NHS: NATIONAL HEALTH SAINTS
“We took more detailed bloods this time. These results are beyond my level of competence. I’d like you to go to hospital for a check-up.”
Dr A, my GP, shuffled in his seat to face his desktop screen. “I’ll try to get you an appointment this afternoon.”
Four hours later, good to his word, I was waiting in Wexham Park A&E. For all of January I’d been feeling tired, sleeping most of the day, then sweating through the night as if laying in a Turkish bath.
Soon after arriving, someone led me into a check-up room, and took my blood pressure, temperature, height, weight before wheeling me into a more private bay.
“A doctor will be with you shortly.”
Like everything else at the new A&E, the walls and the bed glowed spotlessly.
As, indeed, did the medic. Like police officers and politicians, she looked like she was on work experience from Sixth Form. For Christmas she’d probably received 1001 Questions to Ask a Patient – and was determined to run through all of them.
“I think you have endocarditis,” she declared, after hosting 90 minutes of Question Time. “I’m going to ask a senior colleague, but I think we’re going to keep you in.”
She was right: They kept me in for the last Wednesday, Thursday, Friday of January, then all of February and the first two weeks of March.
What follows isn’t a 2020 patient pity diary, but rather a snapshot of how a hospital ward works, and how even the 'invisible' people make such a difference.
Ward 4 at Wexham Park is a cardiac ward, where most of the patients (at least the sixteen on the male side) are late sixties and above, and kept on the ward between three and ten days. My month and a half – receiving antibiotic insertions six times a day (including midnight and 4AM) - neared resident status.
The hierarchy in a hospital is more complex than the combined armed services, but at its heart (excuse the pun) there are five medical levels: consultant, doctor, nurse, assistant and support.
Consultant arrivals can feel like papal visits; once a day, to check your progress or see if you’ve deteriorated with something they missed earlier. Their specialism is either aligned to the ward (like cardiology), or cross-hospital. In my case, microbiologists became interested because endocarditis is an infection that grows on the heart’s inner walls.
“We like you,” said one of the junior doctors, picking up the confetti from a Consultant visit. “Not because you’re a nice person. But because you’re a problem patient.”
Indeed, after two weeks of every scan and cardiac test known to the NHS, there was still no agreement to the cause of the infection. Hence the arm wrestling between departments. The Cardiacs didn’t want further surgery; at the same time, "it was still a cardiac problem – NOT a microbiology problem."
I heard a lot of this over the six weeks. In truth, both sides of the house were doing everything possible.
But without doubt, the most important people on a ward are the nurses. The senior nurses, who are still called Sister (including male senior nurses, who are Sisters too) run the show for their twelve hours a day. Watching Sister management styles could be part of an MBA that came from Harvard, or London Business School:
Sister C, who stood back, directed from a distance, yet knew absolutely everything happening with all sixteen patients. Or Sister L, who was hands-on with patient treatment, even down to temperature and blood pressure. Or Sister K, who was returning to work after time out, and was relearning everything, assuming nothing.
Beneath the Sisters are the Staff Nurses, who are also on 12 hours a day (or night). In one moment, they’re providing medication, in the next they’re readying a patient for an x-ray. In another moment, they’re lifting a patient from bed into a chair, in the next listening to the concerns of a patient’s family.
Most noticeable is the mix of nationalities upon which the ward, the hospital and the NHS depends. I met with Belgians, Indians, Filipinos, Zambians. They have all qualified twice – once locally, once here in the UK – and who all act with grace and equanimity.
Many patients are either too frail, confused or are leaving too soon to learn any names other than ‘Nurse’. But for me, they became part of my team. Learning something about each of them increased the likelihood of care and attention beyond their call of duty:
* Nurse G, whose family from Zambia thinks she’s impossibly rich because she works in England;
* Nurse L, mother to a six-month old baby;
* Nurse P, who asked for advice on where to visit on his four-day break to Paris;
* Nurse E, one of 8 children in the same family, whose names all start with E.
If they are lucky (or perhaps unlucky?), they have a junior trainee, who can be left alone to complete simpler tasks on Day 1 (or trails like a puppy looking for training).
Even with degree qualifications, it is doing that makes a nurse.
So, with 16 male beds and 16 female beds, on paper there would be two sisters, four senior nurses, four trainees. A team of 10, if/when fully deployed.
Then comes the invisible people. They do have official titles – Healthcare Assistant, Caterer, Cleaner – but they are forgotten because their tasks just happen, as if by magic. They make beds, help the incapable to use the toilet, then sanitize the toilet – and the patient - after. They wash hair, help shave, provide washing bowls, unpack urine bottles, find towels, change pajamas, clean under beds, deliver food, change water jugs morning and night.
In short, they are the oil that keeps the ward machine turning.
Perhaps the most important part of the day is handover: seven-thirty, morning and evening. Even if a nurse has been responsible for the same beds for three days, something may have changed for a patient in the previous shift. So even if he has been on the ward for five and a half weeks, don’t assume that the treatment will be the same during this shift as it has been for the previous 37 days.
No matter how old a patient (the most senior I met was 92) nor how young (the youngest was 30), all of us fall into the same trap: the belief that the entire hospital rotates around me. “You told me that I was going for an MRI scan today, and it still hasn’t happened.”
Twenty-seven minutes is a long time in a patient’s mind.
It’s easy to see and hear the anxiety of being in hospital, especially from those for whom this visit is a first time. ‘What’s supposed to happen now?’ ‘When will the doctor say that I’m okay?’ ‘Where has she gone?’ ‘When is he coming back?’ ‘I feel fine – why can’t I go home now?’ ‘’Fucking let me out of here!’
My ‘now’ was Friday 13 March - although actual leaving is very different from scheduled leaving, especially on a Friday, the kicking-out day before the weekend. An optimist told me I’d be out by 6pm; a realist adjusted it to 8pm. My wife and daughter met in the main reception, where I handed over my clothing, books and electronic devices. While they loaded up the car, I had to go back to the ward to collect my discharge meds (i.e. multiple boxes of tablets).
At the ward, there is a desk where those on duty stay, to read notes, share ideas, generally check-in with colleagues about patients, resources, and the Wexham universe.
That evening was very quiet; Nurse T knew I was waiting to go home, and I knew she had finished her shift but had admin to catch up. We stood saying nothing, then there was a sudden entrance.
One of the invisible people appeared and closed the 2 glassed doors between us and the activity. In a moment, a patient and a bed rushed through, wheeled by 4 members of staff, each fully togged in one-piece suits, masks, screen visors.
I watched trying to understand what was happening; Nurse T stood shaking her head. The healthcare assistant disappeared into a supplies cupboard, then re-emerged wearing gloves, carrying some wipe cloths and a plastic squeezy gun full of cloudy liquid. He started spraying both sides of the door and the exit though which the medical team had disappeared.
“Even if your meds arrive now,” said Nurse T, “we won’t let you out until the wipe-down is complete”.
I must still have looked confused. She continued:
“That’s what we’ve been prepping for these past few weeks. That’s a coronavirus patient.”
My penny slowly dropped. “Is she going to the women’s ward?”
“In that direction, it’s the morgue.”
Postscript - As if the timing of my six weeks weren’t impeccable enough, I received the following email from Nurse T on 28 April at 12:15pm (while I was editing this story):
I had hoped to email you sooner but after you left everything changed and work became extra busy with all this Covid business. I became very unwell and had to be admitted. However, after a full month of being sick I am much better.
I’m returning to work this week.
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