Ricardo Makyn/Staff Photographer
"I know I am working hand in hand with God to save lives, and no amount of money can pay for that, nursing is just a calling," says nurse anaesthetist Marjorie Hylton. Here, she preps a patient for surgery.

Glenda Anderson, Staff Reporter

If you've ever had major surgery at the University Hospital of the West Indies (UHWI) in Mona, chances are you have dealt with Nurse Marjorie Hylton.

A 26-year veteran of nursing, she was the hospital's first nurse anaesthetist and functioned for at least a decade after as the only specialist nurse (anaesthesia) for the 500-bed teaching institution.

Her colleagues say she is the best at what she does.

She says she cares deeply for her patients and is simply 'working hand in hand with God to save lives'.

But for the scores of patients wheeled into the operating theatres daily, it is critical care. She must often make the call that saves their lives.

Anaesthesia is the use of drugs, gases, and nerve blocks to provide a partial or total loss of pain during surgery. Caring for patients before, during, and after surgical procedures, nurse anaesthetists blend nursing skills with the practice of anaesthesia.

They interview patients before surgery and design a customised plan of care based on medical history and type of surgery. During surgery, nurse anaesthetists administer anaesthetic drugs, monitor the patient's vital signs (blood pressure, heart function, temperature, etc.) and adjust the doses of anaesthetics and other medications. They also manage the patient's airway and control breathing.

Post-surgery (recovery room and ward) follow-up are also part of their crucial responsibility. They also provide services similar to those of anaesthesiologists (physicians specialising in anaesthesia).

Legally, in Jamaica, nurse anaesthetists always have to practise under the supervision and responsibility of a physician anaesthetist (the doctor anaesthetist may not be on the hospital compound, but always in telephone communication) and are only allowed to practise under contract to government hospitals, that is, they are not allowed independent private practice.

Great responsibility

Jamaica operates with a core of 50 nurse anaesthetists who often are the sole anaesthesia provider in rural areas. The UHWI has five such nurses, Kingston Public Hospital (KPH) has three.

"It's your responsibility to determine whether the patient is fit for surgery, usually through an interview, and physical assessment on the ward after which you design a plan for each patient, including the type of drugs to be used in surgery, for example. While under normal conditions the nurse anaesthetist must consult with the hospital's anaesthesia consultant or the anaesthesia school (KPH), in an emergency, that split-second decision is yours," Hylton says.

And the emergencies can come fast and hard for the hospital mandated to serve the needs of the Caribbean, minutes away from one of Jamaica's volatile spots - August Town - and next door to the University of the West Indies' Mona campus.

But a tenacious, almost aggressive desire to heal, drives her, she says. "I don't give over patients - I've seen too many dead people walk."

One incident still gives her goosebumps.

"A 'gynae' patient was in theatre for surgery, and while on the operating table, there was no pulse. I checked, the surgeon checked and there was nothing, we rechecked still nothing. I said, 'God, this woman cannot die - she has children, this will be her fourth, she cannot die ... this is all You now.' I turned around and picked up the syringe, and by the time I swung back to her, we got a response, the patient had a pulse.

"As far as I am concerned, she died. It was a miracle, and there are so many of those every day, every week. These are the reasons I do what I do - I've seen it too many times. I know I am working hand in hand with God to save lives, and no amount of money can pay for that, nursing is just a calling."

Head of the Department of Anaesthesia and Intensive Care, Dr. Hyacinth Harding-Goldson, agrees and calls her a trendsetter.

"She has set the standard for the practice of nurse anaesthetists. (Marjorie) is very dedicated, very willing, she is an intensive care unit-trained nurse (ICU) and in the early days when we were short on ICU, you could rely on her to resort to her basic training to care for patients post-surgery."

A pioneer

Joyce Daley, director of the Jamaica School of Nurse Anaesthesia (JSNA), says, "She is a pioneer in her own right, since she was the first nurse anaesthetist trained for that hospital," adding that "her consistent excellent performance and resilience has laid the foundation for the tremendous acceptance of nurse anaesthetists in that institution."

Short and stocky, with warm, brown eyes, Hylton is the self-confessed 'tomboy'. Her theatre outfit is standard 'one of the guys' complete with trademark slacks, thick clogs and the gait of a woman with no respect for stilettos.

"I was socialised as a boy, all I had around me were male - uncles, my brothers."

Hylton is from Belmont district in Westmoreland, and says the early nurturing and the guidance she got from then principal of Savanna-la-Mar High School, Guy F. Jobson, set the basics for her career path.

"He told us we need to go to university and college before we step out there (world), so for me there was no looking right or left, you identified what you wanted and went to the next level for training.

"But my mother, Norma Clarke, I laud her with all my heart. She worked very, very hard to give us the best, sent us to a private school. I remember the fee to this day - $25.76 per term, and it was hard to find. She was a higgler (my father, Roy Clarke, a fisherman) and she pushed herself hard for us. She got no 'borrows', and there was no student loan."

Her next move was to nursing school at West Indies College, a family sacrifice as she was the only girl and eldest child.

Graduating nursing school, she worked on the UHWI's surgical wards then began specialist training at the Jamaica School of Nurse Anaesthesia in 1987, at KPH.

"I didn't apply, I was sent. At the time, there was a shortage of anaesthetists and the then head of anaesthesia, Professor John Homi, knew of the programme and talked with the matron about having me join."

Back then, it was a three-year bachelor's programme spread over 26 months, 20 theory and six months hands-on internship. She would rotate through several rural parishes before returning to the UHWI.

Understanding husband

Married with two children (Khadine and Jodiann), she says she threw herself into her career. "It sucks you in really; you definitely have to have a partner who understands and is supportive because when you are at work, you can't think of anything else."

Her husband, Police Sergeant Kenneth Hylton, is her pillar at home. "When I get home, the house is clean, the yard is clean, food prepared, children OK." With his also a high-stress job, they juggled childcare duties in the early days.

She recalls travelling to work on public transportation, children in tow.

"They would be everywhere with me, sometimes sleeping on the floor in the nurses lounge, out early and late, walking sometimes in the rain." These days her schedule includes two days of 24-hour work, and a work list that spans the breadth of specialities - obstetrics, orthopaedics, general surgery and paediatrics. She also lectures in the hospital's nursing programme, (critical care and the school of midwifery), and was recently honoured for eight years of service lecturing at Northern Caribbean University.

While she says the work is gruelling, "It's not really hard because I love what I do. A bad day for me, for example, would be when things don't flow right, when some things are not in place that messes you up."

These days she is bothered by a seeming lack of care in her profession.

"The type of nurses being attracted, I find them uncaring and it bugs me. The nurse anaesthetist is a special person. You have to be sober, have a clear head, heart and mind and be committed. Nursing is a calling ... and we still have to hand-pick our nurses because when you take the best nurse, you get the best care."