My Extraordinary NHS

 

On November 1st- last week as I write this- I had fairly major surgery. I hadn't been unwell and in need of surgery, it was elective in that it had been planned for nearly a year and followed numerous tests and examinations to ensure my physiology was strong enough to cope with surgery and recovery. I initially started this process around seven years ago but did not feel able to compete the procedure at that time- I was informed then that being fit and healthy was necessary for my long-term survival and at that time I could not be 100% sure that my then-new lifestyle of running, weight-loss and vegetarianism was to be permanent. But it became clear since then that my "new" way of living wasn't particularly new but was instead a more profound return to the person I was born to be having given up good health and sports for 20 years when I discovered motorbikes, cigarettes and whisky as a teenager. Seven years later, here in 2022, I had no excuse to not continue with the process of surgery as I had run every week for the last 10 years, cycled whenever I could, walked and hiked every day, lifted weights, stopped smoking, stopped drinking alcohol, stoped eating meat and had generally become an annoyingly smug arsehole with a pointlessly restricted lifestyle (but it felt more natural to me and I was happy with it). Time to put my money where my mouth is.

I attended many appointments in the hospital over the months of 2022 being weighed and measured, being drained of blood and urine, being poked and prodded and tested. Here is rough list of some of the tests I received during only one typical day, for free on the NHS, remembering that had anomalies been identified they would be immediately addressed and treated, also for free:

• Full Blood Picture 
• Liver Function Test
• Cholesterol level
• Urea and electrolytes 
• Coagulation screen
• Testing for Hepatitis A, B and C, HIV and syphilis 
• Body weight and blood pressure
• Cannula insertion into my arm
• Ultrasound of kidneys and bladder
• DMSA (dimercaptosuccinic acid) injection 
• EDTA (ethylenediaminetetraacetic acid) injection
• Electrocardiography (ECG) test
• Chest X-ray 
• Blood set
• DMSA scan
• Next blood set
• Urine test
• MRSA swabs
• Next blood set
• X-ray Computed Tomography (CT) scan
• One to one with medical consultants including physical exam 

There were many other tests at other times including a psychological evaluation in readiness for surgery, kidney tests, etc. 

I was admitted to the ward on the afternoon of Monday 31st October, sharing a large room with two other patients, had some baseline, last-minute tests ready for surgery, nil-by-mouth from 10pm (after I was stuffed with toast and jam and a gallon of tea) then surgery at 9am the next morning for three hours, into the recovery ward for an hour then back to the initial ward for three days recovery prior to discharge home. Discharge included physiotherapy support, medications for two weeks and ongoing outpatient appointments each year for life. 

Every single member of staff I saw during my entire three days as an inpatient moved with quiet and calm purpose through their respective roles. The surgeons were pragmatic and to-the-point about the physical procedure ahead (their focus is mainly on the unconcious patient), the auxiliaries were supportive and thoughtful without being over-familiar as they helped me choose the most appropriate vegetarian meals and advised me about low salt and low fat options and which may suit my delicate stomach post-surgery. The two cleaners were as much a fascination to watch as I would a carpenter making a chair or a skilled sushi chef feeding customers- they used exactly the correct and specialised mops and clothes and liquids to clean every single square centimetre of that 4 bedded room, every horizontal surface and door handle and light switch at known risk of contamination, they wiped under my bed in a strict and meaningful pattern, they moved with the cordinated efficiency of robots but were also polite and warm, apologising for their "intrusion" (their diligence was almost usurped by their inspector who arrived minutes later and ran his fingers along the light shade two metres up the wall, then the heating switches and then crawled under a bed to wipe his little finger along the floor in the hardest to reach corner and then, obviously satisfied with the lack of dirt on his hand, nodded lightly, scribbled a tick in his clipboard and strode away). The medical consultant was the overseer who collated information from all sources and kept me educated and informed about all the processes I would undergo and about the treatments and prognoses. 

The nurses moved with a sometimes contemplative and sometimes reactive but always well-measured care-giving. This is clearly and primarily based on their training and learned skills but is also because they are all, simply, kind and because they wanted the sick person in front of them to feel better, as one human to another. Certainly, you can learn the skills of nursing in a classroom and on the hospital wards- from empathy improvement to catheter insertion, from violence deescalation to intravenous medication administration, from surgical procedures to electrolyte management- but, as a patient, their care only feels truly human, genuinely valuable, when their hand is reassuringly and empathically placed on your forearm or when a tissue is somehow created from nowhere after a tear drops out your eye or when, after being extraordinarily sick, post-general anaesthetic, and covering everything- myself, my bed, the floor, my wife's shoes- with watery vomit, a small team of meticulous staff suddenly appear as if from nowhere and unfussily wipe and clean and mop and disinfect and change everything for new in two minutes and without one word being said except to reassure me because I was feeling guilty for making a mess. Practical skills are absolutely necessary of course, and every member of staff I met had those specific skills or were there to learn, but those skills flounder without the most important human foundational attributes- that of warmth and genuineness and common decency and, it has to be said, simple human kindness.

As is typical of the NHS I was looked after by staff from India, the Philippines, Pakistan, Poland, Australia, Ireland, Northern Ireland, England and other countries. I can think of no other employer with such a broad range of staff, from the young student nurse nervously measuring my blood presure for her first time to the elderly porter wheeling me to the operating theatre from my ward.

And it is "my" ward in "my beloved NHS". Such is the admiration for the NHS we should all talk about it in that vernacular- free to use, tax-funded, human-centred and socialist-modelled- just about every UK resident and foreign guest receives care and support at some time in their life. The NHS has around one million employees, half of them clinically trained, and almost all of them are underpaid for their efforts but are buoyed by their ethical beliefs and moral priciples, clearly seen from their behaviour.

Hospitals are places where most people become well but also where, inevitably, some people die. Staff must support patients through both these experiences- to facilitate improved wellness or to help someone die well. To be cared for by the staff and to be a recipient of their shared humanity and warmth is to be afforded a clear recognition of the extraordinary beauty in human kindness.