Tue 13 April, 2004
Another good day. Walking around, exercising and continuing to improve. Today the hospital returns to the normal routine after the four-day bank holiday. I arrived on this ward on Good Friday, and today is the first official working day since. There is a marked difference in pace.
During the doctors’ round, I asked one of the surgeons if he would spend a few minutes with me to tell me what had happened in the operating theatre. I said I was trying to write a full description of what had happened, mostly to work it all out for myself. He agreed to return after the ward round was complete.
During the ward round Mr Mudan noticed that my right knee was swollen and requested an X-ray. I had thought that he only dealt with the soft bits and that the bones were someone else’s responsibility. I was wrong. The consultant is in charge of all medical care, so I should have told him that in fact my ankle was giving me more pain than the knee. This was a case where my brain did not act quickly enough.
Meanwhile, I carried on writing and during that process managed to convince myself that I must have blacked out prior to the collision. More on that tomorrow.
The surgeon came along, and told me he had about 5 minutes to talk. I think he stayed for about 25 altogether, as we went through the details of what happened and then discussed some of the background to the incident and how they had made the various decisions during the early stages of the treatment. It was fascinating talking to him, and I think he quite enjoyed it too, as I gave him a couple of opportunities to leave, but he took the conversation forward. We talked about who worries and why, and how the surgeons have no time for worrying about their decisions. Worrying doesn’t help, he said. True, that.
At about 2 o’clock, a porter came along with a wheelchair. I was unprepared, but climbed into the chair while the porter gave me a blanket to cover my knees. He whisked me down to the X-ray department where I spent half an hour or so waiting, with nothing to do. Eventually I was wheeled into a large room and told to lie on a bed, where the radiologist positioned the camera above my knee and retired behind a screen. The machine buzzed for a moment and the radiologist re-appeared. She took the plates away to check that the image had been exposed properly and sent me on my way.
On the way back, I realised that my medical notes were tucked into a pocket behind wheelchair and I had missed a golden opportunity read them while waiting for the X-ray. I managed a few minutes looking at them before the porter handed them back to the nurses on the ward. They did not tell me anything new.
The physiotherapists came round once more. They asked about my knee and I told them about the ankle. One of the assistants fitted me for a walking stick. Despite his best efforts, it was too short.
The Daily routine
Our day officially starts at around 6 am, with a blood pressure check. However on a busy night, the activity on the ward never really stops. It so happens that my berth is in almost the worst possible location within the ward. The ward comprises a long corridor, off which there are a series of bays, each containing six or eight berths, arranged three or four on each side of the bay. Two bays are for women; two for men. The best position in any of the bays is next to the window, as we are up on the 5th floor of the building and there is a magnificent view over London from the ward. I am in the berth nearest the corridor, and furthest from the window. I barely even realise what the weather is outside, let alone see any of the view.
One of the advantages of being near the corridor is that I see pretty much everything that goes on. I can see the main administration station, the nerve centre of the ward, where appointments are made, the notes are kept and all the nurses gossip about the patients, the doctors and their various paramours.
Many of the patients are moved between wards and within the ward overnight, so there is often a great deal of activity along that corridor, and lights go on and off. On a busy night they might move 15 or so patients, and bring another two or three onto the ward. Each of these admissions involves a long interview with the patient, and because of language difficulties, strong accents and other factors, the interviews are often held at high volume.
Then there are the emergencies. If a patient vomits, or has some other kind of crisis, then the nursing staff have to respond. Again, the sleep of other patients does not appear to be a high priority.
Nevertheless, whether the staff have had a busy night or not, the lights go on and the activity starts to increase around 6 am. The first official call is the blood pressure check, around 0630. This involves an armband around the upper arm; a clip attached to a finger and a disposable thermometer in the mouth. The armband is a standard blood pressure monitor. It inflates, restricting blood supply, and then steadily deflates until blood is able to pass once more. Sensors in the air pressure system detect the flow of blood both at systolic and diastolic pressures. The clip has a red LED which detects the colour of the blood, and hence calculates the oxygen saturation level, while both the clip and the armband give a readout of pulse rate. The disposable thermometer shows the body temperature. All this data is noted in the daily record book and on a chart, which eventually finds its way into the patient notes.
After this, I usually go for a shower and shave, before the other patients emerge. There are four toilets for use by about 30 patients and about 10 staff. In addition, there are two bathrooms and one shower room. All are properly fitted with sturdy support bars and rails for use by disabled people. These supports proved very useful. I can see why anyone with even a slight disability would need them in their home.
Many of the patients have catheters fitted, which means their urine drains directly from the bladder, through a silicone tube and into a plastic sac, with no voluntary effort on their part. I had one of these fitted for three or four days. Although this may seem somewhat revolting, it was quite a pleasure not to have to visit the bathroom during the night. The sensation as the catheter was withdrawn, however, was certainly something I have never experienced before.
By eight o’clock, the pace starts to pick up. The first event is the morning handover, when the day shift takes over from the night shift. The nurses visit each bed in turn and briefly discuss the events of the most recent 12 hours. Next, breakfast comes around on a trolley, followed by medications, and changing the bed linen. These are swiftly followed by the highlight of the day: the doctors’ rounds.
This being a teaching hospital, the consultants are followed by a trail of junior doctors, learning the medical trade. These consultants are at the top of their respective professions. Mr Mudan and Mr Finnes in general surgery ; Mr Day in orthopedics and others. These are the people called in to operate on the Queen and other important figures in politics, business and government.
The doctors sweep into the ward, followed by their trail of students, and they have a brief -- two or three minutes—consultation around each patient, in which they discuss progress with the doctor in charge of the case. It is quite clear that these consultants operate on a rapid time clock, they speak quickly, make decisions quickly and walk faster than anyone on the ward.
If you, the patient, want to ask a question you have to be quick and spot the opportunity, because the visit is over quickly.
Once the doctors have left, the pace of ward life slows down once more. Usually the blood man comes along to take a sample of blood for testing. He has many nicknames, mostly revolving around vampire or bloodsucker. Even so, he is skilled with the needle and I barely feel his needle going into my vein. Another check of blood pressure and then calm for a few hours until lunchtime. The patients either sleep, read, watch TV or, less commonly, chat. Some of the women go to the common room to watch quiz shows and other daytime TV. The nurses get on with their many tasks, while the cleaning crews come around, sweeping, cleaning and polishing.
Lunchtime comes and goes. The food is surprisingly good, with soups, meatetarian and vegetarian options, salads, and fruit. More medicines and another blood pressure check, followed by a nominal rest period between 1pm and 3pm. Visiting and the noise starts at 3pm. Some people get a lot of visitors, others rather fewer. But the influx of visitors changes the atmosphere on the ward.
This is London, so the visitors are mostly in a rush, wanting to get as much done in as short a time as possible. This wave of London energy comes into direct contact with the slow, steady pace of the ward, and then moves on.
The evening meal arrives around 5:30, with more medicines at 6 o’clock. By 8 o’clock the visitors have mostly left and the ward returns to normal. Another change over, with the night staff coming on duty at nine o’clock. By 10, there has been another round of medications, more blood pressure checks and a nominal lights out, ready for another night of admissions and bed changes.