Living In The Real Ward

It was interesting to note the admission by Prof Anthony Clare the other day that nowadays, doctors tend to ignore patients as people. This was partly, he told WONCA 98, the medical conference at the RDS, because of the development of elaborate medical technology and treatment. Decades ago, Prof Clare said, doctors had a better bedside manner; however, this might "have been all they had to offer the patient then". However, doctors themselves, when they become patients - though very often notoriously bad patients - are apparently beginning to note the absence of a sympathetic ear. For one doctor, any sensitivity she found as a hospital patient came from nursing and cleaning staff: "The physician that I had, the sicker I got, the further he moved away from the bed. He began up by my pillow but as time progressed he used to just stick his head in the door and say `are you still sick?' "

I sympathise with the doctor in question and I am familiar with the situation of modern high-tech facilities and pressure on time adversely affecting the bedside manner. Many years ago I worked as a cleaner on a hospital ward. I was familiar with many of the longer-term patients, and with their ailments. I had plenty of time for them: there was much cleaning to be done, and it was time-consuming, painstaking work. So it was possible to chat with a patient for an hour while down on my hands and knees, for example, polishing the floor under a bed. The intimacy also allowed for relationships to develop, for me to understand patients' innermost concerns. I knew their families, their worries, their symptoms, their hopes, their dreams.

I did not realise it at the time, but I was these people's unofficial psychologist, counsellor and friend.

Gradually, however, I found myself seduced by more elaborate cleaning methods. After weeks in my workshop at home, I introduced the first electric floor-cleaner to the ward. It was very successful, but of course it drowned out conversation. I was too busy, and too pleased with myself, even to notice. In the evenings I began to rush home to my workshop without even saying goodbye to the unfortunate patients on my ward. After three months I had patented the battery-powered duster, now used in hospitals across three continents. I was promoted to head cleaner. I flew around my wards, obsessed with higher levels of cleanliness, hardly stopping to say hello to patients I was once proud to call my friends.

The human element had almost disappeared from my work. Seven of my colleagues in the cleaning department had lost their jobs, thanks to my improved methods. I no longer talked to the patients of their symptoms, their problems, their families. My bedside manner was almost entirely gone. And I had scarcely noticed. Everything came to a head on the day I installed the computer-driven automatic air-freshening system, which I reckoned as a huge improvement in timesaving and in environmental terms. The ward revolted. I had just finished attaching the small-gauge Wavin piping to the skirting boards when 12 patients, all of whom I knew were seriously ill, rose from their sick-beds as a man. Two of them pinned me to the wall: the others dismantled the entire air-freshening system, heaped it in the centre of the ward, and took turns throwing pieces of it out of the windows. They spoke not a single word. And then, as quietly as they had arisen, they returned to their beds.

My world was shattered. It became instantly clear to me what I had done - sacrificed the emotional and psychological needs of sick people in order to gratify my own lust for technological advance and improvement. I had become a monster of the modern age.

I stood there in the middle of the ward, 12 pairs of eyes focused on me. I thought back to my forbears, hospital cleaners of decades ago - simple, decent people who understood that while bedside manner was all they could offer, apart from Lifebuoy soap, and Windolene, and elbow grease - they understood that manner maketh the man.

This was what I had forgotten. As if in a trance, I took one of my own battery-powered dusters, walked slowly to the open window, and dropped it the eight storeys to the ground below. I heard 12 breaths drawn in shock. Then I dragged the huge, noisy electric floor-cleaner to the window, and dropped that out too.

The ward erupted in cheers. I rolled up my sleeves. I found an old scrubbing brush in a press. I got a bowl of soapy water. And I got down on my hands and knees to scrub the floor, and talk to my patients, and share their lives, and live again in the real world, or at least the real ward.

Times Square will resume on Thursday, July 2nd.