This site is intended for health professionals only

The secret life of a supernurse

Janet Webb
BSc(Hons) RGN
DiPN(Lond)
Practice Nurse
Lindum Medical Practice
Lincolnshire

The week had started badly, with a complaint letter. I'd sent out a batch of reminder letters, carefully checking each of the case notes to make sure they hadn't just seen one of us, moved house or died before posting them the previous Thursday, using second-class stamps because I'm conscious of the appropriate use of resources. One of the intended recipients died on the Friday, and the letter - inviting him, in a cheery fashion, to pop in and see us - arrived on the Monday. His widow was understandably upset, and had put pen to paper.

After that, every child I saw screamed within seconds of my ministrations; I broke the plastic measuring jug I used for mixing disinfectant while trying to throw a fly out of the window; an order I'd been urgently needing turned up with the wrong item; and the door fell off my dressings cupboard. I was just a disaster.

Like picking a scab, I began thinking about every criticism and insult I had suffered at the hands of patients. The woman who asked if I'd ever wanted to do my training and work in a hospital like a real nurse; the one who, when offered dietary advice said, quite seriously, “Oh no, I don't want to end up looking like you, thank you” and the man who said, “I don't think I've seen you before, it was a nice, pretty girl last time”.

They don't think we have feelings. I sometimes think they don't think we're real people - I've had women carefully describing what it's like to have a period, and people telling me there are roadworks outside the surgery. And there are the “tired all the time” consultations when I'm told how difficult it is working full-time and running a home. Feeling sorry for myself? Moi?

It was this poor excuse for a practice nurse who Matt came to see on the Thursday. He'd come to talk about his erectile dysfunction, having been unable to maintain an erection for about six or seven months. He's 27, and in a stable relationship, with no concerns about infidelity. He works as a builder doing physical work six days most weeks, and up to 14 hours a day while the weather is good, but enjoys his work and the money it brings in, which goes towards the mortgage on their new home.

Matt denies any stress, feels fit and well, eats well, takes no street drugs, has the occasional beer or odd glass of wine, has never smoked and his weight has been stable since leaving school. His father had a heart attack in his 50s, however, and his younger sister was recently diagnosed as diabetic and now uses insulin. He had no dysuria, no soreness or discharge, bowels regular, no testicular changes. He could ejaculate by masturbating, and the semen looked quite normal. I asked him to provide a urine sample - it showed 1% glucose.

Supernurse had found the solution. I swept straight into “new diabetic” mode, telling him I'd need some blood to confirm what seemed an obvious cause for his erectile dysfunction, and since he had not yet eaten and drunk only water, I took fasting glucose, urea and electrolytes, liver function, lipid profile and thyroid function tests. So profound was my conviction that I didn't do a fingerprick test, thinking the venous blood would be more conclusive. I then gave him dietary advice and an explanation of diabetes, showed him how to access the Diabetes UK website (www.diabetes.org.uk) and told him we'd meet again in diabetic clinic once the formality of his diagnosis was confirmed. Arranging for the results to be telephoned to us, I made him an appointment for later that night by adding him as an extra to the duty doctor's clinic - he would be back to working all hours the next day.

I am capable of idiocy. Just to prove it, his only abnormality was a raised ALT (alanine transaminase) on the liver function. I hadn't requested any hormone levels. The duty doctor wondered why I'd brought in erectile dysfunction as an emergency. I can't imagine what Matt must think of my overenthusiastic diagnosis.

On the Friday I saw Valerie, who had come to have blood taken for hormone levels, having experienced missed periods in her late 40s. She revealed how hopeless she had become at everything, no longer able to function as a sentient human, constantly revealing her “true self” as an utter waste of space. When I'd finished taking the blood she said brightly, “It's great to be able to talk about this to someone who takes me seriously. I bet you've never felt like this though, you always seem so calm and capable. Thanks for listening; now you know how the other half live!”

I later read that a raised ALT indicates a risk factor for type 2 diabetes: “Prospective studies found that levels of ALT predicted incident type 2 diabetes - this was independent of the classical risk factors or changes in obesity” (Harris 2005). He'll thank me later.
 
Reference 
1. Harris EH. Elevated liver function tests in type 2 diabetes. Clinical Diabetes 2005 23(3):115-19.