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August 07, 2006

Four days in an NHS hospital - Christopher Peachment relives his terrifying recent experience

Posted by Christopher Peachment

Christopher Peachment has recently spent four days as a patient in a London NHS hospital. Here he explains why it was a terrifying experience.

I take the same attitude to the NHS as the French do to their police. As long as you do not fall into their hands, then they can get on with whatever they are doing without my scrutinising them too closely. However last week I fell into their hands and was lucky… I was about to say lucky to get out alive, but then I believe the super bug takes a few weeks before showing itself, and so I had better not tempt the gods.

Fortunately I was comatose when wheeled in to the Emergency room. Had I seen what I saw when I walked out of the hospital four days later, I would have been very worried indeed. If you are not anxious before going in to hospital you certainly will be after you walk through the door.

I won't bore the reader with my illness. Suffice to say that both the team of doctors who treated me and the nursing staff who tended me were all very impressive. Aside from their professionalism, the interesting thing about the doctors was their enthusiasm to uncover what was wrong with me. I think I detected disappointment when it didn't result in brain surgery.

The first place that I arrived at after the Emergency room was a small holding ward called the Clinical Discussion Unit. This did not mean that anyone stood around discussing anything. It was a pleasant, clean ward with about ten beds, air conditioning which was welcome in the heat wave, and a team of excellent nurses, including one whose name tag said "Modern Matron". I am glad they have revived the office of Matron, it is very reassuring. And I can understand why they felt it was necessary to add a little spin by adding "Modern". There was always something Gothic about old fashioned Matrons, though they certainly knew how to run an efficient hospital.

There was a Dutchman in the bed next to me, over here on a business trip, who had succumbed to bad vertigo and vomiting. He was as cheerful as a man could be when falling over and throwing up. He did complain to the Matron however about the noise and his inability to get some sleep. The noise was coming from a drunken couple, who were arguing about who should have the last roll-up cigarette. God knows what they were doing in there, though the nurses dealt with them with good natured tolerance, when my inclination would have been to tie them to the beds and gag them. I was now getting regular morphine so the problem faded.

After a couple of brain scans, I was taken up to a ward, and this was when the fear began. I have never encountered a modern public building so daunting. The corridors were filthy. The lino covering the floors was pitted with holes. Anything not bolted down had clearly been ripped loose and stolen. I forget the colour of the walls, but it was the sort of green or brown that I had thought died out in the 50s. It looked like a Victorian prison or workhouse. Later I remembered scenes from The Elephant Man.

Inside the ward was cleaner, though there was no air conditioning, and the inmates were suffering with the heat. There were about a dozen beds, three feet apart, with the usual curtains which didn't reach the floor, and couldn't be properly closed. The idea that any of the sick men got any privacy was comical.

Much is made about patient-doctor confidentiality, and how the use of computers might damage this by laying open people's medical files for casual inspection. This may well be a pressing issue, but the idea of anyone in hospital enjoying the same privilege is ridiculous. Even with the bed curtains drawn, it is still possible to hear everything that doctors and nurses say to every patient on the ward. By the end of the first day, I knew very much more than I wished to about all the men on the ward. Not only was I embarrassed for their sake, it was depressing too.

The Dutchman had said to me before we parted that, in Holland, everyone is automatically given their own room. He said that in some of the remote, more primitive hospitals you might have to share a room with another patient. An Australian nurse confirmed the same about her country.

Whoever thought that communal wards were a good idea? It cannot be for reasons of nursing efficiency. The only rationale behind it I can think of is that it is a hangover from the days of the war, or of National Service, when conscripts slept in barracks.

It was impossible to get any rest or sleep throughout the stay. Aside from the clattering of the hospital, there was the old man in the corner who spent the whole night keening and wailing and calling on Allah for mercy. It turned out he had severe constipation. Another fact I did not wish to know.

In the middle of one night, I was trawling along the ward in search of a clean lavatory, through a couple of sections for women, which were open to the men's sections without any door to separate them. I finally reached the double swing doors to the outside corridors. I went through, and the doors swung to and locked with a click behind me. I was thus standing in public, clutching a drip stand for support, in desperate need of a toilet, and clad in a gown specifically designed to humiliate you by leaving your bottom hanging out in the breeze. After frantic banging on the doors, a nurse finally came and let me back in. I asked why they locked the doors, and got the expected reply about thieves.

"They'll be stealing patients next," I said.

"That happens," she said darkly.

Aside from rest or sleep, any way of gaining strength from the diet was also impossible. I don't know what it was that they served at meal times, because I have never eaten anything like it. I have stepped in it a few times though.

At one point I asked whether they had any fruit, and was handed a bowl of tinned mandarin slices. There were some vegetables included, next to the grey meat-like substance, but they had been boiled to extinction. I don't see how anyone could recuperate on that sort of diet.

The toilets were usually clean, but sometimes filthy. One can't entirely blame the staff for this. Why it should be impossible for a man to clean a toilet after he has used it is a mystery. But it was so.

So too with visiting hours. These were liberal, but there are times of the day when visitors are not allowed. This was widely ignored. One man surrounded himself by up to a dozen family and friends from nine in the morning until eight at night, all of them noisily gossiping and yelling on their mobile phones. Again, rest was difficult. A nurse told me that they didn't dare enforce the rules these days, for fear of a string of human rights lawyers queuing up to sue for their lack of "respect".

I have never before believed that "hell is other people", thinking that it was just another manifestation of Sartre's massive egotism. After a spell on an NHS ward, it is gaining in appeal.

I took a look at the notes hanging on the end of my bed, and discovered, among the reams of forms that nurses are now expected to fill in, thus lengthening their day by many hours, was one which posed questions about the patient's mobility. It looked irrelevant. But one question caught my eye. It said "Expressing Sexuality".

My immediate thought was "chance would be a fine thing, in here" and then I started to wonder just what form anyone expressing any form of sexuality might take. Short of a mass gay orgy for a dozen men who were patently impotent or past caring, I could think of nothing.

The nurse had written "Maintains own dignity" on my sheet, which left me feeling very pleased with myself until I asked her what it meant.

"It means you don't grope the nurses," she said.

"Does anyone manage that?" I said. "In here?"

"You'd be surprised," she said.

And then I remembered the fact that there was no barrier between the men's and women's sections of the wards, and wondered who on earth ever thought that was a good idea.

The hospital was a large East End one. I won't name it because I don't want to start pointing fingers. And to judge from conversations with friends in London and around the country, my experience was typical. One friend of mine even elected to go private, when it meant a more old-fashioned invasive surgery than the modern keyhole type available on the NHS, simply because of the private room.

And I want to repeat how very good the doctors and nurses were. All the problems that I have spoken of strike me as management ones. But I never saw anyone from management anywhere near a ward, so I don't know who they are, or how many of them there are, or what they are doing. And if any of them reply to this article, please don't say anything about "meeting targets". I might be moved to homicide. I forget how much Gordon Brown recently splurged on the NHS, but none of it is going on food, brooms, toilet cleaners or privacy for the patient.

I left the hospital after four days, a stone lighter and weak from lack of sleep and food.

Incidentally, after a few shots of morphine, I found that for the rest of my stay I had no craving for the bottle of wine or the three or four cigarettes which are the high point of my evenings. Not only did I not crave them, I did not notice that I was not craving them. The government is always on at us to cut down on drinking and stop smoking. I think I have found the solution.

What had caused the illness in the first place (suspected brain tumour) was in fact the result of some medication from my GP, which was replicating the symptoms. I see from the recent book Bad Medicine: Doctors Doing Harm Since Hippocrates by David Wootton (OUP, £16.99) that it is called "iatrogenic" illness, which means medically induced poisoning. And it is much more common than you might think.

The medical profession's main journal is still called The Lancet, the instrument that used to be used for bleeding people, which has fallen out of fashion lately. This is the equivalent of the police having one called The Rack and Thumbscrew.

Christopher Peachment is the author of Caravaggio: A Novel (Picador, 2002) and The Green and The Gold (Picador, 2003). He has been Film Editor at Time Out and Arts and Books Editor at The Times.

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Hello, Christopher. Very amusing article - probably not a particularly amusing experience though!
Your cousin, Louise Graf (Auntie Pam's daughter)

Posted by: Louise Graf (nee Milburn) at November 1, 2006 08:19 PM

well in thinking that matron had any say in the remit outside of nursing shows the crucial ignorance of the british public in what they actually did.
nurses were cleaners in those days and didn't do things like taking blood pressure of giving injections intramuscularly or intravenous drugs. patient stayed for two weeks for simple procedures than would take 72 hours now.
the advent of feminism showed that single girls didn't need a headmistress figure to keep the naughty girls in line or babysit them whilst they waited around for a husband to rescue them.
alsoh aving someone old and out of education meant that nursing had a very low glass ceiling.
matron would have had no say in contract cleaning and thus standards would have dropped anyway as cost driven cleaning was more important to the tory leadership.

nurses arent the reason why hospitals are dirty because nurses arent cleaners jsut like women arent 'wives in waiting'

she will make little difference and is a backwards step in terms of advancement

Posted by: jay at February 6, 2007 04:12 PM

I am currently have my first serious encounter with the NHS as a result of my partner's collapsed lung. My experience very closely matches yours, in particular the lack of privacy and the god awful slop they call food. I would not say that the nurses (and care assistants) were univerally wonderful - though most are. They seem to have very little time to offer basic care and kindness, a few seem to lack essential training, some seem to have the wrong psychological profile and one or two were downright sadistic.

I think most human beings in hospital feel vulnerable, dependent and grateful. They do not wish to complain or cause a fuss when they are not happy about something. The NHS machine finds it convenient to assume the absence of complaint means everything is fine.

Posted by: Dicky at October 17, 2007 03:33 PM

Hi Christopher, I hope you have not had any reason to go back onto a ward since you wrote your blog. I empathise completely with your experience having been on a ward at Homerton Hospital several times over the past 6 years, 4 times within the past year.

I agree that the doctors were deeply committed and enthusiastic. The open ward system is an antiquated disgrace. I guess someone should stand up and and fight the issue through Europe if necessary, as patients are left without privacy or security. Last time I was in the Homerton two weeks ago there was a genuine bone fide kleptomaniac in my bay, who went around gathering things from people's bedside cabinets when they went to the toilet. She would also take and eat any sweets people may have left on their cabinets. I was put opposite a lady who was dying. She and her family should have had a private room. I was next to a demented person who screamed all night. I got only 3 hours sleep over each 24 hour period I was in there. If I weren't a single mum, I honestly think that next time I'd rather die than have to go back there, that's how bad it has been for me.

I am trying to move out of the area in the hope that I can find a better hospital, but the open ward system is by far the biggest problem as far as I can see.

It was a hellish nightmare and as I have a chronic and incurable illness (which means I am broke because I can't work) I can only look forward to many more hellish nightmares on that ward in the future.

Unlike you, I found the nurses were usually moody, defensive and stressed. But on the other wards, such as the emergency admissions ward, they were a quite different and much friendlier bunch.

Posted by: Kate at October 29, 2007 10:12 AM

Hmmmm good article obviously written with insight!
Having worked in a PFI hospital for some time cleaning not too bad, its the cost of having any work done in a dept as the building company own the building and act like microsoft when quoting for work. No one else can do it!!!
I am glad that you have acknowledged the nurses and doctors as I have been a nurse now for 7 years and feel very frustrated on a regular basis...............I believe that I am called an idealist...........
I also think that this idealistic approach to my nursing should be called realism!!! Many nurses especially all of the collaegues known to myself share this frustration because we physcially cannot do enough for the there are not enough of us........two there are not enough hours in the day and admission rates are ever increasing and turnover of patient numbers is increasing with this therefore everything is becoming short sharp and swift............
A famous saying:
To get something fast and cheap is never good.
to get something good and fast is never cheap.
to get something cheap is neither good or fast!!

Think the NHS need to learn this!!!!!!

Posted by: chris s at January 17, 2008 12:19 AM

As an inpatient at Addenbrookes ( in 2004 and 2008), which is one of the better hospitals ( and certainly one of the newest ) in the UK, I can't say that my experience matched yours in any way, apart from the food. But I did have two unnecessary operations for kidney stones, which resulted in unnecessary post-operative pain.

But could you please tell me if Book & Magazine Collector is likely to reappear in print from another publisher.
Best wishes from a frequent contributor to the magazine.

Posted by: R.M.Healey at April 22, 2011 06:04 PM
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