Embedded Files
Soon after I completed my five year contract with the Malaysian Government I handed in my resignation to the Perak Health Department. I could see there was so much one could do to make the health system better for nurses. However, if I was the only one who seemed to be rocking the boat in the system, I would be simply banging my head against a brick wall. There was a nursing union, but it was just too weak and had its teething problems. Nurses were fighting amongst one another for power and they appeared to be looking after their own jobs rather than for the general nursing population. I needed to pursue my dreams, but what dreams were these? I would go overseas even though I did not know what the future would hold. Hopefully a new environment would be better. I had to taste the fruit before I knew whether it was tasty or sweet. Anyway, leaving Malaysia to further my career overseas meant I got to travel and see another new country. I did not think that I was ready for marriage and have a family even though my boyfriend at the time would loved to have been married.
London was a cold, wet and dreary place. It was drab with the old dark grey buildings around. I expected to see tall huge buildings like there were in New York, but it was not to be, as London was a very old city. However, as I spent more time in London, I grew to like the place and its culture. There was the Tower of London, palaces to visit, the changing of the guard and a live show or two to watch. I admired the gothic architecture; it looked so majestic and full of character.
Before I went to England, I had all my necessary documents and permits to enter England to extend my nursing career. I was offered a nine month Cardiac Thoracic Course at St George Hospital, Hyde Park Corner, London. The location of the hospital was great. I often found great joy when I finished my shift to find myself on the streets of London sight-seeing or attending a show or listening to talks at Hyde Park Corner. I did not have much money but I could window shop and admire the beautiful expensive items in the window stores. There was always something to do after work if I was not studying. London was such a vibrant city.
I stayed at the Hospital nursing quarters at Earlscourt during my course. I took the Tube to Hyde Park from Earlscourt or walked to the hospital from Earlscourt through Kensington and Hyde Park. I often enjoyed the walks through the park. The gardens were very fascinating. Every week or so there were changes in the gardens with different types of flowers being planted. If I walked through Knightsbridge, I often walked into Harrods for some window shopping or browsed around the boutiques. So whichever walk I chose to take, there were always things to do and look forward to before I locked myself in my small room at the nursing quarters or at work.
Photo: At Trafalgar Square, London (1972, archive ref. A03/043)
Photo: At Kew Gardens (1972, archive ref. S23a/004)
Image: Cardiothoracic nursing certificate from St George's Hospital issued on 2 August 1972 (archive ref. P7/22a)
The course was very intensive and I learnt quite a bit which was not covered in my basic nursing course. I had to study cardiac physiology, care of cardiac monitors and pacing, pathology of the thorax, diagnostic techniques like cardiac catheterization, electrocardiography and cardiac operations. We were also taught how to care for cardiac patients with artificial ventilations, pacemakers, arrhythmias and all types of cardiac problems. The course was conducted under the guidance of a clinical teacher who held a Cardiothoracic Nursing Certificate. The ward sisters in the cardiac unit supplemented the clinical instruction in all areas. There was always one experienced staff-nurse on duty to assist student staff-nurses like myself doing the cardiac thoracic course. I must say frequently their intentions did not eventuate when they were short of staff. The students were expected to do shift work like all the others nurses. We were required to do night shifts as well as morning and afternoon shifts. Every six to eight weeks we were rostered to do night shifts which were difficult on us, especially when there were lectures to attend. All the same we had to bear it if we wished to pass or complete our course. Many a time there was no experienced staff on the monitoring unit. The nursing administration thought that the experienced staff at the cardiac ward could be called upon to assist the monitoring unit staff if there was a cardiac arrest. This was not often possible as the ward staff often had too much to do themselves. The nursing administration thought with four patients in the unit, a cardiac thoracic student would be able to run the unit, moreover the students were trained staff undergoing the course. I must say there were times that shifts were uneventful but there were many a time it was hectic when there were problems with unstable cardiac patients or admissions. One thing the nursing administration did not seem to understand was that if there was a cardiac arrest, resuscitation had to be instant and efficient to save the patient's life. The ward staff might be held up and help to resuscitate a patient might be too late in coming.
One good thing about working in the monitoring unit was that nobody was there to bother or boss us around, but if it was busy, there was panic as nobody was there to assist you. Apprehension, anxiety, stress and great pressure could make one clumsy and make mistakes. It was the life of the patients we were dealing with and we could not afford any mistakes. I remembered there was a patient who had what was diagnosed as malignant ventricular fibrillation. No sooner than he was reverted to sinus rhythm he would revert back to ventricular fibrillation. Finally, the doctors were so tired of reverting him that they implanted a pacemaker on him. The patient was very pleased that they paced him as he was sick of having black-outs and medical staff defibrillating him every fifteen minutes. I was glad too because then my other three patients would not be neglected. It must been very frightening for the remaining patients on the ward to witness the activities around the small unit and see what was happening to other patients and what the medical staff were doing to the patient. There were screens around the patients, but the noise around the unit must have been frightening for the other patients to hear. The hustle and bustle would have scared anybody who had a cardiac problem or even no problems. Thoughts could have crossed the patient's mind that it could also happen to them or they may have wondered what the nursing staff and doctors were doing to the neighbouring patient and if the same could happen to them too. The anxieties they experienced might have evoked a cardiac arrest or increased their stress level too. It was just not the place to rest when one had a cardiac problem.
The many shifts I was rostered to the unit were not without excitement; there was frequently either a cardiac arrest or patients developing cardiac problems or complications which arose from their existing cardiac conditions. I remembered a patient who was admitted with a cardiac arrest to the monitoring unit. She was unconscious on admission. I assisted with the doctors in reviving her. After reverting her to sinus rhythm she was attached to a monitor. I took observations every fifteen minutes till her observations were satisfactory. There were three other patients to look after too with hourly observations. I was kept busy all the time. I had to assist patients with meals besides giving each one of them a bed bath. By the end of the day I was often exhausted. The unit seemed to be understaffed and overworked. Not to mention too, the nurses were very poorly paid. I remembered I had to eat cheese on toast for my dinners which was the cheapest thing to survive with during my stay in London.
Somehow we often got rewarded with grateful patients. I remember a cardiac patient who gave me some large beautiful Mayfair chocolates and apologised to me for misunderstanding me. She confessed that when she regained her consciousness, she was shocked to see me running around looking after her and the other patients. She thought to herself, "A Chinese nurse looking after me after my heart attack? Will she have the knowledge to attend to me?" She was scared that I did not have adequate knowledge to attend to her but was pleased when she was well that she had misjudged me and felt guilty about it. The chocolates were such a treat as I would not be able to afford such a beautiful box of chocolates and it did make me feel good that my work was appreciated.
Besides the monitoring unit, we were required to work in the intensive care unit and the cardiac pacing ward. There was lots to learn whichever ward or unit we were posted to as specialty nursing was a post-registering course. I liked working in the cardiac pacing ward as it was a less stressful ward. There were three other nurses working in the ward besides the charge-nursing sister. The responsibilities for us students were not as great. We knew there was always a trained nurse to attend and assist with any crises or emergencies. Besides having the ward at her fingertips, I remember the trained nurse saving patients' meals for her nurses on duty. She often served just enough for the patients and left the remaining food for her staff. The trained nurse hated waste and knew the nurses were not earning much and instead of wasting the patients' food she gave it to the nurses. I often enjoyed working in the cardiac pacing ward. Besides the free food we got, we could watch the changing of the guards at the staff-room windows during our morning tea break. Every morning at ten o'clock the elegantly dressed guards in red rode their horses past the hospital to Buckingham Palace. It was a real treat to work at the cardiac pacing ward.
Top: Lai Fun outside St Georges Hospital with Buckingham Palace Guards in background (1972, archive ref. S09/006). Bottom: With other nurses at St Georges Hospital (September 1972, archive ref. S23a/006)
The intensive care ward was a four bed unit. Each trained staff and student had a patient each to look after. The trained staff was responsible for the nursing student. She oversaw and supervised the students. If there had been a complicated open heart operation, there would be two nurses looking after that one patient. Five-minutely observations were taken at the most acute period when the patient was still hypothermic until the patient observations were stable and the patient's temperature improved. The patient was suctioned every half hour or fifteen minutes to maintain a clear airway. The patients came straight from the operation room to the intensive care ward, generally still being ventilated and unconscious with various drainage tubes and intravenous lines inserted into their body. There was always a doctor or doctors accompanying the patient to the intensive care ward besides two or three operation theatre nurses.
They would assist the intensive care nurse to attach the patient to different kinds of monitors once in the intensive care ward. After seeing the patient settled into the unit a hand over of the patient would be given to the unit staff by the operating theatre staff. After the hand-over of the patient it was then the responsibility of the unit staff to look after the patient. Initially it could be overwhelming to look after the patient as there were numerous tubes and intravenous drips and monitors to attend to, but as the patient's condition improved, one by one the gadgets would be removed. There was always a resident doctor close at hand to make sure all was well with the patient. I found working in the unit most rewarding as one was close to the patient and was able to see the patient improving daily till the patient left the unit to the ward for rehabilitation. Members of the patients' family were also often very grateful to the nursing staff. To show their appreciation, the family sometimes would bring the nurses boxes of chocolates or baskets of fruits.
One thing I did not like was having to work a weeknight shift after five to six weeks. It was difficult to adjust my circadian rhythm. All the same I was glad that we only had three months in each ward and time did fly very quickly. During my night shifts, I remembered working with a particular permanent staff at the unit who loved to tell stories which supposedly had happened in the unit and hospital. She believed that there was a past patient who had died at the hospital that still frequently visited the hospital as a ghost. The nurse claimed that the ghost gave bed-pans to patients and wandered around the hospital. It was quite scary if one believed in devils or evil spirits and of course during the night when the place was quiet, one could hear funny odd sounds. I remembered working with this particular staff nurse who told me such stories and had me frightened as I felt strongly I could hear strange noises around the place and in my mind the echoed of stories I heard during my younger days in Malaysia. I remembered in Malaysia we were often threatened with ghostly stories when we were naughty, or not allowed to do certain things like not to enter a dark environment as there could be devils lurking in the dark. We were told not to go swimming in the waters as there might be water devils and incidences of such happenings related to us to make us scared. So the strange sounds like a little crackle around the ward or unit could be frightening especially when one was alone in the unit or ward at night. I must admit, I learnt a lot at the unit and the knowledge gained at the unit gave me great confidence in my nursing career.
Photo: Lai Fun with school friend in Wales (June 1972, archive ref. S23a/001)
At the end of our nine month Cardio Thoracic Course, we had to submit a case study and that helped determine whether the nursing student passed or failed, along with other papers and tests. Just towards the end of my Cardio Thoracic Course, I met one of my former school mates from Malaysia who was also a staff nurse at one of the London country hospitals. She visited me in London whenever she had a few days off and I often put her up in my small room. We shifted a mattress onto the floor and shared one mattress each. She informed me that there was a team of Directors of Nursing from America recruiting nurses over to America. She talked me into applying for some experience in America and that it would be good to go together. I thought to myself why not, since the American hospitals paid better. Here I was in London working hard, and in order to save for a holiday I worked during my two days off with a Nursing Agency. Moreover, I had to send home money to assist my parents to run the household in Malaysia. In Malaysia there was no social welfare for the elderly. I worked hard to survive in London and still enjoy a trip or two during my holidays around England or Europe. When thinking about working in America, the chance for me to travel around America was appealing.
I applied for a position with my friend and was selected for an interview with the recruiting agency and the Director of Nursing at Beth Medical Centre, Newark, New Jersey. At the interview I was told by the Director of Nursing that she would offer me a job at the hospital but I was required to do at least three months of Psychiatric Nursing before my qualifications were recognised in America. She also advised me to make up my qualifications in London as it would be expensive to do it in America. She would help to sponsor me to her hospital for a year contract and I should contact her when I was ready to work in America. Going to America for some work sounded exciting to me. When planning my Psychiatric Nursing I thought about changing from the city to the countryside. I applied to a country hospital at Welyn Garden City, Hertfordshire which offered three months Post Psychiatric nursing. I was accepted into their program. A change of environment would give me a bigger picture of life in England and I wanted experience at a country hospital.
Queen Elizabeth II Hospital. Howlands, Welwyn Garden City, Hertfordshire was located in a beautiful part of the country. Behind the hospital were bushes and tracks for horse riding. I remember accompanying patients for some blackberry picking. Cooking was one of the occupational activities offered to rehabilitating patients besides painting, craft work, outings, etc. A short walk over the road was a nice little pub which staff frequented for their many socials. I remember admiring the scenery around the compound with its majestic trees and gardens. The grounds of the hospital were very well maintained for outdoor activities for patients. The change of colour during autumn was just beautiful with red, orange, yellow and brown on their tree branches. The Psychiatric Wing was an extension to the General Hospital. The nursing quarters were just outside the compound of the hospital, so it was within walking distance for work. A privilege of being a nurse was that accommodation was taken care of wherever we went. There were no night shifts for students in this course which was good.
The three month course was conducted by a qualified psychiatric nurse with a Diploma of Education. The ward staff complemented the teaching in the clinical area. We were required to learn the Mental Health Act, the aetiology of psychiatric language and terms, psychiatric illnesses, care of patients with different psychiatric illnesses and treatments like electroplexy (ECT), continuous narcosis, etc. In the clinical area, we were required to do morning and evening shifts with trained staff. We observed counselling sessions with patients and families and participated with rehabilitation activities like cooking classes and craft work. I liked the cooking classes the most. We bought our ingredients if required or picked blackberries for blackberry pie at the back of the hospital. After the cooking sessions, we got to sample the cooking and learnt about Western cooking and preparation.
Image: United States H-1 visa sponsored by Newark Beth Israel Medical Center (10 March 1972, archive ref. P1/MY/17)
I found that Psychiatric nursing was not my cup of tea. I found it too testing and I did not have the patience or perseverance for the job. I felt I had my own problems too; how could I help the patients when I had my own? My shoulder was not big enough to handle my own problems as well as somebody else. I did not have the patience to be insulted or shouted at by the mental patients without reason. When I saw patients coming in and out of the hospital, I often wondered whether there was any cure for their conditions. It appears the patients were treated by trial and error. If the patient was not responding to one drug, they were than given another drug. Often I found patients were too drugged and walked like zombies staring emptily at space. Most young patients were admitted and diagnosed as having personality disorders. I had a chat with a couple who were admitted together. They told me that they were better off staying at a hospital and not working than living out in a flat and working. They got welfare money and could save the money without paying a single tax. They could go in and out of the hospital like a hotel with all meals provided and a clean bed. They thought they were having it good. I wondered how they could abuse the system. They looked fit, young and intelligent to me, why were they not working? In Malaysia, parents would punish their children for disobeying them or being stubborn.
If this was psychiatric nursing, working as a psychiatric nurse long-term would frustrate me. Soon after I completed my three months of psychiatric nursing, I applied to go to America. I did not bother to retain my Permanent Residency in England. While in England I enjoyed the sight-seeing and visiting new places that I had learnt about in school when I studied Geography, but I did not enjoy working as a nurse with so little pay to survive on. When I was accepted to work in America, I realised that nursing was not just a job to earn me money to survive, but a profession which could bring me to many places around the world due to the shortage of nurses.
Images: Registration certificate issued by the General Nursing Council for England and Wales (26 September 1969, archive ref. P7/18), nurse's pin accompanying registration (archive refs. Z25/05a-b)
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