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Rearranging the deckchairs as the ship goes down

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It was 10 o’clock at night and I was sweating and cursing under my breath as I attempted to re-catheterise a very confused octogenarian with advanced prostate cancer. The corridor outside echoed with the cries of other confused octogenarians all vying for the attention of a non-existent nurse.

An all too familiar story

Was this two decades ago when I was a junior doctor? Well it could have been, but it was actually last week.

As a junior doctor though, at least I had a trolley to lay out the paraphernalia on, a bed at the correct height, decent lighting and trained nurses around me. Last week I was carrying out this procedure if not actually by torchlight in the African bush, as near to this experience as you get in a supposedly modern care home.

The reason I’d been called on to use my rusty catheter changing skills was because the care home had been informed the district nurse on duty that night was not trained in male catheters.

Am I alone in thinking a district nurse that can’t change catheters is about as much use as an ITU consultant who can’t intubate?

I’ve no doubt it is not the nurse’s fault and they probably need to ‘update their skills’ on catheter changing which probably involves them attending a course which nobody wants to pay for.

The staff at this care home were overworked and exhausted and some had stayed on beyond the end of their shift to assist me. Not being nurses (this being a residential home) they had no training in catheter changing and nor should they need any. This patient had complex nursing needs and should have been in a nursing not residential facility, but there was nowhere else to place him, an all too familiar story.

I left the home leaving the staff instructions to call an ambulance if the catheter blocked again in the night and admit the patient for what would be the third time in seven days.

The day before this I’d been asked to remove all non-laminated notices from the walls of my consulting room in readiness for the CQC. They can be an infection risk apparently.

An image crept into my mind of someone bending down to tighten the screws in the deckchairs on the Titanic, as the bow plunges into the icy depths of the North Atlantic. 

Dr David Turner is a GP in west London

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Readers' comments (4)

  • doctordog.

    Bravery bordering on the foolish.
    Catheterisation in such conditions potentially hazardous.
    Surely London has some central clinical facilities for this type of problem?

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  • Mr Mephisto

    Abide with me, fast falls the eventide:
    The darkness deepens, Lord, with me abide:
    When other helpers fail, and comforts flee,
    Help of the helpless, O abide with me.

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  • Why does this not surprise me?

    Our district nurses have been spread so thinly that there is often only a HCA level "nurse" on for at least part of the day or night in the area. They can't do catheters, but nor can they do syringe drivers or stat doses of drugs for end of life care.

    It's not their fault - they are underfunded and understaffed, and their roots have been made so horrible that their numbers have been decimated.

    But it does lead to situations like this, inevitably.

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  • 20 years ago you would not be under GMC, civil, media and criminal sanction should something go wrong.

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