I had awoken with a new ileostomy pouch on my right side, positioned, according to my surgeon, at the end of my small intestine. I did have an added extra; a vent bag plugged directly into my colon through my stomach on my left side. Attached to a pipe that ran directly into my bowel, this was there to prevent any further problems arising from the fistula on my hip. I was told that at some point this would be pulled out, with no anaesthetic, which filled me with angst but I would worry about that later.
The surgeon had also remved my appendix at the same time. Not that there was anything wrong with it, it was just a precautionary measure to limit any future trauma.
My now extended stay, at the NHS' pleasure, seemed more and more to me like a prison sentence than a period of recouperation. Although the bed location changed and the ward room changed, the experience was still familiarly repetitive.
Let me walk you through a typical day on the ward in an average hospital in the UK.
Regardless of the evening before, whether you were successful at getting to sleep prior to midnight or not, you will be woken regardlessly at 6am when the nightshift has to take the first of the days 'obs' ('observations' to you and I), which consist of body temperature taken using the ear probe device and a blood pressure reading using the traditionally velcroed arm band and noisy machine that is wheeled about the ward from patient to patient.
"Bleary eyed and non compus metis .."
Should you be one of those unique individuals that is able to instantaneously drop off to sleep again following a disturbance, then you will be fine at this stage. However, if you are anything like myself, once disturbed I find my mind engine begins to start up and the difficulties of retrieving slumber again elude me until the next phase of the morning routine.
At 7am, the morning shift of nurses arive .... and the lights go on. Not only at the ward nurse station, but the corridors (if there are any) and the ward rooms. Bleary eyed and non compus metis, the ward swings into action with a 7:30am start at the individual patient washing gambit. Those patients again lucky enough to be able to walk are a godsend to the nurses and healthcare assistants; a quick command to march off to the sinks with their washbags is a tick on the list. Those unfortunates who are restricted to their beds are another matter. When it's your turn to be honoured in this daily ritual, a healthcare nurse descends into your bedspace, draws the discretion curtain and brings the bowl of hot water and wad of wipes. If you have shower gel, it will be added to your bowl, frothed, and applied to your naked body following being stripped of your nice green, one-size-fits-all (ed.-like heck it does!), NHS pyjamas.
However, regardless of whether you're unable to move a great deal or not, it is the 'prime directive' to have neat looking wards and so it is of the utmost importance that patients aren't lounging about on their beds, rather, sitting nicely in the somewhat uncomfortable seats next to their cabinets for the day. So, once washed and dressed in a clean set of (not) made to measure pyjamas, you're sat in your chair awaiting breakfast and the tea trolley.
" .. not the most glamourous affair .."
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| On the ward in those months, you can see the weight loss I suffered |
Breakfast in hospital is not the most glamourous affair, very basic and simple. Added to that, it is also regularly the same. On the breakfast menu is:
- Cold toast (its frigid temperature owing to the fact that it is made en-masse prior to the trolley coming into the ward from the small kitchenette. If you're looking for an adequate weapon to throw at people, save this item and use in a modified frisbee action at 10 paces)
- Cornflakes
- Rice Crispies
- Bran flakes
- Ready-brek porridge
- Orange juice in an unbelieveably difficult to open carton which, if navigated unsuccessfully, will decorate the ward floor in front of you in a nice orange swatch
From the drinks trolley, you have a choice of either tea or coffee and your choice of milk (whole fat, semi, or skimmed).
While you are still consuming your breakfast, the teams of doctors flood the ward. Each primary consultant (that you have been assigned to, and there could be as many as 3 or 4 consultant surgeons on the ward) has a team of associated doctors, secondary surgeons and a phalanx of trainee doctors in tow. Depending on the severity of your individual circumstances, the curtain may or may not be drawn while you are visited.
Your notes consulted from the mobile notes trolley, the team leaves you alone for the day having requested blood tests, x-rays or other specialist actions. Following the doctors rounds, which should conclude at about 10:30am or 11am, the phlebotomist swoops into the ward like a vampire in a white coat. My phlebotomist was great. With the veins I had, she always knew how to tap my veins to obtain blood if it was needed. We used to have many a discussion on all topics.
" ..like a vampire in a white coat."
Your blood having been drained, if you were lucky enough to be on the list, you should now be in receipt of your menus for the following day. These, if you are in a hospital that has outsourced its meal supply to an external contractor, are a sheet of tick boxes for your lunch and dinner. I found this very bizarre. It was difficult enough knowing what to eat on that day, let alone having to choose what you want for the next day. Peoples taste can change hourly; what you fancy to eat one hour might be something completely different the next. The menus used to be arranged in a three week rota. This changed to a two week rota where I was able to begin to predict what meals were offered on what days. This then seemed to be reduced again to a weekly rota so that every Monday the meals were the same, every Tuesday the same, and so on.
It did get to a point where my wife was bringing in rotisserie chickens from the supermarket, soups not available on the menu and we even sent out for evening pizza, chinese and indian on a few occasions.
Digressing from my daily breakdown for the moment, let me touch on the food aspect. It was at this time that a documentary was completed on television about the NHS outsourcing their meal supply to external contracting companies. The hospital that I was residing in had their contractor featured heavily on the programme. Being in charge of the television remote control for the ward, I was in the unique position to ensure all patients in the room saw the show. Such was the programme, the following day the hospital catering department urgently sent around 'Satisfaction questionnaires' for all patients to fill in. I can say that filling it in was very satisfying. I recanted all my problematic issues with the system; the poor quality, the importance of nutricious meals to aid recovery and previous meal disasters.
"This was, in my view, totally inadequate"
So, to return to the daily diary. After the tea trolley returned for a ward sweep at 11am, the ward physios now cascade through the ward doors and begin their tireless activity of moving the more mobility needy patients. In my case, I was one such person requiring the attendance of these teams. One of my gripes with some of the physio sessions is that, owing to the nature of the circumstances of the NHS, they have to get around so many patients in an allotted amount of time which was 10 minutes per patient. This was, in my view, totally inadequate. With most in this time frame, it was only possible to get the patient to their feet, walked 10 feet in the ward room, turned and walked back to their bed.
Another of my exasperations was one of ability. Some of the physios I encountered were unable to both interpret and understand restrictions from a physical perspective. Rather than analyse how the injuries I had sustained limited my movement in differing ways, they instead expected that I should be conforming to their taught practices and ways of conventional movement. I feel that a team should be able to look at a patients file, note the injuries sustained, and develop more ideal ways of adapting movement to yield the best outcome, rather than just expect that all patients are 'equal'.
If you were lucky to be seen by the physios before lunch, then count your blessings. If not, you'll be scheduled afterward.
Since my original move to this hospital 6 months ago, the way of serving meals changed. Lunch would now arrive at 12:30pm by way of a heated food trolley, rather than reheated in the kitchens. The previous days meals selection tick sheet is referenced and your meal is served.
" .. a woefully inadequate filling .."
Lunch over, physios receeded, there was then some adequate respite before the first of the visiting hours with another return of the tea trolley at 2:30pm. On some occassions, the porters (also sub contracted with the cleaning staff to the same company that handles the meals) would take you to x-ray if required. At 4:30, it was visiting time for an hour, giving you a little time to catch up on events on the outside.
At 6pm it was tea time. Tea usually consisted of a combination of:
- A sandwich (which already on the Use by date on the packet had a woefully inadequate filling and barely any butter. If there were any left over, these sandwiches would be collectively sold to the nurses the following day)
- A salad (consisting of a large proportion of coleslaw, beetroot, lettuce, a cut tomato and an added extra which was either processed turkey, ham, plain tuna or corned beef)
- Soup (tomato, vegetable, chicken, mushroom if you're lucky or a local specialty that left you aching to rub a scouring pad over your taste buds)
- Cheese and crackers (a packet of two Cream Crackers and a small shrink wrapped centimetre square by 4cm rectangle and a pack of butter)
The nurses on the night shift would arrive at 7:30pm and the handover would commence. This was either done by senior nurse to senior nurse or, if time was going to be an issue if staffing levels were low, by a recorded message detailed by patient and bed number.
8pm saw the drinks trolley of coffee, tea, Horlicks or hot chocolate be dispensed. Then the night team would busy themselves with preperations for the nightshift; obs, catheter bag emptying, urnine bottle replenishment and other tasks.
Depending on when you wish to sleep depends on whether the television is switched off in time. Additionally, the noise levels are tried to be kept to a minimum but this is not always possible. Nurses will still have jobs to do, the lights are dropped but not switched off and unforseen problems with patients in the middle of the night still arise.
That concludes the daily grind of a typical ward!
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