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Renewed appreciation for the NHS

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After an accident on holiday in France, Kate found herself admitted to hospital and needing to adapt to healthcare in an unfamiliar culture

We had been enjoying a pleasant Sunday afternoon drive in a part of rural France we know well. We’d called in for a coffee at an auberge and were on our way back to our accommodation when, suddenly, a car hurtled out from the left at a crossroads and crashed at high speed into the passenger side of our faithful old Toyota.

The first thing I remember was my husband telling me to undo my seat belt because it was restricting my breathing and seeing oblique cracks running down the windscreen. 

A passerby alerted the emergency services and I was cut out of the car so that they could deal with me. We waited for an ambulance to take us to the nearest hospital and X-rays showed I had multiple fractures: to the neck, pelvis, sacrum and hip. My husband’s glasses, however, were lying safely on the back seat entirely intact!

”I had multiple fractures: to the neck, pelvis, sacrum and hip”

Some consideration and kindness was shown at my reception at the hospital’s A and E, but my husband who, though not requiring hospitalisation, was badly shaken with a serious whiplash injury and various cuts and bruises, was not offered the chance to sit down for six hours, apart from an X-ray session and an interview with an unhelpful doctor.

A nasty cut on his leg was examined, without wearing gloves, something smeared on it, and he was told it would be all right. (Back in the UK, the cut became ulcerated and had to be treated with antibiotics. The area is still quite sensitive.)

I was measured up for a ‘Minerve’, a neck brace that had to be worn for at least three months. It came with two smart, stretchy cotton T-shirts.

I must have been given powerful painkillers, as the wall opposite my bed began to bulge and dance, while patterns resembling ferns and fanciful plants in tasteful shades of grey and white moved incessantly over the surface. 

”I was encased in a rigid corset that reached almost to my waist, back and front, and felt extremely stiff”

James Rennie Macintosh might have been inspired by my hallucinations! 

I was encased in a rigid corset that reached almost to my waist, back and front, and felt extremely stiff.

The reality began to sink in. At least three months… No turning over in bed, just lying flat on my back.

And my situation got worse: unbeknown to me, any violent disturbance to the pelvic area could cause digestive problems. The first bowl of soup I was given was rejected by my system very quickly, and most of it was received by the nurses round my bed!

The whole gamut of constipation remedies was tried: pills, potions, powders, suppositories, prune paste (delicious!) and finally some sort of salt solution. 

For several days I had to fast until lunch time, and then only have a bowl of soup for lunch and dinner – I actually didn’t mind that too much, though it did become a bit tedious in the end. It wasn’t until they were absolutely sure that my stools were acceptable in every detail, that I was allowed to partake of the hospital menu – no choice, but it wasn’t too bad - we were served a four-course lunch every day!

Recovery

I had thought that the French physiotherapy service was living up to its good reputation, starting me off again on my feet, and I soon progressed from frame to crutches. It wasn’t until I got back home, however, that doctors forbade any weight-bearing on my left leg because of damage to the sacrum, which had not been picked up on by the French doctors. 

It was almost as bad as going back to square one, because I had to spend several weeks hopping with the aid of a frame!

Apart from essential daily care and medical attention on the ward, my experience was not a happy one.

On the whole, I was made to feel like an intruder, expected to immediately understand the system even though I was unfamiliar with it. After a very few days, the daily question began to filter down from the higher echelons, first the doctors, then the rest of the medical staff: “Any news about your repatriation?” Or just, “Any news?”.  

”I made it quite clear in no uncertain terms that I was aware that they were trying to get rid of me”

I was not made to feel that concern for my welfare and happiness were behind this interest. I might have been better off if I had not understood any French, particularly on the occassion when a group of doctors were at bottom of my bed discussing the patient who had overstayed her welcome. I made it quite clear in no uncertain terms that I was aware that they were trying to get rid of me, and that as far as I was concerned I was doing my best (or my husband was) to activate the travel insurance company and would be delighted to return home as soon as possible.

Articulation while wearing a tightly fitting brace is not easy and French requires more mouth movement than English but I succeeded in making my point, and there were embarassed denials, smiles and even some attempts at jokes after that!  Added to this, I realised that the medical report required by our insurers was in the hands of the doctor on my case, who did not seem to be making any progress! I mentioned this to a more sympathetic doctor and there was an increase in affability.

The daily regime was 12 hours in bed and 12 hours out of it, depending on the circumstances.

Supper was served around 6pm often rushed through as quickly as possible and sometimes the room doors were shut well before 8pm.

It was late summer-time and still broad daylight, as well as being quite stuffy in a small, warm room. There would be frantic activity leading up to the door closure, no encouragement to prepare calmly for the night, or any help for me in my initially prostrate state to clean my teeth and get ready for bed.

Those who wished to read or watch television were free to do so, but I was not in a position to do either with any comfort. So I just chatted to my room-mate until she fell asleep.

I needed to pass urine very frequently, especially at night, so I accustomed myself to lying there, calculating how much longer I could last before using the call button, given the fact that this was rarely answered promptly. Then, the door would open, harsh light flooding in from the corridor framing a stony face, and I would be at the mercy of the skill, or lack of it, of the member of staff wielding the bed pan.

Sometimes it seemed ages before it was collected, and I’m convinced that some of the staff thought I’d called them on false pretences. A doctor I spoke to since I returned to England was surprised that I wasn’t fitted with a catheter.

Another fact that required reinforcement was the increasing discomfort of pressure points caused by the neck brace. When some protective padding was provided, it never stayed in place, and being at the back of my head, was impossible for me to adjust. During the day, I looked like some kind of wierd, sad clown, or a reject from the Commedia dell’arte, with pieces of yellow or blue padding flapping round my ears!

I lay, night after night, imagining the development of raw patches on my scalp. Towards the end of my stay, some of the staff were persuaded – and it took some doing – to work out adequate protection for my sore head.

French hospital beds are narrow and uncomfortable, so another nocturnal torment was back pain, which developed around 5am, causing me to toss and turn until between 7 and 8am when the new day and breakfast arrived. Tossing and turning, by the way, while wearing a neck brace is hard to imagine, but I did my best!

”I think they were unaware of the psychological effects of the accident”

My inability to get in and out of bed made me entirely dependent on help, which was not always willingly given. These manoeuvres were recognised by the physiotherapists as some of the most difficult, given the fact that I was wearing a heavy brace and that I had several fractures down one side.  Most of the medical staff were actually able to explain to me what to do, and I understood well enough, but what they were unable to realise was the time it took for me to co-ordinate the necessary movements. 

I think they were unaware of the psychological effects of the accident on my reactions, which were slower than normal. 

How much impatience I encountered from poorly trained or uncaring medical staff – from the sarcastic: “Oh, if the physios say so…” to the refusal to extend a hand in the right direction, a judicious push, for example, which would have helped me cope with what seemed then an impossible weight to push up from my head end.

Some of them actually lifted me onto my bed, but I didn’t request this, so it didn’t really help in what should have been a positive  learning process.

I can’t forget the confused tirade, spitefully informing me that if I did not master this technique I would never be independent and that when I did get back home, where there would be no hospital places for me, I would be forced to fall back on some inferior help at home, so how would I cope then? 

Everyone had seen me walking up and down the corridors with my frame, so why couldn’t I get in and out of bed?  Ignorance, assumption and a callous lack of care.

If no nurse or assistant was available to answer the call button in person, a sulky, disembodied voice would sometimes shout through the intercom system: “Que voulez-vous?” (What do you want?). To answer, you had to be sure to project your voice and keep the request fairly simple, otherwise no help, even grudging, would come. 

My 83 year-old room-mate had the right idea, enunciating very clearly and succinctly: “Pipi”. Her sense of humour was intact. The same elderly lady was one day left to wash her top half while the care assistant went off to have a late breakfast. An hour later she returned, with no apology, saying she’d had to attend a meeting. This lady was in the early stages of incontinence. I once heard a trained nurse complaining quite audibly to her colleague that all she seemed to do was empty bed-pans, followed by my room-mate’s quiet comment: “You’ll be old one day”.

Part of the way through my wash another day, a nurse announced: ”It’s Sunday, and we’re not washing feet!” (Admittedly, they were short-staffed.)  My reply was: “But I didn’t get my feet washed yesterday, either”.  

Silence.

The following weekend my feet also remained unwashed. There were no useful slipper-socks for us to wear, so I’d been reduced to using the well-worn trainers I’d been wearing at the time of the accident – no socks.

Once a week, there was the chance to be transported to the bathroom to use the glorious ‘douche brancard’ (stretcher shower), which involved the added privilege of having my hair washed.

But benign, merciful faces did occasionally appear, mostly at night, beaming down on my flat, rigid, comfortless repose. They probably contributed to my overall recovery, via the psychological route – absence of fear is a wonderful healer and comforter. 

Once, in the dead of night, I heard the whisper in my ear: (and I must put this in French first, because the English translation loses so much) “Voulez-vous qu’on vous masse les fesses?’” which is quite simply offering a buttock massage. Was I hallucinating again? Or was this an invitation to take part in some voluptuous rite? Naturally I accepted. The kindly offer was made several times and would sometimes include heel massage too.  Sweet almond oil is frequently used in France and in hospitals it helps to prevent bed sores.

”I was always on the look-out for these exceptional nurses, always delighted when they were on duty”

What an unexpected leap from being shouted at and bullied! Then there was the considerate nurse who moved a particularly raucous patient into a single room, so I would be able to get a bit more sleep. I was always on the look-out for these exceptional nurses, always delighted when they were on duty.

The proportion of fully-trained nurses seemed very small, outnumbered as they were by the “aide soignante”, whose limited training only lasted for one year. However, the more experienced ones were extremely competent and seemed as fully committed as the fully-trained nurses. There is, of course, a graded system to distinguish seniority, but no apparent control – in this hospital at least.

A thin veneer of politeness existed, so patients’ names were rarely used, just ”Madame”. Nurses did not introduce themselves, so one always had to ask, or pick their names up as they called to one another. Polite euphemisms were used while washing, as a nurse informed you that she was about to do your ”petite toilette” or your ”toilette intime” ( both meaning ”down under”). 

Nevertheless, beds were not curtained off during these operations, no covering was used to maintain dignity, and I can remember being seated on the commode very close to my room-mate’s bed while she was being washed. Courtesy in language was at times dropped very noticeably, in fact language was infantilised to the extent that the patient’s needs were reduced to one word, either ‘pipi’ or ‘caca’.

My room-mate was perfectly able to use the normal ‘uriner’ and ‘aller a la selle’ (open one’s bowels), so there was no need to bawl at her using childish language.

French style was certainly perpetuated in the plentiful supply of beautifully laundered cloth napkins. Nightgowns were immaculately pressed.  The nurses’ uniforms were well-cut, with smart white trousers and a variety of well-designed tops. 

Returning to the UK

On the nineteenth day an English ambulance arrived to repatriate us. It took nine hours, via the Channel Tunnel, to reach South-East London. I lay in the reception area of Lewisham Hospital for some time, answering questions, eating even a typical “hospital” sandwich with relish, hearing those welcome Irish, West Indian and local voices going about their normal night-time business; two policemen who seemed to be enjoying what appeared to be a peaceful period, and an inspired social worker, with a nonchalant manner and colourful touches to his clothes, sorting out someone’s lifestyle problems.

I was found a bed in a busy, darkened ward, plunged from exclusively North-European company into the multi ethnic one I had become used to over the years, living and working in South-East London.

After perhaps two days I was transferred, at night, into more permanent accommodation, and settled into the ward that was to be my home for many weeks. 

”I’d looked forward to greater consideration, but this was exceptional”

I am not in the habit of exaggerating, but I really did feel as though I was receiving treatment in an exclusive, private institution: genuine concern, gentle, courteous attention, a carefully modulated voice, regard for my comfort, as far as comfort could be achieved considering my circumstances, and the basic aspects of care were addressed with a respect I had not even dreamed of in the previous weeks. 

I slept on a cloud that night. I’d looked forward to greater consideration, but this was exceptional.

So here, in this country, routine certainly exists but it is not imposed by bullying and feet are certainly washed at weekends, even on a Sunday evening - after dinner if necessary!

Yes, there is a serious staff shortage, but this has not led, in my experience, to a lack of cheerfulness and good will. Help is never very far away. Any disturbance is likely to emanate from a selfish, unreasonable patient or a weak point in the organisation, but there is no evidence of an “us and them” approach in my experience. 

If smiles are not quite as bright at 3am, the reason lies in fatigue and short staffing. Doors are not slammed shut at “bedtime”, and whatever pressures pass down from the hierarchy, these rarely seem to be communicated to the patients. The priority is that the nurses make sure they understand patient needs and preferences, carrying out their wishes within reason.

”Britain’s NHS nurses and all other medical staff cannot be bettered, wherever in the world they originate from”

A major step towards recovery is greeted with unfeigned, genuine delight, on a personal level as well as the reaction of a team. The morning after I had my neck brace removed, I was met at the nurses’ changeover time by a sea of smiling faces – something I will never forget. And the rest of the day, this reaction was repeated from physios to doctors, from pharmacists to occupational therapists, to staff responsible for cleaning and maintenance, to the ladies who pushed round the drinks trolley – everyone was genuinely pleased, tempting me to feel a bit like a celebrity! 

In conclusion, I can safely say that on this side of the Channel I encountered a higher percentage of truly dedicated nurses, student nurses and health care assistants, some of whom were quite frankly inspiring. 

Professionalism is one thing and is greatly to be desired, and it was demonstrated equally by the physios and the occupational therapists, but if to this is added tender-heartedness, a sincere desire to relieve pain, and a constant well of good humour, courtesy and energy, then Britain’s NHS nurses and all other medical staff cannot be bettered, wherever in the world they originate from. 

It is vital that this ethic is not lost.

Kate Kolesnik

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