous access devices. Sometimes it seems to me that the majority of the public have little idea what nurses actually do. The Government seems quite happy to keep it this way as long as it means they don't need to pay nurses any more - and ideally less.
But this isn't about money, although it helps. It's about facts. I am tired of damping down our role. Let me tell you what I do. It's what many nurses do. It's nursing. I want my daughter to know that I don't just pass things to the doctor.
I will be one of the first health care professionals you meet after you've just been told you have cancer. I will have time to talk to you and go over what you have been told and what will happen next. I will understand the impact of this news and understand that you will probably forget what we have told you. I will give you my card and be your person of contact on the journey that is about to begin.
If you are admitted to a ward, I will answer your call bell and take you to the toilet. I will wash you when you are not able to. I will get extra pillows to re-position you. I will cream your legs and wash your hair. All without rushing you.
I will advise you on your nutrition. If you need the help, I will spoon feed you, or put a tube down into your stomach, making sure you are not hungry. I will administer medication into your most personal orifices, while making you feel comfortable and at ease and telling you not to be embarrassed. I will make sure I know how your medications work. I will assess your vital signs, measure your fluid input and output and adjust, record and report to keep you safe.
I will wash you if you have lost control of your bowels, and I will continue to do this all shift, sometimes more than ten times in eight hours without blinking an eye or raising an eyebrow. I will take samples of your bodily fluids, draw your blood, check your results and order the medications you need. As I do this, I will listen to you talk about family, friends and life's experiences; listen to what you are thinking about as you have just been told the cancer has come back and you are to start a new treatment. I will help you understand what the consultant has said. I will speak with your partner and answer their questions, and then hold them while they silently cry on my shoulder and tell me not to let you know that they are upset. I will hold your hand and be comfortable in the silence. I will feel your pain and understand and empathise because I have seen your future. I know what you will face and what all this means and that it sometimes won't be okay.
I will make tea for you and your family and try to keep you smiling by giving away small parts of my personality to normalise our interactions so that we develop a relationship, which we both acknowledge is special but which we won't ever talk about.
If you require chemotherapy, I will give you a pre-chemotherapy chat. I will explain how the treatment works and how the chemo may effect your body. I will cannulate your vein in a way that won't cause infection, and apologise for any discomfort. I will carefully administer toxic drugs, checking that the cannula is working perfectly so there is no danger of leakage, which could damage your skin. I know the immediate and long term side effects of chemotherapy and what we can do to help counteract these problems. I know the normal range so I will be able to protect you from errors in the prescription. I know I am responsible if I give the wrong dose.
If you require a longer term intravenous device, I will be the one to insert it because I am the expert. I will consent you for your central line, I will explain the risks and benefits and will adapt the how and why depending on how you are looking at me. I will realise when you are not coping and know that you need more time or something else to help you get through this. I will get you more medications; I will delay my schedule and other patients to make sure your procedure is as easy on you as possible.
Because I care that it goes well.
I could just do the procedure, but I know you need to be okay psychologically to be able to get through this; Because sometimes what I'm doing to you isn't what is bothering you, I know sometimes it's not what I'm putting in you, it's what it represents and what is coming next. I will use ultrasound to place this device carefully into your upper arm and use ECG to help me navigate it to just above your right atrium. I will request and check your chest X-ray if needed.
Your treatment is complicated and lasts a year. For when you are in hospital or at home I will type letters and refer you to services and speak to different people on phones and email to order specialist equipment.
I will attend meetings that discuss services you need and act as your advocate.
I will book interpreters or speak to you through your relatives that interpret for you.
I will communicate using my eyes, touch and hands; and try and get across that I understand how scared you are and that we are going to do everything to help you get through this.
I will be the one you call in the middle of the night if you have any pain, sickness, numbness or a temperature. I will know what to suggest to ease your symptoms and I will know if you need to come into hospital because you need urgent attention. I will reassure you and give clear instructions. I will document my decisions correctly, closing loopholes and handing over to appropriate staff.
I will be there when you are told that the treatment hasn't worked, when you tell your children and plan your death. I will cry with you but not too much; enough that you know I care but can still be practical and professional. I will agree it is totally sh*t and wonder why this always happens to such lovely people and families. I will be strong for you and I will do all I can to get you home if that is what you want. I will liaise with the palliative care team and keep trying and tweaking until we get you comfortable.
I will clean your mouth and remove unnecessary devices. I will support the doctors and other health care professionals and help them support you. I will stay past my home time to sit with you, to listen or to talk to your relatives and explain what is happening and what they might expect. I will take your anger, shouting and unhappiness with the way the system works, because you were promised an air mattress but there is a waiting list and you won't have one for a day or two. I will understand it's not directed at me but maybe at the whole awful situation.
I will call your partner to tell them that it won't be long now. I will hold them and explain syringe drivers and care plans. I will involve them in caring for you if they wish. I will suction you, give you sedatives and pain relief to help you have a comfortable end, so you can let go. I will tell them when you are taking your last breaths and I will stand with them and hold your hand and feel totally honoured to be there.
I will be the one to tell other members of the family how you died and explain the process. I will know when to leave them to be alone with you. I will lay you out and give you the last offices and feel privileged to do this for you. I will help your partner tell your children that you are gone. In between I will answer the bleep because I'm managing beds. A patient is breaching their 4 hour wait in A&E so I need to move you off our ward, but your partner is not ready to leave you, so I will fight for your family and explain that they can't have your bed yet.
I will arrange to handover the other 23 patients to the next shift in a different room because your family need time together in our office, because leaving the place where you died is too hard and they are not ready to go.
I will go for a drink with my nursing colleagues and talk about you and how sad it makes me, what you went through, how brave you were and how you inspired me. I will keep your story with me forever, joining my ever growing library of patients that I have cared for with cancer.
So Lilia, yes, Mummy is a nurse, but she doesn't just pass things to the doctor.
