The first time I walked onto Intensive Care (ICU) as a new staff nurse I thought “Holy Crap! This is like the bridge of the Starship Enterprise!” All those bleeping machines, monitoring equipment I didn’t recognise and so many lines and tubes attached to each patient. I thought I had made a huge mistake and would never manage all this chaos. It reminded me of when I started on A&E, again I thought Holy Crap, this is like a friggin warzone, blood everywhere, I’d never be able to understand the organised chaos that is A&E!
Happily it didn’t that that long to get up to speed on ICU because there were many similarities with A&E. In ICU the priority was always the heart, lungs and kidneys, as long as we looked after those systems then the odds were good that the patient would survive. We had the same philosophy in ICU, look after the heart, lungs and kidneys and the rest will all follow in good time. That may seem like a very medical anatomy and physiological model but overriding this was absolutely everybody’s focus on the patient and their family, we worked as hard as possible to get absolutely everyone out of ICU in the best condition possible.
That was one similarity ICU had with A&E, the other similarity was nurses reaction to the fire alarm. The theory goes that nurses should prepare their patients, decided which ones can be evacuated from the unit and which ones are OK to stay, the nurse should be getting ready to move the patient into the next safe zone, usually theatres. However, what invariably happened was that every single female nurse (and some of the male ones too), would make a beeline for the changing room and put on their lippy and brush their hair for the expected firemen. Nurses and firemen… and policemen, a potent mixture.. Sometimes when the fire alarm went off I would look around and realise I was the only nurse on this side of the unit! Nurses in A&E and ICU wore scrubs, what surgeons wear in theatre, it helps minimise infection control, you get a fresh set each shift and dump them in the laundry at the end of the shift. However, even Pamela Anderson with her enhanced silicon valley wouldn’t get a second look if she was wearing scrubs, so the priority was to rush into the changing room and pretty oneself up. Sadly we never had any female firemen – ermm firewoman so I never got to dash off to the changing room to make myself (even) prettier.
Another similarity between A&E nurses and ICU nurses is nothing grosses us out – plus our sense of humour would always stray to the really sick kind, graveyard humour. I think it was a protective reflex, nothing grosses out nurses or doctors. I’ve been out with a bunch of medical staff and their respective partners and will happily discuss wee, pooh, blood and guts and some intricate procedure I assisted the ICU staff with and then notice that the non-meds are turning green and off their food.. oh dear!
But there are a few differences between A&E and ICU, in A&E there’s a special phone and when that rings everyone stops what they’re doing and listens. It’s a direct line from Ambulance Control and it’s nearly always AC telling us of a Blue Light on the way in, the ETA and any details they have from the paramedics.
Another difference is that the A&E staff generally only ‘patch & dispatch’ as we say, patch patients up and dispatch them on to ICU/Surgery/Wards. So the time they have with patients is very limited and they don’t get to know patients in the same way we did on Intensive Care. As an aside, in the Medical School they have a department that incorporates Obstetrics, Genetics and Elderly and it’s referred to as the Hatch’em, Match’em’ Dispatch’em department! I think that would be an excellent title for a murder mystery book.
But by far the best difference between A&E and ICU is that occasionally A&E staff get to go on the Ambulance so they have insight into what the paramedics do. In reality it’s just an excuse for the paramedics to chat up and impress the nurses, they were always disappointed to see a male nurse join them… I have been out in a ‘blue light’ a few times. It’s fantastic! It’s like being in a snow plough, all the traffic in front of you parts like Moses and the Red Sea. I’m sure there’s a scene in Bruce Almighty like that, it’s the fastest time I’ve ever got from work to the other side of London.
During my time in A&E I learnt a few things that I thought I might share, these are not all mine but the medics out there amongst you will be able to relate to them.
- Don’t tell the nurse you have a bad back and then have sex with your partner on the trolley behind the curtains. Yup, coitus interruptus was interrupted by moi.
- The phrases “I know what I’m doing” and “Hey, watch this!” is almost always followed by a trip to A&E
- Never get into a road rage incident and go head to head with someone who has a spanner in his hand.
- Never try to get away from a police dog, they are quicker and from what I have seen, have VERY sharp teeth.
- Never allow your sex partner to push a screwdriver/wine bottle/apple/cork/banana/etc up your jacksie, and then tell the nursing staff you don’t know how that got in there. Remember, your rectum is an exit point really, and bowel perfs are NOT fun.
- Never walk in front of your brother when he is practising his golf swing.
- Don’t jump off a bridge into the river without first checking it’s more than one foot deep.
- Never…NEVER…hide your weed in a toothbrush holder and stick it up your butt and think it’s a safe hiding place from the officers in a prison. It could get stuck!
- Never assume you are sterile just because you didn’t get your last 3 lovers pregnant.
- If you are having an MRI done, we REALLY need to know about those “personal” piercings, because they will get ripped out by the magnetic pull.
- Always wear safety goggles while playing paint ball/or checking out the paintball gun
- Spermicidal foam tastes like hair shampoo (apparently).
- Vaporub definitely won’t prolong your erection (and you’ll taste very bad!).
- Do not assume you are “going thru the change” when you suddenly stop having a period when you are 43. Consider the fact that you might actually be pregnant!
- Do not try to sandpaper off tattoos by yourself. Also do not use a sandblaster or scraper to do it with.
- Insulin needles should not be shared by family members, especially for weeks at a time.
- And finally, no matter how bowel obsessed you are, do not strip down naked in your back garden and have your husband (whom you met at a psych unit) give you an enema with a garden hose. Your neighbours will call the police and you will get a bowel perf and peritonitis, and you will be sent back to the psych ward where you met your husband in the first place.