A few months ago I had an idea that I didn’t carry-through. The idea related to the concept of ‘going back to zero’ – or at least, that what my provisional title. It was to relate to the situation we would face on the ward when the inevitable happened – when a patient developed C. difficile diarrhoea, and the numbers of ‘days since’ we display on the ward door, would go back to zero.
I didn’t write about this as I guess I didn’t want to jinx us; I stayed quiet, watching the days pass, the numbers accumulate, our patients moving in and out of the ward, receiving meticulous treatment from staff who consider in many respects, the wellbeing, safety and care of those on our ward to be their reason for being.
Well, it happened on Sunday.
On Monday morning I arrived in work and logged-on to my PC to find an electronic incident report in my mailbox. ‘Patient with C. difficile diarrhoea on Mallard Ward’ – I was stunned, as I saw the tower of clinical excellence that we have been nurturing over months – 1328 days being over three and a half years, collapse. (This was also how long the ward has been open – in all this time, none of our patients, despite their vulnerability, had contracted this infection while with us).
I was probably thinking more about myself and my ego at that moment.
I haven’t been shy in publicising our fantastic record of safety on Mallard – a record that has bucked the trend seen elsewhere of the very many sick and vulnerable patients occupying beds in NHS hospitals who experience significant harms; ‘harms’ is an NHS term that means anything adverse happening to a patient during their time in hospital (or other venue or situation of care or treatment), that shouldn’t.
And C. difficile. This nefarious micro-organism that overwhelms the gut microbiome I wrote about last week – perhaps I was tempting fate.
…My office on Monday;
My ego got in the way. The ego, that is me thinking about me, probably affected my judgment. My thoughts ranged from, ‘Have I done something wrong,’ to, ‘Has someone done something wrong,’ and here is the confession, here is the dark side of my soul – I did think of the patient, but my considerations were clouded by anger and frustration and my actions, and the potential, actions of others, and, the numbers.
I didn’t conduct myself very well when shortly after I went on the ward to see what had happened.
At the time, the nursing staff were ‘handing-over’ that is, the night team conveying all the clinical details of the patients to the day team.
I don’t quite remember what I did; I know I didn’t say very much to the team, all of whom would of course have known about the patient, all of whom would most likely have been feeling as much hurt and sorrow as me. I know I looked pretty miserable, as this was later conveyed to me by one of the nurses the next day, when she reminded me that I wasn’t the only one who was upset.
I know now I should have listened to the team, heard them express their emotions and feelings. I should have led, instead, I was caught-up in a cycle of frustration, anger and doubt. We probably should have had a group hug, instead I let the side down.
This, is probably just a problem of emotions. The emotional labour of the team on Mallard is great; there is physical labour – the back-breaking work helping patients to mobilise, helping with washing and bathing, manoeuvring and supporting, this I know is the most common occupational hazard to nursing staff. The emotional labour and its associated costs – is likely even higher – the energy invested in hiding our emotions, remaining cheery, positive and optimistic, smiling, when inside we are struggling, sublimating the weight of our lives as we provide the care that is our vocation.
This blog, I feel, is in a way an apology. A request for forgiveness, for letting down the team, by being too occupied with my own emotions to support the grief of others.
Fortunately, the harm that has happened is limited, the main cost being the patient’s discomfort and isolation – which we know in turn is likely to impact on their overall recovery, the patient should get back on their feet and carry on despite what has happened; I don’t think, looking back anyone did anything but provide excellent care, that the patient was failed by the team or the system – it was likely, one of those things.
One of those things that has taken us back to zero.
And moving on, I actually felt a great sense of pride in the team as they rubbed-off the ‘1328 days since a case of’ sign on the door and went back to zero.
It is perhaps too easy to forget that numbers are just numbers, that people aren’t numbers, people are more than the sum of their parts; they aren’t diseases or malfunctioning organs, they aren’t flow or machinations of the system; they are universes unto themselves and those who love them.
That is perhaps what I will tell myself in the future.