Repeat repeat

September 23, 2008

A man in his late 50s, cropped grey hair, tanned and lined face, classic bushman. New jeans, faded denim shirt, Peruvian-style woven waistcoat, dust-caked work boots. Left hand to right ear, mobile talking. Right hand fumbling for a pen in his shirt pocket. He stops next to a tree in the cafeteria forecourt (I’m sitting at a table 6 feet away, nursing a mocha), kneels, says “Right, go on” then notes down a number on the raised edge of the tree’s concrete planter. He says “Right” again then walks away. 3636 5325, a hospital number, contoured in black fibre ink over the pebbled concrete. Ten minutes later he comes back, sits on the planter’s edge next to the number, rings it; no reply, hangs up, walks away.

Remember remember

September 23, 2008

Agency night shift, medical ward, Sunday 3am: a seemingly frail and formerly ‘pleasantly confused’ man in his late sixties picks up his metal drip-stand, smashes a large hole in the the lower window panel, crawls through, then runs across the carpark with blood soaking his pyjama trousers and streaming from his palms. He is chased by a one-armed security guard whose prosthetic limb has an articulated hook at the end. The patient says he had to escape as we were keeping him against his will. He was due to be discharged the next day.

Sunday 7.25am, leaving the ward for home and scraps of sleep, I see this notice on the wall by the door: ‘HAVE YOU REMEMBER TO ACTUALISE YOUR TREND BEFORE GOING HOME’.

I read it three times, then started to read it again and gave up at REMEMBER.

Exponential

September 2, 2008

I am a minority in a majority: I am male, and I am a nurse. I am also straight, which according to some views makes me a minority in a minority in a majority. There is also the problem that nurses, as a vast and discrete body of people, are viewed by themselves and others as professionally and socially oppressed – by governments, by doctors, by the media, by the institutions they work for, and by their own persistently poor self-image. Which would, theoretically and despite their numerical advantage over every other group of health care workers, make them, in character at least, a minority.

Which makes me a minority in a minority in a minority. A minority3 as it were.

This might be enough to unman me (though paradoxically, that might help) were it not for Henrik Ibsen. Ibsen is depressing, yes, but to a man in my severely minoritized position he also offers the best source of hope. “The minority,” he famously says, “is always right.” (That he has a doctor say it is merely one of life’s perverse little twists). As a straight male nurse, that makes me right to the power of three. Or right3.

I only wish I knew what it was that I’m so abundantly right about…

On the Observation Ward
there’s a hanging basket with pink flowers
which I hadn’t observed before –
but I’ve just observed it now
and I’m vaguely overawed
at the nudeness of the petals and
the limbs of the leaves and
the body of the basket, hanging,
and I almost want to ask it
if it has observed anyone else
observing it
on the Observation Ward.

But I doubt that anyone has as
they all look rather ill,
and bored.

Beyond the zero

August 20, 2008

In 20 years working in acute care hospitals, as a porter in England and as a nurse in England and Australia, I’ve seen upwards of 20 human corpses, and been witness to a dozen or so deaths.

I’ve seen bodies with skin so taut and white against the bed linen they looked almost translucent, and others where the blood has pooled in the folds and divided the body into a yellow-grey upper level of face and chest and belly and knees, and a ravaged purple bruise of a lower level, of shoulders and back and buttocks and heels.

I’ve seen bodies barely recognisable as such: an old man hit by a car on the motorway, one leg half out of its socket and with the foot up by his ear, both arms surreally rearticulated, intestines pressing against thinning viscera through a long horizontal gash in his abdomen; a woman whose leg had been run over and pulverised into fresh red mince by an artic cab.

I’ve seen people who, even after looking at them for several minutes, I had trouble convincing myself weren’t merely sleeping.

People have died while holding my hand.

Most of the people who I’ve watched die suffered some kind of intervention in the process – CPR, adrenaline, the elastic of an oxygen mask tangled in their hair – but only as a sort of necessary or expected constituent of where they were, rather than of what they were actually doing. ‘For the world, I count it not an inn, but an hospital; and a place not to live, but to die in,’ wrote Sir Thomas Browne.

I know that what I’ve seen is nothing compared to soldiers, or police officers, or paramedics. But it’s unique to me. I don’t believe in anything beyond the zero. But I believe in the zero.

Words for wounds

August 19, 2008

Highest-rate adjective use in a nurses’ meeting discussing wound irrigation: horrific, horrible, ugly, disgusting, hopeless, ghastly, horrifying, grisly, necrotic, foul.

‘To rationalize horror is to tolerate it,’ says John Clute – something the nurses at the meeting were emphatically not doing. Clute has also theorised the first of the four main parts of Horror’s ‘narrative grammar’ as ‘Sighting: Some small sour lesion in the world is suddenly visible, even in daylight.’

Not unlike a surgical wound. Or, at least, not unlike certain surgical wounds as perceived by one particular group of hospital nurses.

I love a good ritual

August 18, 2008

A house officer attempts to persuade a diabetic 83 year old man with a gangrenous toe to sign an informed consent for surgery to remove the offending digit. This old man has spent the last two days talking animatedly to his drip-stand about the weather, Brisbane public transport, and the state of the train carriage they’re both sitting in on their way to work. The house officer makes some initial attempt at an explanation of the surgery and its associated risks (“We need to cut off your toe so that we don’t have to cut your leg off later. You’ll be asleep, so you won’t know anything about it”) and then endeavours to get the man to sign the paper.

“You need to sign it here, Mr Smith… No, here… You need to sign it… Mr Smith ? Mr Smith, can you hear me ?… You need to sign the paper to say you understand what’s going on… Look, here’s a pen… Careful now… No, the paper’s here, Mr Smith – here, that’s right, on the table… No, the table… Can you hold the pen, Mr Smith?… Let’s see if you can hold the pen… That’s it… Can you hold the pen?… You need to hold the pen so you can sign the consent…”

The informed consent. The “I know what reality is, that drip-stand is a drip-stand, I’m in hospital, I have a black toe, I know what you’re planning to do to me and I fully understand all of the associated risks because you have completely explained them to me, and I’m perfectly capable of holding a pen and signing my own name, thank you very much” consent.

The signature was obtained, somehow – either by Mr Smith having a lucky hit with the flailing pen, or by the house officer manoeuvring the relevant space on the paper underneath the quailing nib and then doing a Spectrograph impression – and Mr Smith had his surgery, and lost his toe, and then lost his life a few days later after contracting classic post-surgical old-person-with-only-cinders-of-a-mind-and-no-muscle-tone pneumonia.

I love a good ritual, don’t you ?

There’s a back way to the canteen that takes me past the hospital’s delivery entrance. From the open-sided corridor at the back of the dock you can see two blaring rectangles of sunlight across an empty concrete apron: the open corrugated doors and the truck bays, very ordinary except it looks like an old Bond movie set. Off to one side there’s a cage: ceiling to floor wide-gauge mesh, several signs and plaques of the Keep Out! and Danger! variety. And in this cage, and spilling around it when it’s full, the day’s deliveries are stacked, waiting for the trolleys to convey them to their various destinations around the mini-city of the hospital.

Most days there are boxes of syringes and needles and intravenous lines, of yellow plastic aprons and purple gloves; sometimes there are giant cartons of technology, widescreens and towers and printer/fax/photocopier components; every day is linen day, vast plastic bags of sheets and pillow cases and towels so sharp and rough I’m always surprised the bags don’t shred. Four pristinely empty cribs of white steel tubing. And paper, and manila folders, and staff uniforms hanging orderly in disciplined rows, and more paper, reams and reams of paper, and oxygen cylinders, and gas-scavenging interface valves, and skin-staplers, and scalpel-blade sets, and miles of tightly ravelled sutures, and tubes, lots of different tubes – tubes for people’s brains and for their arses, for their throats and noses and stomachs and bladders and veins and arteries and chests and urinary tracts. Boxes and boxes and boxes of them.

And someone in there, in that cage, is stacking all those boxes. I never see the stacker, though I hear him sometimes: scrapes and huffs and unconnected mutterings of cardboard and carbon-based lifeforms. But he’s very creative. The stacks are never the same twice: you’d expect just piles of boxes, straightforward, efficient, boring. But he builds castles in there, labyrinths that spill out of the cage and spread across the dock, pirate ships, colonial villas – though these are all my interpretations, partial at best, of the built environment in and from the cage that changes daily and across each day. Very occasionally, if I’m passing at suppertime or early on a night shift, the stacks have dwindled and I can just make out a moving shape (though it’s darker then, of course). But the deliveries never really stop, and the building blocks reaccumulate, and he – or she or they – continue their quasi-Sisyphean task.

Today there was a double archway of tracheostomy tubing and what looked to be a pulpit made out of emptied keyboard and mouse boxes. No cross though. Not an obvious one, at least.

Waiting words

August 15, 2008

Night shift, surgical ward. An expected death. Brothers, sisters, children, grandchildren: all have come to see, to say goodbye, to stare and cry and hold a cold hand or kiss a closed eye. All have gone now, and the corpse is wrapped and we’re waiting for the Tin Box.

“Yes,” says the senior nurse. “Death certainly brings out the best in families.”

I saw him in the hospital lobby: the other Samuel Beckett – thin greasy hair and a hunted look, wearing an old parker, haunting public places with quick little steps and inoffensive glances. Unpublished, unlauded, never learnt French, never heard of the Resistance. Scribblings in a dozen manila folders in a suitcase on a shelf in the shed.