40. Bless you my child

Key words/phrases: St Bueno, Wales, advent of secular medicine, Florence Nightingale, Hospital for Sick Children Great Ormond Street, London, Children’s Ward and Sister Shaw at Joyce Green

No. 40

Today (21 April) is apparently the Feast Day of St Bueno, the Welsh saint and patron saint of animals and sick children.

St Bono (to use the latinised version of his name) was born in Powys in Wales. He was the son of a Welsh Princess but later on, after being educated in Caerwent, he took holy orders and became a priest.

History has it that whilst living in Holywell, Flintshire he offered to instruct his brother’s daughter Gwenfrewy (Winifred in English) in the ways of the Christian faith although unfortunately while the rest of her family was in church one day - so the story goes - his niece was troubled by the unwelcome attentions of a randy huntsman.

When Winifred rejected this outdoor type he chased her to the church steps and chopped off her head ! Her uncle the priest rushed out, cursed the hunter and then picking up his niece's head he replaced it on her shoulders - whereupon she was miraculously restored to life.

When he died in AD 640 St. Beuno was buried in a chapel near to his holy well. In bygone days people who were unwell we are told - but children in particular - were dipped in this well and then carried to the chapel where they were left to sleep overnight on the his tombstone. If they managed to sleep on it they were often found to have been cured the following morning, thus St Bono became associated with the healing of sick children.

Most people appreciate that between A.D. 500 - 1500 religion and health care were inextricably linked because of the absence of any scientific understanding of illness. However later on, because of the drastic decline in religious influence on a good most aspects of everyday life but also because of the ineffectiveness of folk medicine, scientific methods and approaches to managing illness began to blossom. The period 1500-1800 saw the advent of secular Medicine and very soon after this the first journal articles and books devoted to rational approaches to the care, including the care of sick children began to appear.

Florence Nightingale even emphasized children's nursing needs in her 1859 book “Notes on Nursing” saying : “It is the real test of a nurse whether she can nurse a sick infant.”

During the first half of the 19th Century doctors resisted getting involved with sick children in their new enlightened hospitals and practices however the situation changed in 1851 with the founding of the Hospital for Sick Children.

Dr Charles West and some colleagues rented a house in Great Ormond Street, London and established a ward with 10 beds for children between the ages 2-12 years who needed of hospital care … and the rest, as they say: “is history”. Well not quite ! Because of course paediatrics didn’t evolve as a specialist discipline without a struggle.

In the early 1900s children were cared for by physicians who normally cared for adults, children being seen as less important. These doctors-in-adult-medicine would often arrange to do their rounds to see these sick childen in between other more prestigious duties. In addition general physicians and obstetricians initially refused to accept the need for a separate specialty, implying that they were perfectly capable of dealing with what were, after all, only miniature adults.

During my 10-12 week clinical placement as a student on the Children’s Ward at Joyce Green I quickly learnt that babies, toddlers and youngsters live in very different worlds to our adult ones and that they had a very wide range of very special needs.

Even to this day I remain very grateful to Sister Shaw and her staff for all that they did in introducing me, and so many of my peers too, to the world of sick children’s care.

I have particularly vivid memories of working on night duty on the JGH kid’s ward with an exceptionally gifted Australian R.S.C.N and one nursing auxiliary and the three of us sitting bottle feeding umpteen babies on umpteen occasions - in between doing everything else that needed to be done. Talk about finishing painting the Forth Bridge and then having to restart the same task again almost immediately !

But I also remember being involved in the day-duty care of a very hyperactive little girl of 8 or 9yrs old who was being investigated for hyperthyroidism and oh boy - did she keep us busy. She never stopped rushing around the ward from morning to night !

What about this little gem to close with ?

School nurse to an 11yr old: “Have you ever been in hospital ?” Child: “Yes, once I had a fraction in my neck and had to stay in hospital for a long time.”

39. Services rendered

Key words/phrases: New Zealand, Dr. Sir Archibald McIndoe, East Grinstead Hospital Surrey, The Mayo Clinic Rochester, Minnesota, Dr. Sir Harold McGillies, St Bartholomew’s Hospital London, The Battle of Britain, The Guinea Pig Club, Neville and Elaine Blond, The Burns Unit Guy’s Hospital.

No. 39

It’s strange isn’t it how one thought coming into one’s mind can set off a whole chain of associated thoughts ?

A recent e-mail from a Charlotte Berry (née Dobbs) in New Zealand, who I trained with at Joyce Green, reminded me of another Registered Nurse friend of mine who trained in Dunedin, on the South Island of New Zealand.

Did you know that Dr Sir Archibald McIndoe, who went on to become the famous Burns & Plastic Surgeon of East Grinstead Hospital, Surrey, was also born in Dunedin ?

Archie McIndoe studied medicine at his local University, became a house surgeon at Waihato Hospital and from there he went to the Mayo Clinic, Minnesota, USA to study pathological anatomy on a scholarship.

In 1930 he moved to London and at the suggestion of his cousin Sir Harold Gillies (perhaps the world’s first renowned Plastic Surgeon) McIndoe took a job as a clinical assistant in the department of plastic surgery at St. Bartholomew's Hospital. Eventually he was appointed as the RAF's consultant in plastic surgery and after this he went on to win recognition for some the amazing surgery that he did on numerous pilots who were burned in plane accidents during the Battle of Britain.

He and the burns unit at East Grinstead Hospital became world famous. His plastic surgery patients automatically became members of the Guinea Pig Club – so called because so often they took part in “first time ever” surgical procedures.

Two good friends of McIndoe - Neville and Elaine Blond - assisted in developing local community help and support for the pilots so that they were not left feeling ostracised from those people whom they had served. The Blonds gradually persuaded various families in East Grinstead to accept the pilots into their homes as guests and visitors and this specialised unit was named the McIndoe-Blond Burns Unit in honour of these three people.

During my own career I particularly remember going as the ‘nurse escort’ from Joyce Green to the Burns Unit at Guy’s Hospital with a lad of 13 or 14 yrs who had sustained 80% burns. During the school holidays this young man had been helping his father to take up some lino that had been glued to a floor. The pair of them were using a glue solvent when the boy’s father unthinkingly threw a match on to the floor after lighting a cigarette, momentarily forgetting that the solvent that they were using was highly flammable.

The circumstances of the accident and the horrific state of the poor lad were made even worse by his fear of dying as he drifted in and out of semi-consciousness. “Am I going to die nurse ?” he repeatedly asked me as we made our way up to London by ambulance.

That question hit me really hard at the time. As young newly qualified nurses, what preparation had any of us ever received during our training that could possibly have prepared us to handle a question like that ?!

As you can perhaps imagine I have never been able to forget that that particular “shift” even though later on during my career I went on to manage a Regional Burns and Plastic Surgery Unit.

Managing that specialised unit was challenging enough in itself but in all honesty I take my hat off to all those people who actually work on the “shop floor” of Burns and Plastic Surgery units.

38. Having your cake ... and eating it !

Key words/phrases: Good Friday and Easter Day, Hot Cross buns, Simnel cake, Easter eggs, Mothering Sunday.

No. 38

Hot Cross buns are no longer solely associated with Good Friday and/or the Easter holiday weekend are they ? I suppose that it's because so many of us have hankered after them all year round that bakers and manufacturers have come to see them as a permanent way of keeping their profits up.

But what of simnel cake ? Did you enjoy a slice or two of this traditional cake during Easter ?

Simnel cake - in case you are not very familar with it - is a light, spicy, fruit-cake containing an INTERNAL layer of marzipan topped with another thick layer of yellow almond paste or yellow icing and decorated with eleven marzipan or sugar balls or flowers.

These are probably the yellowest cakes that you will have spotted in your baker's window over Easter and the edible decorations are usually positioned in a circle representing the apostles at the Last Supper. Judas, the traitor is not included in the circle and the largest central decoration is there to represent Christ.

The word 'Simnel' by the way reportedly comes from the Latin word 'simila', which is the name given to a very fine flour made from wheat.

Do you remember eating slices of simnel cake or toasted and buttered hot cross buns at Joyce Green on Good Friday when the hospital was still functioning ? No ? .... well neither can I !

I have no recollection whatsoever of either hot cross buns or simnel cake ever being “on offer” to patients or staff at Easter-time and this is puzzling me ?

I can understand the absence of hot cross buns on the wards because of the difficulties of toasting and serving them hot in a ward setting, but because simnel cake is a served cold - like Christmas cake -I’m not sure why it never featured on the tea-time or evening meal menu for patients and/or staff ? Or perhaps these customs WERE celebrated on certain tradition-orientated wards ?

Does anyone remember chocolate eggs or special buns or cakes being distributed on the wards at Easter ? Easter eggs were almost certainly distributed on Ward 7A, the children’s ward but as to any other part of the hospital I have no recollections of any other special Easter titbits being given out or served, do you ?

Over the years simnel cake has become associated with Easter Day but apparently it was originally made for Mothering Sundays.

In the 17th century Mothering Sunday was a day when young men and women who worked “in service” were allowed the day off to go and visit their families and because this was something of a special holiday it seems that the girls “in service” would often bake their mothers a simnel cake as a gift and take it home with them.

A tradition then evolved whereby each daughter would give the cakes to her mother as a thank you present although in practice these would not usually be eaten until Easter Day.

Thus the baking of simnel cakes for their mothers on Mothering Sunday was also used - openly or discreetly - to monitor each girl's cooking skills because the cake would not actually be eaten until Easter Sunday when whole family would take note to see if the cake was still moist.

But notwithstanding the strange fact that special cakes and buns never seemed to appear as part of the hospital's Easter catering arrangements I can still remember visitors bringing in food and chocolate for their bed-bound relatives to help them to celebrate Easter.

After all that is one of the ways that we tend to celebrate special occasions, isn’t it … by eating !

So Happy Easter and happy memories too as you look backwards.

37. Accidents, mistakes & chance discoveries

Key words/phrases: Serendipitous occurrences/outcomes, Frank Epperson & Popsicles, Alexander Fleming & Penicillin, Dr Mason Sones of Cleveland, Ohio & coronary catheterisation, disruptive behaviour in a psychiatric ward, Albert Einstein.

No.37

I like words. Do you ? I like the sound of them, their meanings and their origins but in particular the word serendipity has become a favourite of mine. A serendipitous finding is "an unsought and unexpected outcome of a positive nature."

It’s strange isn’t it how sometimes an individual can be actively looking for something quite specific but ends up finding something different yet useful, whilst in another situation a person who isn’t necessarily seeking to discover anything finds that he or she does !

Frank Epperson of San Francisco, for example, was eleven years old when he accidentally created what we now call the ice lolly. One day he mixed himself a drink of water and soda water powder - a popular drink in 1905 and then left it haphazardly on his back porch with the stirring stick still standing in it. When the overnight temperature dropped the mixture froze and much to his amusement Frank found that he had a stick of frozen soda water to show his friends at school the following morning. Eighteen years later, he started producing what he called 'Epsicles' in different fruit flavours and although the name never really caught on over three million 'Popsicles' are now sold in America every year.

If we think about penicillin, Alexander Fleming wasn’t actively "working" when he felt compelled to show a visitor what he was doing in his laboratory. He simply noticed that one of his petri dishes - which he in the process of disposing of - had become contaminated with a mould. On closer examination he found that the invader that had settled on the surface of his culture plate while he had been on holiday was killing off the the staphylococcal micro-organisms. No-one could have blamed his other colleagues for labelling him ‘lazy’ because of the way that he regularly neglected to clear up after himself and yet three years later two other researchers were able to create a stable form of this naturally-occurring fungus to give the world what was to become its first antibiotic.

The first case of coronary catheterisation was serendipitous too. In 1957 a paediatric cardiologist at The Cleveland Clinic, Ohio was attempting to inject some dye into the heart a young patient with valvular disease when he discovered that the cardiac catheter had accidentally entered the child’s right coronary artery and that 30ccs of contrast dye had been released.

Thus Dr. Mason Sones accidentally discovered that the coronary arteries could tolerate contrast dye. Soon afterwards he went on to perfect new techniques for producing high quality diagnostic images of the coronary arteries using specially designed catheters. Thus this accident made accurate diagnosis of coronary artery disease possible for the first time and ultimately set the stage for such future interventions as bypass surgery and coronary angioplasty.

So what I am trying to flag-up here is that although I accept that in general terms we do need clear aims and objectives to help us to structure the work that we do in our hospitals and the efforts we make in our communities, nevertheless chance happenings and accidents can still sometimes produce unexpected and positive results.

I wonder if anyone reading this can recall a mistake that they or someone else made at Joyce Green Hospital which nevertheless had a positive outcome ? Either a practical mistake or a misjudgement of some sort but nonetheless one which had a useful outcome for a patient, a colleague, a relative or someone else ?

Whilst working in a psychiatric hospital once (unconnected with JGH) I can remember taking a very belligerent young male patient by the scruff of his neck and putting him out of the ward and on to the main hospital corridor when I was on duty alone one night.

This young man was disrupting the whole ward and although he was quite capable of controlling his behaviour on this occasion he was really letting rip. So almost intuitively I decided to deprive him of his audience and to exclude him from his temporary ‘substitute home’. Talking calmly to him wasn’t working and he was refusing to take his medication and so because he was menacing other patients and being destructive I decided to do something out of the ordinary both for his sake and for theirs.

And do you know what ? Although this was an unusual and completely nursing unplanned intervention it worked …. and within a few minutes he was knocking on the locked ward-entrance door apologising and asking if he come back on to the ward.

As Albert Einstein once said: “Not everything that can be counted counts and not everything that counts can be counted.”