MARK TYRRELL

“Trying to get a Holocaust survivor with dementia into a shower is a harrowing experience”

I currently work as a practice nurse in a GP Clinic.

I was never too interested in school, and left half way through year 12. I already knew I wanted to do nursing, as I had been a first aid volunteer a few years by then. I started through a Victorian Youth Development program in 1997, that allowed kids to do cadetships with the army, the navy – and first aid.

I learnt first aid basics, went out with the ambos to events like football and concerts. It was pretty confronting for a kid, dealing with cardiac arrests, drug overdoses. But seeing how the paramedics and the nurses I worked with dealt with these situations and people, inspired me to get into it myself.

I did a Certificate IV in nursing, graduating as an enrolled nurse by age of 18. As a division 2 nurse, my only options at the time were to work in a nursing home. I started in a facility in Melton, performing basic tasks of caring for the elderly, showering and toileting them, assisting with everyday tasks.

I still remember the first person we ‘laid out’ – a nursing term for getting bodies ready for funeral home collection. You have to wash and dress them, make sure they look presentable for the relatives.

I didn’t realize, but dead bodies make a lot of odd sounds. They moan.

If you’re not used to it, it can be a bit distressing. But you soon get used to it.

I didn’t love working there, I felt I was capable of more. So I went back to uni and did a medication management course, and an injectibles module. This allowed me to get a job at a stroke  and trauma rehab centre in Geelong.

We dealt with people who were recuperating from strokes, car accidents, other head injuries. We taught them to move again, walk, talk, take showers. A lot of them were completely immobile, you had to hoist them up into a shower, change their incontinence aids. Recoveries were slow.

I remember one patient, he was what we call an ‘incomplete quad’ – so he was a quadriplegic, but he still could move his arms. Except he didn’t have fine motor control, so when he tried to make even the smallest movement, his arms would wildly fly out. Teaching him to shave the first time was scary, as he insisted on a manual razor.

He went to make the first stroke and shaved of a good slice of his cheek.

After that we convinced him to go electrical for the time being…

I stayed there three years, as I enjoyed it. But it was emotionally draining. You had to go into work upbeat, always. You had to provide the positive energy to motivate the patients to work on their recoveries. If they saw you were a bit down, that brought them down, and made it harder to perform the tasks they had to do.

It was especially draining on me, as at the time, my eldest daughter, who was born with only half a heart, was in and out of hospitals. She had three open heart surgeries. I would drive to Geelong to work, then to Royal Children’s, then home – everyday. Besides, it was still part time hours, so money was short.

Something had to give, so I left for a job at another nursing home, as it had full time hours and better pay.

From there, for the next few years, I tried a lot of different types of nursing. I had a lot of jobs, come to think of it!

I worked as a nurse in corporate Occupational Health, for Toyota and Crown Casino. Occupational health is like a mini emergency and health centre on the company site.

So for Toyota, I worked at their main manufacturing plant in Altona, which had something like ten thousand workers. If anybody hurt or injured themselves, or felt unwell, they came to us. We even had a fully fitted out make-shift ambulance, in case we had to go get someone – that’s how big their site was.

We dealt with a lot of sprains and strains there, repetitive injuries.

A lot of their work was done on cars with their arms over their heads, so lots of repetitive shoulder injuries, back injuries.

Then at Crown, it was a similar scenario, but obviously different type of patient! As you can imagine, a lot of alcohol and drug cases, slips and falls, cardiac arrests. It was never boring.

I did agency work for a while, going out on various assignment, and tried working at a hospital, in a surgical unit, which I found too fast paced for my liking, plus I didn’t enjoy the nightshifts.

The late-earlies should be banned, in my opinion!

I also worked at various nursing homes throughout my career. I found I’d always bounce back into a nursing home when I was needing a period of stability and security. It’s predictable work and shifts, the conditions are good, the pay is OK. But they have their challenges.

One job was in a Jewish nursing home, working on the dementia ward. Trying to get a Holocaust survivor with dementia into shower is a harrowing experience – both for them and for you. They think the worst.

They put up the fight of their lives, they’ll bite, scratch, hit you.

We had one resident, he was tortured with water. Showers were impossible. Eventually, we worked out if we put a bit of plastic over his face, we were able to wash his head and body. It was a matter of understanding each patient, really.

At an Italian nursing home, I learnt all the Italian swear words! Unfortunately that’s what patients with dementia do: they are scared and confused, and the nurses cop it. But the way I see it, they are old – they are aloud!

Nursing homes can be fun. When the residents are having their lucid moments, it’s like you’re looking after your grandparents. You have war veterans, and they’ll share their experiences. Some of their stories are just horrific, and humbling – they really touch your heartstrings.

One of my longer tenure jobs back then was at a GP clinic, working as a primary health nurse for over two years. I loved that job. I really enjoy the emergency type of nursing that you get in general practice, you have to think on your feet.

People think they’re having a heart attack, so for some reason, instead of calling an ambulance, they come to the GP clinic.

So now you’re doing ECG, organizing the ambulance, getting the doctor in. It’s rarely a real heart attack, but often the patients are really unwell. They come in pale, grey, clammy – you have to act as if it’s the worst. But it can be anything: massive infection, anxiety attack.

Working as a GP nurse, your scope of practice expands. During that time I did some courses to up-skill: I did a wound suturing and IV cannulation courses, and a plastering one as well, so that I could put the plasters on.

The next period in my life came when I got an opportunity to become a FIFO nurse.

I heard about the opportunity and applied on a whim. For a while, it didn’t look like I was going to get it because I was not a registered nurse, but after a Skype interview, all of a sudden, I was on a plane to Tennant Creek in NT for five months.

You fly to Alice Springs, from there it’s a four hour drive to Tennant Creek; it’s the real outback – no phone reception, 45 degree days. It was a pretty large aboriginal community of around 3700 people.

As a remote nurse, you are also the doctor and the pharmacist.

There were only two doctors there, so people came to see the nurses with pretty much all their ailments: colds, coughs, scabies, lice. Bigger things like syphilis, uncontrolled diabetes, heart disease.

We also encountered child abuse. When that happens, it is mandatory to report it to the police, but it can be very hard to police it in the communities.

In an aboriginal community, you have Men’s Business and Women’s Business – and they don’t mix.

So the clinic was effective divided into two parts, for men and women. That’s the culture. As a male nurse, I would never see a female patient, unless it was a young girl supervised by family or an elder.

In a setting like that, we were doing a lot of pre-emptive nursing. The patient might come in with a sniffle, so you’re looking through their notes to see it’s the first time they’ve been in for 3 years. So you’re saying to them, ‘Oh, I see you haven’t had you flu shot, let’s get that done. And you haven’t had your pneumonia shot, let’s get that in. Oh, you’ve come up as possibly having an STD, so let’s do that too’.

They weren’t always happy about it.

You had to convince them to do it. So I learnt a lot of problem solving, communication techniques.

Also because I was an enrolled nurse, I didn’t have prescribing rights like a registered nurse. So if I suspected someone had an infection or disease, I’d always have to confer with one of my RN colleagues, even if it was over the phone, to be able to prescribe treatments.

In the NT, and other remote areas,  you often work with the Carpa manual.

So say, a child comes in with ear pain. You flick in the book to ‘ear pain’ and it gives you provisional diagnosis’s of what it could be. Then you need to decide what it is. It’s like a check guide, a step by step manual.

I loved working in the outback.

Plus the money was great, everything but food was paid for. Though in the outback, food can be expensive. I felt like an icecream once, went down the street – and once I saw the price, I didn’t feel like an icecream anymore. Two-litre tub of Homebrand icecream was $14!

After a short visit home to see my family, I returned for another three months. This time I was offered a position on the remote team, which is a whole different kettle of fish. Each day we had a different community that we’d visit.

Once a fortnight, we’d go bush for days at a time.

We’d drive to our first destination, which could be 300kms away and set up our clinic, which could be under a veranda of someone’s house.  Then you’re trying to give sterile injections in a place covered in dirt and dust. It’s 40 degree heat, but you have to wear jeans in case of snakes. It was pretty intense – but fun.

Other times, you’d drive to a community 3 hours away and find there’s only two people there, because the rest have gone bush on some tribe business. But you cop that, as that’d be our own fault for not calling ahead!

I returned to Melbourne for a short stint in a GP clinic, but the travel bug had me.

My next job was in tropical north Queensland, on Thursday Island, working in a remote 30-bed hospital. We were the main point of call for anyone getting injured in the PNG, they’d get flown over by helicopter.

Here I learnt about communicable diseases like TB and such, the policies and procedure you have to follow, like visiting patients in isolation room completely clad in protection gear and masks.

I loved the challenge of remote nursing, and the camaraderie between the nurses was fantastic.

We were all their on our own, living away from home and family. It is a female dominated profession still, so out of the 14 nurses, there was only 2 of us blokes. But we all worked well together and I still talk to some of the friends I made there on Facebook today.

I did more jobs in Toowoomba, working for a major hospital there, and in WA, where I almost considered moving my family. But when that didn’t work out, I returned to settle in Melbourne last year and started my current job in a Bacchus Marsh GP Clinic.

I realized I really enjoy the GP environment: you get your mixture of emergency, your chronic patients, it’s a big mix of patients.

I like the ‘unknown patient’ – that new condition you’re not expecting.

Like the other day, we had a patient come in who split his head on his boot door. So that’s what I like – someone like that arrives, and it’s up to you to make them better until they get to a hospital.

Also we get a lot of very interesting wounds. Wounds are my favourite.

The more necrotic, the more infected – the more fun. Because it’s a challenge. How am I going to help heal this? I’ve got a patient at the moment, who was possibly bitten by a spider. When she came in, she had a necrotic cap: a patch of dead skin on her back, underneath which was yellow slough – it literally looks like butter, but hard and thick. Eight weeks later, it’s still healing. Her diabetes delays the healing process, and we try various wound products to speed up the healing.

Sometimes I get frustrated by constraints in health care. There are fantastic dressing products out there, but they are so expensive. Like, we know that this product would heal this wound, but either the patient can’t afford it, or the clinic can’t afford it, so we have to use inferior products that take longer. That’s the reality sometimes.

I know I’ve jumped from job to job, looking for something to captivate me, something that offered the right levels of challenge for me.

I think with General Practice, I come closest to professional satisfaction, it has everything that I enjoy about my job.

I enjoy the challenge of nursing. Every day is different. My main reward though is the gratification you feel when you’re doing a good job, making a difference to people’s lives. Personal gratification and satisfaction plays a big part in being a nurse.

There are negatives, of course. A lot of stress is put on nurses dealing with people who are at their worst. Especially in emergency-type situations, like I’ve experienced with ambulance work, or even dealing with the drunks at Crown.

The amount of abuse that nurses cop is outrageous.

People are drunk or high, and they don’t see, or don’t care that you’re trying to help them. They’re angry and upset, and we’re first in their line of fire. We get hit, kicked, spat on, bitten.

Yes, the abuse does hurt sometimes, it gets to you. But you just have to shrug it off, it has to be like water of a duck’s back. You have to take it on the chin, do your job – and then whinge about it later. Which we nurses are very good at doing!

I don’t have a big plan for the future, I am just taking it as it comes.

Although I’d love to go back to uni and upgrade to registered nurse, right now, with a family to support, it’s not really feasible.

But I do a bit of casual first aid work on the side, and through that job I may do my Certificate IV in workplace training and assessment next year. That will allow me to teach first aid, which ties in with my passion for first response nursing and helping people.

My attitude is, if someone tells me I can’t do something – I will go and find a course that lets me do it.

You’re always learning. Anyone who says they’ve finished learning, they don’t want to be a nurse anymore.

But the most important thing for me is family. Even in my career, I could not have done the things I’ve done without my wife’s support. So I think that’s the biggest thing.