musingsofanewbienurse

[musingsofanewbienurse]

Importance of Sleep

Growing up I’ve always been told the importance of sleep, how you should get your 8 hours to allow your body to recharge and heal. In today’s society, where everything is so fast moving and people are expected to carry out dozens of tasks simultaneously, whilst not being even as half as active as our ancestors to tire our bodies out, it means that getting enough sleep is easier said than done. It just takes one simple google to find hundreds of articles from people complaining about poorly they sleep and their resulting tiredness.  

I’ve spent many a night tossing and turning, whether that due to be stress keeping me up or because I just don’t feel tired, and that has always impacted my performance the next day. Which, as a nurse on a busy hospital ward, could lead to dire consequences.

My family have also never been a fan of having lie ins. My dad wakes up at 8am on weekends and my mum rarely past 7:30, and subconsciously I have grown up turning my nose up at sleeping till 10 or 11 in the morning, viewing it as a waste of the day. It has lead to me not always getting the rest I desperately needed on my days off, as I pushed myself to get up at 8 (9 at a push) when not at work. During university that method was fine. Placements ran for an average of 6 weeks, so even though by the end of this time my exhaustion levels were at their peak, I then had a 2 month theory period to rest and recover. Since qualifying, where I work three to four shifts a week, every week (with a much higher day:night ratio than I ever had during my training) I have since learnt that my previous attitude to sleep and rest was in desperate need of getting updated.

It all came to head at around Christmas time of 2018, when I had been working for just over two months and my body was crying out for some time out. I was lucky if I was managing 8 hours on my days off, and averaging around 4-5 on days when I was at work, equalling to one very sleep deprived gal. I hated the idea of napping, viewing it as a waste of time and as a form of weakness; although I tried to get early nights (often going to bed at around 9pm) I would regularly be tossing and turning for hours or waking in the middle of the night and unable to get back to sleep until my alarm was due to go off. With every passing minute still awake I would be working out how much sleep I was losing, which caused my stress to increase and my brain to be waking up more.

My workouts at the gym also suffered. Although I have the goal of always going on my days off, I rarely had the energy for it and I probably only had one or two decent workouts during the entire month of December. Looking back on it I’m amazed I didn’t fall ill as I was at such risk of burning out.

On the 27th (after pulling 6 12 hour shifts in the space of 7 days) I headed to my family home for a week with the promise to properly rest my body. I slept soundly for at least 10 hours each night and had an afternoon nap nearly every day. But I refused to feel guilty about it as I once would have. My body needed this rest and it was not a sign of weakness I told myself. I know I’m healthy, I’m an active person with a very active job, and it means that because of that, I need to properly rest it when I get the chance.

On entering the new year, one of my resolutions was to start taking the pressure off myself when it came to sleep. For so long I had refused to nap during the day, convinced it would lead to a poor night’s sleep, but I had been having those anyway. Maybe if I had a lie down during the day, yes I wouldn’t sleep all the way through the night, but I would be less sleep deprived come morning.

It was also becoming increasingly clear that going to bed at 9pm was doing very little good for me, and I resolved that if I was unable to sleep, instead of spending hours tossing and turning, and therefore forming a very unhealthy relationship with my bed, I would try meditation or do some light reading in hopes that my brain would start to relax and allow me to drift off. I listen to James Smith’s podcast and he recently spoke of a 5 minute challenge he does everyday. At around the same time each night he would go to bed, turn off the lights and attempt to sleep, if, after 5 or 10 minutes he is still wide awake he would get back up and work to start slowly unwinding, but more often than not it’s enough to help him drift. I’ve been incorporating this into my daily routine and have noticed it does help. And even when it doesn’t, it still successfully works to get me off my phone and break the never-ending social media scrolling cycle we all undoubtably find ourselves in.

Since putting thought into my sleep, and consciously working to improve it, I’ve come to accept that going to bed early wasn’t necessarily a suitable goal for me. I work so many nights which has caused my sleeping pattern to be almost non-existent and I’ve realised that sometimes the best thing to do is to sleep whenever I get the chance, even if it’s not at a ‘socially acceptable’ hour. Keeping to a proper sleeping routine is best for most people, but with the nature of my job I’ve had to accept that this isn’t the case for me. For so long I was trying to do what I thought was best and what I had been told or read on the internet, without spending time actually thinking about my lifestyle and situational factors. When I did that over the Christmas period, I realised that actually, having a set bedtime just doesn’t work when I spend some months working 9 nights and the next only one.

I am also working to remove the taboo I have placed on having a lie in. Sleeping in late does not automatically write the day off, nor does it make me an unproductive slob, in fact, it gives me the energy to actually carry out my goals. Three times in the past seven days I have slept well past 10am (and on all of these occasions I have slept for 12 hours apiece) showing me just how much I needed the rest. And you know what? I have been productive on those days still. I’ve gone to the gym, had good workouts, carried out errands, visited friends and completed some writing.

On waking up and checking the time I sometimes still have an immediate feeling of panic on seeing that the morning is almost over, but each time that’s becoming less and less. 2019 is the year of sleep, and it’s becoming bloody glorious.

[musingsofanewbienurse]

Transitioning to Veganism

In January 2019 I decided to take part in veganuary with the intention of being fully vegan afterward (bar what was already in my cupboard and needed eating up). It wasn’t a sudden decision, in fact, it had been a gradual choice that I had been considering for months at this point. I had been vegetarian since July 2017 and had been gradually decreasing my intake of animal products so that by the end of 2018 my diet was 80-90% plant based already. I had been avoiding dairy for the most part anyway as it causes my skin to break out badly and cheese was an expensive luxury on a furgal university budget. The only thing that really let me down in that aspect was when I ate out or by not checking labels.

Like most people I had watched the world-famous Netflix document ‘What the Health’ in the spring of 2017 and that was probably one of the first major catalyst that lead to me analysing and changing my diet. I had grown up on a small, rural island off the mainland of England, one of its main agricultures being farming. Every-day I would see cows and sheep grazing in fields both outside my bedroom window and on the way to school, I saw these animals had a good quality of life (in a way that they do not always in larger areas of Britain and the US), and like many people, never really questioned the connection between that and my dinner plate.

I was also notoriously fussy, and although I liked most varieties of meat, the same could not be said of vegetables. In fact I hated every single one until I was 16 and then I could just about stomach carrots. A healthy diet I did not have, despite how much my parents tried to push otherwise. Going vegetarian was simply not a viable option for me back then; but on joining university I started to cook for myself and my taste matured, leading me to today, where I now love 99% of veg (broccoli is legitimately my favourite food) and it makes up the bulk of my diet.

It meant, that when I watched the documentary I was able to genuinely consider becoming vegetarian, and started to slowly phase meat out of my diet. Even then, I knew that ultimately I did want to become vegan, after seeing the impact the meat and dairy industry has on our health*, the environment and on the animals who are subjected to it. But I wanted to do it the right way and for the long-term. If I cut out everything at once I knew after a week or two I would revert back to my usual diet, my body craving things that had always been present. I also wanted to be educated about things I substituted meat for; I go to the gym regularly and I wanted to know that what I was eating would have a good variety of nutrients. And most importantly, I didn’t want my mental health to suffer.

Like most young women growing up in this century I have had issues with food and my body. Although I have never received any formal help or diagnosis I definitely had an unhealthy relationship with food, especially in my mid-teens, though even now some days are harder than others. For the most part I am a lot better, but I was wary that if I suddenly cut out a lot of different foods and placed a lot of restrictive rules on my diet that I would be taking a huge step backwards, that I would go back to obsessing over every little thing that I eat. I didn’t want to sacrifice my health and knew that if I was to do this safely, then gradually converting my diet was the only answer.

And that is what I did. First it was dairy milk, an easy swap as there are so many alternatives on the market. I mainly go for soya at home because it’s the cheapest and I really don’t need anything fancy in my bowl of porridge, but oat is by far my favourite and go-to when I’ve gone out for a coffee.

Eggs was one of the biggest changes. In my second year of uni I had eggs for breakfast nearly everyday that I wasn’t on placement, and I genuinely didn’t see myself as able to give them up. But in third year I found a love of porridge and overnight oats, or tofu scramble if I fancied something closer to what I usually had eaten. And eventually I was only having eggs when eating out, there is nothing nicer than an eggs benedict (and if anyone can link me to a good vegan recipe for it, I will love them forever).

Like I previously mentioned, cheese wasn’t a large part of my diet, because as a university student it just wasn’t worth budgeting for. I’ve never had a problem with any of the vegan alternatives I’ve tried, though this may be because I ate cheese so rarely that I couldn’t really directly compare the two.

Chocolate, the crux for many people, was a big one. “But how do you live without chocolate?” I’m normally asked by my horrified coworkers, and the answer is that I don’t. In fact, I probably have it in some form everyday, it just took a bit of getting used to looking for the vegan friendly alternatives in tescos. But there are plenty, and even some of the major brands are accidently vegan (looking at you bourbons).

Eventually it just left occasions where I was eating out (laziness would sometimes lead to me choosing the vegetarian option, and other times it was simply because that was what I wanted to eat), and items where I had not checked the label for hidden ingredients. Milk powder is in bloody everything, and if it’s not that, it’s normally eggs. Quorn in particular is well-known for this, though their vegan range is steadily growing.

By December 2018 I felt ready to take on Veganuary. I no longer felt like my diet, or lifestyle would be negatively impacted by it and I saw it as a great chance to draw a line under the sand. When speaking to my dad on the phone two weeks in he asked if I was struggling yet. And honestly? I hadn’t even noticed, as there had been so few occasions where I would have chosen the non-vegan option anyway. To me it just made sense that after January I continued to eat plant based, and now, at the end of February I haven’t regretted it once. I am a giant advocator of eating a vegan diet. I feel so much healthier than when I ate meat, am more active than ever and can’t remember the last time I fell ill. I do understand it’s not possible for everyone, people who have had or have eating disorders may definitely struggle, and placing a load of rules on what they can and can’t eat wouldn’t be beneficial to their mental health in the slightest (just as it wouldn’t have been for me once upon a time).

I also understand that if you’re not educated about nutrition and the aspects of a healthy diet, then becoming vegetarian/vegan doesn’t automatically mean you’ll be any healthier, especially with the wide range of plant based foods and meals now out in supermarkets (I’m not berating any of these releases in the slightest, it’s amazing to see so many options and makes it a lot more accessible than it once was, it just means navigating for a healthy option isn’t always the easiest thing). Being vegan is still a privilege, I only have to support myself on my wage and it leaves plenty of room to opt for the more expensive meat alternatives and keep my diet balanced. A single parent with two kids however doesn’t have this option, and places like Lidl and Aldi are brilliant for selling a large quantity of meat for a relatively low price.  

But reducing your meat and animal product intake is good for the planet, and I do think that every little thing, whether that be partaking in Meatless Monday or swapping dairy milk for soya helps. No-one has to be perfect or commit to the most severe of changes, especially if they feel it is what they should do because Instagram told them to, but making a substitution here and there helps massively.

*I am not saying that meat and dairy cannot make up a healthy diet, though like anything in large quantities it isn’t beneficial. There is also plenty of evidence against cows milk and how we digest it. In early 2019 the Eat-Lancet commission (linked below) was published, outlining global targets for the world population to achieve a healthy, nutritionally balanced diet whilst keeping food production sustainable. The diet consists mainly of fruit, vegetables, grains and legumes, with a small amount of meat and fish. It is fairly similar to the Mediterranean diet, and emphasises that you don’t need to cut all animal products out, but reducing them would be highly beneficial on a number of levels!

Walter, W., Rockstrom, J., Loken, B. et al (2019) Food in the Anthropocene: the EAT-Lancet Commission on Healthy Diets from Sustainable Food Products. The Lancet. [online] Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31788-4/fulltext#seccestitle10

[musingsofanewbienurse]

Ali

Ali arrived during my night shift at around 3am. She wasn’t my patient but I was passing by her bay as she was getting settled in. She was shouting at the nurse and HCA because there wasn’t a table at her bed (having just moved to a new ward we don’t have all the equipment and supplies just yet, patient tables included).

“Good luck with her,” I muttered to the nurse sardonically as she winced as another outraged shriek came from her newest patient.

The next night I was in said bay and Ali was still there. She had had a stroke just over a year ago and was almost completely paralysed but had been admitted due to an infection.

“Don’t worry she’s been discharged, you’ll just be waiting for an ambulance crew to take her home,” the day nurse told me during handover. “She’s been a nightmare all day. I don’t know how her husband puts up with her.”

At 11:00pm Ali was still there and there was no way of telling when the ambulance crew would arrive. Crews work through a list and there’s no estimated time of arrival given; if you’re lucky you get a 10 minute warning. I’ve had patients transferred at 3am, so it really can happen at anytime. I was very aware that she hadn’t been turned or had her skin checked since I had started my shift four hours earlier (though she had moved herself from one position to another in this time) so myself and the HCA I was working with went to her bedside, pillow in hand so we could reposition her.

I admit I didn’t have high hopes, one glance at her skin chart showed that Ali had been declining repositionings and skin checks all day, but I’m a glutton for verbal abuse so went for it.

Unsurprisingly, Ali wasn’t a fan of my suggestion that we place a pillow under one side, yelling that she had been bedbound for the past year and had never had any ‘bloody pillows’ put under her. My offer of giving her pain relief because she was in agony was shot down in seconds because she ‘doesn’t take any damn pills’, as was me offering to make her a drink as she didn’t drink water when she mentioned how thirsty she was.

By this point I could feel myself starting to lose my patience, and I was infinitely empathetic to the nurse who had had Ali for her whole shift. Nothing I said or tried to do was good enough for her, every response met with a scathing remark or curse. In situations like that I (and I’m sure many other nurses) have to restrain myself from shaking the patient and asking whether they know that the service they’re receiving is completely free, and more importantly, that the people they’re being horrid to are real life human beings, not emotionless machines.

In the same breath of telling me she didn’t want a ‘bloody drink’ Ali also said she hadn’t had anything to drink since 2pm when her stuff was packed up and she was told that an ambulance crew had been booked for her. In that instant, even though the selfish part of me, the part of me that had just had four new patients arrive that needed admitting on to the system and would much rather deal with them, knew that I couldn’t leave Ali.

I asked her whether there was anything she did want to drink, and again when she tried to shrug me off.

“I can only drink out of my cup, it’s been packed away. It has a straw as part of the lid. My juice is in my bag too.”

I told Ali I could get them out and ready for her.

“What about the ambulance crew?”

“They can wait till you’ve had something to drink, and more importantly, what if they don’t arrive for a few more hours?”

The pain in Ali's spine meant she needed to be sat completely upright, pillows supporting her so she didn’t fall back. After pouring her drink I made sure she was ready before I moved the bed, getting her to talk me through how to place the pillows and moving the table so it was in the right place for her to get her cup.

It doesn’t sound like much, in fact, it’s nothing really, but for Ali it must have been something.

“I split my drink four times today,” she told me as she reached for her cup, her hand unsteady, showing weakness for the first time since meeting her instead of lashing out. Her right hand was completely useless, and her left was also incredibly weak. I asked whether she wanted me to hold her cup to which she said no. I didn’t push it, instead placing my hands underneath her cup so that if she dropped it, I would catch it before it could soak her.

Whilst with her she told me about her sons, two boys in their twenties. The pride in her eyes as she spoke about her youngest, having just started at university to study IT and business, shone through.

“We’re not an academic family,” she told me. “But he’s always worked so hard.”

But then the heartwarming chat turned sombre.

Ali told me about her husband, how they had been together for 30 years. How since she had gotten ill, since her condition had gotten worse, he had changed.

She told me about how controlling he was. How he said horrible things to her on a daily basis now.

He wished they’d never met.

That she’d ruined his life.

She was being incontinent on purpose.

That he hoped she’d die whilst in hospital.

When I asked she declined that he’d ever done anything physical. A safeguarding referral was already in place, and the community social team were working on finding her alternative accommodation, but unfortunately, she had to return home.

Her story broke my heart, I could see how broken down she had become.

“I haven’t looked in a mirror for a year,” she told me, unable to look at the woman staring back at her. It all made sense, why she was so angry and scared with the world. She lashed out to protect herself; anyone else in her shoes would do the same.

When the ambulance crew did come (thankfully at half 11 rather than 3 in the morning) Ali took my hand and squeezed it as tightly as she could. It had been a half hour chat and an offer of a cheese sandwich and a drink but I could see just how much it had meant to her. And that, knowing that I had been able to make a difference, no matter how small, reminded me of exactly why I do this job.

Now this day nurse wasn’t uncaring, she wasn’t a bad person in the slightest, and I definitely am no better than her, but our workloads were incredibly different. She had had a bay and a half of patients to care for, that’s nine people. In the final hour of her shift she had discharged three. The night shift was (surprisingly) better staffed and I had a bay of six beds (safe staff levels state that it should be one nurse to every six patients), and only two of them were occupied when I arrived. My other patient had left by 9pm and the four ladies brought up at half 10 were all independent and weren’t poorly, which allowed me to focus on Ali in a way that others hadn’t been able to.

It gave me a chance to get to know her, the extra time allowed me to speak to her properly and ask how she wanted me to care for her, rather than use a one size fits all in terms of moving and handling techniques. I was able to listen to her when she spoke about her sons, I didn’t have to interrupt or rush her along to complete a million other jobs. And that showed Ali that I was there for her, it allowed her to trust me and open up about the darker parts of her life, something she wouldn’t have been able to talk about for god knows how long.

Not everyone has a story like Ali’s (fortunately), not every patient that passes through is needing someone to hold their hand but some do (more than we’d like to think), but more and more of these opportunities to bond with our patients are being lost. Nurses (and other healthcare staff) are being pushed to and beyond our limits. If I actually have six patients (rather than nine or sometimes more) it’s nothing short of a miracle (at time of writing this, this is my first shift in over a week where I have been assigned a singular bay). It makes it hard to actually get to know my patients, when I have such a mammoth list of tasks to complete in such a short space of time, and the first thing to go is the time spent at the patient’s bedside, getting to know them and seeing them as a human rather than a list of jobs.

I spent a lot of time thinking about Ali when she left, and the others who like Ali who I haven’t had time to get to know because I have a workload of two people. People don’t realise what it’s like, how pushed to the breaking point wards are becoming.

More and more pressure is being placed on the importance of person-centred care. Half the nursing competencies are centred on them, but in the real world, we aren’t able to carry them out; and with the way the nursing crisis is going, those moments are unfortunately, going to be far and few between.  

[musingsofanewbienurse]

Loneliness

It’s funny, but when you think of nurses you don’t think of them being as lonely people. The very essence of their job means that they have to be sociable and you’d naturally presume that this would seep into their personal lives.

And in a way it does, sit near a group of nurses and they’ll probably be the loudest in the room, all trying to outshine the other with gory patient stories; but it’s getting them together that’s the real achievement. We have unrelenting rotas, the majority of hospital ward nurses only have three to four shifts a week yes, but on our days off we’re normally completely exhausted by the intense nature of our shifts (which are all 12 and a half hours a piece), or we’re trying to fix our sleep schedule after a string of nights, increasing our current exhaustion.

Even if we do have the energy to get changed into proper clothes and socially interact, sod’s law means that the chances of anyone else being free is close to nil. This month, my housemate (a mental health nurse) and I have exactly one day where we’re both off and that’s only because she’s on annual leave (and also, in Vienna). It’s a miracle if we see each other for more than 10 minutes a day, so times where I successfully make plans with any of my other former coursemates (and then to actually keep to them) are few and far between.

Despite what I wrote above about nurses being the loudest in the room and often naturally incredibly sociable, I myself am quite introverted and have a fairly small social circle. This can lead to me feeling very isolated, especially at times like right now where I’m in a weird break between two long string of nights, so my body clock is far from normal. Due to said small social circle, I don’t really have the opportunities to meet new people with ease (especially as I’m now out of uni and spontaneous nights out/house parties are becoming increasingly rarer), and sometimes I can go days with seeing no-one but my co-workers, the barista at café nero and quick flashes of my housemate. I’m also single and finding that in this job, that meeting new people to date is almost impossible to do, especially if internet dating really isn’t your cup of tea.

I’m also still fairly new on my ward so don’t really count any of my co-workers as friends yet, despite being friendly with and actively liking most of them. I think there’s a number of contributing factors towards this: I’m working a lot of nights currently which are mostly made up of agency rather than the permanent ward staff so don’t actually get much time to spend with them, the majority of the nurses and HCAs on the ward are older with kids so are in very different parts of their lives to me, with different interest and priorities (they’d much rather spend their free time with their partners, children, or older friends than go for a coffee with me which is completely understandable) and I’m also on my ward as part of a 6 month rotation, so maybe subconsciously I’m holding myself back, as I know by April 1st I’ll be moving on to somewhere completely new, starting the whole process all over again.

I’m not sure where I’m really going with this post, I don’t feel like I have any advice for anyone experiencing the same as me (though maybe in a year’s time, when I’ve been qualified for longer and used to how unrelenting it can all be I will have), but maybe it’s to let anyone else reading this, who feels like this is them too, that actually, despite the feeling of loneliness, they are not alone. And booking in a coffee date with a friend six weeks in advance is sometimes the only way to do it.

[musingsofanewbienurse]

Enter Jon.

Patients can make or break your day. Even on the best day, when everything is running smoothly, you’re on top of your workload and you’ve been able to handover to the transfer team before the nurse in charge even has to ask; if you have a patient constantly demanding the world and more, or someone screaming abuse at you it’ll feel like the longest shift in the world.

Alternatively, if you’re caring for someone who appears to be genuinely grateful for what you’re doing, who sees you as an actual human being and not just a robot created to carry out their every whim, the shift becomes a lot more enjoyable, despite what other factors may be in play.

The latter is certainly the case in this instant.

It was a manic shift. I had an elderly patient with dementia who would yell out if you didn’t go over to talk to him and required regular turns with the help of three staff to make sure he wasn’t wet or developing any pressure sores.

The ambulance came to transfer two of my patients to another hospital with no warning from the nurse in charge that they were even leaving, meaning I had to sort their transfer out within the space of five minutes each.

The doctors didn’t tell me a patient was able to go home and stole his paperwork, so when the family arrived to pick him up they thought I had half a brain for not knowing this information.

Another patient had severe delirium and would shout at everyone to leave, try to steal the man with dementia’s food and was on the brink of becoming incredibly violent with each passing minute..

I hadn’t even been qualified for three weeks by this point and just come off super-nummary status. I also hadn’t (and still haven’t) had the newbie nurse break-down, but I was sure this shift was going to be the one to break me.

But then enter Jon. Jon was a 64 year old gentleman who had come in with chest pain. Cardio had reviewed him and said it wasn’t heart related, so he was being given regular analgesia and waiting for a CT scan. Jon was also one of the most lovely humans I have ever had the pleasure to meet.

When I went to administer his morphine he confided in me that he was terrified of needles, admitting that if he knew it was an injection (and not administered IV like his anti-sickness was) then he may not have asked for it. He laughed in disbelief when I told him I was very good at injections and that he wouldn’t feel a thing (not that he was wrong to, I had given two injections into the arm before this point so was very much embellishing). And then he told me he felt stupid for his fear, due to his sex and his age. I told him then about my friend from my course who was also a guy. Like Jon, he has a fear of needles so bad I had to go into the doctor’s room with him for his blood tests after just knowing him for two weeks. I told him that if another nurse could have the same fear, it obviously wasn’t as stupid as he thought, and even if it was, phobias aren’t always logical. I didn’t tell Jon that I had to sit on said friend just two days before whilst he drunkenly had his ear pierced with a stolen cannulation kit. Even after half a bottle of whiskey his fear was still very much real, he was shaking so much that I thought I would be catapulted through the ceiling.

“I barely felt it,” Jon exclaimed when I was done seconds later, his fists still screwed so tightly he’d have fingernail marks in his palms and eyes wide in relief. Apparently, my bullshitting was more genuine than I’d realised.

Later that day, when I was trying to shepherd the delirious patient away from the man with dementia, Jon stood by closely in case things turned ugly. He even distracted this man when he started getting aggravated, moving to be inches away from me and towering above (not that difficult when I was a good foot shorter and less than half his weight). I thanked Jon for his bravery but asked him not to step in the way again. ‘If he punches you, you’ll just be given more morphine injections and I won’t be so gentle next time’ I told him before excusing myself to settle my frazzled nerves.

When I was administering Jon’s anti-sickness IV later that day he talked about his grandson and how they had taken a trip to New Orleans. The love for this little boy was so clear to see as he told me about taking him to his first ever basketball match. In turn, I shared stories about my Grandad and how he had introduced me to my favourite book series, Harry Potter, and how all these years later it still means the world to me. It was a calm five minutes in a very manic hour of trying to catch up on paperwork but I wouldn’t have changed it for the world.

Just before I left to go home that evening Jon pulled me over to the side, passing over a small red book. It was about how the Nottingham Forest football club had formed that he had wrote eight years ago. ‘I know you won’t be very interested in it, but I just wanted to show you me appreciation for everything you’ve done today’ he told me, explaining how he had conducted his research in local libraries.

It’s probably one of the nicest presents I’ve ever received, even though, as Jon had correctly guessed, I had no interest in football whatsoever. Because it wasn’t the gift, it was the meaning behind the gesture and the kind words that Jon said. How he had seen what I had done and even more, the realisation that I had done well that day. I had alleviated Jon’s fears and made him feel less alone in a very lonely place.

I may not have had the newbie nurse cry that day, but there were definitely tears.