The real progress began when Gwen took him to visit some of the patients with CORD. This stands for Chronic Obstructive Respiratory Disease.
CORD is a chronic disease of the lungs, meaning, once youve got it, its there for good. You might have your good days, or your bad days, but as time goes on, it inevitably gets worse.
When Gwen said she hoped his death was quick, she was referring to this disease. Think about running a 100 metre sprint. Now remember how puffed out you were at the end of it. A lot of the people with CORD dont die quickly and they linger for years, for decades even, and constantly feel like theyve run a race.
James spent 20 minutes with two patients, Keith, who was only 47 years old, and Bill, who was 70 years old. Bill had been short of breath for the last 30 years, and it looked like Keith might follow in his footsteps; thats if he didnt die quickly via stroke or heart attack.
Within three days of his visit, James was discharged. Hed stopped going outside for cigarettes. He let Gwen set up meetings with the respiratory nurse. He began showing an interest in his treatment and what he could do to prevent an asthma attack. He signed up for the hospital-funded stop smoking programme. He did everything he could to get better, and he got the results he wanted.
Several months later, Gwen received a letter from James. In it he thanked Gwen for helping him turn his life around. He explained that he had managed to completely give up smoking, and also stated that he had only had one mild asthma attack since discharge. The letter was also accompanied by a box of chocolates.
The chocolates were a nice touch, although the real reward for Gwen was in knowing she had saved a young mans life. It would have been easy for the nursing staff to give up on James. They could have just gone through the motions, such as giving him antibiotics and nebulisers, and hoped for the best. Nurses have enough work on their hands with patients that want and appreciate the care they receive, and its sometimes hard to do that little bit extra for someone who resists.
But nurses like Gwen arent rare many will go out of their way to give the best care, even when the patient doesnt want it. Theyll do whatever it takes, often that little bit extra (which money cant buy).
How hospitals kill
Its not always a single error that kills. Sometimes its a collection of problems, or conditions, that combine with devastating results. The story of Mr Benson was one of these combinations.
Day 1
Mr Benson shouldnt have been here but there was nowhere else for him to go. He needed to be in a less hurried place, somewhere more relaxed, but most importantly, a place that had the time to give him the care he needed.
The nurse escorting Mr Benson from the emergency room explained that he was suffering from pneumonia. He was 79 years old and normally fit and well with no medical history.
The nurse explained that he was normally independent, and for intravenous antibiotics only, and should be straightforward to look after.
At those words I looked down at Mr Benson, who lay slumped against his pillows, his chin resting on his chest. Like all less able patients, he looked to be in the most uncomfortable position possible. He might normally be independent, but the foul infection nestled at the base of his left lung had sapped his strength.
I cant thank you enough, Mr Benson said to me later, as I was administering his antibiotics, youre all so good to me.
Mr Benson probably didnt realise he shouldnt be here. A glance at the three other men in the room told a story of its own. The sight of intravenous drips, drains, catheters, wound dressings and pumps was not the sort of equipment a medical patient like Mr Benson often needed. This was a surgical ward and I hoped none of these patients would catch Mr Bensons chest infection, or even worse, get a wound infection, from him coughing and spluttering all over the place.
Day 2
I had three patients for theatre today and nine other patients all in varying stages of post-surgery recovery; it was all a bit much.
I havent had a decent wash in over a week, Mrs Jones complained to me. When are you going to take me to the shower?
Mrs Jones was on bed rest for leg ulcers and was desperate to get out of bed.
Maybe later this morning, I replied, although I knew I would disappoint her. Ive got to go to theatre now, its pretty busy.
I left her room before she could voice another complaint.
Youre supposed to change my dressing four times a day, Mr Smith declared. Its eleven oclock and nothings been done.
Sorry, Mr Smith, Ill try to get to you soon. My patient from theatre is not very well.
The look on his face softened.
The patient who had just come back from theatre was Mrs Wright. She had lost quite a bit of blood, but was in the process of being transfused, so should be okay. The doctor said that when they opened up her abdomen, the tumour was bigger than expected, but they think they got everything. I was supposed to check on her every half an hour, but sometimes it was nearly an hour before I could make it back.
My mother has been sitting on the commode for 20 minutes. This place is a disgrace, said the daughter of Mrs Blake. What sort of establishment is this? Im going to write a complaint.
Please do, I replied as I helped Mrs Blake off the commode and left.
Sometimes as a nurse you may not be allocated a patient one day that youd had the day before. Even so, I try to keep up to date with how theyre doing. I usually poke my head in their room, even if just to say hello.
This was the case for Mr Benson, and I was saddened by what I saw. It was nearly lunchtime and Mr Benson, my pneumonia patient from yesterday, was still in bed. Hed slid down the bed and was hunched in a ball, his shoulders up by his ears and his head on his chest. Why hadnt anyone thought to get him out? I suppose because no one was around to do so.
Sitting at the bedside holding his hand was another hunched figure. Mrs Benson. It should have been a touching scene, but instead it was depressing.
Good morning, Mr Benson. He lifted his head off his chest and gave me a smile.
Oh, good He was interrupted by a bout of coughing that racked his whole body. When it finally passed he spat some foul greenish black sputum into a jar. I had a peep at his drug chart. Sure enough his ten oclock antibiotics hadnt been given. I didnt have time to give them to him because I was overdue to check on another patient, but there was not another nurse in sight.
Back on my own side of the ward, I was running ten minutes late having decided to administer Mr Bensons antibiotics after all. My next patient, Mrs Wright, needed a fresh unit of blood. I noticed her narcotic infusion was nearly empty, so that would need changing, plus she was due some antibiotics, although to be precise she was an hour overdue for them, but an hour wasnt too bad, at least not in this place. Forty minutes later and Mrs Wright was back on track and everything was up to date.
Any chance you can do my dressing now? Mr Smith asked.
Any chance you can do my dressing now? Mr Smith asked.
He was no longer angry, he sounded almost resigned to his fate.
Day 3
I had the afternoon shift, with a total of 14 patients, none of whom was Mr Benson.
Im just going to the other side for a moment, I explained to Trixie, my nurse assistant for the afternoon. Can you please take Mrs Blake off the commode? If her daughter yells at you just tell her to write another complaint.
Trixie stalked off in the direction of Mrs Blakes room. I had the impression she didnt understand my type of humour. She was only 19 and in her second year of nursing school, and the poor thing seemed overwhelmed. I couldnt help but wonder if this experience would put her off nursing for good.
Trixie shouldnt have to deal with angry patients or family, so I still occasionally had pangs of guilt whenever I sent her off to do an unpleasant job, or deal with a potentially difficult situation. Unfortunately, when youve got such a huge workload, theres no choice.
Good morning, Mr Benson, I said, as I entered his bay, expecting to see him still in bed. But Mr Benson was out of bed, and well before lunchtime at that. But it still wasnt looking like a good morning for him. He had slipped so far down his chair that it was only a matter of time before he would end up on the floor. I tried to lift him up but he was too heavy. He was not a particularly big man, but he had no strength to help me.
Im stuck, Mr Benson managed to say, before bursting into a round of coughing. The bout of coughing made him slip further down the chair.
Hang in there, Ill grab some help.
There was no one around. Whenever I needed someone it was almost as if everyone went into hiding.
Excuse me, can you help me a moment? I asked the lady cleaning the floors. She looked startled; perhaps because I was the first staff member to talk to a cleaner. She remained silent but followed me into the bay. I need a hand sitting him up, I said, indicating Mr Benson.
Im not allowed to do that, she said, Im not trained.
I was sure I didnt hear right.
I just need a quick lift, only take a moment. I wont tell.
Once she made up her mind, she did what she knew to be right and didnt waste any time helping me sit Mr Benson up.
Im sorry I didnt help right away. The boss says we shouldnt get involved with the patients. Legal reasons and stuff.
When the cleaner left Mr Benson clasped my hand.
Youre good to me, was all he said before succumbing to a bout of coughing.
Day 4
It was the start of the shift, and I made a plea to the nurses to keep an eye on Mr Benson. Everyone agreed to make an extra effort. Claire even put in a request for extra physio.
But this patient needed more than physiotherapy. He needed to be mobilised regularly and not just when the physio came. He needed to be got up out of bed. He needed to not be left slumped in his chair, or forgotten in his bed for hours at a time. He needed his antibiotics on time. He needed to be encouraged to eat and drink. He needed what time wouldnt allow us to give, although we were quite capable of giving, and that was basic nursing care.