Motivation is something that you soon loose after your first couple of 100 hour weeks. Don’t get me wrong, you don’t mean to loose this motivation and it isn’t because of you not caring, it is simply because you are too tired to even stand up. This doesn’t matter though, you have to keep going. It doesn’t help with your motivation when you have a ‘difficult patient’. I’m the first to admit that I can be moody when I’m not well and I am very happy to allow for this when people are admitted. Hospitals aren’t nice places at the best of times, if you then add in being scared or in pain then I think you have a good enough reason to forget to say please and thank you. Every now and then however, you come up against someone who you just can’t seem to get it right for.
It was on my thirteenth day working out of a fourteen day stretch that this happened to me for the first time. Mrs Jackson was a 58 year old lady with a history of asthma, eczema and coeliacs as well as a long list of allergies ranging from penicillin to wool. She was morbidly obese and spent most of her time either sitting in a hospital bed or sitting on a sofa at home. She had spent more time in hospital over the past few years than the average NHS employee and she felt she deserved special treatment due to this. It started the moment she was wheeled onto the ward.
As the porter manoeuvred the bed into the bay Mrs Jackson was to be placed in the problems started. She let out a shriek that made me jump to attention, instantly assuming that someone had collapsed or maybe died. I made my way to the source of the noise only to see a very red faced Mrs Jackson bombarding the porter with abuse vaguely wrapped in a veil of polite language. From what I could make out, she was refusing to go into the bay as it was not the one she had stayed in last time. She was a superstitious person apparently and she informed us all that if she was not placed in the same place as last time then it might mean she was going to die. This bay was the worst possible option as on her previous visit there had been a crash call to this part of the ward and she took great delight in retelling the gruesome tale of someone’s demise in her hushed, dramatic tones.
“So you see, I absolutely cannot stay in a bed that someone else may have died in! What kind of an effect will that have on my recovery?”
I thought it was probably best not to tell Mrs Jackson that most of these beds had probably had someone die in over the years so I let that one slide.
All this time, her focus had been firmly on the porter and one of the staff nurses who had been in the wrong place at the wrong time but then she saw me – fresh meat for her complaints.
“Doctor!” She called out as she her hand shot towards me as if grasping for my intervention. “Please, doctor, don’t let them put me there. I need to be in Bay C, that’s where I went last time and everything went so well. I can’t go here, what if I caught what killed the last lady in that bed?”
I desperately wanted to tell her she was being ridiculous and she was much more likely to catch something from the lady with the hospital acquired infection in Bay C than the disinfected bed that someone died in several months ago, and in reality, the beds had probably all been moved around since then anyway. Instead, I found myself reassuring the hyperventilating lady in front of me that we didn’t mean to upset her but also explaining it wasn’t up to me where patients were placed. In the end, Mrs Jackson agreed to sit in the wheelchair in the day room while we discussed the problem amongst ourselves.
The office was engulfed in a cloud of swear words as the ward staff vented their feelings about Mrs Jackson’s readmission to our ward. Apparently she had made a student nurse flee the ward in tears last time she was here and had managed to fill one of the nurses’ night shift with a constant stream of complaints. The sound of her bedside buzzer was enough to drive the sanest member of staff running and screaming for the exit. A debate over where Mrs Jackson should be placed was held with such intensity that you would think we were trying to place a member of the royal family. In the end it was the voice of reason, our ward sister, who decided she should go in the bed that was originally intended for her. It would be wrong to ask someone else to move for her as that would show preference of one patient over another and anyway, the bay she wanted to go in was on the verge of being quarantined anyway due to an outbreak of hospital acquired pneumonia.
The news did not go down well and Mrs Jackson had clearly decided that we should all suffer. The window wouldn’t close properly and so it was too cold. The sun was bright in through the windows and it was giving her a headache. There were not enough blankets. The pillow was too hard. The nebuliser being used by the patient next to her was too loud. The lady in the bed opposite was confused and kept talking to her… the buzzer didn’t stop and it wasn’t just the nurses having to deal with it while at the same time see to the twenty other sick patients. No, I did not escape her sharp tongue either. She had come in on a day when there was no senior ward round and so I was making my way from one end of the ward to the other seeing the patients myself to make sure everything was ticking over alright until the consultant came around the next day. I made the mistake of starting in the bay that Mrs Jackson had been placed in.
“Young man, what time will your consultant be seeing me?”
“There’s no consultant round today Mrs Jackson so you’ll be seeing me. The consultant comes around tomorrow morning.”
“Is this a joke? What kind of hospital allows a patient to be admitted and then wait a whole day to be seen by a consultant?”
I tried to explain that seeing as she had been admitted via MAU, she had been reviewed by their consultant just a few hours ago so technically speaking she had been seen by a senior that day and my ward round was simply to check that any tests or investigations requested by that consultant had been carried out. She wasn’t listening to anything I had to say.
“Who do I speak to about the food?”
“The food! Or should I say the rubbish your chef serves and calls food! I had supper here last night and I can tell you, it was far from palatable!”
“I’m sorry to hear that but unfortunately the food choice is limited. If there is a specific allergy you could talk to one of the nurses…”
“Allergies! You know about my allergies I take it because I have a list written down in my bag if you need it.”
“We have a list from MAU that…”
“I do have a lot of food intolerances so I want to make sure that you are aware of them all.”
“I’ll make sure everyone is informed Mrs Jackson and then…”
“Now about my X Ray. I was told they wanted me to have a chest X Ray, I want to have it in the morning because I’m tired and need to get some rest.”
What are you supposed to say to a request like that? How best to remain professional?
“I’m sorry Mrs Jackson but as I’m sure you appreciate, the X Ray department has to work around any potential emergencies coming in through A&E, so while I can assure you that you’re scan won’t be done in the middle of the night, I can’t book a specific time for it to be done.”
Well done, I thought to myself, that could have been read from a textbook.
“Clearly you are not nearly high enough up on the ladder for me to be talking to!” She barked back at me. “If you can’t do a simple job like arrange me a civilised time for me to visit the X Ray department then you clearly aren’t capable of doing your job. Fetch me the consultant!”
This was going to be a long day.