(VII) Looking Glass Wards - Part one

High dependency neurological wards were the conduit for the next stage of the journey.  Four days after Carolie opened her eyes in the ICU, we found ourselves cruising through the bowels of the basement to a lift skywards up nine floors.  An ICU nurse accompanied the attendant on the ride to this new port in the storm, to assist set up breathing arrangements, and to hand over the status report.  I was anticipating a fresh, airy space with one bed and windows everywhere.  

We arrived at a ward leading off a long, dim corridor, some distance from the nurses’ station, and in the company of three other damaged souls.  A toilet blocked the view out of the window, which was a pity as it was a panorama of the hospital and adjacent university precinct.  My heightened anticipation deflated; I pondered the sudden downgrade in circumstances.

I had understood certain protocols surrounded tracheostomy care.  This involved close proximity to the nurses’ station, preferably in isolation to reduce the chances of infection.  It was clearly not the case.  I knew the one to one arrangement in the ICU would not continue, but I had not anticipated that one nurse would tend four seriously ill patients.   

One of these was suffering delusions and acute pain.  She cried out alarmingly as she fought against strapping preventing her from removing head dressings and getting out of bed.  Her distress was certainly real, with her wounds appearing more than physical, and with little relief on offer.  I suspected she was heading for an ICU bed to receive the intense care she patently needed. 

The neighbouring patient was the inveterate smoker from an earlier chapter. He was recovering from the same problem as Carolie.  His young partner and baby had accompanied him from a rural town and spent most of the day with him on the ward or on his smoking ventures outside.  His TV was on constantly and the baby cried a lot.  The other patient was an older man who kept quiet until visitors sparked him up.  He was from an isolated grazing property; looking forward to getting back to his rural idyll.

The ward was old stock.  I had seen better hospital bathrooms in developing countries.  The ancillary equipment such as supportive chairs were worn and tired.  The troubled woman cried out at the demons plaguing her; a surreal sense of entrapment in a secure facility nagged me.   

Blaring TVs, crying baby, patients beset by various neurological conditions, reduced nurse monitoring, and a detached nurses’ station that had all the warmth and engagement of an information desk in a busy shopping mall.  This was the domain of neurosurgeons.  I recognized members of the team that had managed Carolie’s treatment.  Their studied detachment appeared to suffuse their operational domain; nursing staff had adapted to the management culture. 

Young nurses hurried about between rooms and those at the station seemed preoccupied with whatever was in front of them.  The esprit de corps manifest in the ICU nursing cohort had vanished.  The warmth and engagement that had provided me so much succour during the ICU vigil was in short supply.  The harsh reality of under-resourcing was writ large on the ward operation.   

The quality and quantity of nursing care fell away quite sharply.  I have no doubt these nurses had as much care and concern as their ICU cohorts but their operating culture was clearly different;  more detached, less resourced and clearly subject to the structures of the medical and nursing hierarchy.  This was old-style nursing; know your place in the pecking order, do your job and do not rock the boat.

To be continued...