ourNHS

A hospital Love Story

We are told by its opponents that the NHS must 'profoundly transform' its culture, even if that means privatisation. But this patient finds the NHS culture is still something wonderful.

Fred Inglis
29 July 2014
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Image: Stockton NHS Trust. Rights reserved.

In that incomparable movie, the 1947 version of James Thurber’s classic The Secret Life of Walter Mitty, the hero, working for a publisher of short fiction magazines, comes up with a bright idea for a new series, ‘Hospital Love Stories’, only to see it pinched by his boss.

This little article is a new kind of hospital love story, flung in the teeth of a recent Daily Mail headline (and countless others like it), ‘National Health Shambles’. I hope it will be tossed on to the desk of the well known moralist of the day, the Guardian’s very own Simon Jenkins as he joins the lynch mob outside the Mid-Staffs Hospital and, with Jeremy Hunt, ‘peers into the entrails of NHS culture’.

What follows is an everyday story of hospital folk and their culture, a small slice of anthropology from an observer-participant. The place and the names are undisguised. It is intended to lift up the hearts of all, especially those borne down by lies and tattle and bullying innuendo in the yellow press and the mouth of the Secretary of State.

On July 4th 2013, in the neurological ward of Frenchay Hospital, Bristol, I was operated on to have nerves in my spinal column redirected towards open apertures and away from blockages caused by collapsed vertebrae.  It is a tricky operation and was carried out with masterly precision by surgeon Nitin Patel, a man of poise and grace.

Once he laid open the bone he and his registrar George Eralil, discovered advanced and widespread sepsis in the whole spinal column.  The condition was serious, even dangerous, as well as causing dreadful pain. The only cure was to administer industrial quantities of antibiotics and hope for the best.

The treatment took sixteen weeks. Initial doses of morphine carried the impatient patient off his head for a day or two. There was a need for experimental varying of the doses when vancomycin caused the body in question to be covered all over in a bright purple rash, and the kidneys to threaten to stall.

At this point, it is timely to pin a medal on the scrubs of Dr Tim Hooper, who was on duty in charge of intensive care.  Naturally, he did what was medically necessary, and all was well. Just as naturally, he took several careful minutes to explain in plain physical terms to the patient’s wife and then separately, to the patient’s daughter, exactly the sequence of the treatment and, if it were to be necessary, what dialysis would do ‘to give the kidneys a rest’.

This hospital saga is not, however, a tale like Walter Mitty’s about calmly smiling, brave and successful doctors, life-saving though they were.  

It is about the culture of the ward, its nurses and auxiliaries, with its two dozen or so (all male) sick beds. It is about the living embodiments of that culture - walking, loving, smiling, caring - in the service of scared boys and tottering old men (me), many who had been taught to arrogantly presume that the point of being a woman is to serve a man.

After a week or so one could discern the frameworks of the rational and humane bureaucracy which, exactly as Max Weber set out, directed the nurses in their impartial, anonymous, principled and efficient discharge of duties always worn lightly and met faithfully.  For cabinet ministers of the present government, bureaucracy is merely a swearword. But the nurses’ conduct provided a moral lesson in grace under pressure. Their culture was not about the cant of ‘professionalism’ but about the discipline of vocation, the lived sincerity of authentic cheerfulness and prompt sympathy.

The hierarchies were visible, simple and effectual.  Nurses nursed. They took blood pressures and temperatures, administered injections, bedpans, clean sheets, sampled blood, brought the weighing scales, came at once to calls for help.  A lower, just as necessary rank of attendants pushed the tea trolleys and dished up the meals, and were no less obliging and friendly. The food was plain, easily digestible, better if you went for the halal than the cottage pie.  I gratefully remember Yasmine, happy to return to fetch the right dish when the wrong one had been served.

These daily and nightly shifts were each carefully introduced to patients by the senior nurse in the ward. Alongside them were more specialist and technical officials, who brought particular unguents (for the rashes), or came to tell you what to expect in the next round of treatment, or assigned you to CT or MRI scans...

Strong, silent men arrived with a large mobile bed to convey the next-in-the-queue to the scansion wards.  An MRI scan is for some helpless victims, including this patient, a brief exploit of pure terror. The uncontrollable panic of claustrophobia grips you in the MRI tube. The only relief is exit.  The staff was marvellously tolerant about this, releasing the poor wretch for a breather as soon as he hit the button, calming him with sedatives, commiserating all the time until the necessary torment was done.

A culture, the set texts tell us, is two-dimensional; it is ‘a whole way of life’, or in E P Thompson’s version, ‘a whole way of struggle’.  But it is also the canonical collection of ‘the best that has been known and thought’.  

The life of the neurological wards of Frenchay Hospital embodies the very best way of life sixty-five years of the NHS could imagine for itself.  I think of the calm easiness of manner, the unforced solicitude in her attention, the ready and pleasant conversation of nurse Kim, strongly built, beautiful, brisk.  I see her as the actualisation of the noble ideals which have so shaped hospital life as it teaches and brings out the best in its staff, the Mid-Staffs staff notwithstanding.

Of course, Mid-Staffs is a horrible aberration; everybody knows it to be so and hence the fuss.  Frenchay on the other hand is how it ought to be. I remember with affection Tom, who looked after me for a while during the worst of my illness, and then, moved to another ward, came to seek me out and reassure himself I was doing alright.

The staff were drawn from across Europe and the Commonwealth. Lauren, Steffi, Gloria, Louise, Lucy, Bessie B, Caroline, and their comrades from Austria, Malaya, Sri Lanka, the Philippines, Newcastle, Penzance, Sydney worked together amicably.

No doubt things went wrong in those long, gaunt, single storey corridors (Frenchay was built as an Air Force Hospital during the Second War). There were times when you simply could not find out from anyone what was going to happen to you. But at the same time it is important for us all to grasp that even the all-wise consultants may simply not have an answer to the desperate questions, ‘Am I getting better?’ and ’What next?’.  

Predictably, the mechanisms of social class retained their old grip. If one could speak in the right accent and with due determination the registrars would phone you back with the news you needed. But there again, phone they did; I don’t think they would have done that thirty years ago.

Just occasionally, lost in the egomania of illness, it might seem that a new, nasty symptom – this swollen joint, that unexpected toothache – wasn’t heeded and might be sinister. Almost always, however, doctors and nurses, paramedics and physiotherapists, assiduous cleaners and the porters, responded to bodily disease and physical anguish with a startling, composed beauty. The culture was one of reassurance that fearfulness and deathliness will be quietened down by competence, confidence and knowledgeability, and thereby kept at a respectable distance.

These loose and fragmentary recollections of an observer-participant are shored against something ruinous in the larger national sensibility of the day which makes for rancour, misanthropy, vague and directionless hatred.  A short story from Frenchay Hospital may serve to remind us, however embarrassing the words, that loving kindness lives in these institutions, and that their best medicine keeps for us all the promise of the utter happiness attendant upon the restoration of good health.

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