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Sunday, December 12, 2010

Taking Charge
The Grape
When you are not well, you can be a bit more clumsy than usual. One evening I dropped a red grape (as you do). It fell to the floor and rolled just in front of the visitor’s chair. There was no way I could reach it. Equally there was no way I could push it out of the traffic zone to the bathroom. I wondered whether to call someone, but despite the fact that there was a small risk of someone slipping on the grape, I thought it was frivolous to press the bell. To be honest, I have tried overall to call nurses as little as possible; they are busy, I am not really ill, and I don’t like troubling people. I try to do as much as I can for myself. So, I save up tasks as much as I can and get them to do three for the price of one bell call.
Anyway, I forgot about the grape until the next day, when I noticed it was more under the chair, but still there. When the tea lady (‘food service officer’) came to deliver dinner, I said: “Look I’m awfully sorry, but yesterday I dropped a grape, and I am a bit worried that someone may slip on it. I was wondering whether you could possibly pick it up for me and put it in a bin.” She looked at me, looked at the grape on the floor, looked at me, thought about it for a moment, and said: “I’ll get a nurse”.
So what is that all about? Why would you ask a nurse with all that training and qualification to come into the room and pick up a grape? The answer is that many people are defined by what they do, or they define themselves by what they are prepared to do. Others define themselves by what they don’t do. Tea ladies seem to have one set of jobs, and don’t deviate from this. There are a lot of things they don’t do, and you can imagine some draconian supervisor drumming this into them. So they get the trolley with meals to the ward, they lift the tray from the trolley, they knock, or say “Knock, Knock”, they bring it into the room and place it on the mobile bed table, and then later, at a set time, they return and pick up the tray and return it and all the others to the kitchen. That’s pretty much it.
I guess they also have their rules, although this (like a lot of things) is never made explicit. A rule that might make sense is that they are delivering food, and presumably this is a clean (though perhaps not sterile) process. I guess that as they go from room to room they need to stay clean and not contaminate the food tray for the next person. So to pick up a grape from the floor would mean the possibility of picking up something nasty that had coated it. Of course they could wash their hands… This theory was suggested to me later when I was at the spinal injuries unit. I had one of the tea ladies bring a cup full of lemon cordial, as they do regularly every afternoon. The cup from the morning was empty and on the bedside table. The tea lady placed the new one on the bed table and ignored the old one. When I pointed out the empty one, “Oh, this one is finished, thank you”, she mumbled something about that being the job of another tea lady (who presumably has the job of picking up the empties). “My trolley is clean!” she said. I suppose by touching the cup, and consuming the contents, I had somehow contaminated the thing. (This fetish about cleanliness is explored elsewhere).
There are problems sometimes. So, if you have just come out the bathroom and are naked or semi-naked, some will avert their eyes and just put the tray down, others will retreat and say they will come back in a few moments, which they do; perfectly reasonable. On several occasions, there would be a “Knock, knock”, to which I would respond “Please come in”, and a hand would appear round the curtain and put the tray on the bed table and then, disembodied, disappear. On one occasion the tea lady did her job – that is she came in all chirpy and wished me a good evening and put the dinner tray down. You understand it is not their job to see where the trolley is in relation to you, nor necessarily to move it. So, unfortunately, on this occasion the bed table was at the very end of the bed, where some all neat and tidy nurse had put it, exactly square with the end of the bed. I looked at it. Right, so I am up here, I am paralysed from the waist down, and the table is down there! Now you could call a nurse; mostly the buzzer is within easy reach. But, ‘taking charge’, I decided to shuffle inch by inch down the bed, all cramped up, until I could reach the table. “Good job”, the physios would have said! Problem; all four wheels on the bed table were locked. So, not to be beaten, I nudged, pushed, jerked the table out from the end of the bed sufficient to turn it, then at some danger of falling over the cot sides, I turned it to be parallel with the bed, and then inch by inch cajoled it, locked wheels or no bloody locked wheels, down to the head end. Straightening out the covers, all sweaty, I sat there triumphant for several seconds before tucking in; I don’t remember what the meal was – I didn’t care.
Another problem occurred on about the third day. A young nephew was part of a group of people visiting, and we needed to clear some space for bags, papers, and flowers. So he moved the tray from dinner off the bed table out into the corridor, and tucked it against the wall. We all went on with our conversation. Well, when the tea lady arrived to collect the tray she absolutely lost it: “You are not allowed to do that... You must not put the tray on the floor outside in the corridor; this is an occupational health and safety risk. Someone may fall over it and get an injury.” We all felt a bit sheepish, but as she retreated up the corridor nobody could help themselves bursting into peels of laughter, and then of course there were a series of jokes at which we all laughed. Seriously, the corridor outside the room was very wide, well lit, and relatively uncluttered. What was someone going to do? Look at the tray and say to themselves: “Oh look, someone has left a used tray in the corridor. I think I will make a beeline for it and trip over it. Then I can sue someone…” Let’s face it, in every single hotel across the world, they leave a little notice on your tray, or actually give you an instruction when they deliver breakfast or whatever, asking you to leave the tray outside your door so that it can be picked up without disturbing you. Why in a hospital would it be different? I suppose we could make up a couple of reasons. First there are patients wandering the corridors, and they may not notice or see a tray. Patients who are just beginning to walk using aids like a ‘rollator’ may accidently wander into it. I think there are probably a couple of reasons connected with our tea ladies. The first may be that their expectation is to just lift the tray off the bed table and place it on the kitchen trolley. Perhaps they have been warned about not picking things up from the floor, like our lady of the grape. Or perhaps, being slightly elderly and a little plump, she had a back problem and the effort involved in picking the tray off the floor was genuinely going to exacerbate an old injury. Or perhaps she was just a grump having a bad day.
Another grump was the lady whose sole job appeared to be to deliver the water jug freshly filled. Before I had my catheter removed I was very pleased to drink lots of water alongside the fruit juice, cordial, soft drink and anything else I could get. After I was free of the catheter, I was much more cautious. On the assumption that it takes about two and a half to three hours to excrete a water load, with peak output at about 90 minutes, I didn’t want to drink much after about 6 pm. IO tried very hard to avoid getting up in the middle of the night, calling for a nurse to get me the toilet chair, etc…. Then I tried to avoid times I knew visitors might come. Anyway my intake dropped drastically, and I was looking more for something that tasted good, or at least a drink that washed out my mouth a bit. My grumpy friend took it as a personal insult that I had not used any of the water from the jug overnight. She would empty the jug with a flourish and replace it with a freshly filled one, all the time muttering her displeasure. Several times I used some of the water in the jug to water flowers on my bedside table, just so I did not offend her. I was also slightly embarrassed to tell you the truth. When you are not well you need to drink lots, Jan had been telling me over and over to drink lots, and here I was actively trying not to.
Some of the tea ladies are delightful, and the more you are a permanent fixture on the ward (like you have been there a week or so), the more likely they are to smile while delivering a tray. You never get to find out their names, and they never want or need to know yours. Most appear to be from Mediterranean or Balkan countries, with only limited English. So one middle aged slightly weary lady would come in and say in a very strong accent: “It is really hot outside today”, and smile. I tried several times to extend the conversation, but either she did not understand me, or that was all she had time for. Next day would be the same: “It is really hot outside today”, and we would both smile, and perhaps I would say: “I am really glad to be in the cool then” to her retreating figure.
One young thing, totally out of place in the company, did stop and chatter a bit, beginning with “So what happened to you?” The conversation was always in short sentences, and she was always looking at people passing in the corridor, as if mentally looking over her shoulder. When she found out I was a doctor, she revealed that it was her intent to become a med student after she had finished her first degree. Bit by bit she warmed to the conversation, but always somewhat furtive; again I had visions of the draconian supervisor lurking in the background just to catch her out. She also delivered the evening drinks, and these occasions allowed her to ask for instance what med school was like, and why I had chosen to become a doctor. Funny how much you can enjoy such little conversations, how much difference they can make in long days, even though I always seemed to have lots of friends and family members visiting. She was very much the human face of the tea ladies; I hope she didn’t get into trouble for stepping even briefly outside her role.
I had a variety of experiences with wardsmen (‘wardies’), but they were all memorable in one way or another. The initial experiences were fleeting. I was lying on a trolley having been examined late at night shortly after arrival in Accident and Emergency/Admissions. I was physically helped to roll onto my side, while a board and a plastic sheet were placed underneath. Then I was rolled the other way so they could pull the plastic sheet through. A wardie and two nurses then pulled on the plastic sheet to slide me across to a bed, moving my 95 Kilos with surprisingly little effort. You feel alternately terrified and secure. What are you guys doing with my body? Am I safe? Oh right… How did you do that? This process was to happen time and again over the first few days as I had Xrays, MRIs, and moves of wards.
I remember one occasion early when I was moved from the bed to a wheel chair to move somewhere. The wardie suggested I “swing my legs over the side”. OK, that was the first problem. With help we did that, but I am not sure he fully understood I could not bear weight – there was just nothing there… I was asked to clasp my hands behind his neck, and then holding me tight he tried to straighten – with great difficulty, almost dropping me. He swivelled with me on board, and with (I imagine) a great sigh of relief he half dropped me into a chair. I remember the momentary panic as he was destabilized. I also remember that he was the only wardie who actually smoked. Very strong, stale smell; all the more pungent because I had given up 35 years ago. Then other thoughts crept in. For instance what had I done to his back? He took an enormous risk carrying my weight – was he covered under hospital rules?
That was the only time I felt in physical danger. While the wardies were respectful of the practice I was putting into learning to transfer myself, they never let me do anything stupid, they always checked that transfers were going to be OK. They supported what I was trying to do rather than taking over.
Generally they were cheerful people. There was one in particular who arrived at 6am every morning when he was on duty, literally bustling into the room with his bucket to swab the floor. He cleared all the bins, checked around the bathroom, did the floor and left still cheerful and chatty. He was the one who happened to be on duty during my days of bowel problems. Every time there was a difficulty he would come back cheerful as you like, clean up floors and anything else, and then all bustle and cheer he would let me know he would see me tomorrow. A couple of time there were slow times. With an eye on the door he would ask me what had happened to me, or check on progress.
One day I was telling him of my successful exploit to change a toilet roll. Both had run out, I didn’t want to call a nurse, and I had noticed (while sitting there contemplating) that there was a neat pile of new rolls above my head on a shelf. With a bit of manoeuvring of the wheelchair and my position, I could lean on the handicapped support, reach up and grab a roll. I was very pleased with myself, and no damage had been done. “Oh, you shouldn’t have bothered with that, Graham. Just get a nurse to call me and I can come and do that sort of thing.” And then we had a discussion about trying to do things on your own and independence vs dependence.
On another occasion, he asked about my karate background, and then admitted that as a youngster he had tried Taekwondo, but later shifted to a full contact Karate, which he loved and had continued. I had wondered where he got the body shape – broad shoulders, trim waist and a sense of power as he walked, and an energy and self-assuredness.
Later I came to learn that other wardies were into maintaining fitness through all sorts of means, but a surprising number had followed the path of martial arts. After several brief contacts, they would hang about in the room, looking as if they were busy, and then say: “You do Karate, don’t you?” And the conversation would blossom. Of course my passion for Karate was no secret, and my sadness at the possibility of losing it was also apparent. As I was being lifted across to the bed, I would use my upper body strength hanging onto the monkey bar, taking as much body weight as I could. It seemed to be a surprise to both nurses and wardies, but to me it was part of my fitness regime, part of my promise to myself to try to keep as much of my body working as I could manage. Anyway, the conversations were always brief, with furtive looks at the door and corridor beyond. There was an obvious anxiety that they might be found out to be ‘not working’. I imagine the fact that they were doing supportive psychotherapy with an old man grieving his loss of body integrity, vitality and fitness would have never come into any discussion with a charge nurse.
One of the male nurses did the same thing, talking about his love of martial arts, while furtively checking no-one was listening. A tall well-built chap, I had always thought him a bit taciturn, a bit quiet and withdrawn, focused on what he had to do. It was a pleasant surprise to hear him open up and not only talk about himself, but also discuss the future in terms of the best style for his young son. Another male nurse from the Philipines was seeking some weapons training – not something we focus on in our style. But through a friend of a friend I emailed, I was able to find a local weapons school to meet his needs.
The Wardies are treasures in a public hospital. They know their own limits, are happy to do shit jobs, and bring a spark of light to dingy wards. Treat them with respect. In fact with all the ancillary staff who do such great jobs, you will get more from them if you notice them, greet them, and treat them with the respect they are due.
A word to the wise: “I am sure that hospital rules constrain the staff from doing even small acts outside of their specific role. This is not their fault. Be kind; be generous. Smile, and try not to make their day miserable”.

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