A long time ago, let’s call it 1988, I was working on a urology ward in London.
Yes it was damp, of course it was, but mostly it seemed full of people having legs amputated. We went through one of those “times”, where a group of patients with poorly managed diabetes seemed to gather on the ward in a cluster, eating unwisely, smoking too much, not quite embracing self-care in a way they might.
The sister, whom I believed to be close to all-knowing, managed wonderfully but she was mindful of the fact that her ward was changing slightly because of the different needs, treatment and experience of the patients. She was also aware of the fact that the morale of the staff was being affected. We know this, of course, but some members of the general public may be surprised to discover nurses do not enjoy removing limbs from ill people.
Anyway, as Christmas drew near, the rush of amputations had slowed and the ward was calming a little. The patient group - mainly older people but with a smattering of others - had varying feelings about being in hospital at Christmas. Some dreaded it, one or two seemed ambivalent but a few, particularly among the older ones, were seemingly quite relieved. The sister knew this; we all did. When I asked one nurse if we would, before Christmas, be discharging a woman who was approaching 80, lived alone and had one less leg than when she had arrived, she said: “Why would we rush her out, under the circumstances?” Which struck me as reasonable.
When Christmas came we made a bit of an effort. There may have been dressing up, there may have been singing, there was definitely laughing. I suspect our attitude was borne in part from relief - the lead-up to December had felt difficult and relentless and, perhaps, there was a sense that helping patients who were lonely or recovering through an emotional time was part of the job. There had been so much misery among the patient group and we felt it because misery is contagious. In my head it doesn’t feel that long ago since that Christmas but culturally, professionally, and organisationally it may as well have been another country.
I was thinking of that Christmas when I read last week that hospitals were full to bursting, which was creating a dangerous environment for patients. Coming as it did a few days after another report on poor standards of care, I was struck by the seeming reluctance of the news tellers to put those two observations together. Is it possible that nurses find it harder to care in overly full hospitals? If misery is contagious, might danger be too? I’m not saying this is remotely close to an excuse, but could it be part of a reason?
Beyond that I also wondered about the culture of the “overly full and dangerous” hospital. It is hard to imagine nurses being able to think as holistically about the wellbeing of the lonely new amputee as we were able to in the past. The pressures and measures used to drive care decisions are not made according to those sorts of judgements - judgements that took
into account the wellbeing, recovery, humanity and emotional residue of the patient rather than just the immediate clinical need.
And I suppose I can’t help wondering: might the absence of care that concerns us all also have a little something to do with a decision-making process that effectively outlaws proper care? Or at least limits its nature?
Have a good Christmas when it comes. Be kind to yourself.
Mark Radcliffe is senior lecturer and author of Gabriel’s Angel