Reflections

I retired from nursing in November, 2005, having worked at the Royal Children’s Hospital, Brisbane for 35 years. During this time I was in Charge of a 35 bed ward which housed neurosurgical, orthopaedics and ophthalmology patients. The title “Charge Nurse”, changed to “Nurse Practice Co-ordinator”, and then to “Nurse Unit Manager”. My prime interest was orthopaedics, my knowledge of neurosurgery was very limited, I felt very inadequate. The Neurosurgeons were wonderful people to work with, they took me and taught me, never once did they put me down. The more I learned the more I wanted to know. Royal Brisbane Hospital had a unique neurosurgical unit; a specialist neurosurgical theatre was attached to a specialist neurosurgical intensive care. All paediatric neurosurgery was undertaken in this unit. Patti Cay was in Charge of the theatre, she was a wealth of knowledge, what the doctors didn’t teach me Patti did. After approximately 14 years the number of beds in the ward was reduced to 24. Seat belt legislation had significantly reduced the number of children admitted with head injuries and multiple trauma. Rubella immunisation had reduced the number of ophthalmic patients admitted with cataracts. I first learned of the Australasian Neurosurgical Association in 1977, when the Matron of Royal Brisbane Hospital asked Patti Cay to prepare for a meeting as members from ANNA were going to hold their annual meeting at the hospital, after having attended the Neurosurgical Scientific Meeting. It was at this meeting I was asked to form a state branch and accept the role of State Delegate. Neurosurgeons from Royal Brisbane Hospital and Princess Alexandra Hospitals were invited to speak at our meetings which were held approximately twice a year. In 1984, I was asked to accept the role as President of ANNA. The members who formed the executive were, Patti Cay, Secretary, Wendy Clarke, Vice President and Elizabeth Davies, Treasurer. We joined the neurosurgeons each year at their annual scientific meeting and set aside an afternoon to hold our annual general meeting, one nursing paper was presented at this meeting. The meetings were usually held in a nurses“ lecture room, attached to a hospital… During my time as President the American Nurses invited me to their meeting in Honolulu, what better venue for a meeting. In 1984 we handed the executive over to Jenny Blundell and Gaye Reeves in Western Australia. I continued as State Delegate until 1999 when Tim O“Malley accepted the position. Neurosurgical scientific meetings and ANNA meetings provided wonderful learning experiences. Neurosurgical nursing has evolved over my 35 year career. The diagnostic tools of CAT scans and MRI scans have made a huge difference in the treatment of neurosurgical patients. The development of neuroradiology has also improved diagnosis for neurosurgical patients. Prior to CAT scans, invasive procedures were used to make a diagnosis. Hydrocephalus was diagnosed by air ventriculogram, a needle was introduced into the ventricles and air injected which acted as a contrast. The needle was inserted through the fontanelle of babies, while older children required a burr hole. The children complained of bubbles in their head for some days

Lesions of the spinal cord were diagnosed by myelogram with a contrast dye.The Glasgow Coma Scale has made a huge difference to nursing observation and early diagnosis of patients with neurological deficit. Prior to the introduction of the Glasgow Coma Scale, the Children“s Hospital used a chart which had date, time, level of consciousness, TPR and pupil size and reaction. One tired night nurse wrote, under level of consciousness, “Orientated in time and space!” Everyone has a different perception of size when drawing, which made it hard to determine how large the pupils were. One of the many interesting patients I nursed, I will call Jane. Jane was approximately 9 years old, she was a pedestrian who was hit by a car; Jane’s mother was a single parent and a Registered Nurse. Jane was unconscious when admitted and remained so until discharged. She was dystonic and/or opisthotonos, to the extreme that there were occasions when she arched herself over the bed rail and fell out of bed. There were no CAT scans and the Glasgow Coma Scale had not been introduced. Did she have a brainstem injury or a severe axonal injury, what was her diagnosis? There were no Rehabilitation facilities in Queensland for head injured children, so the mother took her home after approximately 6 months. The mother said to me, “Sister Savill it is easier to look a dead bones than to look at this” Jane’s condition had shown very little improvement since her admission; she was still dystonic and responded only to painful stimuli. The mother enlisted the help of the Damon Delacato technique, which involved repetitive patterning of the limbs. The technique was not approved medically, what more could the mother do; there was no other help available. Approximately 6 months later the mother returned to visit the ward with Jane. Jane had a normal gait, she said, “Hello Mr. Butler, Hello Sister Savill and Hello Sister Tan”. While hospitalised she did not make any response when we talked to her, I asked her mother did she tell her who she was coming to see. Her mother“s reply was, “No, she remembers you from when you talked to her as a patient”. Last I heard of Jane she had grown up and had a university degree. I feel privileged to have been a member of ANNA, to have witnessed the association’s development and to have been given the status as “Life Member”.

Kind regards,

Lenore Savill