Sit down, doctor

So, I was in hospital. I self-presented, got assessed and told I had to stay, I had a ‘procedure’, after which I was discharged home. Here is my first blog about it.

Before offering some comments, I want to thank some people. First, the nurses Laura, Kochuthresia, Annabel, Apollo, Becky, Nicola, Alexandros, you all showed me the human face of healthcare. I will never forget the cup of (dreadful) tea you offered me, Laura – it was so compassionate and empathic. Second, the physicians, Sawan, Craig and Azhar (I did call them by their first name), you were professional and tried your hardest to be reassuring, even though we quarrelled about politics. Deepu, I have a profound gratitude for your calm and coolness, well, and that you saved my life. And nothing I say (below or otherwise) can even change that.

But, grateful as I am, I was also taking part in a little ethnographic study, DG’s hospital stay, a study which produced some interesting results. And here is my first account of them.

1. Standing. The first thing that struck me during my stay was that everybody was standing. As I was forced to lie in bed, people who came to talk to me inevitably stood towering of me. I’m not very tall, but the situation in which I was made to lie in bed and either the nurse or the medic was standing above me, made me feel like a child. The standing created a spatial perspective in which I became a child having to look right up to speak to the powerful adult. I hated it.

I commented on it and heard that it was all about hygiene. Siting on my bed would transfer bad bacteria onto it and I wouldn’t want it, would I? I pointed out that that I had seen visitors sit on beds and nobody seemed to care. Surely, I continued, visitors do not miraculously bring less bacteria to the hospital than the doctors. On that, I heard it was what it was – the usual dismissal of a challenge to a routine. Only one doctor sat down to speak to me and it was a very different conversation.

Of course, I understand that things are complex and it is awkward for a doctor, doing the rounds, surrounded by their entourage, to sit down, let alone for the entire court to sit down on my bed. Still, you need to decide what the priority is. Is it your power and routine or is it engaging with me? No, you’d better not answer.

2. Relationships. I continued to be irritated by doctors introducing themselves by using their professional title (no problem with that) and then proceeding to call me by my first name. Why?! I’m not a child, for pity’s sake, and I take exception to being treated like one.

Me being me, I immediately adopted a defence strategy. So, whenever a doctor introduced themselves, saying ‘Hello, I’m Dr Smith’, I responded with ‘Hello, I’m Dr Galasinski’. And it worked a treat.  You could also touch and taste the difference in the relationship. None continued to call me by my first name, a couple called me Dr Galasinski. Incidentally, a medical student (about whom I will write in the next post) asked me what I would like to be called.  The consternation on his face when I said “Professor Galasinski”, was quite funny.

It’s fairly obvious that it all is about power and me undermining the its default setup between the doctor and the patient. And what my exchanges suggest that the disturbance in the (medical) force makes the powerful quite uneasy and unhappy. But as I was engaged in a power struggle with them, I benefited from it. So, here is my advice. If you’re ill and you’re going to hospital, get a PhD!

3. Invisibility. This is something that was, I think, first written about by David Rosenhan in his famous “On being normal…” article. The medics’ ability to make me invisible. I’d heard about it a number of times before, this time, however, I had the chance to observe it in person. I found it extraordinary how invisible I could become.

Is it really impossible to say hello when you walk into the room in which patients are sitting and chatting, even if you don’t deal with them? Will it really hurt you not to speak of me as ‘he’ just because you stopped talking to me?

Time and again, when a health professional stopped speaking to me, they would turn to another person and it’s like I disappeared. Give him this, he has this, he is like this. For pity’s sake, I’m still here!! Is it really not possible to say: ‘Give Mr Galasinski this, Mr Galasinski has this’? Is it really not possible to acknowledge that I am still listening, and normal social graces still apply?

4. Human rights. Well, my human right to shower…. I woke up on Sunday, after a sleepless night, and I wanted to take a shower. Unfortunately, I was hooked to monitors and I had to be unhooked in order to go to the bathroom, which was 5 metres away.

I asked a nurse to unhook me and she refused. My response was the following. I told her that that there were two scenarios. She unhooks me and I go to have a shower or I do it myself, admittedly in a messier way, and I have a shower.  Either scenario ends with me having a shower.

The nurse looked, probably decided that restraining me was not an option, and unhooked me, saying that she would need to document it. The threat of documenting my transgression of showering only made me laugh. I showered, changed, went back to the bed. Did it need to be like that? I doubt it. The following day the nurse in charge agreed, only asking me not to lock myself and remember that there was a red chord…. Fine.

As it turned out, half an hour later the nurses offered ‘a bit of a wash’ to the patients around me. I would not go as far as say that I would prefer to die rather than suffer the indignity of hearing  nurses talk about having access to ‘my bottom’, but it’s not far off.

The meal on Saturday evening was so vile that I would not feed it to the dog. The reconstituted chicken with cold mash potatoes was beyond disgusting. Why? I don’t know. On Monday I was transferred to a different hospital and I was offered a meal there. To my utter shock, it was eminently edible. Apparently, it is not beyond the realm of what’s possible, to serve food which is human grade.

5. Suing. Could you please stop continually telling me that you do something to me because I could sue? It’s neither polite, nor is it particularly professional. Yes, I can, but if you behave professionally, I won’t. Others may, of course, but please don’t assume that we’re all the same.

Now, a hospital stay is a thoroughly communicative affair. And despite your mantra that language matters, you have a loooong way to go. But I also want to be clear that I would not swap my ‘outcome’ for better communication skills. I also appreciate that to a considerable extent, what I wrote about above are practices that that you don’t even see. You repeat them and by repeating, reinforce them mostly without reflecting. I also appreciate the effort. It mostly comes from you caring for your patients. And for the most part, I did feel that most of you cared.

PS. I have a sweet tooth. Very. So when I refuse to eat dessert, please, do not tell me that’s a stupid idea and I actually should have one. Because I don’t want one, I want three. For starters.

  1. I recognise a lot of this. I don’t think I do most of the things you dislike (eg I do sit on beds, or kneel to the level of the patient). Of course I’m not perfect.

    But I’ve never heard health care professionals telling patients bthey might sue, and I’m wondering in what context this was?

    1. Dariusz Galasinski

      Suing was mentioned when I was moved in a wheelchair, or when I was refused to go shower. And documenting my shower was supposed to protect the nurse from me suing. I must admit that was quite irritating. I can just about understand that I shouldn’t shower on my own because I might collapse, but not because I will sue.

      I hope the blogpost did not give the impression of generalisation. I don’t want to generalise. Of course, there are doctors who, for example, sit on beds (I met one!), but, at least in my experience, that was very much an exception.

      1. No not at all and I’d love to meet you!

        That’s interesting. Maybe it’s in nursing (rather than medical) culture. Obviously doctors get patients to sign forms etc but I’ve never, I don’t think, heard explicit mention of suing (except perhaps as an attempt at humour).

      2. Dariusz Galasinski

        Drop me a line?

        Now that you mentioned it, all references to suing were made by nursing staff. I suppose it is signficant. What’s sad about them is that they were completely unnecessary.

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