Reprinted from Anaesthesia Points West 1973
Recollections of a Recovery Room Nurse
Some four years ago, after an absence of ten years, and for reasons not altogether altruistic, I returned to my calling as a nurse. I suspect that Matron took a long hard look at the care-worn person before her, and placed me where she thought I could do least damage - the recovery ward. After all the patients would mostly be unconscious, and anaesthetists, on the whole, are a long suffering crowd of men. Being very familiar (one could say intimate) with one particularly disorganized member of this peculiar breed, I was not entranced at the prospect.
On the first day, the four stages of anaesthesia* were explained to me:
1. aphrodisia
2. even dizzier
3. deep
4. dicey
I was told that thoracic surgeons do not speak to each other, that anaesthetists require a firm hand and that housemen are extra fresh nowadays, because of their excessive off duty. The R.R. nurses' motto of "chin up, chest out", was imparted, and I was encouraged not to slap the patients awake unless I was likely to be late for lunch. It was a great relief to me that there was no piped oxygen in the ladies' toilet-the perfect place for a discreet cigarette!
My own recollections of how to care for an unconscious patient were scanty. I did recall something important about chins, and spent all my energies hanging tensely on to each one presented to me. I did this as though my life depended on it, let alone that of the patient. They came and went in all shapes and sizes until, horror of horrors, the first endotracheal tube arrived. "Just shorten half an inch a day and take it out on the tenth", a voice said airily. You can imagine how the old hands enjoyed that one.
I soon learned that both surgeon and anaesthetist regard the Recovery Room as their territory. Consequently, I became adept at conveying to the surgeon that the patient's poor condition was due to the noxious fumes given by the gasman. To the anaesthetist I acted as though the operation had been just an unfortunate incident marring his otherwise perfect anaesthetic. This formula seemed to work.
Sometimes my duty was to escort the conscious patient into the anaesthetic room. Always having believed in the personal approach, I remember assuring one nervous lady that she had no need to worry. Why, I myself had undergone two operations such as she was about to have. The startled surprise of the anesthetist was explained by a chance appraisal of the day's list, which revealed that the said lady was to have a termination of pregnancy - I have never quite managed to meet his eye since.
In this particular hospital, RR nurses were also required to work on the ICU - a little something Matron had forgotten to mention. Here fresh horrors awaited in the welter of machinery and plumbing one was expected to cope with - not to mention the jargon. A doctor who says IPPR is not referring to his recto-vesical fistula, and setting up the Bird is not nearly so contemporary as it sounds. Of all the machinery, the defibrillator struck most terror into me. How I hated that monster. Being rather like James Thurber's granny - I have never quite understood electricity. Each time I even cleaned it I expected to be fried to a crisp or disappear in a puff of smoke.
The days passed very quickly and my confidence in my ability grew. However, I must here admit that I never did master the differential diagnosis between induced hypotension and imminent death. Besides my confidence increasing, I found I was now walking as fast as everyone else, and talking as fast as they were too. In fact, so orientated to things medical had I become, that I quite misunderstood the charge nurse when he proudly announced that he had buds on his orchids!
My special joy during this time were of course the patients. How good they were. Yes, working in the recovery room was a lot of fun and something I would not have missed for the world. No-one actually gazed into my face thinking they had woken in paradise, but how else could a middle-aged, happily married, mother of three receive four proposals of marriage in a year?
Isabel Powell
* for the stages of anaesthesia and alcohol intoxication, see GASMAN - chapter 11, 1954