Every year, May 12 is celebrated as International Nurses Day. Nurses have always been the backbone of the healthcare sector. Their contribution to patient treatment outcome often goes unacknowledged as in the pandemic. Their services and placement in critical treatment areas are subject to flexible criteria and dynamics of prevalent situations.
Nurses have helped and guided me immensely leading up to becoming a neurosurgeon. I had taken a couple of entrance examinations for neurosurgical training in 2001 after graduating as a general surgeon. The results invariably waitlisted me.
Having qualified from a small town, I was initially overwhelmed by the weight of clinical exposure of the competition of big-town applicants. An institute in Thiruvananthapuram, where I had applied for neurosurgery residency, required a clinical examination as part of the entrance examination. Having completed the general surgery course in my hometown Mangalore a few months earlier, I had no medical school affiliation. I was without credentials to enter a hospital and examine a neurological case to prepare for the test. The last time I had examined a neurological case was four years ago, during the MBBS course. I went to the neurology section of the medical ward of the medical college hospital and put forth my case to the senior sister in-charge. She understood my situation and asked me to come with an apron and expired ID card to the ward after the resident doctors had left for the day. For over a month and after sundown, I read case files, treatment charts and examined patients with stroke, spine trauma and other brain and spine illnesses. Two months later, I could confidently present a case of pituitary tumour assigned to me in the clinical round of the entrance test and went on to secure admission.
My first independent opening of the skull was guided by a senior neurosurgery theatre nurse from Kerala. She taught me precisely to go slow on the bone drill which ground to the inner side of the skull, while performing surgeries as a neurosurgery trainee. Years of surgical assistance had perfected her skill in identifying the depth of the hand-operated drill from changes in the grinding sound, as the drill bored to deeper layers of skull bone.
During a neurosurgical fellowship training in 2014 in New York City, I was paged to examine a patient who had returned from West Africa with a fever, convulsions and brain bleed. There was a suspicion of Ebola infection in this patient (later reported to be negative). The city was on alert with a recent scare of transmission in the subway transport system. I had never seen or worn personal protective equipment (PPE) before. “We’ve got to get you out safely,” said the infection control nurse at the hospital after learning my predicament. She gave me 15 minutes to go through the safety manual which had a section on donning and removing the PPE. When she returned and noticing that I was unprepared, she shook her head in disbelief and secured me into the medical spacesuit.
After examining the patient, I made my way to the PPE removal area. She was sure that I was unprepared and was waiting for me in the room, having worn the PPE herself. She shouted out the next step with a heavy accent from the Bronx, as I went about removing the gown. “You’ve got to be more resourceful; if there’s a next time,” she replied as I thanked her outside the isolation room.
I read the manual again the same evening, memorising each step, but the turn to treat the patient never came. Years later, I was able to use this knowledge to train fellow doctors and nurses assigned to work at a COVID-designated hospital in Bengaluru during the first and second wave of the pandemic. Many of the healthcare workers were as unprepared as I was back then. The nurse’s training came in handy during the emerging pandemic situation and kept us safe at work.
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