The way I work: Kim Denton

If you’re going to push a tube down someone’s throat within minutes of meeting them, you need to be good at building trust and rapport, says the nursing endoscopist

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People usually react in one of two ways when I tell them what I do for a living. It can be an instant conversation killer or they start telling me at length about the time they had an endoscopy. Neither are ideal, to be honest.

I’ve been working in nursing since I left Huddersfield University when I was 21 and started training as a nursing endoscopist in 2015. I’m now 34.

I have an excellent team around me who always help pull each other through tricky times

There is a lot of responsibility that comes with my current role – which you basically train for on the job – but I definitely prefer this to when I was a sister. When you’re a staff nurse you have a certain job to do but then you’re promoted to a sister and things get very hierarchical and managerial and you get taken away from the actual caring for patients a lot of the time. I am actually on a higher pay scale now than when I was a sister but the only person I currently have to manage is myself. That said, the stresses are different in this department because there is always the chance that by putting a camera inside someone I could potentially make their situation much worse. But I think I handle the particular stresses better now than when I was a sister. Plus I have an excellent team around me who always help pull each other through tricky times.

The first time you do one of these procedures it’s on a real patient. There’s no computer simulation or dummy involved. You’re straight in, so to speak. I’m now qualified to go down into people’s stomachs or all the way around their bowels but I remember the first colonoscopy I did not making me half as nervous as the first gastroscopy. It’s a tolerance thing for the patient and you’re physically more tolerant to something going in the bottom end than the other. I’ve now carried out over 6,000 procedures.

I work at either Calderdale Royal Hospital, in Halifax, or Huddersfield Royal Infirmary from eight in the morning until six in the evening, four days a week, including one Saturday a month. Like many people the first part of my day is spent checking emails then I look through the lists of patients. If I’m doing bowel cancer screening in the morning it will be 11 flexible sigmoidoscopies – which is looking inside the patient’s left side of their large bowel – or it might be five whole colon inspections or 10 gastro inspections or any combination of the three.

Yes, I spend a lot of the day washing my hands. There’s half an hour for my dinner, then either a second scoping list for the afternoon or there may be admin, previous tests to review and patients who we regard as being under surveillance to validate. A lot of people need to come back for regular check-ups – those with polyps, ulcerative colitis or Crohn’s disease, for example.

Sometimes there are patients we’ve seen who have subsequently developed more serious problems so we’ve got to then evaluate how valid it is to have them back for screening considering everything else that may be going on with their health. It’s up to us to decide what’s in their best interest.

I’m basically a technician but while with some patients I simply do the procedure, with others I play a part in advising what happens next. The end decision regarding how long we leave things until a patient comes back to see us or where we go following a procedure is with their consultant. But if there’s any difference of opinion between me and them our lead doctor decides how to proceed. As time goes on there does seem to be more decision making pushed towards us but that’s where my current studies at masters level come in. This additional knowledge gives me the ability to better analyse any data I have.

Regarding personal skills, you need to be a really good communicator and get someone’s trust within the first few seconds of meeting them. If someone comes in for a gastro they’ve probably never met me before and they’ll be worried about what we might find but within a few minutes I’ll be numbing the back of their throat – always a strange sensation – and pushing a long tube down there. You need to build that trust and rapport instantly and that’s made easier by me being calm and confident in my skills. Some of my colleagues compliment me on how calm I stay but there can be times when inside I’m thinking “arrgghhhh!” but you can’t show that to the patient. If I start panicking, it’s helping nobody.

It’s pretty obvious but the worst thing about this job is giving people bad news. A chap came in the other day who was having trouble swallowing and I put a tube down and, to me, it looked cancerous. The problem then is that although it does look like bad news, until the biopsy results come back you can’t put the pieces of the jigsaw together and tell them for certain. Sometimes other tests, including scans, need to be done to determine the course of treatment. I can have an educated guess and relay that to the patient – sometimes it’s a guess I’d put my mortgage on – but it’s all about being open and honest with people.

That particular patient was in his nineties, so while it’s always going to be bad relaying potentially terrible news it’s when I scope someone younger than me who has a strong possibility of cancer that it’s more difficult. It can be like hitting them with a lightning bolt. Most of the time I can’t remember patients from yesterday but sometimes personal things resonate with you. I can recall, word for word, what I said to a patient I saw when we were both 25 years old. I even remember staying for four hours after my shift one night because she needed one-to-one care. She ended up dying two years later.

Like all jobs there are funny moments. One of the things I feel safe to mention is the fact that during colonoscopies we have to instruct patients to pass wind and it can be awkward. We have had older ladies who’ve been married for over 50 years and, well, to be frank they’ve never previously farted in front of their husbands. There’s a first time for everything, I suppose.

I do occasionally bump into patients while I’m out and about socially. There’s that patient confidentiality thing so I have to just remain blank or turn away: some people haven’t even told their husbands or wives they’ve been to hospital. Others do approach me though, so I just try and exchange pleasantries and then move on. What is more embarrassing is when someone you know walks through the door. I do check the list in a morning to see if there are any familiar names and if there is I usually send a colleague out into the waiting room to have a word and see if they’re OK for me do the procedure. Nine times out of ten they’re fine with it as they sometimes prefer a familiar face. I’m not always over the moon about it though.

Photo: Rebecca Lupton

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