Wednesday, March 21, 2007

H is for Homerton, Heroin and Hell

Brilliant cartoon by Michael Leunig who has been my hero for thirty years.

In my delicate mental state I probably shouldn’t really be watching television shows like BBC2’s The Trap since it confirms what I have always suspected – that the world is actually being run by an evil mathematician from somewhere near to the earth’s core and that people who look powerful to us like Bill Gates and Rupert Murdoch, are really only munchkins in Armani, (or in the case of Bill Gates – vintage Man at C&A). The mathematician is responsible for the prevailing world view that if the greediest half dozen people in the world are allowed to hoover up ninety per cent of its wealth with no constraints whatever, it will be good for everyone. Would it be impertinent to suggest that this theory wasn't all that thoroughly thought through?

Last Sunday’s programme, the second of three, explored the mathematical foundation for the promotion of unbridled capitalism in the west since the Second World War. Using Game Theory, economists reduced human interaction to a series of selfish strategies motivated by individual ambition. As you know, I am not all that kindly disposed to the world at large, but even I have noticed that parents don’t immediately put their newborn babies up for sale on eBay despite the obvious financial potential created by the strong demand from Morgan Stanley high flyers who were so busy making moolah they clean forgot to make whoopee while their own biological window was still open. Despite its sixty year longevity, the theory seems flawed because – and this is quite a thing for me to say – most people aren’t selfish, money grabbing cunts – the media just makes it look that way.

But this economic theory has had a potent effect on western governments as politicians like nothing better than to have people reduced to numbers and New Labour have jumped on the algebra express with Keynesian keenness, resulting in the reduction of every aspect of public service to a series of Glengarry Glen Ross type impossible targets. It’s obviously a stretch to imagine Gordon ‘Scrooge McDuck’ Brown in the Alec Baldwin role, although Alec is looking a bit doughty and doughy himself of late, but the deal is pretty much the same – deliver the ‘outcomes’, as they like to call the heinous things they do to us, or hand in your BlackBerry.

The NHS was particularly hard hit by the target-driven approach to social order. The disinclination of humans to run their health as if it were the 7.42 from Bishops Stortford certainly sprinkled liberal quantities of the wrong kind of leaves on the tracks of Health Trusts’ journey plans. The Trap disclosed how ingenious hospital managers became at devising innovative schemes to reduce waiting lists without actually seeing the patients that were parked on them, presumably for good reason. One hospital wrote to all its waiting list patients to ask them when their holidays were and promptly scheduled their hip replacements while they were being wheel-chaired around Broadstairs. Short, easy operations like the removal of bunions were prioritised over brain surgery and you could no longer make an appointment with your GP for more than two days ahead, even if it would be more convenient for you.

But I was going to talk about the person who occupied the next bed for the four days I was on the gastro ward at the Homerton University (???) Hospital where they didn’t actually have any medicated or antiseptic cleaning products. Spew, shit and worse was mopped up with J-cloths whether it be on you, the floor, your beside table or Maeve Blinchy novel that you were given by the mobile library because that was the only book they had that wasn’t Mills & Boon. Holly (not her real name obviously), was a heroin user. I did not know this because of my superior powers of deduction and diagnosis, although I am beginning to think that I could cut it on CSI or ER as I certainly managed to work this out before any of the doctors and nurses had twigged.

Holly arrived an hour or two after I’d been moved to the ward at around ten in the evening with no notice at all and a misunderstanding with the porter in which he interpreted the question ‘why am I being moved?’ as an indolent refusal to co operate resulting in a bad-tempered oratory lasting the interminable journey, punctuated by occasionally body-jarring collisions with corners and parked life-support machines worth millions of pounds. After screaming in pain for an hour and being completely ignored by the night nurses who had all gathered to discuss the latest episode of Scrubs and flog gallstones on eBay, Holly made a phone call. Shortly thereafter she arose from her bed, got clobbered-up and announced that she was going for ‘a smoke’.

Some hours later Holly returned and I was woken by the sound of her chomping on fistfuls of crisps. The next morning, the sound of her groaning rewoke me. She called for the nurses. One of those ridiculous throw-away sick pots was produced into which she threw up the night before’s crisp feast and then clenched her stomach in pain. Nurses offered painkillers but Holly wouldn’t have any tablets because of the nausea (duh!). Eventually she was offered a morphine shot. She even enquired about the dose without raising an eyebrow – how many milligrams? 'No, I need more.'

Whereas a middle-aged lady like Pants, with all her own teeth and zero hospital admissions, was treated like a criminal for asking for painkillers at all, (I was even informed by a nurse barely out of training bras that morphine is ‘addictive’ – well yes, I suppose you could get addicted to the idea of not feeling like someone was attacking you with a fucking ice pick), Holly seemed able to write her own prescription.

The pattern continued over the four days we were neighbours. Holly would wake in the morning retching after her midnight feast and refuse to eat. She would call her large family, many of whom would be on the scene within the hour. Her staunch matriarch of a mother would pace and peruse Holly’s chart harrumphing knowingly ‘Morphine? Why they giving you that then? That’s for dead people’. Well, I guess she was in the ball park, sort of. The family would beseech the doctors to ‘find out what’s wrong with her’ to which the doctors would promise to do ‘the very best possible’. Holly would mercifully then sleep for the rest of the day, only waking to retch, yell and refuse food for long enough to achieve an injection of morphine.

Come the changeover to the languid night staff, Holly would again get herself kitted up and would be gone for hours for ‘a smoke’. Once she even brought ‘the man’, back for a little party. I knew it wasn’t her husband because I’d seen him – timid, damaged and confused, not having the vaguest idea of what to say or do. After that night, the incoming nurses found Holly’s bedside table littered with crisp packets and soft drink bottles and a mysterious brown liquid on the floor which they circled for a long time before finally identifying as ‘chocolate’. The overturned carton nearby was the giveaway clue. A great deal of deliberation was necessary to work out how to deal with this situation as there are no actual cleaning products and no one knows where the cleaners keep their mop and bucket. It was finally decided that a bath towel was the appropriate, or perhaps only, solution and one of the nurses duly tossed one over the brown mess.

Holly is a daily heroin user. I know this because she told one of the doctors who was on the ball enough to ask a couple of obvious questions.
Do you use heroin?
Do you use it every day?
Do you inject or smoke it?

But then the doctor completely blew it by explaining that because Holly used heroin, it might mean that other painkillers did not work so well on her. They didn’t find anything wrong with Holly. She had a non-specific pain that she could not describe. She was using other medications as well. In addition to her night-time connections, she was popping her own anti-depressants quite openly. What is going on here, I asked myself.

Holly is of mixed race. I know this because I saw her white mother and black father visit. I started to wonder if narrow, phobic targets and fear of being accused of cultural stereotyping might be playing a part in the reluctance of healthcare staff to recognise that Holly had a very specific health problem that they should be able to address without worrying about triggering headlines in the Daily Mail. Both of us, in our own very different ways, were numbers that didn’t add up. It’s time for a new theory about how we look after each other…


Ms Melancholy said...

Lovely Pants, I am sorry for your pain and illness, but it is wonderful to have you back on top writing form and with so much material. Remind me to tell you some time about the heroin addict mum who was in the next bed to me on the maternity ward in Manchester....

That's so pants said...

Thanks Ms M. I am only just now starting to feel vaguely human.

Reading the Signs said...

Ms Pants, glad you're feeling better, even if vaguely. I keep coming back to your "what is wrong with everyone?" subtitle. It speaks to me. I thought it was bad at the Mile End hospital where they were out of nappies and formula milk in the maternity ward.
What has happened to the idea of basic care and courtesy?

That's so pants said...

Being Australian and spending a chunk of the year there, I notice what a HUGE difference there is in basic courtesies between the two countries. London is particularly bad I think but I have always thought that everyday communications between people in Britain were conducted with a rudeness bordering on abuse. Phone manners were always appalling and I don't know that there was ever an effort made to be helpful in any walk of business life. I do believe the British are surly by nature and that everything was held together in the past by the rigid application of good manners. Now that's gone, an awful lot of people seem dissatisfied with the general level of unpleasantness that dominates daily life so I think there is some will to change the way we treat each other. The question is how?

Ms Baroque said...

TSP, as I've said over in my own place, the nurses mostly have interpersonal skills that would get them sacked from Macdonalds. This was the case every bit as much when my daughter had broken her arm, needed surgery to put pins in it, and received not a word of comfort nor a drip during a whole long 90-degree day of nil by mouth... she was terrified and only 11 and even the TV in the so-called patients room didn't work - though a few nurses brusquely told her to turn it on.

Mostly not English, though,
these nurses. The system is English, and it is allowing these imported staff not actually to care for anyone.

A friend had a miscarriage. Afterwards she wondered why, in hospital, they had not been nice to her. She had thought they might be, given what was happening to her. Just, you know, nice.

As to Holly, that story is easily explained by the fact that the nurses don't look at the patients. They only look at the charts. Each patient is not a person, he or she is a schedule of tasks. I something doesn't add up it is apparently not the nurses' job to spot it!

That's so pants said...

Amen to that Ms B

Groucho said...

A hospital bed is a parked taxi with the meter running.

That's so pants said...

Hey Groucho - in this country it's more like a hearse.

Janejill said...

I have just found you and , if I knew how to set up a blog roll, you would be there, at the top. We have two definite things in common - Shantaram ( I actually wanted to go and live in a mumbai slum, but only briefly; I still miss him ( I have even stalked Gregory David Roberts a bit on the Internet but cannot find any details after 2006) I intend to continue trying - have you seen his utube talk?? I will not believe that little whatshisname with the wide smile is dead; it hurts.
Also, my daughter worked aa a nursing assistant in the Homerton; she lasted about four days - and this is a girl who had squatted in some of the seediest places Hackney had to offer. She said it was worse than anything she had ever seen and was appalled at the total lack of care and dirty conditions. I am Irish and want to visit Oz but my present husband (I like saying that) spent two years there and won't return and I have to find a friend to go with (I have done too much travelling on my own)
ENough - v glad I have come across you - excellent post . God this is like a post instead of a comment...

swimmer6foot4 said...

I concur, Ms Pants, on the acquired rudeness of Londoners. I've never visited Oz (tho' I'd love to go) but in the US, which I frequently visit (especially the deep South) there is a level of courtesy that I find is charming and plain infectious. I love it! Then I return to Hackney and - no matter how much I try to share a smile - the surly attitude eats away at my magnanimity.

A dear friend was incarcerated in the Royal London for many months. As a highly experienced (nay, decorated) nurse - she was in her 80s and never really retired - she was appalled at the standard of care offered by modern nurses. She noticed how they came by, looked at the chart, at the electronic instrument my friend was wired up to and at the level of fluids being fed via IV. But they never once would look at her or speak to her.

At last, exasperated, she cried out to a nurse standing beside the bed adjusting her IV container: "Could you please pay a little less attention to the drip in the bottle and a bit more to the drip in the bed?"

Great line, hey?

That's so pants said...

Hello JaneJill and welcome. Have not seen GDR's UTube talk - thanks. He burst onto the internet with good intentions, bad poetry and very weird philosophical musings but then the Shantaram website seemed to suddenly get mothballed around the time he got fired from the film. I've heard Johnny Depp does fall out with people. Maybe GDR's learnt the hard way that Hollywood is only one layer of tinsel deep. I think the demise of Prabaker is one of the most skillfully handled deaths in fiction. I don't know anyone who wasn't shocked by it, despite its being telegraphed to the point of inevitability. Let's hope GDR has gone quiet because he's adding the finishing touches to the sequel. I'll be moving back to Australia in a few months so stay in touch.

That's so pants said...

Hi Swimmer - The Americans are very polite indeed. When they bump into you on the subway - something which they only occasionally do and certainly not willfully, they say 'sorry Ma'am' rather then glare at you because it was your fault for being there.

Yes - patients, like customers in shops, are invisible because people in Britain only go to work to discuss EastEnders and check their leave card.

GoAwayPlease said...



That's so pants said...

Hi GAP - thanks. I'm feeling much, much better. Surviving a British hospital is a must do. It's been 25 years so it was bound to happen sooner or later.

Anonymous said...

Britain is now run according to compliance with "performance indicators" and statistics. Sadly no one has come up with a mathematical measure of "Care" so it's become less important.
My wife is a nurse and she cares, and so do a lot of other nurses. I sometimes think she cares too much. That's why she gets hurt by the abuse and being treated as skivvy(usually by relatives, rather than patients).
Why not spend a day clearing up shit and vomit and blood, and seeing what humanity does to each other after night's binge drinking, and being cursed by the drug addict (who's life you've just saved)because you've wrecked his high. Spend some time with relatives who want their parents kept in hospital so they can sell their house.
Then come back and slag off nurses.

That's so pants said...

Hi Anon. Sorry, I didn't mean to sound as though I was slagging off nurses per se. Although I did receive unacceptably callous and even inhumane treatment from both doctors and nurses, there were two or three nurses from whom I received extremely compassionate and highly expert attention. My beef, like yours, is with the system. British nurses are leaving the country in droves because they don't find they are able to give the standard of care that can and should give.

Janejill said...

I understand Anon's feelings but I think that Nurses should be able to identify and still relate to the people who treat them with respect; I am appalled , though, at how much abuse hospital staff have to face in this country, and they must feel there is no-one rooting for them.
Tsp (i hope I may call you that?) I am shocked to hear about Gregory being sacked; I don't think Johnny Depp is right for the part - it would have to be Daniel Craig, though I'm not sure if he could shrink enough for the prison parts. It's amazing how GDR could combine brilliant story-telling and character descrition with shit philosophy and still be credible;( I used to feel slightly apologetic on his behalf.. ) I could hardly put the book down - I was travelling thought Goa and Kerala, so it seemed so close. I felt the same about "A suitable boy" - very different characters but so attractive and alive.
Keep well - organic apricots (2 daily) do the job for me..........

That's so pants said...

That's the other side of the coin - badly behaved patients. Despite the fact that I was in casualty for about 6 hours on a Friday night, I didn't see one D&D patient and neither did I see any violence or even raised voices on either of the wards I was in so I would question whether the adversarial approach of hospital staff is justified. An assumption of normal all round would make more sense - with a strategy for dealing with abnormal incidents.

Like many before him, GDR seems to have learned the hard way that there is more to adapting your own novel than meets the eye. I gather the fast friends thing with Depp didn't last five minutes before some serious Hollywood hardball kicked in. Must have been tougher than Pentridge! No, no, no to Daniel Craig (much as I loved him in Layer Cake). I picture Lin as a messy, hippy type. I can see Depp pulling it off but I'd rather have Rhys Ifans.

Thanks for advice but my er, system, seems to have returned to normal of its own volition. Just a strange blip it seems.

Anonymous said...

The number of NHS staff being physically assaulted has fallen, official figures have shown.
NHS Security Management Service data showed there were 58,695 physical assaults against NHS staff in England in 2005/06, down 1,690 from 2004/05.

Despite the overall fall, assaults against staff working in NHS hospitals rose last year.

In June police and health security officials announced a crackdown on any abuse of staff in the health service.

The new figures equate to an assault on one in every 23 staff members - down from one in every 22 staff in the previous year.

The number of people prosecuted for assaulting staff also increased by 12%, from 759 to 850, the NHS Security Management Service (SMS) said.

A detailed breakdown of the figures showed assaults on ambulance staff, primary care trust staff and those working in mental health services all fell last year.

However, the number of assaults on staff working in hospitals rose from 10,758 in 2004/05 to 11,100 assaults last year.

Source - BBC - It doesn't of course, include verbal abuse and sheer rudeness.

That's so pants said...

Sobering stuff indeed. I'd be quite interested to know how those figures compare with countries where people aren't kept waiting in casualty for six hours in earshot of idle staff stood around chatting to each other about what they did on the weekend.

Anonymous said...

That was a cheap shot and it will probably hurt decent, caring NHS staff far more than the bad ones that you were unfortunate to meet. One Friday night, in one hospital, does not make all hospitals bad, nor does it mean that all NHS staff are incompetent and uncaring.

That's so pants said...

Did I say all NHS staff are incompetent and uncaring? Did I? It's not a matter of sitting here and arguing the toss about whether all hospitals and staff are good or bad. This is a blog not an evaluation report for effsake. I was simply relating my honest experience. If you want to DENY that these experiences are real then you are providing proof that there are some nurses out there WHO JUST DON'T LISTEN.

Anonymous said...

I genuinely sympathise with you for the poor treatment you received in hospital. I appreciate that this is only a blog (and a good one) with a brilliant sense of humour and many serious points to make.
But you said - "I'd be quite interested to know how those figures (for physical attacks on NHS staff)compare with COUNTRIES where people aren't kept waiting in casualty for six hours in earshot of idle staff stood around chatting to each other about what they did on the weekend."
You probably didn't mean to imply that what you experienced was the norm, or that the level of violence to NHS staff in the UK was brought about by staff attitudes and waiting times, but that's how it came over.
I don't doubt your honesty and integrity, particularly as you have included these comments on your blog, but NHS staff take a lot of criticism in silence.
Thank you for the opportunity to redress the balance a little.

That's so pants said...

Fair 'nuff.

dr moctor said...

I am a doctor at The Homerton A&E department. I doubt that "idle staff stood around chatting about what they did at the weekend". Sometimes (horror of horrors) staff on a 12 hour shift who are working their arses off do pass the time of day with each other. There are even some staff there who are occasionally idle. Me, especially. But we do not leave sick patients sitting around for 6 hours while we have a fucking chat.

That's so pants said...

Dear Dr Moctor - not a real blogger - you've just set up a blog profile. Well that's just cowardly.

Question for you 'Dr' M - why would I lie about my personal experience? There is no danger of me influencing anything or anyone.

If you really are an A&E doctor at the Homerton then you would know that you fucking do leave fucking patients fucking lying about while you have a fucking chat. You just don't notice because patients are invisible.

I agree completely that health workers should not have to do a twelve hour shift but I don't know what else I can do about that beyond continuing to pay 11% of my salary in National Insurance contributions, complaining if I feel I have been treated badly by the NHS and sharing my experience with others.