I'll Have Your Eye Out!

Are you squeamish? If so, you may not appreciate this post!

I spent Tuesday with Wayne, the corneal eye retrieval nurse. Wayne's job is to assess the eligability of all deceased patients to donate their eyes for corneal transplant. Obviously this role is immersed in ethical, professional and legal issues and therefore many patients are unable to donate. For example, if "confusion ? cause" is written in the patient's notes, they cannot donate just incase their confusion is due to a degenerative neurological disease (e.g. dementia or Creutzfeldt-Jakob disease). Other contraindications include;

• long-term corticosteriodal use



• IVDU



• Stabbings/traumatic RTA



• Malignancy



• HIV, Hep B/C



• Auto-immune diseases



• Diseases of unknown aetiology
  

So to you doctors out there, please write CLEARLY in patient's notes so that these can be found easily!

If the deceased patient is deemed suitable, the family are contacted and asked about donation. If there's any uncertainty among the family, the donation cannot be carried out. If the family consent, Wayne has 24 hours from time of death to get those eyes out!

This is the fun part: getting into our mortuary greens, plastic shoes and what can only be described as a plastic version of a butcher's apron! The patient was in the mortuary ready: a 99 year old gentleman who had actually been extremely healthy - his eyes were in fantastic condition. And so the removal process began. I was fortunate enough to remove the patient's left eye :)

The process is actually very straightforward, and easy when you know how. We began by securing the patient's eye open with what can only be described as mini tongs! These keep the eyelids out of the way. Then, the muscles need to be cut. Six extrinsic muscles are attached to the eyeball and walls of the orbital cavity; four rectus and two oblique. A small hook is placed down each side of the eyeball to pull the muscle out a little, enabling it to be cut.

Once all six muscles are cut, the only thing holding the eyeball in place is the optic nerve (II cranial nerve). A curved pair of scissors is used to feel for and cut the nerve located at the back of the eye. This is quite tricky - cutting the optic nerve is like trying to cut through electrical cable! Then the eye can be removed.

Saline-soaked gauze is placed into the orbital cavity and covered with a small piece of plastic covered with nicks in order to hold the eyelid shut. The eyes were then packaged up and sent off to Manchester. Someone can now be cured from cataracts because of this donation. Amazing!

I then observed the removal of a heart for organ donation... How morbid do I sound?!

A Messy Matter of Bad Practice: Part 2

Well, I turned up to work following the writing of a report against a registered nurse, and what a shift it turned out to be...

The nurse in question barely took any notice of me all day which was probably a good thing, until she bellowed at me in the reception area! I wasn't quite prepared for that, and apparently stood bewildered whilst trying to muster an appropriate response. The nurse then made a patient cry.

Nice one.

Later on and feeling victimised, this nurse phoned an RCN rep who spent about an hour in the Sister's office with her. We were a little surprised yet relieved when the RCN rep sent the nurse home and informed her that she wouldn't be working on Eye Casualty again. However, the following day she was working on a ward upstairs causing more trouble. Apparently she shouted at the ward Sister in front of a bay full of patients...

So it's a continuing issue and one which I'm no longer privy to. Let's hope things are sorted out as quickly as possible without further atrocity. And that my report isn't called for in a legal environment!

A Messy Matter of Bad Practice

As a student nurse, I've spent the best part of two and a half years being beaten with the NMC Code of Professional Conduct. I like to think I've learnt a thing or two from it, and that my practice is in accordance with what it states. So what do you do when you meet a qualified nurse whose practice is questionable?

Always a tricky one - to say something could seriously jeapordise your placement final report and make the rest of the placement a nightmare. But then surely we have a responsibility to pick nurses up on bad practice?

This week I have been working alongside such a nurse. I'm sure she's a lovely person; perhaps she's just become somewhat disillusioned with the job. The other staff have also found her extremely difficult to work with, to the extent that we all looked like we'd worked a 14 hour shift after about 20 mins! The Sister asked myself and the other student there on placement to write a short report about this nurse's conduct/practice, which we did. We then discovered the nurse in question was writing a report about us...

So I'm dreading going in to work tomorrow. We were very careful as to what we did and didn't write in our report, trying to avoid accusations and generalisations. I've just read the report again and feel confident in what was written. I'm still rather nervous though... Let's hope something positive comes of it all.

The Art of Communication

It's been an interesting couple of weeks on Eye Casualty so far...

• One patient asked for "Dr Gaylord", when they were actually due to see Dr Hayward.
• An elderly lady telephoned to find out if it would be suitable for her to come in. I asked her what the problem with her eyes was and she began, "well in 2004..." It was a long conversation!
• Whilst triaging a patient, he kept referring to me as "doctor" regardless of my uniform.
• And a very nice gentleman asked me out for a drink. He was blind.

So I'm settling in well and enjoying the challenge of determining what may be the cause of various symptoms. Some patients, when asked what their symptoms are, will simply say "my eye" as if from that descriptive information I can ably diagnose on behalf of the doctor! We also see patients who will tell us that they've had a sore eye for four years now. Would it be innappropriate to define the word "casualty" to these patients?

That aside, we do also see some very sad cases, particularly of young people whose vision has become severely compromised due to simple accidents. I always find it difficult to triage young people, particularly if they're distressed. It certainly encourages you not to take your sight for granted.

We had a lovely 86 year old gentleman with us yesterday. He suffers from Parkinson's and had fallen over. He had a fantastic bruise on the left side of his face. Maxillo Facial sent him to us to ensure his eyes were ok before they got involved. I often find that elderly patients are stereotyped as "confused" all the time. While this gentleman would have been confused following such a bang to his head, it will generally wear off. He was on the ball when I had a cuppa with him - he told me about his adventures during WW2 as a Wellington navigator.

Another elderly lady was with us this week, a Polish lady who moved here after WW2. At 12 years old, she was taken to a ghetto in Germany. It was facinating learning about her life and understanding how different our world is today.

That's the luxury of being a student nurse - we have opportunities to sit down and talk to patients. I'll certainly miss that when I qualify, but aim to talk with patients as much as I can. All good for holistic care I reckon.

A New Year, A New NHS?

It's a new year! And what better way to welcome in 2008 than with - you've guessed it - another shuffle in the NHS!

While we're all still in the throws of recovering from the last major shuffle (Agenda for Change), Gordon Brown has seemingly decided that he would like a turn. Cue the NHS Constitution - an outline of the rights and responsibilites to be expected in healthcare. Not a bad idea, but when Gordon Brown warns of "a major shake-up", it just doesn't appear quite so simple...

Months of debates and reviews are set to ensue before the shake-up becomes a reality, but as Dr Michael Dixon (chairman of the NHS Alliance) stated, "To the average member of the public and patients and, frankly, doctor or nurse it doesn't mean much. It's just another big idea from on high."

Happy New Year!