When was the last time you saw someone you don’t know asleep?
This happens to me every day.
It is a standard of hospital practice; take a person, young or old, lay them in bed, add the complexities of an acute medical illness and there you go. Asleep.
This does not mean that at three in the morning they are achieving restful rejuvenation, indeed, their daytime nap is likely a consequence of a disturbed night, yet, seeing another person in this state of vulnerability is something I always find fascinating.
I have only been a patient overnight in hospital once and I was fortunate enough to be provided a side-room; I can’t imagine how I would cope with a bay-experience – particularly if they popped me in the middle of a Nightingale row.
The sleep thing also talks to another element of my personality; I hate being woken-up.
Some people have the ability to sleep-in. This is not me. I am always on time, awake and alert at the relevant hour. I am an early-bird; it is who I am and over the years I have come to appreciate this quirk of my genetics.
Because of this innate wakefulness, when I am dozing (and yes, I am a napper, if given the chance – see, Shloff), it is incredibly easy to wake me and once eyes are open, off I go, unlikely return to the land.
And so, I often consider that patients are similar.
I consequently hate waking-up people who are asleep.
Yet, as a doctor, you cannot get much information from an unconscious informant; it is difficult to listen to the heart, sound the chest; get the details relating to the onset of infection or pain if the patient is out-of-it.
And so, I must wake the sleeping souls.
I find this all the more challenging when I know that a person has any form of cognitive impairment. I know that upon opening their eyes, and my squatting-down beside their bed, they will see a strange guy – brown eyes, shiny bald head staring at them.
Fortunately, I don’t have the type of face that freaks people; I have only rarely had someone scream when I have woken them. Here, I picture the former US SEAL, Jocko Willink, who, whilst being a very handsome fellow, has a more expressive face than mine (I feel).
And the man or woman, 90, normally resident in a care home, their dementia stable, their body weakening, looks at me, mostly smiles as I smile back, and we talk.
I introduce myself, I always try to reassure. Rarely starting with, ‘Do you know where you are,’ ‘It’s the doctor,’ being my strap-line as I imagine if you are going to wake, disorientated, ‘doctor’ is not a word that will immediately inspire fear (I could say ‘nurse’ but that would not help orientation, despite being less intimidating).
And then, the conversation begins. Sensitively feeling your way through the discussion, establishing as much information as you are able, reassuring, smiling, focusing.
And I drift-off, back to the computer, the medical record and the patient either returns to their dreams or focuses into the distance, waiting perhaps for breakfast to arrive.
This, my morning routine.
Would I change it?
Is it the best, the most effective way to provide care and support?
Something to consider, something to debate.
I am sure that the value of the ‘ward round’ has gone. Like the other remnants of Beveridge’s Welfare State, it is still relevant but needs to change, needs to evolve into something different if it is to retain its worth.
I think, back on Mallard Ward, this was the start of the change, when I would begin the day, joining patients at the breakfast table, offering tea or toast. That was a much better way to connect, to understand what is happening.
Perhaps I should push for this?