My Horrible Two Weeks

Nearly four weeks ago I described what I called my horrible two weeks – wherein my gallbladder, which we had thought was okay, unilaterally decided to develop a few gallstones with one thinking crawling up and blocking my pancreatic duct and causing a massively painful case of pancreatitis might be fun. Hint: it wasn’t. Well, at least for me. I also mentioned in that article that I would return to the experience of my hospital stay to discuss a prolonged incident of patient abuse that I observed, and reported, firsthand. Today is that day.

Setting The Scene

Around lunch time during my third day in the hospital I was moved from the Surgical Assessment Unit onto a medical/surgical ward. I was placed into a four-bed room that, with my addition, was fully occupied. To my right was a middle-aged middle-eastern and clearly muslim man who, with his visitors, spoke almost exclusively an Arabic dialect. I think I might have heard him speak English three times and that was only to the nursing staff twice and consultant’s registrar once. Diagonally opposite me, and opposite the man to my right, was an African man who was clearly also muslim and, like the man to my right, had clearly been raised in another country. When talking or acknowledging me, both men were quite polite. When the African man’s smartphone went flat, I lent him the USB-C charger from mine so that he could charge his device and call someone to come collect him because he was being discharged. His English was typical for many Africans from countries like Zimbabwe and Siera Leone that I know, well learned and quite formal. Where things fell down was that when dealing with some of the nursing staff, especially two of the nurses we had over the course of that first day and evening who were clearly Christian (the obvious sign being crucifix necklaces), both suddenly either didn’t understand what they were being asked or were simply being intentionally discourteous. However this, whilst clearly a problem on its own, was not the thing that truly disturbed me.

In the bed directly opposite mine was an indigenous British white man in perhaps his late 50’s. This man kept to himself. It was clear to me as someone who originally trained for several years in both adult and psychiatric nursing (I admit, almost 30 years ago) that he was uncomfortable and embarrassed either about his medical condition, or simply about being stuck in hospital and away from his home environment. He had suffered some recent insult to his health, possibly a stroke, that had caused paralysis on the left side of his body. This paralysis meant it was clearly difficult for him to roll over in bed, or to get up and address what in nursing we refer to as his activities of daily living (ADLs)1. However, when I did hear him speak to the doctors during medical rounds the next morning, it was clear he had had a formal private school education. He was neither stupid, uninformed, nor belligerent. However, what was visited upon him during the night was all three of these things. Possibly, worse.

The nurse on night shift for our room and the adjacent four-bed room was a rather robust African lass in her 40’s with a heavy accent that I believe identified her native language as isiZulu2. She wore a Christian crucifix and while no-nonsense was very polite with me, but was clearly standoffish with the two muslim men. Incongruously, with the British man in the bed opposite mine I observed that she was very clearly dismissive. I had seen him at least twice during the afternoon call upon the day staff for assistance to toilet; assistance he had received in reasonably short order and for which he had shown himself to be embarrassed but grateful when it was received. However, this night nurse told the man she was too busy and if he couldn’t address his toileting need on his own, she would have to come back later. This is where the problems began. He tried to explain to her back as she walked away that he was paralysed on one side and could not stand on his own. She didn’t turn around or acknowledge him. So he did the only thing he naturally could do. He was left by her absence of care to the humiliation of soiling himself and his bedclothes. And while it was not in any way his fault, I can tell you that even from across the room it smelt offensive to the rest of us.

What Happened Next

Three hours into her shift at 10:30pm our night nurse finally returned to our room to do the medication round. This was also at least two hours since she had told the man in the bed opposite that she would return to help him use the toilet. Other than to say I observed no emergencies or issues on the ward and suggest that she may have simply forgotten, I cannot say what she may have been doing during that protracted period of time. In any event when she got to the British man, she became very curt and clearly upset with him for his unavoidable misfortune. She again concluded by telling him she would ‘come back’ shortly. And, as you may already be thinking, she again didn’t return for at least another hour.

On a side note this was not her only example of poor planning and time management. I had been scheduled for intravenous pain medication at 8pm. In fairly severe pain I had hobbled my way out into the corridor at around 9:15pm and politely asked her if she could please ‘hang’ the medication3 I was meant to have already received at 8pm. I reminded her I had received my last medication before lunch and it was clear from my being hunched over and having cold sweats that the pain had finally gotten too much for me to manage4. When she came at 10:30pm to do the medications she realised she had forgotten the medication ordered for me which was already two-and-a-half hours late. By that time I had already done something I don’t recommend any of you do. I had been in so much pain that I was literally curled up in a ball and was, at times, crawling about the bed on all fours. In my backpack I had some plain liquid Ibuprofen tablets and some 30mg codeine tablets I carry for when I have the occasional visually impairing, vomit inducing, migraine. When she hadn’t returned by 9:45pm I had self-administered a couple of the liquid ibuprofen tablets in the hope that, as an anti-inflammatory analgesic, it would take the edge off my incredibly swollen pancreas and abdomen. It did. Just enough that I was able to at least sit still. She didn’t manage to start my IV medication until 10:52pm. Only, almost, three full hours late.

Not long after 11:30pm I was standing at the foot of my bed after visiting the bathroom. The nurse returned with another nurse who, I gathered from their conversation, was working in the patient rooms down the left hallway perpendicular to the one our room was located on. This nurse, dressed in the same uniform, was an even larger, louder, and more abrupt woman of African descent with a different accent I was unable to identify. Even though it was after 11:30pm and the rest of us had our lights out, and in spite of the fact that he was not her patient, she proceeded to castigate the British man in what my grandparents would have called her outside voice.

“Oh, David5. Look at you. You have shit yourself and shit all over your bed.”

“If you needed help you should have asked for it. We would have helped you had you asked for it. Now look what you have done. You’ve shit everywhere.”

When the man tried to tell her he had, in fact, asked for help, she proceeded to talk over the top of him.

“Now I have to clean up your shit. It’s everywhere! You’re disgusting. How could anyone be so filthy.”

Hearing what was being said I had peeked through the join between where the two curtains around my bed came together. Leaving aside the loud scolding, the nurses had also made no attempt to protect the man’s physical privacy or dignity. His curtains were fully open and his naked body was on full display to the other two men in the room who did not have their curtains drawn as I did. Worse than that, they were rough-handling him. They were using their arms under his armpits to pick him up and flip him to one side to the other, back and forth, by the shoulders. He started to protest, quite clearly telling them to take care with his arm as he was paralysed, was in pain, and was not enjoying how he was being treated. The second nurse, not content with her continued loud debasement of his having soiled himself, picked him up by the paralysed arm at the shoulder and elbow and proceeded to roughly toss him in the direction of our nurse so that she could change the sheet under him on her side.

It was clear from his face and his reaction that her rough treatment this time had caused him considerable pain, and he said as much. When this second nurse again reached for his paralysed arm, he used the other functioning hand to push her hand away. There was no real venom or force in what he did, and speaking as an outside observer I wholeheartedly believe his response was justified and reasonable. However, this prompted an even louder tirade from her:

“Look at him. He just assaulted me! How dare you hit me! You evil man!”

He responded, again telling her he was paralysed on that side, that she had hurt him, and he didn’t want her to touch him.

“I don’t know why I work here. Every time I work here, I get assaulted. And it’s always these racist white people. I’ve been married for 27 years and my husband has never hit me. How dare you hit me.”

When he began to repeat his protestations, she proceeded to threaten him:

“If you hit me again, I will call security and have you thrown out of here. I don’t care what is wrong with you. I will call the police and have you arrested.”

To our nurse she repeated:

“He hit me! I’ve been married for 27 years and my husband has never hit me and this guy hit me!”

When they had finished, and without even attempting to dress him, they threw a sheet over his naked body, turned out the light, and left. It was the most disgusting example of nursing care I had ever seen and unfortunately, when I read some of the online patient and public involvement (PPI) forums, I can see it has become all too common. While we are constantly led to believe that it is patients who are rude and abusive toward the nursing staff, reports like the investigation into the criminal acts of patient abuse at Winterbourne View Hospital:

…and Greater Manchester NHS Foundation Trust’s Edenfield Centre:

…and Oxford’s John Radcliff Hospital:

And the fact that the Nursing and Midwifery Council (NMC) regularly deal with reports of nurses physically assaulting patients (but cover up the name of the nurse and name of the organisation if the NHS request it):

…mean that these examples are just the known tip of a very large, ocean liner sinking, iceberg.

Sadly, the gentle and caring profession is not always so.

My Response

There was little point my attempting to intercede at the time. All that would have happened was that my care would have also been compromised, and potentially it would have resulted in these nurses, or at least the second one, either escalating her aggression towards the man or redirecting her ire towards me. The following morning I attempted to seek out the day shift Nurse Manager in order to have a confidential chat with her. Almost as if she thought I was going to complain about something that had or had not happened to me, she brushed me aside twice and by lunch time had failed to come and speak to me. Not wishing it go unreported, I turned to the least qualified person on their team – the healthcare assistant (HCA). She was an older woman who I had seen have several positive interactions with the man opposite me during the morning. I asked her if I could speak to her outside the room, told her what I had seen and heard, and explained to her I had been trying to get a few minutes with the Nurse Manager to formally report these events. I asked her if she would please raise them with the Nurse Manager on my behalf.

Not even ten minutes later the Nurse Manager came to see me. We went into the sluice room across the hall and I described the events I witnessed the night before. I also described that I had seen the previous day’s staff interact with the man positively, and my observations that morning. I explained that I added these observations for context – that it was clear, for example, that the man had dealt with staff who maintained his dignity by approaching him, telling him what they were going to do and seeking his assent politely and with respect. That the two nurses from the night before had failed to tell him what they were going to do, failed to seek his consent, denied him any dignity by not only telling the whole ward that he had soiled himself but also by calling him names, accusing him of doing to them what I had observed them doing to him, and exposing his naked body for all to see. The Nurse Manager responded that no, that is not how we treat patients. I replied that I knew this, which is why I was coming forward to make the complaint. She proceeded to try and tell me that it must have been HCAs and not registered nurses, to which I replied I knew the difference.

“How?”

I asked her what colour the registered nurse’s uniforms were in this NHS trust.

“Like mine. Dark blue.”

I then asked her what colour had I told the HCA the uniforms of the two nurses from the night before were. When she replied that she couldn’t recall, I prompted her to go ask because she will find that I correctly described their uniforms as both being the same – they were both dark blue. I knew the RN’s uniforms were dark blue, and every HCA I had seen had been dressed in maroon. Further, I added that it would be unlawful for the first nurse, the one who had administered my and other patient’s IV medications, to do so if she were not in fact a registered nurse. HCAs cannot administer medications, especially not IV medications.

This elicited a very defensive “How would you know?”.

To which I replied:

“I not only trained for several years in nursing a long time ago, I am currently a lecturer in a nursing school and I hold a law degree in health law.”

She stopped. Looked at me for about fifteen seconds. And then told me they were just about to have a staff meeting about the events of the night before, which tells me that the second nurse had likely raised an entirely unfair and improper complaint against the patient. She thanked me for speaking to her and walked away.

I expect nothing will have been done and the nurses who perpetrated this assault upon the man will simply continue in providing sub-standard and abusive care unabated.