What with all the controversy this week about the NHS concerning the publication of The Francis Report on the Mid Staffordshire Hospitals and because things medical have been shunted involuntarily up the list of my priorities recently, I feel the need to spout a few words.
A quote from Oscar Wilde says: ‘The pure and simple truth is rarely pure and never simple.” I found that to be very true concerning the workings of the NHS during my two weeks as their guest last autumn.
Following our accident, I had the huge good fortune to be taken to the John Radcliffe hospital in Oxford, which is a large University teaching hospital with an excellent reputation. Maybe it follows that a top-notch hospital attracts and employs top-notch staff, which would make my experiences different from those in other hospitals - or at Stafford. But because I feel sorry for the very many hard-working caring and compassionate professional and non-professional staff working in the NHS, and think it must be quite grim to be part of an organisation with such a bad press, I want to say why I found that there were two sides to this story.
Firstly the treatment and attention I received in A & E was exemplary. OK so there was a lot of hanging about, but during that time I had a couple of x-rays in situ, was wheeled down for a CT scan and separately for further x-ray, had my lower leg temporarily plastered in situ (with the sad loss of a virtually new pair of skinny black jeans) and a mass of other examinations, prodding, poking and not to mention questions and form filling, all by kind considerate and smilingly supportive folk.
Eventually I was admitted to a four-bed room in the Trauma Unit. By the time we got up there it was well past lights out and once the ‘admission procedure’ was done and my poor weary husband, daughter and son-in-law finally went home, although I spent the whole night horribly awake, I wasn’t really aware of what else was going on around my own bubble of pain and confusion.
But with the waking of the ward and the dawning of new routines I began to take a bit more notice. Of the four beds in the room mine was directly facing the door. If I leaned well over the side of my bed (which I couldn’t for several days since leaning anywhere was out of the question due to a fractured sternum) I would be able to see through the open doors and down the corridor to the nurses station. In the bed on my right peeping above the sheets snuggled around her tousled head was Vera. Who turned out to be a softly spoken, shy and slightly nervous, un-assuming lady who had fallen over her great grand daughter’s bicycle and broken her leg. Both she and her opposite neighbour had the pole window positions giving them better views of the weather and life external than we of the peripheral beds. But nobody would deny Maggie any extra little perk she could get. She had already been on the unit for four weeks when I arrived and was still horribly paralysed and poorly following an accident on her motorbike.
Which brings us lastly, and by some very very long pieces of chalk by no means leastly, to my own opposite neighbour – dear little docile and doe-eyed 90+-year-old Doris. Aside from the knowledge that they are an absolute con, Doris may well have been a reason for my not bothering with the Hospicom computer TV thingy over my bed. She was quite entertainment enough for one tired, broken achy person.
For the whole of the first day, completely under the spell of her little old lady lure, I empathised with her constant cries of ‘Nurse’ and ‘Help me please’ and cringed at the occasional seemingly tardiness of the staff to respond to her discomfort. To the extent that I even found myself crossing my legs and holding on till I might burst to save interrupting the nurses answering to Doris. And when at one stage having dropped her bell-ringing device to the floor she called to Maggie to come and pick it up for her, I was quite taken aback at Maggie’s snappy and irritable tone when she replied.
“I can’t – I’m paraplegic!”
Even after watching at least three times in rapid succession as she called for the nurses because she was ‘wet’ – the ‘wet’ whispered with a child-like little smile that said ‘I couldn’t help it’, ‘It wasn’t my fault’ – and each time with cajoling words and smiley faces they changed all her bedding and left her all cosied up with her whispy white hair feathered against her pillows, only to be summoned again within minutes, I still thought she probably had an infection that was causing all these problems.
But as day dragged into evening and evening into night and still her relentless calls for attention came at a minutely rather than an hourly rate, my own patience and sympathy began to wane.
The essence of Doris permeated the ward like an all-enveloping mist blanketing out any communication or camaraderie amongst the other three of us. Both Vera and Maggie avoided eye contact and concentrated on their own concerns and routines – and I began to feel quite miserable.
Generous visiting times (from 12 noon to 8pm) though were a big relief and luckily I was rarely without a visitor. I was quite amazed however, during one lull, to overhear Doris telling her family how the nurses never came when she called, left her lying for hours in her own urine and faeces and that she hadn’t had any breakfast.
No. She hadn’t had any breakfast. Because having kept us all awake all night, when her pre-ordered porridge and tea arrived she was fast asleep. Attempts were made to wake her but after opening her eyes several times and seeming to acknowledge that breakfast was here she was determined to sleep on. A couple of times a care assistant came back loudly exclaiming.
“Doris! Doris, your porridge is getting cold, shall I help you eat some?” When she finally surfaced of course she didn’t fancy stone cold porridge. But her many protestations about having had no breakfast and being hungry were met each time with patient friendly efforts to cajole her into eating something else.
“Nope, can’t swallow them!”
‘Some nice toast?”
“No! Just as hard as cornflakes?”
“I already have bananas, look!”
“OK, some bread and butter then!”
Which was brought and studiously ignored.
In the early evening of my second day my daughter nudged me and whispered to look at Doris. With no visitors and no attention she was actually amusing herself. With an impish little grin she was experimenting with her bed controls. Gnarled fingers clutching the widget she prodded randomly at one of the buttons and waited, wide –eyed with expectancy, to see what would happen. Then grin broadening with glee watched as the foot of her bed rose up towards her face. Another jab and the bed lowered. Next she shot herself so bolt upright she nearly did a full back bend towards her toes – and we both had a dose of laughter tonic trying to suppress our giggles.
But the true performance came when visiting was over and the four of us were calming down towards lights out. Doris remembered the game, and that there were un-tested buttons on that widget. With the grin now verging on wicked, she jabbed another button and her whole bed lowered silently towards the floor. With the widget now inches from her eyes and with a frown of concentration she jabbed again – and the bed began to rise. Now her finger control was improving and by degrees she got herself back to where she started. Then with another little push she noticed that her bed table – containing her water jug, water beaker, newspapers, spectacles, fruit, sweeties, etc – was rising with the bed. Her smile now switched from wicked to roguish as she inched the bed and the table higher and higher until – with a resounding clatter the whole lot crashed to the floor. Then being of sound mind, Doris carefully lowered the bed to its normal height before shouting.
A long-suffering care assistant came and cleared up the mess with not a single cross word or muttered tut. But later that night after all that naughtiness and excitement, Doris developed some genuine cause for concern and in the morning they moved her further up the unit closer to the nurses station. Or, was it that they hoped she might behave if under the eyes of authority? Whichever, miraculously the mist cleared behind her and Maggie, Vera and I were able to get to know each other at last.
Beds did not stand empty for long. Doris’s place was very quickly filled by a stunning-looking polish girl, with silky blonde hair and doll-like features, who had mashed up her leg coming off her motorbike. Vera, who emerged from her sheets and her shell with the disappearance of Doris, became mobile enough to go home to her daughter’s. And then came Alice.
If Doris was small then Alice was diminutive and her voice when she called, ‘Help me. Help me please. Oh please help me!’ could have been likened to the bleating of a lamb. When I heard that she had fallen out of bed in her care home and broken her hip, my hackles rose up in her defence and my finger rested on my buzzer to bring the nurses to her aid. Doris was a one-off I thought, Alice must not be tarred with the same brush.
That was before I witnessed the power of her punch and the depth of the scratch she inflicted on a care assistant’s wrist as they tried to change her bed, or the venom in her raised voice when she warned the nurses not to go near her. The words ‘Go away and leave me alone!’ were screamed so loudly they could have been heard in the car park below. And when she ripped the canula out of her arm with such force, splurting blood all over the curtains and her sheets and bringing nurses running, my poor husband turned quite white.
Yet, having been cleaned up and calmed down in time for her tea time visitors who asked her how she was doing she replied quite demurely.
“Oh, not so bad”
So, whilst these were a sample of only two elderly ladies in a hospital of good reputation, it still has to be said that their recalcitrant behaviour would each have tried the patience of several saints but never once, from care assistant or nurse, did I hear a cross or even muttered word against them.
Sir Robert Francis’s report last week suggested that there is a ‘Culture of Neglect’ in the NHS and when reading of the scandal at the Stafford Hospital this appears to be so, but, in my experience, it wasn’t so in The John Radcliffe, particularly in the care of the elderly, who certainly in Doris and Alice's cases, took more of the share of the time of the over-worked, and sometimes visibly stressed, staff than their less demanding patients.
The Report also said that the NHS had moved from a Patient Caring Culture to an Institutional Business Culture. I saw some truth in that. Aside from the sheer volume of work they needed to cover, the rapid turnover of patients of varying degrees of difficulty and the fact that there never seemed enough of them to go around, their work load seemed unnecessarily burdened with form filling, note taking and constant box ticking. In just over two weeks of my own personal patient care there were only two incidents that could have been called less than 'caring'. One was when a rushed and overworked, but nonetheless rather thoughtless, nurse put an ordinary sticky plaster plonk onto the burn on the back of my hand the upshot of which caused a deep wound which has only just healed. And the other was when a rather less than empathetic care worker was irritated that I hadn't marshalled all my wash gear together when in fact I was barely able to move. Otherwise from admittance to discharge and consultant to cleaner - with extra special mention for the wonderful physiotherapists - every person who cared for me was truly lovely.
Finally, with suggestions this week for a need to cultivate compassion throughout the NHS, there can be no better example, from bottom to top, than the compassion I was shown on my last day at the JR.
With the knowledge that I was going home and would have to cope somehow I ventured to the bathroom alone on my crutches. When I came out and was teetering my way back to my bed, a young woman was mopping the floor in the corridor. Other than her there seemed to be no-one about. The fear must have shown on my face, as she took one look at me and, in broken English, said
'You OK? Is alright, I only cleaner, but I here for you. If you fall, I catch!"
(NB : Of course I have changed the names of all patients mentioned in this post and in the event there was anyone recently in the John Radcliffe Trauma Unit bearing my fictitious names they are purely coincidental and bear no relation to the events mentioned!)