wendy house

12noon 7th September

18 days after surgery Jess walked me through my exercise regime – to be repeated once an hour for 15 minutes. That’s intense, almost no room to do anything else!

1. Lie forearm on a table. Keep the elbow still and roll forearm left then right as far as it will go.
2. Move thumb across the palm then away from the palm – as far as it will go.
3. Move each finger back as far as it will go and hold for 20 seconds.
4. Curl all fingers  into a grip position – squeeze a foam ball
5. Move hand from wrist – backwards and forwards, side to side, as far as it will go.

Massage the skin around he scar with a good moisturizer to encourage healing and blood flow.

It feels like a ritual, casting a spell…

4pm 28th August: 6 inch scar revealed

10 days since the operation, with my arm in a cast, I returned to the Fracture Clinic for my first follow-up appointment. The statuesque painted blonde nurse admires the neatness of my scar and stitches as she removes the cast. The petite naturelle orthopeadic physiotherapist also compliments the neat scar that’s healing well.

Is that all you can move it?

It hurts quite a lot….

The physiotherapist demonstrated a regime of daily exercises.  Our schedule involves weekly physio check-up sessions and an overall progress check in mid October. After explaining this she just stood up and left the room.

I sat there in silence for a while, It was a wierd segue. Was this the end of the session? Was she coming back? Was someone-else coming in? Should I leave now? The statuesque painted blonde nurse wandered in and gave me a ‘sick note’ for my employer – so they can claim my Statutary Sick Pay.

Do I leave now? Will the appointment times be sent to me?

Go to reception, they’ll sort the appointments

The young receptionist was flustered. She couldn’t work out how to book my Physio appointments. I was the 3rd patient this afternoon that had asked them to arrange this type of appointment….

The patient behind me in the line laughed:

I used to work at this hospital, there’s a 2 week waiting list for a physio appointment, you wont get one next week!

The young receptionist looked bewildered, earnestly asking me:

Do YOU work at the hospital?

No. I’m just a patient. The blonde nurse sent me here when I asked if the appointments would be sent to me.

Oh, if you don’t mind waiting I’ll go and ask them

Thankyou, I don’t mind waiting at all

She smiled, her wonderfully humble and respectful way added a little joy to this otherwise dour place.

6pm (ish)  18th August *

I can’t be sure of the time when I came round. I wasn’t screaming. A nurse noticed me gain consciousness, she was prepared with my request for a pain killer

This is the equivalent of drinking a bottle of Vodka, but it doesn’t taste as nice

A porter wheeled me back to the ward where I greeted my fellow patients and happily climbed back into bed 26. As I started to snuggledown ready for a drug-enhanced dreamy sleep

Stout Agency Nurse walked over with a big smile:

You can go home now

Instant tears. She pulled the curtain around my bed as I spouted all the reasons that I felt that I couldnt go home now:

• I wasn’t stable -  I could hardly stand up!
• I would have to use public transport which the patient guide recommended that I should not do (no lift arranged until tomorrow)

• there is noone at home to look after me for the critical 24hrs after the surgery.

She told me that I had misunderstood. Naughty me misunderstanding while I’m drugged-up. She wasn’t sending me home right now. I asked her to leave me alone, which thankfully she did.

Then I climbed out of bed, opened the curtains to my neighbouring patients who were all real sweeties gently teasing me about this and that.

3.30pm 18th August

The stout nurse bought over 2 of those ‘operation gowns’ – knee-length, short-sleave baggy jackets with small ties. She asked me to wear one with the ties at the back and one over the top with the ties at the front.

Where are your ID tags?

I ‘ve never been given any

You must have ID tags

She wandered off and returned with 2 plastic strips showing my name and date of birth, attached one around my good wrist and the other on my ankle. Strange dresses and plastic wristbands?  Just like going to a festival!

We’re walking to the operation Theatre? Should I wear my sandals?

Stout nurse grabbed my arm and used this, unnecessary, technique to steer me down the corridor towards the Ward’s reception desk. At the reception desk she confirmed the name and route to the operating Theatre. I didn’t take notes. As we walked the hospital corridors where other people were fully dressed stout nurse explained that she was an agency nurse so she didn’t know her way around this hospital.

We got lost.

Stout agency nurse asked directions and we found the right set of swipe-card operated doubledoors. The nurse told me that she had meant to borrow a swipecard from the ward reception, but forgot.

I started crying.

Are you in pain?

A flood of words burst through my tears about how disconcerting it was when you have to walk in a silly dress amongst fully clothed people, how scarey it is to have surgery, and how getting lost then being locked out of the operating theatre just adds to a general level of distress.

You’re not in pain?

Normal pain for a broken and dislocated tibia

She didn’t understand. I put some effort into quelling the tears, wiping my face on the sleeve of the operating theatre gown. A lady’s face appeared in the round window of the secure doors. She wore green and a little hat. Her body-posture inspired confidence.

The anesthetists assisstant greeted us. She looked me in the eye as she told me her name, her role and started explaining what was going to happen. I gave the agency nurse my sandals as I climbed onto the operating table. I told her about the times before that I’d had a general anasthetic and how I was scared of waking-up screaming in pain like my last operation. The last thing I remember before waking up was her reassurance that I wouldn’t wake-up screaming in pain….

9pm 17th August: check-in

Friday night on a Trauma ward was set against a background chorus of quiet crying, distressed mumbling and snoring. A blanket of private sadnesses reverberating through the ward.

The lady at Ward reception wasn’t expecting a patient to checkin. She went off to find someone who might know about me. A 2 inch thick folder of patient notes lay on the reception table facing me. I read my name on the cover. Mainly empty forms, no X-Rays, no notes, a couple of interesting letters from my GP. The lady returned.

Bed 26, follow me

The silver haired patient in bed 24, opposite, smiled and nodded in a silent welcoming way.

2pm 16th August: Hospital check-in arranged

After nearly 5hrs witing at the RBH fracture clinic a young lady wearing a white jacket and stethoscope tells me what’s going on. Hooray!

There’s a hand and wrist specialist surgeon on duty covering Accident & Emergency over the weekend. Since the operation will be tricky they want a specialist to do it so they’re going to book me a bed in the Trauma ward for the weekend and the specialist will operate on me inbetween the accidents coming-in.

So, hospital checkin on the 17th August after 7pm.

Meanwhile, I provide Pre-op information to a nurse in another building. The nurse gives me a large glossie brochure about coming into hospital.

Don’t you just want to climb onto that trolley?  So welcoming…

12.30pm 16th August

After the X-Rays I retrurned to my normal status of main corridor fire hazard. A nurse came out from the back rooms, moved a child off a chair and sat me down in that chair.

The consultant has seen your X-Ray’s, he thinks they are quite serious and you need an operation. He’s called our hand and wrist specialist who agrees. So please wait here.

As she leaves I start crying.  I’m not sure if it’s because:

• of the relief that RBH have actually considered my injury.
• a nurse has been nice to me – rather than treat me as an inconvenient object.
• reaffirmation that my injury is quite serious – I’m scared of surgery.
• I’m developing a bad habit – cry way too easily.

Luckily this time I’ve been accompanied by two large monogrammed white (mens) Hankeys that can handle the waterfall

12noon 16th August

nurse: you must go to X-Ray

wendy: have they seen the X-Rays from Worthing?

nurse: the consultant wants so see today’s X-Ray

wendy: ok

Waiting outside the X-Ray room I chat with a shy Welsh man on crutches. He’s holding a CD from Pontypridd.

Were you on Holiday in Wales?

No, visiting my daughter who lives there now

He explains that the Reading hospital system can’t view his CD copies of his X-Rays, so he’s having the X-Ray’s done again. I suspect the same is true for me, but my nurse was focussed on what can and should happen rather than what doesn’t work.

The CD contains an executible file for a small program that views the X-Rays and enables them to be exported into standard file formats. It was easy to view on my PC. I suspect RBH’s system prevents users from being able to run exectuibles from CDs – for security reasons.

11am 16th August

A nurse announces that the clinics for 2 specific doctors are running 90 minutes late and 2 hours late. I have no idea which Doctor I’m seeing, no paper appointment.

Another nurse moves the people with fractures out of the main corridor to allow hospital traffic to pass. She explains to us that standing in the corridor is a fire risk.

I’m the only person with a fractured arm, everyone ese has an injury to thier legs. Standing on crutches in the main hospital corridor.

I grin at the man who has a mini plaster cast on his toe. He looks suitably embarressed.

4pm 15th August: RBH are not expecting me.

I wandered to the Royal Berkshire Hospital (RBH) to

• find out where I needed to go.
• personally doublecheck tomorrows appointment time.
• hand-over my Worthing Hospital CD of notes and X-rays.

The Royal Berkshire Fracture Clinic weren’t expecting me.  They had no appointment booked and no record of a phonecall about me. They didn’t want my CD to check my notes in advance of the non-existent appointment. I felt betrayed by Worthing hospital not having clearly established the appointment with RBH.

The RBH Fracture clinic reception staff were not happy at my turning-up, unannounced. They tutted and huffed at the inconvenience. I quietly cried. They ignored my tears making it easier to let those tears flow.

They double-booked me into the a clinic on the morning of the 16th.

1pm 14th August

Worthing hosppital gave me a CD with my data on it. They told me this includes notes and X-Ray. I was to carry this information to the Royal Berkshire Hospital (RBH) in Reading town. Apparantly, human hand delivery is more secure and reliable than using a cloud based system or encrypted email….

I was impressed that the two hospitals use compatible healthcare software so they can share electronic data. This assumption was wrong. I thought I was being transferred.  This assumption was also wrong. I was told that the RBH fracture clinic was expecting me at 8am on the August 16th. Guess what? Sigh…

Time to catch a few busses and a few trains…

When you’ve got a broken arm everything takes longer and people are more able to offer help… an elderly gentleman helped me to carry my small bag onto a bus.

 8pm 14th August: Arriving in Reading

Home with my cuddly kitty, fresh bed linen, and tea on tap. A wonderful sense of relief.

A long journey in less than 2 days and more to come…

12noon 14th August

ward nurse: I can’t find your drug chart, you don’t seem to have a drug chart!

She looked flustered

wendy: I’ve made a note of what drugs I’ve been given and the times they were given to me, if that helps?

The nurse looked more relieved as I read my notes to her. The Worthing hospital team never found my drugs chart. From what I’ve seen of their documentation it omits many key details and is frequently inaccurate – for example the name of my GP is wrong and I repeatedly pointed this out. They normally replied by telling me it was actually accurate on some other document that I hadn’t seen. As if getting the information right on one document makes it ok to have it wrong on this one. This is frighteningly poor reasoning for people that are looking after my health.

When I was let out from Worthing the junior doctor (F2) said that I didn’t have a drugs chart because when I was admitted (reported to reception of the A&E) I’d said that I wasn’t

• normally taking any drugs
• allergic to any drugs

I was impressed by how this explanation actually implicitly blamed me for the fact that while in hospital, where they gave me drugs, no-one bothered to keep a written track record of what drugs I’d been given, in what doses, and at what times. Their blazé (not our fault) attitude to their behaviour that produced a major patient safety risk was quite Flabberghasting!

8am 14th August

A flock of Doctors swoop into the ward and bounce from bed to bed with the senior Doctor asking the more junior doctors for thier opinions and quizzing the patient.

By listening to thier garbling I managed to find out that:

• I need surgery.
• Worthing will not be able to operate on me before Thursday and most likely after that depending on what other emergencies arrive.
• Worthing want me to go to my local Hospital (Royal Berkshire) because it’s more convenient. I cried, I felt like I was merely being shifted off thier lists…to start again on another list…
• Doing the paper work to let me physically leave the hospital takes 5 hours.

midnight 13th/14th August

By midnight I’m tired, in pain, lonely, nowhere to go, no book to read and with the prospect of 10 more hours of this.

Barely holding back the tears of temporary, pure, sadness.

I’ll feel better after a good sleep. I’m a talented sleeper. I can sleep almost anywhere. I lay my jacket on the floor against the wall in a quieter part of A&E, then gently lay myself on top of it and started drifting into much needed sleep.

This action removed my invisibility-to-hospital-staff cloak. Staff started waking me up to ask me what was happening.

I don’t know….

mumbled between my tears

Within 10 minutes they’d moved me to a ward and a bed.

8pm 13th August

The unnamed Australian is about to go off shift.

He explains that I need an operation to ‘pin’ the arm. It’s a tricky operation and he wants a good night’s sleep before doing it. They’ll be keeping me in over night for “Obs”, but there are no beds available so I’ll have to stay in the A&E waiting room.

Broken arm. Dead cell-phone. I wonder what more the night holds.

The surgeon injected some drug into the fracture before pulling my arm to ‘reduce’ the misalignment of the broken pieces.

It hurt a lot.

I screamed a bit.

He gave me a lovely hug, just like a parent with a hurt child. That moment of thoughtful kindness was wonderful and helped keep my spirits from crashing dramatically across the next 4 hours. Instead they slowly spiralled downwards

6.30pm 13th August

Doctors are easiest to recognise because they mainly wear a stethoscope around their neck. None of the staff  introduced themselves – no name, no role. They’ve done away with these useful basics. They occassionally use my name to call me out of the increasingly amorphous queue in the waiting area.

Staff were all wearing different uniforms, I don’t know what the different colours and styles mean. Maybe I don’t need to know, maybe the uniforms are for the staff to know who they are, not for the patients. I saw:

• White tops with collars
• Light-blue tops with collars
• Royal blue tops with collars
• Green jump-suits
• Blue jump-suits
• Pink Jump-suits

Things changed slightly after my 6.30pm X-Rays. I became the “Smiths Fracture“. I could evesdrop on the staff talking amongst themselves about me- the fracture.

4.30pm 13th August

After two and a half hours waiting – Triage was disappointingly short. The nurse asked exactly the same questions as the paramedic. Both people wrote copious notes on everything I said. This felt reassuring, more scribblers!

2 hours after triage a young female in one of the many hospital uniforms asked me to tell her what had happened. She also took notes and aked familiar questions.

I started crying.

Are you in pain?

Just normal broken arm pain, I’m crying because I’m upset and don’t know what’s happening.

Do you want some pain killers?

No, I just had some at 4.30pm, thanks, I’d like to know what’s happening (blub)

Everyones’ notes were on paper, on different clip boards. The notes never seemed to get collated, read, or used. I was beginning to get the impression that different specialists weren’t sharing inormation terribly well.

2.00pm 13th August

Do people have to wait hours for ambulances?  I felt a little bit guilty about an ambulance being called because I didn’t need any ambulance-fancy equipment or go-faster Sirens.

I persuaded the young paramedic to take me to Worthing A&E, less that 5 minutes drive away, even without sirens. Standing-room only in the waiting room, good job the curb hadn’t attacked my legs!

Facebook confirmed that my relatives are not shy about liking that I have broken my arm despite the clear social convention to avoid liking such things. The Brit’s normally start thier comments with an empathetic variation on “Ouch!” and the USA people go straight in with the positive get well wishes.

It was so good to feel the waves of empathy and positivism…

Tiger and I tried out the informalness of his patienthood

We asked the nurse if we could leave the hospital for a cup of tea in a local cafe.  The nurse described several places we could go, gave us directions, made sure Tiger had the ward’s phone number and then unlocked each of the 3 sets of doors to let us out. The nurse couldn’t have been more supportive, it was wonderful

Once outside Tiger held my arm. The Co-operative funeral care service across the road  made me smile – for all your funerial needs,  on the hospital doorstep

Tea and honey in a small atmospheric, indenpendent, cafe was all very pleasant.  Tiger was also very pleasant company, albeit with the aid of antidepressant and antipsychotic drugs

5 days after arriving at the Maudsley Tiger was discharged into community care. He happily moved back to his peaceful home and has started coding again…

Take the National Express

I used to enjoy the long distance bus rides when I was a student. A National treasure, so cheap and comfortable and everything the Divine Comedy says…. I must find an excuse to use them again.

Though cheerful, the setting of this video felt a bit spooky given my recent hospital visits:

Finding Maudsley Hospital was straightforward especially with a sign that says ‘main entrance’ and an ‘i’ for information

The “Centre for Anxiety Disorders and Trauma” sounds like just the ticket for Tiger.  He’s been talking using phrases like “I get very anxious” and “it was  traumatic” since before he even got to hospital. The sign label for the centre clearly maps to his, and my, more colloquial language

The entrance area was deserted except for a young man who looked of African origin sitting behind a desk wearing headphones. I could hear loud music escaping from his headphones. When he noticed me walking towards him he took off the headphones, switched the music off, turned to face me and gave a wonderful big smile. He was both cheerful and helpful. The place feels small and personable despite it’s obvious size

The walls are covered in photographs of key influential people in the history of the hospital and patients doing all sorts of things, mainly smiling. Natural daylight falls into the main corridors. Walking the corridors doesn’t feel like being trapped in subterranean tunnels – my normal experience of big hospitals. The architects have clearly thought carefully about helping the building provide things that raise spirits like natural daylight. throughout the building there were many more windows than normal in hospitals or other buildings of this period

Subtle signs demonstrate that this hospital genuinely listens to their patients and treats them with respect

Wouldn’t it be good if all hospital architecture, signage and decor could create this kind of caring supportive impression for their patients

As a child, I remember falling in love with Richard Dadd’s “The fairy fellers’ master stroke“‘ when I first saw it, in the Tate gallery. I went on to read about Richard’s exceptional and tragic life. When studying for my psychology degree I recognised some of his paintings on the covers of books about mental health

Richard Dadd stayed in the hospital that is now known as the Maudsley hospital. It’s probably the oldest (1247) psychiatric hospital in the world!

Tiger is now an ‘informal‘ patient here. Informal means that theoretically he consents to being there – he can leave. He believes that he would be sectioned if he tried to leave. I’d be scared if he didn”t have 24hr  professional care nearby

The ACCU (Adult Critical Care Unit) was full of Beeping, flashing, colourful, dynamic machines. Gadget heaven. The nurses were all very modest about their ability to read and use these fancy computers.

This is Tiger’s very own beep-beep machine. The yellow light at the top-right changes colour from green through yellow and finally to red when any of the meters plugged into Tiger measure something out of acceptable ranges. As we watched the beep-beep machine Tiger gradually learned how to make his vital signs move from yellow to green. Awesome!

The nurses could gather an impression of the patients status just by listening to the beeps. They could tell which machine, patient, from the direction of the sound and quickly check the lights and displays visually for confirmation. All very imrpessive

Unfortunately the noise keeps Tiger awake… and the songs of all the machines on the ward are sending Tiger messages. He thinks they are saying more, and more sinister, things than patients vital signs

I found the noise rather hypnotic, strangely calming. It was easy to imagine professional dancers swirling and leaping through the isles, coordinating their movements to the beep-beeps. My imagination is more kind to me than Tiger’s is to him

In the ACCU (Adult Critical Care Unit) I found Tiger with 3 identity label tags on his wrists

Two wristbands were identical and accurately stated his name and date of birth. He’s the same person 2 times. Split personality?  The other wristband was placed on him when he arrived, when he was unconscious and alone – they didn’t know who he was. This wristband had his date of birth as 1st January 1900 and named him after the mouth of a river – Delta

Looks like Tiger has a 3 way split personality and is looking good for being 112 years old

Wendy: Which ward is he in?

Hospital receptionist (HR):ACCU

Wendy: Does ACCU mean something?

HR: Adult Critical Care Unit

Wendy: So I should come to the hospital and ask for the ACCU?

HR: 4F ACCU

Wendy: Does 4F mean something?

HR: Floor 4

Wendy: OK, I think I can remember that, any other advice for a visitor?

HR: follow the signs for ‘Lift Core 5′

Wendy: Does lift core 5 mean…

The signage at the hospital was new and thorough. I found this hospital sign interesting because it has an ecclectic structure which makes scan-reading it quickly more difficult. If it had a clear structure I could anticipate the approximate locations of the labels that I am looking for – find them quickly

My guess is that the

• top item is arranged by ‘importance’ – put there to be found quickly, including the sticky-tape apparant afterthought of the ‘Urgent Care Centre’
• the next 2 items are arranged by ‘Frequency of use’ – most people want to get out and use the underground at the end of their stay or visit.
• Below the top items they are arranged alphabetically, with the exception of the sticky-taped “GP out of Hours” which may have originally been something else.  The main problem with Alphabetically ordered lists is that the reader has to know the name of what they are looking for. For example, that “Day Unit” comes before “Haemetology” and “Reception” comes after “Transport”

The sticky-tape was really facinating, I wanted to peel it off to find out what’s underneath the “GP out of hours”. I resisted the temptation and followed the trail to lift core 5…