The Loop of Henlé

Making the first forays into clinical areas for visits, and feeling the strangeness of it all.

            Once settled into Nursing School, between days of lectures we made occasional forays into the hospital.  Pre-arranged small groups, always accompanied by a Clinical Teacher, we visited ‘The Wards’.  A gentle introduction into an alien environment.  The wards were Nightingale style – long, wide spaces, high ceilings, invariably painted cream, lofty windows on either side.  Iron bedsteads ranged down each side (no adjustable beds then, just a winding handle to raise the foot, and a sloping thing that pulled out behind the patient to lean the pillows against). On the first ward we visited there was a faint smell of something sharp.  Pee? Or should I say ‘urine’ now?  Our excited chatter stopped abruptly as we stood just inside the entrance, transfixed by the scene in front of us. Patients, all men, either in bed or sitting in chairs beside the bed, pyjama and dressing gown-clad. Some beds had curtains drawn round them (what’s happening behind there?).  A Nursing student – a third year, identifiable by the three navy stripes on her cap –  walking a man to the bathroom, another filling in a fluid chart at the end of a bed. A Staff Nurse – white uniform, long-tailed linen cap - emerged from the drawn curtains and greeted the Clinical Teacher: “Hello, I’ll tell Sister you’re here.”     

A substantial woman in a bottle green uniform approached us with an even longer long-tailed cap. We had already been told this was a urology ward and had been taught common conditions and care of patients with said conditions, and the anatomy and physiology of the urinary system. I silently chanted “kidneys, ureters, bladder, urethra, glomerulus, Loop of Henlé…” just in case she surprised us with a question. We were allowed into the ward and suddenly, all eyes were on us.  The men smiled at us encouragingly.  We were supposed to move away from the group and chat to patients who were willing. I suppose it was about learning to put people at ease - them and us. I chose a smiley, elderly man sitting in a chair.

“New, are you?” he said, “They told us some new students would be coming in. Don’t be nervous, you’ll soon get used to it.”

I smiled gratefully and crouched beside his chair to ask how long he had been on the ward.

“Yesterday. Couldn’t pee. Terrible. I’ve got this now...” he pulled aside his dressing gown to show a tube going into a bag at the side of his chair, half-full of straw-coloured fluid.  “It was a relief, I can tell you. I’ve got to have an operation, on my prostate.”

He was easy to talk to. We chattered away happily about his wife visiting and how he missed his grandchildren until I was called to join the others. As I left him I said that I was sure he would be sorted out soon.  He grinned at me and said “Thank you, Nurse”.  Nurse!  A real patient called me Nurse!  My beaming face could have lit the front at Blackpool.

We moved en-masse into a Treatment Room where a Nurse was testing urine. Test tubes lined up on a worktop, dip-sticks at the ready.  There were racks with packs of sterile catheters, dressing packs, gauze pads, big brown bottles of lotions and antiseptics. Everything very tidy. After a quick demonstration of dipping test strips into urine we trooped on into the sluice room. Ceramic sinks with huge taps, galvanised work surfaces. Two huge chrome and green enamel bedpan washers hissed threateningly and leaked tendrils of steam. This was not a quiet place. There were big plastic containers on the floor, labelled with names.  They were for 24-hour urine saves.  There was a wheeled crate like an oversized shopping trolley with thick glass urine bottles in it, clean from the washer and waiting for the next ‘bottle round’ where full ones would be exchanged for an empty one.  A bedpan trolley was parked against the wall, stainless steel bedpans gleaming. A Nursing student bustled in with a pan and opened the washer, steam curled out and a puff of warm air, the bedpan went in, she slammed the door and pushed the start button. There was a whoosh of pressurised water entering as the cleaning cycle began.  I knew her, she lived on my floor in the Nurses Home.  She flashed a quick smile before bustling out again.  As we left the ward ‘my’ patient grinned again and waved, giving me a thumbs up.  I was thrilled. That hadn’t been too bad at all. And nobody had asked me about the Loop of Henlé.

These short visits to the wards were about acclimatisation.  Getting us used to unfamiliar surroundings, the sights of unwell people, the bustle and busy-ness of clinical areas before we moved out of the Nursing School environment and onto our first placements.  It was a kind of ‘warming-up’.  I’m not sure they helped that much. We weren’t there long enough to get a real sense of working and we didn’t actually do very much. I wanted the safety of the classroom, to learn as much as possible before I was expected to actually do something.  Others felt differently, they were desperate to start on the wards, to be part of the ‘doing’.  I was anxious about those patients seeing me and thinking I could help them, when the chances were, I couldn’t.  The conflict again between what I was and what I could be, or between what I was and what others thought I was.  Instead of being pleased, as I would now be, of being aware of my limitations and therefore conscious of the safety of others, I thought everyone must be learning more than me, must be more capable – why else would they be so keen and confident to get stuck in?  The notion of unconscious and conscious incompetence wasn’t taught to us then, but on reflection, that divide was clear in our group.  I put my nervousness down to lack of confidence and failure to learn, rather than insight into the implications of my very reasonable limitations.  Judging myself harshly, as usual, and having to wait another twenty years or so to give meaning to my early nervousness.