Reflecting (because every nurse loves a good reflection)

Did you know my blog has lasted longer than my nursing career did??

A failed career in Sports Science- well it was a career that never started thanks to my lungs resulted in me falling into nursing. I never thought I would be a nurse. If you were to ask people what I would end up doing as my career (albeit short) it would not be nursing. It would most likely be something to do with sport.

I can honestly say I have enjoyed every single minute of my nursing career (there may be a few exceptions but generally). From day 1 at uni to what turned out to be my last day (I wish I knew it was at the time).

I have looked back and have some key highlights from over the years.

First Year Student Nurse-

  • The first day of uni and sitting in a lecture theatre with about 250 students and not knowing anyone, wondering if I had done the right thing.
  • Pulling on my student nurse uniform for the first time and feeling so proud
  • My first hospital based placement in the Renal ward and working out that Cat was actually my cousin.
  • Fainting on the ward after a patient split their head open and being fed toast by Sheila the ward clerkess who also kept asking if I was sure I was not pregnant!

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Second Year Student Nurse-

  • Being a student nurse on the high dependency ward, having an asthma attack on the HDU ward and then later that day being a patient on the ward.
  • My ITU placement at the Western General where I got to see brain surgery and also on night shift looking out the window of the break room and seeing my bedroom window. It made for really long night shifts.

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Third and final year student nurse

  • Once again fainting but this time in theatre while wearing a lead dress as it was radiology. It was an 8 hour operation to stent a renal artery and it was very hot so down I went, stumbled out of theatre and fainted again in one of the consultants offices!!
  • Being terrified that I wouldn’t pass my degree as I could not revise properly because my grandpa was seriously unwell and had major heart surgery in the lead up to the first lot then was on palliative care at home and died just before my final ones. Thankfully stuff must have sunk into my brain and I got my degree with distinction.
  • Management placement in renal and always being told I ask a lot of questions, but also always asking people to test me as I was applying for jobs so wanted interview practice. Turns out that practice was not great as had an awful interview but thankfully got the job.
  • The day I got told I had a job on the renal ward I was on nightshift and remember Laura the other student nurse from my year also had an interview but neither of us knew if the other person had got the job so we were super awkward around each other till we both knew!!

Of course the biggest highlight of my time as a student nurse was graduating and getting a distinction in my degree which meant I could go on an register to be a staff nurse with the Nursing Midwifery Council.

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I had 3 years of being a student nurse and then 7 years being a renal nurse where I spent all my time in Renal. Oddly I hated learning about the kidney in school and spectacularly failed my Biology AS Coursework which was about the kidney!! I was not much fussed for the kidney at uni either but once on the ward I found it fascinating. I think its because I am a practical learner!

It has been really hard to pick just a few highlights or memories that have stuck with me from my time as a staff nurse on the renal ward.

  • Pulling on the cornflower blue uniform for the first time and sitting in handover waiting to be given my first patients. I was so scared. I kept thinking what happens if I do something wrong or kill one of them etc. I had millions of scenarios going on in my head all negative of course.

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  • Every nurse will remember their first cardiac arrest. I heard the arrest buzzer go off and I was standing next to the crash cart when it happened, so I grabbed the cart forgetting to unplug it from the wall and off I went. I didnt get far before I jerked back and knew I had forgotten to do something fairly vital!
  • I did a bank shift on the transplant ward. I knew about kidney transplants as had dealt with patients who have had failed transplants etc but never really spoken to someone with a new transplant and one that was working. I was curious. It turns out that patient taught me a huge amount. Firstly they don’t take your old kidneys out if they don’t have to and then when asked to see what their scar was like and helloing them pull their jumper up thinking the scar would be at the back I was shocked when they started unbuttoning their trousers. Transplanted kidneys go in the pelvis!
  • Catching a patient who had really horrific bloods and lots of fluid on board munching on lots of crisps. When advising the patient that perhaps they shouldn’t eat them as they are so high in salt and this will make them super thirsty etc. I was told that it was ok because they were cheese crisps and not salted ones!! I must say I couldn’t help but laugh.
  • In the ward you get given 4 patients a shift on day shift. Either one bay of 4 people or 4 side rooms. I had a bay of 4 people this particular shift. We were also due for an inspection this same shift. I start to get all my patients up and washed, go for my break with one patient left to wash. Come back from my break to find water pouring out from under the bathroom door, one patient not in their bed so I think they must be washing themselves. Next thing I see is the clinical nurse manager coming out the bathroom soaking wet with the patient. She had decided to be helpful and wash my patient before the inspection. I was very grateful to her for doing this by my goodness she made a mess!!
  • There is of course the Christmas parties, tea parties and just general camaraderie of being part of a team.

When my lungs got too much for me to keep working on the ward and when patients were offering up their beds to me as I looked so unwell I was given the chance to move to the Community Dialysis Team. This was a job I loved. I could spend time with patients, work their treatments around their life and felt I could really make an impact to their lives. Of course there are some memories from this role too

  • Being back in my own clothes and everyone calling me Dr- I think because I wore chinos and a shirt or chinos and a polo shirt.
  • My first day being shown the ropes and managing to burst a bag of peritoneal dialysis fluid all over a patients bed (I was mortified).
  • Coming into work but not feeling great, which was then made worse by people smoking at the doors so I ended up in quite a bit of difficulty to the point that my boss found a wheelchair and basically ran with me in it to A&E. So embarrassing and terrifying (not the attack but the wheelchair driving!!!)
  • Seeing patients transform as they start dialysis and really getting to know them, and help them get their treatment optimised so it can still fit in with their lifestyle so they can pursue their hopes and dreams.

Over my entire career there is one moment that stands out above and beyond everything else and that would be when the whole renal team and chaplaincy worked together to pull off a wedding for a patient who was still very young but had to withdraw from dialysis because all her access failed. The wedding was put together in an afternoon and each department did their bit to being their bit of special to the event. It was lovely to see everyone doing what they felt was right from decorating the rooms with the christmas lights, to getting 2 beds into the side room, sneaking in some beer and champagne to celebrate the marriage. It is not only an event that is a moment in my career I won’t forget but in my lifetime I won’t forget.

In this blog post I could go on and on and write about so much because I have really loved my time as a renal nurse. There have been lows but then there are lows with all jobs.

The biggest low for me is that it has come to an end and I couldnt really say goodbye. My last day as a nurse I didnt know it was going to be my last day. Often when people leave their jobs they know they are moving on and retiring so can say goodbyes. I didnt. I have so many people who have been so influential in my career and so many patients that have shaped me as a nurse that I would have loved the chance to thank them and say goodbye.

For now I am no longer working as a renal nurse. I might one day be able to go back and practice again once my health is in better shape but for now my career is on pause and who knows the it will resume again.

For now this is me…..

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Severe asthma- family and friends misconceptions.

I was asked to write this blog post by Asthma UK as their report about severe and difficult asthma has just been published and the statistics are shocking. Asthma is not taken seriously or respected, some people don’t take their medication as they are meant to for a variety of reasons but this can be fatal. Those with asthma and those who know people with asthma need to understand just how serious it can be.

I consider myself very up to date with the latest asthma treatments, ensure I taken my medication as I am meant to and when I am meant to. I ensure I step up and step down my medication as my symptoms ebb and flow according to my personal asthma action plan. Even with my diligence to treatment and keeping myself well it is sometimes no where near enough and asthma wins over you, leaving devastating consequences such as death, the need for life support machine, very toxic drugs to relax the smooth muscle int he airways.

I have lived with asthma almost all my life. Over the years it has progressively become more difficult to control and severe which has impacted my own life and also my families lives as well.

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To manage my asthma I am in the very fortunate to have a team of specialists at the hospital who work hard to ensure I am on the best medication and most appropriate treatment aiming to control my severe asthma as best as possible. Despite this support and regular contact with the team my asthma remains severe to the extent I was put in a medically induced coma and was on a life support machine just under a month ago. I am sure if I did not have the team of specialists then there is a high chance my life would be very different if I was to have a life at all.

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Having severe asthma has resulted in many life changing circumstances from the sheer number of medications I require to control my severe asthma but then also medications to treat or prevent the side effects caused by the medication required to help my breathing. I currently take a total of 37 different medications, 14 of them are for asthma and 23 are for the side effects mainly caused by years of oral corticosteroids. I have also had to give up playing sport, change my career and now have had to give up my career, but the biggest impact has been on my family and close friends.

Living with severe asthma most of my life also means my friends and family have also lived with it too. They see how I try to manage my condition day to day, witness asthma attacks, call 999 for me when I don’t have the puff to call them myself, watch as helpless onlookers while an ambulance, with lights flashing and siren going, takes me to hospital as quickly as possible to stabilise the attack and make my breathing easier and then finally visiting me either in hospital or once I am discharged home. They see all this as well as my determination to manage my asthma desperately trying to ensure it does not take over and dictate my life. Despite witnessing all the above they accepted that this is what my asthma is like and that is that. An assumption was made that my asthma is as bad as it would get and my breathing wouldn’t get any worse than they have all witnessed. They thought this because I am under the care of a specialist asthma team who I can phone for advice whenever I am struggling which in my family and friend’s eyes means my asthma cannot get so bad that I may have a near fatal asthma attack.

My brother commented that he had become used to my asthma and almost complacent about how bad it could be. He said he has heard me speak recently of others who have died from asthma or friends who have been in a very serious condition but because I now have such a specialist team then I would be ok. It was everyday life me having severe asthma with the potential for requiring hospitalisation. He had taken this as normal and accepted it. So events earlier in the month were a huge shock and wake up call for the whole family because they had assumed I was safe with my asthma because I have some of the best people in the country looking after me and my asthma.

I look back now and see how my family normalised me being in hospital and me going to ICU so often which is really shocking. Going to hospital often should not occur let alone going to HDU or ICU that often. In any other health situation or if this was one of my siblings then it would not be just run of the mill and would be a life-altering event for the entire family.

My best friend who has known me my entire life and has been through thick and thin with me, seen me have asthma attacks and visited me in hospital never thought asthma could get as serious as it did during my last admission because I was under the care of specialists. She could not understand how asthma could get so bad when you are taking the latest medication that is available and have access to a team of specialists. She said she had never seen me look so unwell and vulnerable, not being able to do anything for myself reliant on others for everything.

The new report about severe and difficult asthma, which has launched by Asthma UK, makes me feel so fortunate to have such a good team and access to specialist asthma services to manage my asthma. Even with everything I have available my friends and family don’t fully understand how severe and life threatening asthma can be. I am sure if I did not have access to the specialists then asthma would have killed me. Everyone who may have severe asthma or difficult to control asthma needs to have access to specialists to help them live the lives they deserve to.

#MentalHealthAwarenessWeek2019 Acceptance

In my first post for #MentalHealthAwarenessWeek2019 I looked at dealing with being in denial. Wether that denial be of your physical health or your mental health, I am sure it is something we have all done. Tried to brush things off and say I’m fine. But what does saying fine really mean. To me now saying “fine” says a lot more that it means. To me when someone says they are fine it means they don’t know how to explain how they feel, or they don’t want to admit how they feel, or they don’t know how they feel. This happened just tonight speaking to a friend whose response to my how are you? was Im fine when clearly they were not.

I think we all just jump to I’m fine because we think it will not lead to anymore questions and we can move on to a different topic. Why do I think this? I used to be that person and still am sometimes. I would think if I said I was fine then I would be left alone to get on with things and could feel rubbish with out anybody pestering me. When I first started seeing a psychologist we spent a session talking about “Im fine” and why we use it. It was interesting to explore it further. It caused me a lot of pain as it brought up thoughts I didnt want to deal with, and made me realise my situation but now I look back and see I needed it otherwise I would still be telling people I am fine when I am falling apart.

Exploring the I’m fine became a lot more. It helped me accept my health. It helped me move out of a denial phase where I wanted to pretend to everyone I was ok. I didnt want to be the weak one who struggled to breathe or could work like everyone else. I didnt want a condition that can be considered by many as “just asthma” to rule my life and dictate it so if I didnt knowledge it to other people then everyone was happy as larry. All this did was hurt me more as no one else was getting more unwell or lonely because of my asthma and my health it was only me I was punishing.

Opening up and being able to explain how you feel is hard. I started off by trying to verbalise it but I found doing word clusters easier. I had 3 sheets of paper and each one contained a word: asthma, physically, and mentally. I also had coloured pens where I then wrote down how each word made me feel right there and then in one colour, in another colour I wrote down how i have felt in the past and then in a third colour I wrote down how I wanted to feel about the words.

This task made me accept my health both physically and mentally. It made me acknowledge that asthma is not just a physical condition but impacts you mentally as well. By treating each part in isolation I was never going to be able to really get to where I want to go. One each sheet of paper I had the same words particularly with where I wanted to be in the future. I had a common goal across everything and this is when I realised that to achieve that goal I need to look at every aspect of my health and how my condition is effecting me.

I found also that by doing this task I accept my health. I was able to see where I was and where I wanted to go. Rather than focusing on the here and now I was able to set goals for the future both short and long term. Goals which are achievable but also including some that are going to push me because you don’t want to make life too easy. Doing this meant I evaluated myself there and then, how I was feeling, what I needed to do to keep me stable or what I needed to do to change the situation I was in if it was a bad day. Accepting that you can have bad days is a big part of this but to accept bad days I found I need to have strategies on how to fix these bad days. It was not about looking for a fix such as a cure but looking at things that can still be done and achieved despite you not feeling well. For me a big part of not feeling well was feeling like I was failing. If I was not well enough to work or when i cut my hours cut down I found myself sitting at home thinking I should be at work just now but am not because of my lungs. Accepting that this is where I was at that point and doing something to change it even though I am not able to change my lungs I can change what my brain is doing. For me that is being involved in research. No matter how unwell I feel I will always be able to be involved in research.

One of the other big things about moving from denial to acceptance is evaluating yourself. You are going to have days where you slip back into the Im fine I don’t want to talk about things from time to time but if you can reflect back on why you felt like that. It might be that it was the people you were around you at the time and you did not want to share your feelings with them. This is ok. Everything has to be done in your own pace. Some people maybe able to reflect on themselves and feel they can shout from the rooftops about their condition and how it makes them feel where others cant tell a sole. Everyone is different and everyone has their own way of dealing with it.

I would be really interested to hear about how others found self acceptance of their health when they had previously been in denial about anything being wrong with them. I am always intrigued as to what skills others utilise to help them.

The above is just my experience. It might not be right for anyone else, but I found this is how I got my head around things and accepting how my asthma is impacting on life and how I felt about my asthma, the impact it has on my physical and mental health too.

One thing I want to get across this week is that a physical health condition is not isolated to just the physical body, and a mental health condition is not just associated with your mental state. They all over lap with each other and to truly get the best management for you everything needs to be looked at not just the condition in isolation.

Sick leave- what do you do??

Being on sick leave seems to be an all too common occurrence for me. It is never just a day either its weeks and weeks which feels like months and months (well sometimes it is months).

Often people say to me they would love to be off for as long as I have been off and it must have been nice. I hate saying its not and Im glad to be back but it is the truth. I hate being off as I do love my job. I think when you are at work and having a really hard, difficult day the idea of being off is just great, and then when you have had a week of annual leave that has gone by in just a flash you long for more time off to have a good recharge so when someone is off for a extended time you think it would be bliss but to me it is far from that.

Time stands still, it feels like it moves backwards, hours drag and minutes feel like hours. It is ok when I am in hospital and unwell because you feel so awful- time stands still in a different manner, you want time to speed up so you will be out the attack and find it easier to breathe but it doesn’t speed up, again it takes forever but once out the initial terrifying difficulty to breathe has passed you are left feeling exhausted and time just passes as you dose on and off requiring medication in-between but time just passes in a haze so you really have no idea about time or what day it is. This bit is ok as you really do feel ill and just curl up.

With asthma the tricky bit is when you feel better but you feel better when doing nothing and I mean doing nothing. Lying on a bed you are totally fine, breathing is good, heart rate is comfy, pain is at a low and all seems ok with the world until you need the toilet, shower, something to drink and thats it. Your lungs tighten up, heart rate sky rockets and pain rips through your lungs and you think to yourself all you did was stand up and take a few steps but feel like you have just run a marathon. This is when time is at an ultimate go slow. There is only so much lying on your bed or sitting on the sofa you can do. There is only so much day time TV or on demand TV and films you can watch.

They say rest is good for you, enforced rest is even better for you but even harder especially when you know that any movement you do will cause you to feel pain and go backwards. It is frustrating and difficult. Many of my friends with asthma and other lung diseases know exactly what it is like and share my frustrations. For me it makes getting back to work difficult because doing nothing you feel invincible but when do you know that you are ok to go back to work?? It is a hard call and loving work means you want to go back as soon as possible.

I find my self very fortunate as I have my patient and public involvement stuff which I can occupy myself with when having to be inactive and resting. It keeps my brain really active and i feel like I am doing something good with my down time. It is important and it stops me dwelling on what I imagine I should be doing. I would torment myself otherwise. Also writing this blog and the various support groups I am in helps me through it all but I know others don’t have that which is why I am so passionate about PPI because of the impact it has had on me. I am sure I would have long given up the prospect of even returning to work or do anything had I not had a such positive experience being involved in research. It has made the time that stands still move on and passes and soon it is the day to return to work.

How do I know when I am ready to go back to work properly and actually ready rather than my brain is super bored and I need to do something? This time it has taken me longer to go back to work which Im not ecstatic about however over the past week I have noticed how many people say how much better I am looking and how my breathing appears and sounds. This is the first time in a very long time that people have said positive things about how I look or appear compared with how I look like death warmed up and sound like I have swallowed a whistle. It think this is down to a combination of things, 1 having a better steroid regime which is preventing the dip I kept having late on in the day, 2 switching medical team to a new consultant, asthma nurse etc and having confidence in this team and knowing that things are getting looked into compared to before, and lastly I have been off longer but then I was kept longer in hospital and was reliant on less nebulisers when I was discharged than when I am admitted to the Royal and get discharged often before I can even walk the length of the room and often just bounce back in meaning I am not great and more stress on my body. So there is a number of different factors this time that have changed.

The last few days have been a great test for me to see how I really am doing. Going in to work to help with registrar peritoneal dialysis teaching which I really enjoyed and felt like I was useful. I must say I do love teaching but not just the teaching about something but instilling in the teaching and training how important the patient is and not just to get them better but respecting their choice and understanding what is important to them. I feel in renal this sometimes can be over looked especially when a patient chooses peritoneal dialysis as the work up can be longer and if they suddenly decline and require dialysis without a second thought a temporary line is stuck in them and then thats them on haemodialysis.

Today was also another great check to see how the lungs were doing. I attended a collider to discuss ‘Decision Support for Asthma’ which was industry partners, researchers, clinicians as well as patients to brain storm ways to help those with asthma. It was a fascinating meeting and what was clear was the passion of all those that attended to help people with asthma. Ideas were not the same in the groups but the patient and patient choice was at the centre. As a patient it was great to share what is useful and what is not useful to living with asthma. I will write a different post about this as I hope it will have positive outcomes and lead to new innovations.  I was tired by the end of the day but a good tired and not too chesty either despite the really hot weather and humidity (which I think will only get worse as the weekend goes on!!).

 

So fingers crossed when I see the GP on Wednesday she gives me the thumbs up to go back to work and some normality can return to my life!!!