I started nursing longer ago than some of you have been alive. I started training as a nurse in 1958, and have worked in the field of alcohol and other drugs treatment since 1986. I officially “retired” December 2009. It has been almost 10 years since I worked face-to-face with our incredible clients full-time.
Since retiring from full-time work, I’ve remained in touch with alcohol and other drugs (AOD) and nursing in a number of roles: providing clinical supervision to detox workers, teaching Dual Diagnosis students about working in addiction treatment, and AOD & Gambling telephone counselling with Directline, along with working occasional stints at the Turning Point Clinic. Finally, (so far), I have moved into the Nurse & Midwife Support program as a counsellor.
At the beginning of my career, I didn’t know that I would devote so many years to alcohol and drug addiction treatment, but after all these years, I am still glad that is the path I walked down. My life as a nurse has been challenging, constantly-changing, and wonderful.
My father was posted to Malaya (now Malaysia) in my early teens. The family all went with him and we were attached to the REME regiment in Port Dickson. I was just starting high school, so had to go to Singapore to the Brit Army Grammar School. I completed my schooling there, boarding in the hostel in Katong that was provided for the children of Army officers.
When I came to the end of my schooling, I had to decide what to do. Back then, most women only had the stereotypical options of teaching, nursing, hairdressing, ‘shopgirl’ or secretarial work available if they didn’t have the money or a scholarship to go to a university.
I didn’t have either, so it was back to the cold UK in December 1957 to find some way of surviving. I chose nursing because I wanted to go to uni, but that option wasn’t available to me. I figured that nursing would give me a tertiary education. It would also provide board and lodging, clothing (in the shape of uniforms), a small salary, and a chance to live in London.
In 1958, I entered the Pre-Training School of the London Hospital, to begin a career in nursing. The Pre-Training School was located in Bow, of Bow Bells fame, as in the nursery rhyme ‘Oranges and Lemons’. The main campus of the London is in Whitechapel. Whitechapel is East 1, the heart of the East End of London. Cockney territory. At that time, it was also the Jewish quarter of London, which was wonderfully educative. There are too many memories about this time to include here (but I wish I could).
I was there for three months to learn the basics of my new trade. In fact, I was becoming an apprentice, but I didn’t think of it that way at the time. After three months, we moved into the Nurses Home of the London..
We were in sight of St. Paul’s Cathedral in the West, about two tube stops from Tower Bridge, and a short walk eastwards to one of the largest and busiest docks in the world. The cockneys were wonderfully kind, rough and colourful. I loved it all.
We did a lot of walking, even as far as to the West End, because the monthly wage was £9 (equivalent to £207 today) and I had to buy social clothing, necessities, extra food and drink and public transport out of that.
It was the start of the 60’s era: rock n’ roll was coming, miniskirts were new, stiletto heels were gorgeous, and the groups, bands, and jazz musicians were in all the coffee houses, jazz cellars, and night clubs... not to mention the free tickets to the theatres and ballet, Albert Hall Proms, museums, galleries, etc. It was a rich cultural environment.
Off duty, we had the world at our feet. We were the Nescafé Generation (that was new too) and the hems of our miniskirts rose in direct contrast to the length of our uniforms. We were invited out by medical students and ships officers, met policemen and patients. We were protected and respected by the local East End community. We had fun.
On duty, we were the lowest of the low: a student nurse. We were lower than the cleaners, the medical students, and the patients. We cleaned bedpans and polished the brass plumbing to a high shine. We washed ward cutlery and counted it before putting it away. If one teaspoon was missing, we could not go to lunch or off duty until it was found, polished and restored to its place in the ward kitchen.
We damp-dusted everything: beds, curtain rails, lockers, floors, light fittings, chairs, desks every day. I suppose the cleaners did the corridors and the ward floors, etc., but we student nurses did the rest. Sister would make you do it all again if she found a speck of dust.
Simultaneously, in wards of 30 patients, we had to do bed baths, dressings, medications and make beds for all of them, all in time for meals, ward rounds and surgical or medical procedures.
Just the usual stuff! Working in pairs, we learned to make a bed perfectly. 15 beds in 15 minutes, with or without the patient in it.
However, despite the gruelling hard work and some sadistic ward sisters, there were wonderful patients, incredible teaching, and great comradeship, both on and off duty. We had hilarious debriefing sessions over breakfast after nightshift or in the bedrooms in the evenings.
The hospital’s mission was to minister to the disadvantaged, derelict, and addicted. The experience gave me a sense of social justice I still retain.
In this environment, I met my first known alcoholics. They were often homeless, living in the still unrepaired bomb sites from WWII, on the streets, or in Rowton House or Booth House, the men’s hostels nearby. The hostels were equivalent to Ozanam House, or Salvation Army Flagstaff Hostel in Melbourne.
At that time Whitechapel seemed to be the Mecca for alcoholics, ‘winos’ and down and outs. They were everywhere, with their bottles of cider and VP Wine or worse still, methylated spirits. Many had to sleep rough in the parks or in shop doorways. Others, who could manage to look and act sober (or indeed were genuinely sober) and had the small cost of admission, could get a bed for the night in Fieldgate Street at Tower House. Another place for them was Booth House, the Salvation Army hostel, was along Whitechapel Road. It offered the same service, but was far stricter than Tower House about who got beds. They were known as "doss houses" back then.
Tower House was one of the famous Rowton Houses opened all over London by Lord Rowton in the late 1800s. This philanthropist was also a member of the Guinness Trust. He put massive amounts of cash into the project. It closed permanently many years ago and stood derelict until property developers converted it into luxury apartments for the wealthy in 2006. Booth House is still doing the job it was intended for today (2018).
I was there in the 1960s, but it was the same then. Some of the men who were living rough became my patients.
The London had famous neurosurgery and neurology departments. I remember the large numbers of patients admitted for investigation of what was called Pre-Senile Dementia. We did Air Encephalograms which would show great lakes of air inside the skulls, around the atrophied brains of 30─40-year-olds. I didn’t realise at the time that in most cases I was looking at alcohol-related atrophy. There was no treatment, simply diagnosis and consignment to family, aged care, a hostel or mental health ward. Alcohol was never even mentioned!
I remember treating people who were derelict, homeless and alcoholic, who had lice and scabies, chest infections, ulcerated legs from untreated varicosities. One man wrapped himself up in multiple layers of newspaper to keep out the cold. He was noisy and agitated as we restrained him and unwrapped and bathed him. Now, with the benefit of modern understanding and years of experience, I realise he was probably also withdrawing.
There was no Benzodiazapines then. We used barbiturates. When patients were agitated and violent we knocked them out with paraldehyde - a powerful sedative hypnotic hydroquinone. Thirty seconds after injection, the patient would drop.
We used it whenever necessary. It had an acrid smell that lingered in the ward for hours afterwards.
I remember alcoholic patients with acute psoriasis, absolutely raw. They attended outpatients two or three times a week to have pastes and dressings re-applied. No steroids then, but there was ultraviolet therapy. The London was famous for it. It’s still recommended for the treatment of acute psoriasis. Often they were alcohol-affected but very grateful for the respect and help, and usually no trouble to us.
There were many foreign sailors with varying degrees severity of Hansen’s disease (leprosy), other tropical diseases and TB. Diseases that, thankfully, you almost never see now.
We even had a TB hospital in the country in Brentwood, Essex. I spent some time working there during my second year. Because TB was gradually being brought under control with antibiotics, half the hospital was now being used for neuro patients, and a lot of major surgery was done there. That was a wonderful break from the city streets and grime. I came to know the Essex countryside a bit and learned to love the changing seasons of Britain.
I embraced the words on the Royal London Hospital crest: Humani nihil a me alienum puto —Nothing human is foreign or strange to me. I gained a lifelong interest in brains and pathology.
My nursing career took me all over the country. After completing my third year at The London, I wanted to move on, so I did my graduate year in Taunton Hospital, Somerset. I worked on the wards, did a lot of night shifts, fell in love with Somerset, learned about cider and the local sherry business (!) and decided to specialise in neuro nursing.
I had already applied and been accepted to the Kent and Canterbury Hospital to do a Theatre Certificate Course, so the next year I did that, moving to the Kent Coast where my family lived. It was the first time I’d lived near my family since leaving Malaya. I enjoyed the course, but after a year I moved to Oxford to specialise in neurosurgical nursing while working as a staff nurse on the neuro ward of The Radcliffe Infirmary.
The Radcliffe was another great hospital with a famous neurosurgeon in residence. Patients came from all over England and the rest of Europe. We frequently had patients from Egypt & the Middle East, as well as local referrals. I was the ANUM, responsible for arranging patient’s transport from London Airport to Oxford and back, and for nursing care while on the ward.
I learned so much about coordination and management alongside neurological pathology and treatment, medical imaging and surgical techniques. That experience has stood me in good stead for the rest of my life — and I had a wonderful time, sharing a house with six other nurses.
I would have stayed indefinitely, but I wanted to do further education in my field, so I moved to The Midland Centre for Neurology and Neurosurgery in Birmingham where I did a post- grad course in neuro.
I learned about brain function, and the chemical, electrical and neurotransmitter functions at the cellular level. While I was in Birmingham I saw surgeons use diazepam for the first time to treat status epilepticus in a child, with results that were stunning at the time. It was seen as the answer to many treatment prayers. It was the start of the huge prescribing surge that led to so much over-prescription, and in the end to whole populations with dependence.
The natural progression was to use diazepam for alcohol withdrawal. Until then we’d been using barbiturates and anticonvulsants. Diazepam worked with great effect, and much greater safety — so it became the gold standard. It still is.
In 1967, I emigrated to Australia and started working in St.Vincent’s Hospital neuro ward. The hospital reminded me of The London, with its underground tunnels linking the buildings, its philosophy and work specialisations. At that time, St Vincent’s Fitzroy location was like the Australian equivalent of London’s East End. Not surprisingly, there was an emphasis on care for the disadvantaged, the addicted, and the destitute. I felt right at home.
One of the first things that I noticed in Australia was the drunken behaviour at parties. The way men and women separated into groups and the men drank themselves unconscious. The sheer volume of consumption was staggering. I had seen similar behaviour among the undergrads in London and in Oxford. Nurse’s parties were notorious for somewhat disinhibited behaviour everywhere and I was not shy, but I have to say that it seemed more extreme here. Thankfully, the young Australians of today drink much less than previous generations.
I would have continued in neurosurgery forever, except I got married and had a child.
When my partner and I bought a house in a bayside suburb of Melbourne, I moved to work in the local hospital in a peri-operative role, and for a while in the major surgical ward, but that came to an end as my pregnancy advanced.
Back then, there was no maternity leave and very little child-minding. I had to leave full-time work. Instead, I worked around my partner’s work hours, for agencies in aged-care and home nursing. In nursing homes, I saw people with alcohol-related brain injuries. In private homes, I saw practicing alcoholics being watched and cared for by nurses, paid for by their families. My commitment to caring for people affected by alcoholism grew.
In the mid-80s I started working part-time with the St V’s Department of Community Medicine. That’s a euphemism for the Alcoholism clinic. I ran drink drive courses. In ‘85 the problem was almost entirely alcohol and I had a great education there about drinking problems in Australian culture.
So: I started my second career. The transition from neuro to addiction medicine seemed a natural progression to me, as much of the symptomology in I observed in addiction patients was neurological or psychological. I felt my career progressed from brains and biology to brains and behaviour.
At that time, drink driving was rife. In the last year before the point .05 legislation was introduced we ran four free groups a week, 48 weeks of the year. We had something like 1500─2000 attendees a year.
The scene has so changed now that some younger nurses may not have any notion of the national mindset that accepted as normal the practice of people staggering out of pubs and driving. I know it still happens, but most young people these days see the .00 driving regime as normal. Drink driving is taboo, not accepted as a cultural norm.
In that period, I was also involved with kids who were referred from the children’s court for treatment and counselling for alcohol and other dependence. I soon discovered that the complexity of their problems and the intergenerational nature of the condition demanded responses beyond the system’s capacity. I am pleased to say that, as a result of the work done by colleagues at that time, the Victorian Youth Substance Abuse Service was funded by the Victorian DHS, and continues to this day as Youth Support and Advocacy Service (YSAS).
The 1980s were a time of change in our national approach to alcohol and other drug treatment. In 1985, then Prime Minister Bob Hawke revealed on national television that his daughter was a heroin user. In the wake of the revelations, the first non-government detoxes were funded by the National Campaign Against Drug Abuse. His government also started the program which now is the National Drug Strategy.
At the same time, the State Government was starting to close their funded treatment centres in a move to get out of direct care.
St. Vincent’s obtained funds for a detox that they named DePaul House. I got the job as deputy director. That was fun — there were no nursing positions in AOD in those days in Victoria. I was hired for my nursing skills but paid as a social worker.
The detox clinics at that time were initially ‘non-medicating’. They offered a true ’cold turkey’ experience with supportive care. Fitting was a frequent feature of withdrawal. The skills of the workers and the quiet environment were the treatment. We were all learners, so the staff with a history in AOD recovery modeled client management to their colleagues, and did it very well.
We met and cared for some wonderful characters and some lovable rogues who pushed the boundaries, and we could tell many stories from that now almost legendary time. Many did well and have gone onto live productive lives.
I believe there is still a place for this kind of withdrawal unit for appropriate clients. In a way, it’s a pity we couldn’t retain some of those facilities and add extra places for the fully-medicalised units we have now. However, it wasn’t to be, and these early detox programs are now largely defunct.
The mid-to-late ‘80s was memorable for a major shift in the counselling field. In the early days, the standard technique was to confront the patient and ‘paint him (at the time, invariably him) into a corner’ to force him to admit he had a problem, on the understanding that if he didn’t, he couldn’t be helped.
With greater understanding, we moved on to the biopsychosocial model and applied it with compassion at DePaul House, with great effect. With 24 beds and a 24-hour intake, the clients came to us from AA, the police, local GPs, Emergency, other welfare agencies and the streets. If there was a bed available they came in, and with a few days of shelter, good food (as soon as they could eat), fluids and no alcohol, showers, clean clothes and care, a new person would emerge. It was inspiring!
I stayed there until I was invited to start a pilot home Detox Program and left reluctantly to pioneer the model in a Victorian Metro area. Only two of these programs existed already, in Geelong and Western Australia.
Our skills and understanding grew. The literature started to show better results with empathy, Rogerian unconditional positive regard, and client-centred counselling — all the models that we now consider basic. Two models changed our whole approach to clients: Miller’s Motivational Interviewing and the Stages of Change model initially developed in smoking literature. They were soon being taught in universities in social work, nursing and psychology courses.
During the ‘80s, we began to see the growth of poly-drug use in patients. It became apparent that the times, they were a’changing — on many fronts, as returned Vietnam vets sought treatment, AIDS was discovered and proliferating, and the drug scene blossomed into the multiple-substance industry we know today.
Alcohol was, and is, still the main problem, although the heroin glut before 2000 covered it up for a while and the Ice ‘epidemic’ has done so again recently. Binge drinking stays on the front page, even as we fear that heroin use is making a resurgence.
New, symptomatic relief medications are being developed to manage the neurotransmitter imbalances caused by neuro-adaption and to help with withdrawal symptoms and cravings. The AOD field is trying to address tobacco, and the latest change is attempting to start addressing what we have always known was needed, treatment for the compromised mental health of our clients.
I am a nurse, I’m proud of it, and when I die I will be a dead nurse. It is my craft, profession and identity — but I’m also an AOD nurse and a counsellor. I have the incredible privilege of working with the Nurse & Midwife Support program, which allows me to share time with the generations of nurses who follow me, and perhaps to give back some of what has been given to me: a lifetime of learning, and satisfaction.
When I look back over those 60 years I can’t believe it’s been that long. There has been so much change, but one constant has been the patients. While the faces change and the details are different, the patterns and themes are the same. The other constant has been the wonderful people I have worked with. So much compassion, dedication and laughter. I love being a nurse.
If you need to talk, remember we are here to support you just call 1800 667 877 anytime.
- Jackie Shaw RN., Grad Dip Soc. Sc. (Addictions.)