‘The station now approaching is xxxxx.’ Legs uncrossed, papers folded. A familiar train of commuters winds down the station steps and fans out to East London. Many are drawn by the gravitational pull of the nearby hospital, an eclectic bunch but identifiable nonetheless: untucked shirt, black shoes, headphones- medical student; chinos, brown shoes, skirt with pumps- junior doctor; straight skirt and heels, suit- administrative or managerial. We wind our way along the residential street, mind elsewhere as the movements are reflex: right, right, straight over, past the bus stop, cut across the car park. 4 minutes to the main entrance, 5 to the ward. Predictable, well- trodden, known. There is a sense of belonging as soon as I enter the grounds stamped with the trademark NHS blue-and-white.
When are the visiting hours? Are there times when it is inconvenient to come? Can I come straight after work? My friend has recently been admitted into hospital for chemotherapy, a hospital where I used to work in fact. Immediately plans to come and see him were riddled with niggling anxieties, the fear of intrusion, of being in the wrong place, at the wrong time, with unwashed hands. Then my thoughts turn to my friend. How unwell is he? Will he even want me to be there? What are we going to talk about? I don’t want him to feel he has the scraps of my time yet I mustn’t outstay my welcome. Is his room already a vineyard of grapes? I walk up the steps towards the main entrance. Grab a box of celebrations. Inappropriate? Uncertain. An outsider coming in.
‘Morning doctor.’ ‘Morning sister, how was the night?’ ‘Fine. C4 causing trouble again though. Had to call the on-call doctor for haloperidol. Eating his breakfast happily now though.’ I dump my bag in the staff room next to a three day old copy of the metro and last month’s issue of Heat, turn the TV off (few things irritate me more than a TV on in an empty room) and wander onto the ward. A quick wave to the ladies in A bay who are merrily drinking tea and brushing hair. The very unwell man in B1 is still alive. D bay is half empty (relief). I feel a sense of ownership as I get up to speed with how my patients are doing. I ask the sister is there are any problems that need to be addressed immediately (needed). I locate the new patients who have arrived during the night and sit down to review their clinical details. Time to think.
‘Doors closing. Lift going up….fifteenth floor. Doors opening.’ I step out. A nurse in a dark blue uniform steps in, briefly looking at me then moving on past. Was that just a passing glance? Did I detect an element of surprise, perhaps annoyance? I’m sure he’d said visiting times were open. Were there any exceptions to that? I turn left, through the double doors, up to the second set of doors marked ‘Haemato-oncology.’ ‘Please wash your hands.’ Gosh, I knew I should have used the alco-gel in the entrance hall. How could they tell I hadn’t? What if I’ve already started an MRSA outbreak? I furiously pump the dispenser before ringing the bell as the doors are locked, secure. I wait. The buzzer sounds in the distance, alerting the ward to an intrusion. I know the sound well from my hospital. Always when you’re busy, arm full of needs and gloves. Please God let it stop. But it doesn’t, and my ears are ringing, and I can’t concentrate as I anticipate the next…buuuuuuzzzzzzz. Click. The door opens. A small sign in the entrance says welcome.
I’m only half way through the ward round. The three new patients were complicated, and I had to talk to my senior colleagues for some advice. The phlebotomists also couldn’t (wouldn’t?) bleed half our patients and the most junior doctors kept being called to the Medical Day Case Unit or the Bereavement Office or one of the other regular sources of doctor’s admin. Unfortunately, despite my extra efforts to arrive early and start the day in good time, it was already 11 O’clock and in my mind that only means one thing: visitors. At first you don’t notice anything, other than an imperceptible bubbling of activity. But like a slow running bath left to its own devices, before long the ward is flooded and we have to wade through our work rather than glide. I’m sitting at the desk looking at some blood results and x-rays. Creatinine climbing. Sodium falling, CRP through the roof. Worsening consolidation and effusion despite asbestos antibiotics. Looking increasingly unwell today and I’m not sure what else to do. ‘Excuse me doctor, can I have a word.’ ‘Noooooooooo! Can’t you see I’m concentrating? Have you seen how unwell this patient is? Just look at these numbers. You’re a man; you know how difficult it is to multi-task. Do you honestly think now is the time for me to have a word???’ I beat down my irate thoughts. Compose myself for 5 seconds and come up with a brief clinical plan for the sick patient which will have to be implemented later. I’m tempted just to look up across the desk, to maintain enough distance to communicate the inconvenience. But no. I speak to myself: professional, kind, caring, patient… I walk round to the visitor, hold out a hand, smile. Already I feel better. I know this is the right thing. This is my job. But the dying patient, the rising creatinine…’Of course you can sir, how can I help?’ ‘It’s my mum, the credit has run out on her TV. Can you fix it for her?’
I found my friend, after walking the length of the ward twice and asking for assistance once. He was on good form. The pile of ‘read’ books had significantly encroached on the ‘unread.’ Playstation light was on. But breakfast remained uneaten at the side so it must be a doxorubicin day, where the nausea grips and smothers you until all trace of hunger has vanished. He’d had a steady trickle of visitors until his blood counts had dropped, at which point he’d wisely stemmed the flow. He thanked me for the chocolates. Thankfully no ironic gags about celebrating. He added them to the pile of confectionary by his bed, and rued the fact that when he was nauseous all he could eat was plain, dry food. Earlier he had downed a pack of Rivita and cream crackers in one sitting. I said in some girls boarding schools that was classified as anorexia. He raised an eyebrow and gave a rye smile. Fancy a game of Perudo? Thank goodness we could do something. Helps the being. Unfortunately there was no chair, so I crept out onto the main ward and sidled up to the nurses’ station. Two people filling in charts, sitting down. There was one spare in between them. ‘Excuse me…’ One looks up, manages a half smile. I’m terrified. Have I broken the number one rule, No visitor shall be seen approaching the nurses’ station?’ He looks at me, down at the chair, back up to me. ‘Of course, no problem. Make sure you bring it back though.’ ‘Ah thank you, sorry, thank you, sorry….’ There’s some awkward manoeuvring as I extricate the chair from between them, and I scurry back to the room.
I won’t forget my foray into the world of the visitor. I’ve realised that as a doctor we have the tremendous advantage of being on our home ground. My default is peace (bred from the familiar), whereas for the visitor it is anxiety (from the unfamiliar). My job therefore grows into that of a host as well as a carer. I must make them feel at home.