Hospital Diary

via Hospital Diary

These events took place in February and March 2006 in the Mater Hospital

 

Part One

Fever

He’s cold. He’s shaking. He’s soaked in sweat.

Not again.

He’s hot. He’s thirsty. He tries to drink water. His stomach revolts. He gets up. His head’s spinning.

Kitchen.

He shakes a bottle of kaolin and morphine, swallows a tablespoon of of the minty, chalky mix.

He sips water.

A little bit.

Then another.

Then no more.

He can’t face the minty stuff.

His head’s sore.

His feet are freezing. He pulls on socks, shivers under the covers.

It comes.

He’s not forgotten. How can he?

Paracetamol.

He can barely hold it down.

It’s no good.

Get the spray.

He soaks his chest muscles in Ibuprofen.

He breathes in.

Raw pain.

He breathes out.

Raw pain.

He tries to sleep.

It’s the morning of the third day.

Every movement shoots agony through him. It can only get worse. He has drunk no more than half a litre of water.

He knows. He’s had this thing before.

He has a choice to make.

It’s no way to die.

He remembers watching someone else; a man bigger than he now is reduced to a skeleton, unable to even speak. Just a croak.

He looks at the clock.

9am

If he’s to make the phone call, it has to be now. He will not have the strength later.

Today I die.

He dials the number.

“Surgery. How may I help?”

“I…..”

“Yes?”

“I need a doctor.”

“Yes? What are your symptoms?”

“Fever. Pain. Chest pain.”

“Can you make it to the surgery?”

“No. I….”

“Would you like a doctor to come out to you?”

“Yes.”

“What’s your name?”

She doesn’t recognise my voice.

“Adam. Adam Miller.”

“You may have to wait a while.”

“Okay.”

He falls out of bed. He can’t stand.

Crawl.

He slides down the stairs, turns the key in the deadbolt. He wants to be able to open the front door.

He shivers on the floor, hugs his knees and waits.

********

The doorbell rings. He panics, moves hand over foot.

Pain!!

He can’t stand. He raps the door to show he’s in.

Reach up.

Click!

The air is ice. She stairs down at him,

“Adam Miller?”

“Yes.”

“What appears to be the problem?”

“It’s sore.”

“What’s sore?”

“Chest. Come in.”

She looks scared.

Please help me. Don’t go away.

He crawls back to his place before an empty hearth. She opens her bag. Cold metal touches his chest,

“Can you breath in…….?”

Pain!!

“And out.”

Pain!!

And again.

Please make it stop!!

“You appear to have a chest infection.”

“I can’t move…..”

“I can give you a script for antibiotics.”

“I can’t get water into me.”

Yes, your eyes look quite sunken. I can give you something for the nausea.”

“Serotonin antagonists?”

“Yes.”

“I can’t take them. I have depression.”

She looks confused. The contagion of his terror appears to have afflicted her,

“I can give you a script now…….”

He’s shaking his head.

Please don’t leave me here to die.

She’s looking around her.

Maybe it’s the filth. I’m sorry. I can’t help it.

“Um……..”

Please………….

“Do you think you need to go to hospital?”

Thank you!

“In a word……?”

“Do you have a phone here?”

“Upstairs. Bedroom.”

She looks anxious.

Say something.

“I don’t blame you. The whole house looks like a bomb hit it.”

“I’ll call from the surgery. The ambulance should take about an hour. Can you wait that long?”

“I’ll have to.”

She’s relieved to be going.

“I would see you to the front door, but, you know…”

She lets herself out.

Get some clothes.

He crawls to the stairs.

Pain!!

Moving’s worse than breathing.

Sweatshirts fall from the shelf.

Rap!! Rap!! Rap!!

He slides down the stairs on his backside, reaches up,

Click!!

“Are you the patient?”

“Yes.”

“Do you have your details?”

“Yes.”

He points to a printout she’s left. and staggers with a stooped gait into the kitchen. He grabs a used polythene bag, and tries to squeeze his clothes into it. They spill onto the floor

The paramedic helps him pick them up,

“Can you walk to the ambulance?”

“I need help.”

They hold his armpits. Pain lances through him.

They’ve made it. The paramedic sits opposite him and clips a monitor to his thumb. There’s confusion and concern. Dehydration has made his blood pressure dangerously low. An oxygen mask slips over his face,

“Breath deep and slow.”

Pain!!

“It’s like a fuckin’ knife!!”

“Don’t swear. It’s like a knife.”

“Every breath, every breath………”

“It’s pleurisy.”

“Where are we going?”

“The Mater.”

His partner puts the siren on. He holds Adam steady as he wobbles with the acceleration.

“How bad is it?”

“It’s not good, but we’ve antibiotics.”

“You don’t get treatment resistant strains?”

“You’ll be fine. We can treat MRSA. At the moment anyway. There’s a new bug. We don’t have it here. Not yet.”

This was interesting,

“We’ll end up going back to the 1930’s, before we had penicillin.”

“It’ll happen.”

“Bad times. A lot of people will die.”

“You’ll be okay. We can treat this.”

His partner calls from the driver’s seat,

“We’re here.”

Arms swing his legs up onto the trolley. They crank it’s back up so he’s sitting.

********

Part Two

The Pain Scale

It’s warm in here.

The doors flap open. Chill wind follows another trolley.

Casualty’s full. He waits.

A doctor comes,

“Where do you rate the pain, between one and five-”

“Five.”

“Take these.”

He sips water and swallows. He’s still nauseous,

“I haven’t been able to drink.”

“I’m gonna put you on a drip now.”

He looks away as the cannula slides into his arm. They inject antibiotic into the valve.

“We’re trying to find a bed for you. It’ll take a while.”

“Okay.”

I’m not going anywhere. I can wait.

Hours pass. He breaths shallow and slow.

Pain!!

The porters come.

********

It’s a surgical ward filled with emergency admissions. Beside him, a drunk argues with his delirium tremens, occasionally noticing the nurses who try to restrain him. They’ve become, it seems, inured to verbal abuse. His shouting and violent writhing do not dilute their concern for him. His cannula works loose and falls to the floor.

“Jimmy, we have to put a new one in………Jimmy……Jimmy……Jimmy……it’s okay.”

He’s old and tired and weak and filled with the strength of his rage. They overcome him, open the valve in the drip, and apply a nicotine patch to his arm. Velcro straps secure him to the bed. They leave him to it and he becomes, not calm, but less distressed.

*********

Adam coughs up a mass of yellow goo and spits it into a specimen cup,

“Must be strep or staff.”

The nurse looks at him,

“Are you medical?”

“No…No….I’ve just……..I’ve read about it”

She looks at his chart,

“You’re on Augmentin.”

“What is that?”

“It’s one of the penicillins.”

*********

He stands facing the wall, wraps the lead gonad shield around his backside and clings onto it. The technician’s talking to him,

“Okay. Just hold your back straight. That’s it. Now I need you to hold your breath………”

The x-ray machine buzzes, then stops.

“That one’s blurred. I need you to stay perfectly still.”

Buzzzzzzzzz…..Click.

“That one’s better.”

The porter takes him back to the ward.

**********

They’ve been phoning for hours and now, finally, she’s come. Maura stands in the doorway, afraid, it seems, to cross the threshold and engage with what’s happening. He looks at her. She comes and sits by his bed.

“The hospital called.”

“You’re my next of kin.”

They have become brother and sister to each other, two wounded souls cast adrift on a sea of loss. He understands the terror in her eyes. She’s facing the sudden threat of imminent bereavement. He thinks back. He’d barely turned eleven, and could not recognize the man they took him to see. He had been huge once, all the more so in the eyes of a child. He was reduced to skin and bone and sinew. His father had hours to live. No-one had told him what a “shadow on the lung” means.

Adam can barely speak. Like him, she has no words.

*********

“Hi. My name’s Emma. I’m a junior doctor. Where’s the pain?”

He points to the bottom of his chest and left side and back.

She nods,

“That’s where the consolidations show on the x-ray.”

She puts a cold stethoscope to his chest,

“Can you breathe in deep for me…”

Pain!!

“It’s sore….”

“If five is the worst…”

“Five.”

She looks at his chart,

“I can give you more painkillers now if you want.”

“Would you do that for me?”

“When did you last eat?”

“Two days ago.”

“You must be hungry.”

“Nausea…… Couldn’t……..”

“Do you want to try something now?”

“Yeah.”

“I’ll see what the canteen has. Lets see what you weigh.”

“You should be eighty-four kilos, and you’re currently seventy-two. You’re suffering from malnutrition.”

********

He swallows the tablets and slowly eats sweet and sour pork. Maura sits beside him. She has respected his privacy and left the doctor to have her little chat with him.

It’s time to go. He gives her his wallet for safekeeping and to purchase necessaries.

********

“I need diazepam at night.”

“We can’t give you it. Your breathing’s too bad. It’s dangerous.”

“What about a sleeping tablet?”

“It’ll be a few hours before a doctor’s available. See how you go.”

He lacks the will to insist.

********

The nightmare’s vivid. It’s family.

He wakes.

Oh Fuck!! Where am I?

The ward’s dark. There’s light and movement out in the corridor.

Try to sleep.

********

The entire ward grumbles as Jimmy wages war on his hallucinations. Adam tries to doze. A nurse checks his blood pressure in the night.

“How are you feeling?”

“I wish he’d shut the fuck up.”

Her rebuke is like a snarl,

“He’s sufferin’ too.”

“I just wanna sleep.”

********

“Hi…Hi……..Adam?”

“Whaaaa…….”

A different nurse, this one young,

“Your fever’s bad. You’re burning up. I’m gonna put this fan here to try and cool you down.”

“Thanks……..”

********

Morning comes with the rattle of the medication trolley. No-one has slept. Jimmy’s private war had taken its toll on all of them.

His eye has crusted over in the night. A cold sore blossoms on his lip.

*********

Doctor Lim is Korean and strictly professional. She shows her medical students the print outs of his x-rays, pointing out the shadows,

“You see the consolidations here and here. Atypical pneumonia and pleurisy. What’s he on? Augmentin. Add Claricid to that.”

The nurses look worried.

********

As she changes his bed, Adam asks Carmel, a Staff Nurse,

“What is it I have?”

“Pneumonia.”

“It’s not TB or nothin’?”

“No.”

“What’s the big deal?”

“There’s a consolidation sitting over your heart.”

“Ah…….”

********

“Zovirax cream is no better than placebo.”

“It works. Use it.”

He does, but when a medical student is taking a blood sample, asks her for an alcohol wipe,

“This is what my old GP taught me. You watchin’?”

He douses the cold-sore with it, burning a fire-break of dead skin to stop its spread.

She’s impressed. She’s learned a new trick. He feels better already. He’s taken some control of things. Every little bit helps.

********

The physiotherapist is young and lovely.

“You need to get oxygen deep into your lungs.”

He tries. The pain is less, maybe a three on the scale. She gets him up on his feet and walking.

“You’re a shoulder breather.”

“What’s that?”

“You’re hunching. Get your back up straight. That’s it. Now pull your shoulders down, breathe in deep, down into your stomach. Slow and deep.”

He’s learning to walk like a man.

********

Part 3

Harry

The nausea has gone. He’s eating and the food’s good. You can’t beat hospital porridge. He loves those lumps. He’s still on a drip, but he’s drinking water. There are special drinks for the malnourished, very, very high fat content. He tries. It’s like drinking banana flavoured engine oil.

I’m not that brave.

********

The shortage of hospital beds has created an absurdity. Emergency admissions are slotted in anywhere a vacant bed can be found. This means that a surgical ward is filled with patients who are not there for operations. Doctors, followed by their gaggles of medical students, walk here, there and everywhere looking for their patients. In his eight days in the Mater, he bears witness to the chaos of a Health Service “Reformed” to the point of perpetual imminent collapse.

********

Harry’s an elderly, quiet and dignified man who’s come in for major bowel surgery. He’s pleasant and appreciates Adam’s little moments of wry humour. They wheel him away to the theatre.

He returns a different man.

*********

He’s confused and babbling. Carla, a senior staff nurse and shift manager, talks his daughter and son in law through the technicalities.

“This is the stoma. You see where the bag goes? Like this. Okay, now you try it. That’s it.”

Harry’s oblivious. He’s back in the Army, during the war,

“Yes, Sergeant. I’ll do that.”

********

Carla’s heard of Jimmy’s antics.

“He’s gettin’ a sleepin’ tablet. I’m not havin’ another night of that.”

Things are looking up.

********

Carla’s dedicated and disciplined. She puts the nebuliser mask over his face to feed warm, salty water vapour to his lungs.

What’s that?

It’s a medal. She’s a nun.

What order does she belong to?

He’s shocked. Her compassion is genuine. He remembers the wimpled and terrifying monsters from the primary school in Turf Lodge.

*********

Evening has come, and Maura sits with him. They listen to Harry, whose outer monologue is fascinating. Carla’s speaking,

“It happens with post-operative shock. They usually recover.”

Carla preparing Adam’s Augmentin. He asks her,

“Why is it given intravenously?”

“It works quicker. It takes forty-eight hours for the antibiotics to kick in.”

“You mean I’m getting worse?”

“The nebuliser helps break up the consolidation. Your infection count should start going down from here on.”

She opens the valve on his cannula and slips the nozzle of the syringe in. She has to force the plunger down hard. Maura flees. She returns a few minutes later, her eyes raw, her tears rinsed away.

**********

“Can I have valium?”

“Your breathing’s too bad for it.”

“What about a sleeping tablet?”

“The doctors are busy.”

He wakes from one nightmare after another. No doctor comes.

Harry doesn’t sleep. He’s driving a truck up the narrow road that never reached Arnhem.

“The Germans were waitin’ for them. The Paratroopers had no chance.”

A shell bursts nearby and he ducks, peering over the steering wheel. He will not get to relieve the beleaguered Airborne Division.

*********

Morning comes. He’s shell shocked. Hypervigilance sends every noise through him like a gunshot. He hasn’t slept in days.

“I need Valium.”

“It’s too dangerous.”

“I only need two milligrams.”

“I’m sorry.”

“You can cut a tablet in two. One milligram.”

She speaks to Carla. They get a pill-cutter. He swallows his slice of salvation like a communion wafer and dozes.

********

Night comes.

“I need a sleeping tablet.”

“We’ll see.”

“Please. I can’t………I…….”

“I’ll speak to the doctor.”

********

“Take this.”

“Thank you.”

Peace comes.

Part 4

Scrubs

He’s off the drip, rehydrated. Wobbly on his feet, yes, but in a stable condition.

It’s late. The night shift are on. The big lights are off. The little ones, above the head of each bed, provide illumination. The corridor, out there, has a soft yellow glow. It’s quiet. Harry’s sleeping. The ghosts of Arnhem’s tragedy no longer keep him awake. A woman comes to Adam. She wears crimson scrubs. He can’t help himself. He has to say it,

“You’re surgical aren’t you?”

“Why do you say that?”

“It’s the scrubs. They kind of give it away.”

“How would you feel about moving to a different ward? It’s smaller than his.”

“Quieter?”

“Yes…….… We’ve someone coming out of theatre and we need this bed.”

“Now?”

“Yes.”

“Can you inform my next of kin that I’ve moved?”

“We’ll do that.”

He piles his stuff together on the bed. His head’s spinning. He falls into a chair.

Toilet.

He asks a male nurse,

“Can you help me? Just to get me from here to there?”

“Put your arm around me.”

He bolts the door, shaking with terror and embarrassment at his powerlessness.

********

It’s a mini-ward called a bay. It has four beds and three heart patients. This is apt and surprising. After all, it’s a heart ward. Then again, its patients are mostly emergency admissions. They’re in urgent need of specialist care.

The ward’s quiet, but not the corridor. The nurses keep the door open. During the night he tiptoes up to quietly push it shut.

********

Morning comes and an Indian nurse gives him medication and checks his details,

“Do you need a chaplain?”

“No…..… I don’t believe in that.”

She’s sympathetic. He’s glad.

*******

He’s living from one panic attack to the next. They haven’t contacted his next of kin. He asks for a phone. It won’t work. He’s screaming at a nurse. He draws the curtains around his bed and tried to keep the world at bay.

********

“I’m sorry about earlier.”

“It’s okay.”

No it’s not.

********

It’s the weekend. The junior doctors are on their own. They’ve no consultants for backup.

“We can take that out now and put you on oral antibiotics.”

He looks away as they pull the cannula free.

********

Part 5

Them and Us

“What happened to that?”

Doctor Lim is not amused,

“I didn’t authorise that.”

She looks at his chart,

“You’ve been switched to oral…….. I want you X-rayed. Take care of that please.”

********

The consolidations are disappearing. The nebuliser’s flood of salty steam into his lungs has bought him time. The antibiotics are working. The pain has shrunk down to an ache. The nurses always make sure he gets co-codamol.

********

It’s lunchtime. Two medical students interview him. They’re eagerly accumulating case-studies. Adam tells them his personal history and the onset of his illness. They go away, then come back to examine his hands. They’ve forgotten to look for clubbed knuckles. He has none. The pneumonia is atypical. The nurses are visibly angry. Mealtimes are supposed to be quiet, their charges left in peace.

*********

The sheen of new construction has faded. The Mater is filthy, the cleaners forever overworked. Hardened grime gets a quick wipe with a cloth. A manager comes and watches them,

“I have to see you do the thing.”

She’s taking the piss. Then again, that’s what they pay her good money for.

********

The shower room in his bay has become its own ecosystem. A commode is glued to the floor by an ancient, crusted jay-cloth. He tells Maura to go have a look.

“Holy Fuck!!!”

The whole ward giggles.

********

The cleaner sits down and fumes,

“Who does he think he is? Does he think I’m a piece of shit? I told that consultant to go fuck himself!!”

It’s was as if she has spoken for all of them.

“Good for you.”

*********

Orla is a senior Staff Nurse with twenty-five years on the job. She will not allow it to harden her. She and Adam have become friends and, in a sense, conspirators. They talk about the hierarchy. Consultants are demi-gods, surrounded by their acolytes, the medical students; junior doctors a snobbish clique who treat nurses, patients and auxiliaries with equal disdain. It strengthens the bond between the lesser beings. The little acts of kindness are all the more meaningful because they stand out in sharp contrast to the casual disregard of the “other lot”, who act for all the world as if they are a better class of person. The lower orders beg to differ, but, usually, keep it among themselves.

********

Every day he looks away as a hypodermic is slipped into his arm and blood samples drawn off.

“You can tell I’d never make a junkie.”

Louise smiles. She’s a staff Nurse in her early twenties. He feels an affinity with her, which goes beyond mere physical attraction. She’s working class. Her speech, like Adam’s, is full of colloquialisms and intelligent content. He thinks back to his own years in Sullivan Upper. He can picture her in a grammar school, struggling with the barriers of class, set apart by the “tells” of accent and dialect. In the class war that plays itself out on the wards, she’s one of us, the little people, lorded over by their betters.

Every little act of revenge is delicious. Medical students swoop on a computer terminal like school kids, eager to see his latest X-rays. Louise walks up to them,

“Does any of youse medical students have alcohol gel?”

They have none. Their smugness evaporates.

Adam’s in love.

If you weren’t married, I’d propose to you.

********

Part 5

The Day before Ash Wednesday

The other three men on his ward have just had heart attacks, but they’re not happy with the chaplains who hover like vultures. A near death experience has not brought them closer to God. Instead, one of them gives smoking right away. He doesn’t even ask for nicotine patches. He just stops, and that’s that. It’s how he deals with his existential crisis. Adam’s own, in the aftermath of the fever, is beginning.

********

He’s losing weight as his body devours itself in its efforts to fight the infection. Every day, in the mirror, his face gets thinner. His cheeks become craters. His eyes get ever bigger.

********

They want to send him home. They need the bed and the threat of MRSA is so great that patients are discharged fast, lest they catch something worse than what they’ve come in with.

“I’m not ready for this. I live in a cold house and I have to work real hard to heat it.”

“We can only hold you so long.”

“It’s snowing.”

“We’ll see.”

********

“I need to ask you something.”

He doesn’t want to do this.

I don’t have a choice.

Maura’s looking uncomfortable,

“What is it?”

“I need somewhere warm, ’till I get my strength back. I need your back room.”

“Yes.”

She knows she’s saving his life. He sees the burden of it in her face.

She can barely carry it.

********

It is interesting to Adam that the Mater, a Catholic hospital, has a mostly Protestant workforce, and treats mostly Protestant patients. As he emerges from his fever he notices this. He’s on a ward where people feel comfortable talking to their “own kind” and tries to “pass” for one of them.

Never drop a “H”.

He’d done that once before in a different place. The sudden and terrifying silence had made it clear.

Never drop a “tell”.

********

A contract nurse on the night shift is confirming his details,

“Okay, and your next of kin is Maura….”

“Shhhh……”

********

His last night in the Mater is Pancake Tuesday, and they have pancakes for supper. The night staff are good to their patients, but there’s a hidden layer of solidarity.

“What’s for lunch tomorrow?”

“Chops. But it’s Ash Wednesday, so if you’re one of thowwwwwwse people……..”

She makes window-wiping motions with her hand,

“……..it’s fish.”

He laughs,

“That’s long gone.”

“Chops it is then.”

He’s just become an honorary Prod.

Part 7

Discharge

It’s time. He’s leaving. It’s Ash Wednesday and he gets to have his chops for lunch. They’re tasty. Apostasy may be hard work, but he makes the most of its benefits. It’s the little things that matter.

After he’s eaten, he gets dressed and fills hospital bags with his accumulated stuff.

*********

There’s a problem. They give you a month’s supply of drugs when you leave, but they’ve forgotten to prescribe his diazepam. He has to wait ’till a junior doctor is free.

Orla and Adam exchange a knowing look,

“They’re busy, right?”

“They’re on their lunch. You’ll have a long wait.”

The afternoon wears on, and on, and on. It would have taken a handful of seconds to sign a script. The nurses keep reminding them, but……….

Louise returns from their staff room. They’ve been politely ignoring her requests. She’s not amused. Adam says what they’re both thinking,

“I fuckin’ hate those people.”

She nods in silent agreement.

**********

Tea time comes. He enjoys his last meal.

**********

The sun sets. Still no script.

**********

The day shift is ending and the junior doctors have one last thing to do.

Louise brings his valium. They say farewell. He goes to the nurses’ station. Orla phones him a taxi, and lets him call Maura.

“Thank you.”

“Look after yourself.”

“I will.”

He has yet to learn the significance of that commitment.

*********

On the way home, he feels like his eyes have become enormous. Even in the fading light of dusk, every detail of the world jumps out at him.

*********

That night, in the quiet haven of Maura’s flat, he watches a public service announcement telling us all not to bother the doctor or go to casualty unless it’s absolutely necessary. He thinks back to his panicked conversation with a locum eight days ago.

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