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Nurse Bel and the Patient Who Couldn’t Get Comfortable

May 12, 2013

A call bell is ringing in a side room. When Bel goes to investigate, she finds Kayleigh, the first year student, is already at the scene. The patient is Mary, a mountainously large woman who has been admitted with decreased mobility. As Bel surveys the bed, stray pillows and corners of sheets overhanging the sides, hillocks of soft flesh rising from the mattress, she is reminded of nothing so much as a tin of over-risen dough. Bel has an idea of what’s coming, but decides against making assumptions. “Do you want a nurse?” she asks.

A gravelly voice gets straight to the point. “Can you do something about this bed, love? Only I’ve never known anything so uncomfortable. All I do is slide down it”.

Kayleigh, keen to appear sympathetic, nods in agreement. “Everyone has that problem with the beds” she says brightly. “We went to a training session last week and the rep, you know, from the company that makes them, he said that if you raise the patient’s feet like this…” she presses a button on an electric console, whereupon the lower end of the bed, with Mary’s feet resting upon it, rises several inches “…it stops them sliding down. Doesn’t work though.”

Bel, her eyes fixed on Mary’s face rather than her feet, notices that it has contorted into a wince of pain. “All right Kayleigh” she says quickly. “Lower Mary’s feet back down. We’re going to slide her up the bed now anyway.” To Mary she says “Is that what you want? To be higher up the bed?” She’s only asking out of politeness; she already knows what the answer will be. There has been no patient in the entire history of the NHS who doesn’t want to sit higher up the bed.

Mary proves not to be an exception. “I want to be higher up, love” she splutters “but mostly, I just want you to make me comfortable”.

Bel feels her shoulders sink. ‘Make me’ and ‘comfortable’ are three of the words she dreads the most: such a vague request, requiring such a specific outcome. Conscious, however, of the need to set a good example to Kayleigh, she feigns enthusiasm, and hopes that if she tries hard enough, she might really feel it. “OK, Mary” she says “ we’re going to move you up the bed on the slide sheets, so first we need to lie you down flat”. She nods to Kayleigh, who, standing on the other side of the bed, does the honours with the bed controls.

The two of them insert the slide sheets, pull Mary up the bed, remove the slide sheets, and then raise their patient to a sitting-up position with the electronic controls. Mary wheezes appreciatively.
“Right” says Bel, hoping she doesn’t sound too sarcastic. “Phase one of Operation Make Mary Comfortable completed! Now, what’s phase two going to be?”

“My bottom’s sore” announces Mary.

Kayleigh, armed with up-to-the-minute research data, knows exactly how to respond. “The best thing you can do for that” she says “is if you can lie on your side for a bit”.

Mary turns her head and considers the student for a moment. “No love” she says  quietly. “I don’t lie on my side”.

Shielded by the invincibility of science, Kayleigh doesn’t catch the hint of menace in Mary’s voice. “And why not?” she asks cheerfully.

“Love” says Mary. “I know you mean well. But I haven’t lain on my side since I started with my legs, for the simple reason that I can’t get comfortable on my side. And what my doctor told me years ago was that for someone in my situation, comfort is what I need to aim for. And I’ve never forgotten that”.

“I’ll bet you haven’t” thinks Bel. Inwardly, she feels torn. Her gut instinct is to stop antagonising Mary and move on to the next problem (she suspects that Mary is on the point  of declaring that the only thing standing between her and the ultimate comfort experience is the fact the she is having to scrape by with a mere six pillows), but she also knows that she should support Kayleigh in trying to implement what she has been taught at university. She squats down so that her face is level with her patient’s. “Look Mary” she says “it’s lying on your back all the time that’s making your bottom sore. Kayleigh’s right. The best thing you can do is lie on your side, relieve the pressure. Any nurse will tell you the same”.

Mary remains stubbornly unconvinced. “Can’t you just rub a bit of cream on it? That’s what the District Nurse used to do”.

“Mary, rubbing cream on it won’t help. It might even make it worse”.

Mary glares at her. “Well I am not” she says, with magisterial finality “lying on my side”.

Bel gets to her feet and stands back. She waits a heartbeat before activating the nuclear option. “All right” she says casually “if your bottom’s that sore, and you won’t lie on your side, I’ll just have to order you a pressure relieving mattress”. Mary is a notorious – and vociferous – critic of the pressure relieving mattress. The explosion is immediate and spectacular.

“No you bloody well won’t, love, pardon my French! You’re not putting me on one of  them…contraptions! I’d rather have pressure sores! Last time, the noise kept me awake all night…all night” she repeats, lest there be any doubt about the indignities she has already been forced to endure “and it was like lying on corrugated iron, and then I got stuck in a big dip in the middle and I couldn’t move…and I was ringing and ringing and I couldn’t breathe and nobody came…Whoever invented them mattresses…” she wheezily concludes before descending into the inevitable orgy of coughing “…they want stringing up!”

Bel regards her patient calmly. “Mary” she says when the coughing subsides “you either lie on your side, or you have a pressure relieving mattress, or you get a pressure sore. Those are your choices. It’s up to you”.

Mary fiddles with a tissue. Bel waits. It is Mary who cracks first. “All right love” she sighs. “I’ll tell you what. I’ll lie on my side after tea, OK? Just let me have a couple of hours like this first. Work myself up to it”.

Bel recognises this as just a play for time; after tea it will be visiting, and Mary will no doubt want to sit in her wheelchair so her family can take her outside for a smoke. She also knows that no better offer is going to be forthcoming. “All right” she says. “Deal”.

Mary makes the predicted demand for more pillows. As a gesture of goodwill after the compromise over the side-lying, Bel fetches her an extra one even though the bed is already piled high with so many of the damn things that there is hardly any room left for the patient.

Kayleigh  commits another faux pas in the positioning of the bed table (“Not that side! The other side! And put my drink, my tissues and my sweets in a line next to me so I can reach them! And the tele there so I can reach that as well!”) but by the time they leave the room an air of satisfaction prevails.

“Are you comfortable now Mary?” asks Bel from the doorway.

“Yes thank you love, I am”.

“Anything else you need?”

“No thanks love. I’m just going rest my eyes for a bit”.

Five minutes later, out of Mary’s earshot, Bel is giving vent to her frustration. “Honestly! You see what we’re up against? We give them evidence-based nursing, thousands of pounds’ worth of state-of-the-art equipment – and what happens? They don’t want to know! They’ve got more faith in some random ointment they bought at the Pound Shop than they’ve got in the accumulated weight of a hundred years of medical and nursing research! But then, when they end up with a pressure sore, suddenly it’s all our fault! It really… ” The sound of  a patient call bell interrupts her mid-rant. Turning round, she sees that it’s coming from Mary.

Kayleigh nervously approaches the side room door, exchanges a few words and returns to Bel. “It’s Mary” she says. “She wants to use the bed pan”.

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From → Nurse Bel

4 Comments
  1. Gay Lee permalink

    Truly wonderful and wonderfully true. Been there and tried to do that a thousand times…

  2. Cream for your bottom and pillows for your back…solves everything really.

  3. Breda Williams permalink

    Brilliant !!!

  4. Thanks. One of my better attempts…

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