Wrecked ‘um

“And by the way Steve.”
“Yes?”
“Have you any ideas for spicing up my love life? I’m afraid my wife and I seem to have forgotten we live at the same address.”
“Er……well I’m not really an expert Sid, but you could try scented candles and a pink light bulb.”
“Oh. That’s worth a go I suppose, but I don’t think virility and girth are really the key problems. Still, thanks for the suggestion, anyway.”
“That’s okay.”
“And another thing, Steve.”
God help me.
“Well….you’re the only person I dare ask….Do you….do you think arseholes deserve rights? Be honest.”
“Oh….you mean conmen, cheats and vagabonds?”
“No. No. Real arseholes.”
“Oh…..perverts, rapists and granny bashers….”
“No. Actual physical arseholes. Anuses.”
“Pardon?”
“You see Steve, I find it terribly upsetting that oral and vaginal orifices always get such a good press, while the poor lowly rectum is forever mercilessly vilified and pilloried. I feel as though I have a calling in life – a sort of holy quest, to defend the rights of all downtrodden and belaboured back passages.”
“Oh….yes…..absolutely….I couldn’t agree more.”
“I knew I could count on you, Steve” he said, a single tear trickling down his old craggy cheek.

That’s just the way I felt. Angry, defiant, and just a little mad.
But tomorrow was the day of the big inspectors’ meeting, when we would all learn our fates.
Tick, tock.

Day Dream Believer

“Sooty and Sweep are just capitalist puppets, claims Marxist” said the radio.
“It’s time for me to discharge myself” said Sidney.
He was gazing at a dog-eared photograph of a blond, bare breasted lady in stockings and suspenders, who was draped over a Harley-Davidson motorcycle, drinking frothy lager from a bulbous bottle. In the background was a long-haired biker in studded leather jacket, unflattering thong and jackboots, with a three inch spike through his nose. A waterfall of artificial sweat ran freely over the lady’s tanned shoulders, down her back, and through the culvert of her perfectly formed derriere. Nudity, as always, left plenty to the imagination.
“I didn’t know you were into that sort of thing” I said.
“Oh, I’m not Steven” he said quietly. “She’s my muse.”

The clock was always ticking on a psychiatric nurse, as you wished your life away in the tick tock world of stress and release. Anticipating the end of a shift, craving days off, booking holidays with the drooling relish of a mad dog waiting for the final kick, and absolutely dreaming of retirement. Cottages in Wales, cruises in the Caribbean, fawn jackets and bowling woods, illness and death. A lager at the end of the desert crawl.

Defining ‘Fine’

“We’re back” said my colleague from the afternoon shift.
“How did it go?” I enquired.
“Oh, I’ve hired a Michelin Man costume for the next charity walk and made an appointment for my hair to be tinted. I’m a really mad sort of person you know.”
“I was referring to the walk with Stuart.”
“Oh…right…. no problems. He was absolutely superb in town.”
I glanced at Stuart who was stood behind, and noticed that a large wet patch had formed around his crutch area, that his hands were shaking uncontrollably, and that saliva was dripping constantly from his mouth. Everything was relative in psychiatry, and I knew that my colleague was pleased because Stuart hadn’t attempted to run off, hadn’t become angry or agitated, hadn’t stolen anything, and hadn’t been incontinent of faeces in the shops. His term ‘brilliant’ still seemed a little extravagant, though, and it occurred to me how often we compared patients’ behaviour with other abnormal behaviours on the unit, rather than with standards in the outside world. This was not perhaps a great sign of community care success, where ‘integration’ with the outside world was the main guiding principle.

Filing the Prison Bars

I grimaced at the patient’s file in front of me; the great wedge of admission forms (eight pages), global assessments, risk assessments, Care Programme Approach assessments, Health of the Nation Outcome Scales, SCART assessments, bed sore assessments (altogether twelve pages), care plans (four pages), care plan daily record sheets (twenty two pages), multidisciplinary team meeting sheets (eight pages), blood pressure charts, weight charts, pathology test records for possible urinary infection, blood counts, drug levels, and physical examinations (in total ten pages), Care Programme Approach records (Six pages), Correspondence (Seven pages), personal finance receipts (four pages), a pair of broken false teeth in a plastic bag, and the seven cardboard dividers which attempted to structure this ridiculous monster.
I then thought about the patient in question; a fifty year old man who had a long standing inadequate and manipulative personality, no suicidal ideation, went on home leave every weekend, was physically fit, who had been on the unit for almost a decade without significant change, and who would have been transferred to a private sector hostel years ago if there had been the funding available to do it. This man was not acutely ill and he didn’t really belong in hospital at all, and yet we continued to treat him as though he had just arrived as an emergency admission on a stretcher.
He didn’t need the heavyweight ‘everything but the kitchen sink’ nursing care plan, because he didn’t need the hospital environment at all, yet instead of making a common sense adjustment to his care we continued to submerge him under a sea of medics, tests, re-assessments, specialist referrals and weekly multidisciplinary meetings, simply because that was our professional ‘role’ and we were too inflexible to change it. Due to the absurd overkill involved, the man had slowly become conditioned to think of himself as a desperately ill and permanent hospital patient; one who could no longer conceive of a future beyond the unit, even though one day he would no doubt be rocketed into the private sector where no such attention would be given.

Home

There was a 1960’s Olivetti typewriter on the dressing table, with a half finished letter cock-eyed in the carriage and three keys locked together in one metallic embrace – the consequence of a large yellow index finger striking them simultaneously. In the wardrobe lay three large sacks of letters (dating back to 1971) which had never seen a stamp. There was no need for the mail, when a man was corresponding with his past.
Cassette tapes, toiletries, cups and matches lay confused on every horizontal surface, while the man’s clothes modelled Mount Blanc on the floor, and his ‘patient’s charter’ fluttered in the breeze – countersigned by a key worker who emigrated to New Zealand in 1999.
On the bed, lay the man himself, trousers and underpants down to his ankles, waiting for his regular intra-muscular injection, fast asleep.

Delivering the Paper

I was just about to leave, when the unit manager said:
“Oh, by the way. I’ve got one or two little jobs for you to do here.”
An hour and a half later, I had finished transferring lots of old nursing notes into archival boxes, using W.H. Smith circular reinforcements to patch up the existing sheets and dividers, and adding up how many hours of overtime and agency nursing we had used for the last five months (a lot). I had also toured the entire unit documenting how many chairs, tables, wardrobes, beds, cupboards, dressing tables, pot plants, cookers, desks, monstrous food warming machines, shelves, and filing cabinets we had, comparing these figures faithfully with those gathered six months earlier, and accounting for any differences. I had additionally, checked through the maintenance book to see how many maintenance jobs were still outstanding (a lot), I had filled in the monthly patient status form which told us how likely the patients were to move on and why they weren’t, and I had undertaken to audit the care plan entries of my colleagues during the next week, so that we would know whether blue pens had been erroneously used, abbreviations had crept in, or any other capital crimes had been committed.
I didn’t challenge Richard, as I had many times before, with the reasonable contentions that some of these jobs were unnecessary, some were his, some should be given to a ward secretary not a clinician, and some were perfectly mindless. He refused to accept the view that somebody with a £100.000 nursing degree shouldn’t really be spending long periods wrestling with W.H. Smith’s sticky reinforcements. Today, I allowed myself just the one comment:
“Let’s face it. These care plan binders are so thick and heavy, they’re bending open the high tensile steel rings. We can’t really hold back the tide for much longer with paper reinforcements”.
“Hmm….hmm. Well, do your best. The clinical auditors may be coming soon, and we need the records to be as complete as possible.”
“I can only try.”
“I’ll give you the thumbs up then old boy.”
“I’d rather you didn’t, if you don’t mind” I winced.