district nurses

Needles

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Week Three after my first chemotherapy session included an appointment to oncology outpatients to see a nurse. I told her how fit I was feeling and she reassured me the fatigue would get worse each time  ( perhaps she said slightly worse )  and it was amazing how fitness levels dropped. She also said this was the week when hair thins… but she did order me mouth wash for next time; sore mouth and food tasting like mashed cardboard is probably the worst part. But like the fatigue it had suddenly got better and food tasted wonderful.

Sure enough, two days later my hair did start falling out; yay, no need to bother with the cold cap next time and I could get out my collection of colourful scarf/hat Chemo Chic wear, mostly ordered from Hannah Bandanna. It didn’t all fall out and I look rather like my grandmother, who even when I was young had very sparse wispy white hair. We just took this as being what a grandmother looked like, along with the large pink plastic whistling NHS hearing aid box that hung on her chest. Now I wonder if the hair loss was upsetting for her and was it the stress of bringing up three children while Granddad was away in World War Two ( away in Southport with the civil service, not on the front, he had already done that in WW1) or perhaps genetic, her sister was completely bald and hung her wig on the bed post overnight.

May not be accurate representation of Tidalscribe

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Sunday ‘chemo eve’ I went with my son to the beach hut and we had a swim in the sea. He probably got more than he bargained for; walking along the cliff top we met a couple I know, who hadn’t heard about the big BC. He has lung cancer so lots to chat about!  On the way home, walking along the promenade, we met more friends at their beach hut and she recalled her bowel cancer   treatment…  You’re never alone with cancer!

In the ward on Monday was the young lady from last time with a full head of hair and about to put on the cold cap, proof it can work. The lady opposite me was sitting quite happily with her bald head uncovered. They were trying to put in her canula, while she repeated she didn’t usually have any trouble. At the chemo group chat the sister had said they can always find a vein. I gather putting a canula in is a nerve wracking rite of passage for medical students and I would certainly not like to try putting a needle into and not straight through a thin or even invisible vein.

Smugly I assumed mine would go smoothly, but my nurse also had trouble. I have only one arm they can use – the arm of the lymph node removal is apparently out of bounds for everything including doing blood pressure. Inevitably the desperate tapping of veins etc has to be performed with the patient looking on, which can’t help, but third time lucky. Meanwhile it was about fourth person lucky, a nursing assistant, who managed to get into the vein of the lady opposite.

The ‘red poison’ is put in slowly by syringe; it is so strong they must keep a close eye to make sure it doesn’t go into surrounding tissue. The second drug just goes in by drip and was only supposed to take fifteen minutes, but no sooner had I messaged my lift that I wouldn’t be long than the alarm beeped. The drip had come to a halt; much tapping of the tube and fiddling with the box the tubes feed through between the bag and the arm. In the end the nurse removed the yards of plastic tube, dumped it all in the bin and started with a new length of tube; an idea I had been tempted to suggest myself. All was well until just two minutes left when it stopped again, luckily she was able to restart.

Soon I was ready with my bag of prescriptions to take home, the large bottle of mouth wash making it deceptively heavy. I followed the WAY OUT signs, but luckily paused at the entrance to rearrange my stuff and glancing in the prescription bag realised the seven day course of injections ( which stimulate white cell growth ) was missing. The centre is actually in temporary accommodation in a large ward while the regular place is being upgraded; I had great difficulty finding my way back through the maze of desks, little rooms and other bays till I found Bay Three. My needles were still in their fridge.

At home three days later I was waiting for the district nurse to come and do my first injection, they can call any time between 8am and 5pm, but I had this funny feeling the hospital may not have contacted them and phoned up before noon to make sure. No they did not have me down and did I have the prescription form? NO, I had not thought to look in the bag and check. They cannot do injections without the oncologist’s prescription form on which they have to stick a tiny label peeled with difficulty from the syringe and write the date. What number to ring? After searching through my bundles of information I had no idea, but actually phoning the main hospital number and working through the options is the easiest approach and I did end up in the right place. The nurse said notification should have ‘gone to the hub’ and then out to the district nurse. I was home alone and no I couldn’t send anyone to fetch the forgotten prescription. Fortunately she agreed to phone the district nurse and email them the form…  I wasn’t totally convinced and had almost given up hope when the nurse turned up at 4.55pm.

Now my aim was to learn to do injections myself, it looked quite easy. In the stomach is not as bad as it sounds, subcutaneous, under the skin, just a matter of taking a fold of fat skin. I’m sure there are many people out there used to doing injections on themselves for various conditions, but this was my first time. The next day I did it under supervision, no problems, yes I would manage fine by myself tomorrow.

The nurse said the cap on the needle point is very stiff so you have to grip tightly and pull hard. Next morning I did exactly that… the plunger came out and liquid sprayed into the air. I had broken it. I took out another syringe and made sure I gripped the right part, success. Perhaps I would keep quiet and not tell anyone about the broken one…

Friday Flash Fiction Five Hundred – Harry H

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 ‘…well not exactly sore, my tongue is sort of tingling… and when I took my temperature this morning it was 36.9 and then thirty minutes later it was 37…’

‘Okay Harry, it sounds as if there is nothing to worry about, just let us know if…’

‘…and I didn’t go this morning  do you think I should take the laxative?’

Harry the hypochondriac had never been so happy since being diagnosed with cancer; after forty years at last somebody believed he was ill. He was no longer worried he might have cancer now he actually had it. Now he had started chemotherapy he even had his own hot line to call anytime, twenty four hours a day, if he had any symptoms. That was lucky because he had a lot of symptoms.

At the group chat for chemo beginners he had been the star pupil, it was rather like being back at school only with tea and cake. The nurse praised him for asking plenty of questions, though his classmates kept looking at their watches. She emphasised they must ring the hot line, even if they did not think their symptoms were important.

At home Harry checked his home made charts. He had a good collection of lateral flow tests which he did daily, one could not be too careful with Covid. He took his temperature every hour after the nice chap on the hot line said there was no need to take it every thirty minutes. But he was still worried when he thought of all those white blood cells that had been destroyed.  When he had told Pam across the road all about his diagnosis, treatable and curable, she had patted his arm…

‘That’s what they said about my John, but his immunity was shot to pieces and it was the pneumonia that carried him off.’

He liked Pam, she understood his worries.

‘Now Harry, you be careful that district nurse gives you the right injection, our Julie went into that anaphallic shock…’

The district nurse came every day to give Harry an injection to boost his white blood cells. They were very nice and listened sympathetically when he updated them on all his symptoms, though he seemed to get a different nurse each time, so he would have to tell the story of his diagnosis right from the beginning… If they were not there by one o’clock he would ring to check they had not forgotten.

He was quite sad when the seven day course was complete, but at least he would see them again after his next chemo session. He kept the yellow plastic ‘sharps’ tub on the mantlepiece so visitors would appreciate the seriousness of his condition.

Harry began to worry again… supposing they had got his diagnosis wrong. Surely they should have operated first, those scanners might have missed something, perhaps he had another tumour of a different sort…  

A Long Attachment

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Read no further if you are squeamish, read on if you are going to have an operation or look after an operatee.

Torrential rain immediately after my operation meant helpers did not have to water the garden and I wasn’t missing much in the outside world. I wasn’t as incapacitated as I expected, but for nearly two weeks I was attached to a long tube which led to the wound drainage bottle – a contraption the district nurse said she hadn’t seen before, patients often have bags that are changed daily. A green concertina device showed if the vacuum was still intact, the same principle as syphoning petrol.

In the days when people spent a good few days in hospital after an operation they would be attached to all sorts of tubes putting fluids in and taking other fluids out; people who managed to avoid hospitals would know little about such mysteries. One of the the district nurse’s daily tasks was to measure output and replace a bottle if the suction went. Carrying this bottle, even with the handy bag sewn by a kind patient who had invented them, was like never being able to put your shopping bag down. I was also constantly forgetting it was attached. If I had known that the amount of tube inside me was about a foot long I would not have worried so much about pulling it out. Family and visitors wondered what was going into the bottle to make the ‘strawberry smoothie’ – some blood plus a lot of lymph fluid that wasn’t sure where to go after all the lymph nodes were removed. We all know about blood circulating and kidneys etc, but the lymphatic system is unfairly ignored by most of us!

This long attachment precluded any serious attempt to get dressed or try on the surgical bra and foam falsie, but haven’t half of us lived in our dressing gowns since Covid started? So what to do except sit and receive visitors, cards and flowers? I soon got bored with resting; thank goodness for the back garden, I could sneak out and do some dead heading when the rain stopped. I tried to avoid the kitchen; family were great with meals and coffee and tea for visitors, but there was a relaxed attitude to washing up and tidying the kitchen!  

The wound was sewn up with dissolvable stitches, sealed with ‘superglue’ and a hundred steri strips and to my relief the dressing stayed put for the required two weeks. The super glue allowed showering, though soaking in the bath was not recommended. The whole area stayed numb for ages and I felt like a first stage Cyborg, half my rib cage replaced by a steel plate. There are exercises to do from day one, then more after the drain is taken out and continued for ever… Lifting is forbidden to start with and reaching up for things catches you out.

I was glad to get out for walks once the bottle had gone, now there was another week to wait before going back to the hospital for pathology results.