Bed 4 is young enough that she really shouldn’t be on the stroke ward. She has multiple organ issues – her heart has dilated chambers that mean it cannot function effectively as a pump to send blood to the rest of the body. Her legs have swollen with pitting oedema, as a result of her cardaic failure, making her skin tight and at increased risk of infections like cellulitis. Her lungs are battling an infection because on the way to hospital she vomited and as a result of an ineffective swallow (due to her stroke), ‘aspirated’ (swallowed down into her lungs) her vomit. That means Bed 4 now has a right lower zone aspiration pneumonia. She will require intravenous antibiotics through a cannula in her vein. This is looking red and painful from superficial thrombophlebitis. On top of the problems with her lungs and her heart, Bed 4 has also had a massive, debilitating stroke. This has left Bed 4 with a functional right sided weakness and an inability to speak – known as aphasia. Because of the location of the stroke she can no longer swallow either and has to be fed by a nasogastric (nose to stomach) fine bore tube. Bed 4 has multiple organ pathologies and is being treated aggressively with medicines through drips and medicines to tackle them. Even at a young age, if this person’s heart stops, the medical team would not resuscitate her. She would be highly unlikely to survive a resuscitation attempt with her heart in such poor condition.
Of course Bed 4 is not Bed 4.
Bed 4 is a mother, a daughter, and a wife. She is a best friend to somebody, a confidant to a dear friend, a fan of some terrible TV programme probably (who isnt!). She has a name, a personality and feelings. She is no doubt scared, unsure of the future and confused by all the frenzied activity around her.
Bed 4 is a composite of multiple patients I have seen, and of course, fictional. However, this type of hospital patient is VERY real, trust me.
We live in a very faced paced world. We meet people off-line, on-line and rarely get a chance to stop and really know the strangers that we encounter in life. Afterall, we are too busy, going somewhere, preoccupied with our own problems and don’t have time to understand someone else. Besides, we need to check Facebook, see if we have a message from that person we liked on an online dating website or rush off another busy appointment. We are often passing ships in the day – and the night at times. Life has become fleeting if you let it.
And then it struck me – amongst all the rush of life, my stroke ward can be the parallel to this. My patients are here for some time, undergoing intensive neurorehabilitation with physiotherapists, occupational therapists, speech and language therapists, and dietitians. Then there are us, the doctors, and the nurses who aim to meet their medical needs like treating chest and urine infections that regularly crop up from prolonged hospital stays and urinary catheterisation. Now because they are here for some time…I am lucky enough to get to know them.
Every morning when I come onto the ward, I fill up my water bottle and I put my arm around the ward sister (that’s the boss) asking her “Today is going to be a good day, right?”, before walking into the three bays of patients a saying good morning each. I don’t do it because I think it looks good for the hospital, or I am trying to be a cheeseball (ignore the terrible use of American slang – I heard it on the London underground and it’s stuck in my head) – I do it because I want a warm, open, flowing team environment – And the patient is the biggest part of that team. TEAM: Together Everyone Achieves More.
As the days go by and I learn what makes my patients tick, their subtle ways, the ones that get nervous, the ones that like a joke and a laugh. You begin to be able to tailor your ward-round to not only meet those medical needs (which of course, come first as a matter of duty), but to meet their psychological needs. What’s more, Bed 4, is no longer Bed 4 – she is the patient who lights up with a smile when her daughter comes to visit and attempts the yo-yo trick in front of her that she can never do. She should never be bed 4 infact.
And this IS important. It is important because patients are beginning to feel like a bed number, a disease or illness, rather than a person. This is very very wrong. Imagine if you were in hospital, or your mum, brother or grandfather was – do you want them to be referred to as a Bed Number? Of course not. It requires a cultural change within hospitals. And of course, this is is also something that is not going unnoticed either – just see what this young lady had to experience:
This is disappointing in itself, isnt it. After-all, what has changed over the years to stop us looking and seeing the person before the disease or bed space in the first place?
Something lighter next week, I promise…