Tuesday, 5 August 2014

27. Saved by the chemo nurse

In the Chemotherapy Lounge
Well. So far, so good.

I had envisaged all manner of things. I had, after all, been duly warned. About waiting times, for example.

"Do you own an iPad? Bring it! Watch films on it! It is so booooooring, sitting here!" said the breast care nurse in a loud whisper when she showed us around the VIP Lounge yesterday. "And they'll want to keep you here for an hour after you've had your chemo, because it's your first time. Just to see if there are any bad reactions." 

"Be prepared, there is often a long wait between you coming in and the chemo drugs arriving from pharmacy," said a colleague who is a senior cancer nurse at the hospital. (She must have read my blog post on waiting, and she understands that forewarned is forearmed).

Then there are the 20 pages of chemotherapy side effects in a booklet on my now overflowing cancer shelf. Plus the stern warning from the breast care nurse that I mustn't venture out of London during the first three days, in case I start to throw up and need to be brought back into hospital to stop it. ("We can usual manage the vomiting. But we can't always stop the nausea.")

Oh, and "No, you shouldn't go home on the Underground," she'd said when I asked. (I thought that was concession enough. At least I wasn't proposing to ride my bike.) "Not the first time round. Get someone to take you home in a car."

So I'd envisaged anything from keeling over on the spot to clutching a sick bag all the way home.

I'd told my son that we wouldn't be home before 6pm at the very earliest - and it could be a lot later than that. My husband, who came along, had planned to go home to get the car once the chemo was given, whilst I did the sit-a-bit-longer-to-be-observed thing.

We had lugged in enough stuff-to-do to keep us occupied until tomorrow morning if needs be. Books, laptop, magazines, iPod, headphones, a briefcase full of work (for him, don't worry, not for me).

What I hadn't envisaged was this:
  • being cheated out of our reading-and-listening-to-music opportunity, as things kept happening (and I was too interested to watch what was going on in the VIP Lounge, and to eaves-drop on conversations, to bother with the book and the headphones. I think my husband managed to make one phone call),
  • feeling fine,
  • going home on the Underground after all (with the chemo nurse's blessing),
  • arriving home at 5.45pm because they felt no need to keep an eye on me,
  • cooking a large pot of maraconi cheese (and enjoying eating two platefuls),
  • and sitting down to write my blog, instead of lying in bed with the sick bowl by my side.
I also felt OK about the poison entering my veins. I think writing about it yesterday has helped me to think it through and accept it.

I am not fooled into thinking that this is going to be a walk in the park (although the doctor did say that getting out every day to get some exercise helps with the side effects). I have heard from the experts (that's other cancer patients) that you feel fine on day 1, but collapse into bed on day 2. But the chemo nurse today told me that there are also patients who come back for their third cycle, terribly worried that the chemotherapy isn't working because they haven't had any side effects at all. So there is hope.

Speaking of that wonderful staff nurse, I deem her single-handedly responsible for saving me from a chemo overdose.

It happened like this.

I was one of her allocated patients today. She called us out of the waiting room, explained everything again, installed me in one of those recliner armchairs with my husband on the straight-backed chair next to it.

She gave me a cup-full of anti-sickness pills (never in my entire life have I taken six pills at once), including, she noted, a really strong one that the doctor had prescribed, presumably because of my poor track-record of feeling sick during pregnancy.

"Your chemotherapy drugs have arrived," she said. "I'll go and get them now."

She returned with a filled-in form and asked, "Do you mind if I weigh you?", wheeling out the scales.

This didn't strike me as odd. There is such constant measuring going on in hospitals, blood pressure, weight, height, temperature. I could give you the numbers off the top of my head now, and they will be accurate, give or take a decimal or two. (As it turned out, perhaps that is exactly what I should do in the future.)

What was odd was her request for me to get onto the scales twice. "It DOES read 69 kg, doesn't it?" she asked me, correcting the numbers on her form. "Not 96? I thought so. It says 96 kg here."

Off she went, returning a little later with an alarming explanation about an unexpected delay.

"I have to send these drugs back to pharmacy. They based the calculations on you being 96 kg, so the dose is will be too large."

It all worked out fine in the end. She rang the doctor who confirmed that I absolutely mustn't be given those drugs, so new ones were ordered. Miraculously, these arrived within an hour.

My first lot of chemotherapy drugs
Two large syringes with red poison, which the wonderful chemo nurse pushed into my vein as slowly as possible, taking a good 20 minutes over it. ("What are the side effects of this one?" I asked. "Ah," she said, "the red one is the one that makes your hair fall out.")

One smaller syringe with clear fluid, which was a bit quicker. And a bag with the third drug, dripping into my bloodstream over 15 minutes. A 10 minute flush with some saline, and I was done. All I had to show for my Significant Day was a small plaster where the needle had been.

At one point, another nurse (who I presume must be Saviour Nurse's manager) came to talk to us, telling me how lucky I was to have a nurse who knows what 96 kg looks like. "The newer nurses don't always know their maths".

Isn't it standard, then, to double-check patients' weight here? No, apparently not. "I trust the measurements taken at the breast clinic the day before," Saviour Nurse said.

So what made her decide to question it?

"Well, I was looking through your notes before you came in. I read about your cancer, your surgery, everything. I saw that you were 50 years old and I saw your weight. So when I looked into the waiting room I was expecting a much larger lady. I was surprised when I called your name and you stood up. I thought to myself, yes, she is tall, but surely she can't be 96 kg?"

An excessive dose of chemo might not have done me that much harm, beyond a likely inability to do any blog-writing at the end of it. I am not cross or upset about this near-miss. Errors happen in hospitals. That is why there are such stringent systems for checking and double-checking everything.

When you have breast surgery, they write a huge arrow on your chest pointing to the side they need to operate on, so you don't end up with the wrong breast missing. When you have chemotherapy, two nurses read everything out loud: the name and numbers on your wrist band, on your prescription form, on the syringes. Just to make triple sure that they match.

Although I would be interested to know, therefore, how and where the 96 kg appeared. Did yesterday's nurse misread the scales? Write it down wrong? Did someone put the handwritten numbers onto the computer and swapped the 9 and the 6? (Easily done.)

What I find most striking is that this error was prevented, not by a clever hospital system, but by a nurse who thought about me as a person.

She took the time to read my notes and thought about who I might be, imagining me as a person, not just another chemo-recipient on her conveyor belt.

She didn't see a patient and thought of it as a number. She read a number and thought of it as a patient.

I asked her why she chose to become a cancer nurse. She explained that after she had come over from Asia to work in England, her father died of cancer. She couldn't get back to her country when that happened.

She wasn't sure whether he had received the right treatment. "They only gave pills. Not chemotherapy, not like they give everyone here. It's not like the NHS. You have to pay for everything over there, and chemotherapy is just so expensive. Many families can't afford it."

As for so many nurses working in emotive areas of practice, it was a personal experience that made her want to help others in the same situation. I think she deserves the Nurse of the Month Award. In fact, make that Nurse of the Year.

And let me just throw in a bit of politics here too. Where on earth would we be without immigration? Most of the wards and clinics seem to be staffed by fantastic doctors and nurses from overseas. (I am biased, of course. I count myself among Britain's immigrants.) The NHS would collapse without them.

Plenty of time for a nice long chat with the nurse...

Hang on a minute... Six hours after this picture was taken, I am hit by my first wave of nausea.

So please excuse me, I am signing off and heading for the tin of ginger biscuits.

I'll try and keep you posted, but you may have a bit of a wait ahead of you. I recommend a book. Or an iPad with a film on it.

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