The day I became a nurse.(indi) The following is a fictionalized account of a real life experience. All names and identifying details have been altered.

It was about eight in the morning and the ward had received a new patient.
I walked into the room with two beds, one of which was vacated and its sheets fixed and neatened hours before. I wheeled with me my computer, what I called a droid (which was a machine which took ones blood pressure, pulse, temperature and other data). And an ECG machine. My mission was to admit the new patient to my ward. The new patient was sat on the edge of a made bed. A bulging bag by her feet and a single pronged stick leaning on the bed by her side. Sunlight pouring in from behind gave her a halo and drained her face of all color.
She looked round as I entered.
“Knock knock.” I announce my presence and greeted her. Referring to the board above her bed for her name. Molly. “Hi Molly, my name is Jenny, I’m one of the nurses on today. As we admit you to the ward I need to gather some data. I’m also going to help you get settled and answer any of your questions.” I began to explain myself.
My patient smiled. “Hello dear.” she said.
I began to take down some notes, I took down her blood pressure and pulse with the probe on the droid. I counted the number of times she took a breath in a minute. I shone a light into her pupils, observed her track my finger from side to side, up and down. I listened to her lungs and abdomen as she lay on the bed. All the while chatting with her about why she found herself on my ward, her home situation and some of her current health concerns.
“I have been very tired, I just don't have the same level of energy I used to since I fell down my own staircase at home’. She said in her thick Welsh accent, it was all I could do to comprehend. I nodded as I palpated her radial pulse, something I at that point had not done. Having not listened to her heart by then either, I scrutinized my watch as I counted the beats, noting each one’s strength and character. My own heart sank as I observed its irregularity.
I ran my eyes up and down her body, noticing for the first time her ankles and feet. Her socks dug into her skin, creating a kind of trough round her ankles. The skin on her shins was purpled and the flesh pitted as I pressed my four fingers to her legs. I went back to palpating her pulse and connected the dots in my head.
“Are you on any medications Molly?” I asked, taking up a chair and sitting myself at her eye level. “Yes. I’m on those water pills and some other ones for my heart. The names escape me but one makes me pee and the other slows my heart rate.” I nodded. “Would you mind if I had a quick look at your medication bottles?” I asked, hoping my charm would persuade her to let me have a peak. She nodded and handed me a bulging plastic bag filled with boxes and blister packs from the bag at the bedside. I took out and read each of the boxes in turn noting as I did so that many of her medications were for symptom management. Not commonly prescribed on a regular basis. I then came across two medications that I zeroed in on. I had a hunch that these two she had mentioned were the ones I then held in my hand. The water pills she mentioned, diuretics and the heart meds she also mentioned, a powerful glycoside and commonly prescribed for arrhythmia. My heart sank further as it dawned on me that if took an ECG now, my findings would not be good. “You said you’d been feeling tired, run down. Do you ever have palpitations, dizzy spells or feel very unwell?” I asked, putting the two boxes back in the bag. Molly nodded looking up at me with concern and nodded. I realized I had begun to frighten her and adjusted my facial posture.
“I’ve noticed that these two meds you mentioned, they don't seem to be working very well. Your legs are quite swollen and your pulse is slightly irregular which could explain your occasional dizzy spells and fatigue.” I saw her face tighten in fear and I put my hand over her clasped ones. I looked into her wide eyes and explained that I was going to take an ECG tracing which is painless and takes no time at all, then get one of the doctors to come and see her. At that point I was convinced that the two medications I had put back in her bag earlier needed to be changed or she would deteriorate and we would have to send her to ICU shortly after her admission.

I assured her that nothing would happen to her if I could help it. That my nagging would convince the doctor to see her promptly which made her giggle. I placed the ECG dots and collected them to the machine. I recorded a tracing of her heart's electrical activity and labeled it with her name. I held it up to the window and scrutinized it closely.
The beats (QRS complexes) were as irregularly placed as those of her pulse. I noticed squiggly lines between the beats (where the P and T waves should have shown clearly) which were not supposed to be there and that some of the waves varied in amplitude. The thing about the tracing which caught my eye however wasn't these things as I had expected to see them from the beginning, but the very obvious premature ventricular contraction which cut lead two like a knife. I didn't like it. It confirmed my fears. That her heart medication was not working and needed to be reviewed. I didn't need a medical degree to realize she was in danger of suffering a cardiac event if this issue was not remedied.
My unease was mounting and I fought hard not to show this to Molly. I knew at that point that my patient needed a blood test to measure the levels of the medications and a dose adjusted accordingly. I quickly asked Molly if she had any pains in her chest to which she shook her head. I thanked her for her time, assured her I would return with some results, confirmed that there was nothing else she needed and left the room, dragging all the equipment with me.

I quickly located her doctor and after introducing myself I explained that his patient whom I had just assessed, needed to be seen by him as she was experiencing severe edema, arrhythmia and resulting fatigue and various other signs for which she needed to be examined. I hoped hard that the unease in my voice carried over my concerns. I explained she was taking a medication to regulate her heart rate and another to drain excess fluid, neither of which were having any effect, and that I had taken an ECG, which I showed him, pointing out its irregularities. I saw his eyes narrow as they focused in on the PVC and then travel over the paper, focusing on each lead. My unease seemed to have been transmitted to him as he looked at me and a smile flickered across his face.
“Thanks for bringing this up nurse. I’ll see to this right now before the patient has a code.” He took the paper with him into the patient's room, taking his stethoscope from round his neck as he went.
I watched him go from the nurses station feeling taken aback. The charge nurse then swirled round in her chair and looked me up and down. I caught sight of her face and she was smiling. “What just happened?” I asked, astonished. The charge nurse laughed. “I think he took you for your word. That never happens.” she said, snickering.
I relaxed a little but not fully until I saw the patient again later on that day on my medication round. I saw then that the diuretics had been stopped as had the heart medication. I found out three days latter that a blood test had been done and the doses for both these medications had been altered.
A week later, her edema had completely resolved and her ECG was regular and normal. The color returned to her face and she was regularly taking short walks up and down the ward. As I got to know her, her condition improved dramatically.

The charge nurse and I were talking about her condition at the nurses station a day after her discharge and she told me something that would make my spirits soar higher than the house from the film Up. She told me that I may well have saved Molly’s life by bringing the doctor into her care when I did. I never met the doctor again and I never saw the patient again. But this remains one of the highlights of my career so far. I made something integral happen for a patient who may otherwise have suffered a heart attack and it is this ability to advocate that makes me damn proud to be a nurse.

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