On The Ward

We the visitors tread a well-worn path from car-park to bedside. We who long ago said everything there is to say but still talk, who drink tea we don’t want as we both cling to some semblance of normality, who dash to get food from the canteen with a fraction too much enthusiasm because we can get away from bedpans and pain, drips and catheters for a few precious minutes, giddy in the stale air of the cafe, guilty that loved ones must stay where they are.

More than anything, we have time on our hands. Time to look around and seek distraction, any distraction, just something to remark upon and air fresh words together. Time on our hands when those we worry and care about are getting the most effective medicine of them all, untroubled sleep not dictated by night or day, only the body’s needs. We the visitors have time to know what’s going on.

You don’t notice for several days. To begin with, it’s busy. This tablet, that doctor, more examinations, the results will be back soon. “Feeling better? The drip’s working. The drip will work, give it time. The op is one step nearer getting out of here.” Something is happening, something to aim for, a sense of purpose. Always niggles, that’s only to be expected. The doctor forgets to call, she’ll be in again tomorrow. Late with the bedpan? The nurses are really busy, don’t know how they cope. Hospital food – we’d say something if it was decent!

It’s when the days turn into weeks that you begin to understand. When there’s nothing to do but wait for the body to rest, recover and work its magic. When the doctors try something and wait to see what happens. If they told you that they were not entirely sure, they couldn’t be certain, fine, we could cope with that, that’s reality after all. But they don’t want to tell you what they don’t know. You just find out along the way.

The orthopaedic ward has 4 bays each with 6 beds, plus 2 single rooms.  In a ward like this, most patients have restricted mobility because they’ve broken something below the waist. Many are old and are in hospital because they have fallen. They can do little for themselves and certainly can’t go to the toilet unaided. 

Over a period of three weeks, at any one time at least two patients had dementia or Altzheimers, so being somewhere unfamiliar disoriented them even more.  One woman got up from her bed, went to the door, was prevented from leaving and taken back to her bed. The cycle was repeated for 5 hours every day, on top of the fact that everyone has too much to do. It’s so busy, you don’t realise until you think about it. For 26 people there is one sister, two nurses and 4 health-care assistants. Sometimes there’s an extra nurse.

The vast majority of the staff are unfailingly cheerful but because we’ve been around for a while, long-stayers we are, they drift to our quiet corner and talk. One man gave up his art career to be a health-care assistant. He loves his job with a passion even though he’s knackered every night and can barely pay his bills. He’s here because he wants to be.

The sister breezes onto the ward, her ward, and when she’s on duty the atmosphere lifts through the sheer force of her personality. A word of encouragement here, she’ll fill in for absent staff who need to get off their feet for 5 minutes, taking the pee out of the new young doctor. The staff nurse is kind too. She’ll go to another ward to find another pillow, forbidden really in case it exceeds the two per bed rule. She plumps them up and we both no longer sag. She’s moving to out-patients next week, she’s had enough. Can’t do my job properly any more, she says forlornly.

Intensive care is curiously comfortable and reassuring. Life and death dramas are played out in a calm, purposeful atmosphere. There’s one nurse to every two beds, with cover if a patient needs one to one. The nurses (they talk to us, you see) are motivated, well-trained, work as as team and despite the pressure elect to work here because they have the support and time to do what they want to do, which is to care.

Back to the ward. It should be a sign of progress but there’s a sigh and heavy heart. The sister winks – she briskly moves a couple of beds around so our corner is free. But it’s not so quiet because now there’s one man amongst five women. He spends the evening shouting down his mobile and demonstrating that hospital gowns cover a bare minimum of his tattooed legs. 

Next to him is another new arrival, a well-spoken and apparently frail woman in her seventies who sounds nervous. Not sure of the etiquette, I leave my post and help her with the table and her drink. She’s grateful but doesn’t look me in the eye. I say my goodbyes and walk to the exit past the laminated pledge from 2009 that wards will be single-sex.

Appearences can be deceptive. Later she’s visited by two younger relatives, who spend this and subsequent evenings talking about her trips around Europe last year, about her plans for the house and a walking holiday in Italy as soon as this leg is sorted out. Indefatigable is the word. Me, I heave my paunch around with a loud sigh just because my legs ache from sitting down for an hour.

There are visitors every day but not the same ones. They don’t see what I see. She doesn’t fancy a drink because the water is warm and it’s been there all day. But that’s what she said everytime someone asked her to drink and she hasn’t drunk since morning. Not hungry tonight, don’t really fancy the sandwich, oh OK then if you insist just one bite. But that’s all she’s had. The nurse encourages her to drink, scolds her like a schoolgirl, she takes a sip then the nurse is gone. Another more pressing task. And the water jug remains full.

Isolation now. This hospital has been heavily criticised in the papers because of hygiene problems. First sign of MRSA and here we are, plastic gloves and aprons preventing the spread of germs but separating us even more. Still, it’s a room to ourselves, with a TV. This was the old private wing. More nurses too. More risk means more care. 

The ward. The bed where the old woman lies is quiet now. Her visitors are still there but she’s asleep for long periods, waking occasionally to mumble a few incoherent words. The operation has gone well, it’s not that.  On the way out, I take the plunge and catch her visitors up. I’m no doctor but… They thank me but don’t quite know what to make of this stranger. Don’t understand it, she was so active until last week.

We wait two hours for a doctor to come in response to a leg pain. It’s the houseman, on rotation. We can tell, we know what’s going on. She listens. Without a word and without pulling the curtains round the bed, she takes a felt-tip from her pocket and draws a black mark around the area that hurts. Still silent, she smiles and gets up, presumably to inform a superior about her findings.

In the corridor sits an elderly man, upright and dapper in a worn tweed jacket, tie and proud-polished shoes. He’s ready to go home but because he lives alone, there’s no one to take him. Because it’s late, there’s no hospital transport. Because they are busy, there’s no one to sort it out. Because of the cuts, there’s no hospital social work department. That evening, I leave later than normal, a tearful day so the staff kindly let me stay past the end of visiting time. At 10pm he’s still there, sitting upright, proud and patient.

Three months on and we’re not going back. Another hospital, that odd feeling again. We’re professionals now. Patiently we give the same history for the umpteenth time. They can’t find the notes (don’t worry, the file is only a foot thick), of course they can’t.

But it’s different. Nurses rush around and don’t have a lot of time for personal care but there are more of them so things get done. The doctors are dead keen, anxious to get noticed as they forge their career. There’s a drinks machine on the ward. Same plastic water jugs but ice in the water. On the ward desk there’s an admin person. He takes the calls, gives directions, sorts out the files, all things that are distracting, time-consuming yet vitally important for patients, family and staff. No one waits patiently for a lift home that will never come. 

Tests and treatment will take a week, unpleasant and who knows what the future holds. But there’s a bed by the window. We hold hands and watch the sun set over Westminster Bridge.

Gay Marriage Bill passes second reading, all straight people in UK instantly get divorced

With the news that the Marriage (Same Sex Couples) Bill has passed its second reading, a shockwave has passed across the UK with the surprise news that all heterosexual couples in Britain have instantly divorced.

The housing market has been thrown into chaos due to the sheer volume of couples putting their homes on the market. Schools have described mass abandonments of children, and maternity services nationwide are reporting that new referrals have dropped to zero.

John and Debbie Longley of Totnes experienced events that have been repeated all over the country. “We’d set up a joint account to pool our finances, got ourselves a foothold on the property ladder. In a year or so’s time we would be getting ready to have our first child,” explained Mr Longley. “Then the news came on the TV that gay marriage had passed. Suddenly, it all just seemed so….meaningless.”

Mr Longley then turned to his now ex-wife and sighed, “You’re nothing to me now.”

Mrs Longley concurred, “I suppose I just have to get used to these new realities and consider my future options. I’m contemplating bestiality.”

Social affairs experts admitted being stunned by the turn of events. “All the warnings by opponents of gay marriage just sounded so daft,” said one leading sociologist. “Heterosexual marriages being undermined…A breakdown of values and norms…Nigel Farage actually being right about something. It seemed totally implausible.”

The news has also resulted in severe traffic delays across Britain. The Highways Agency report that this is because it’s raining men.




When a breach of ethics is not misconduct: The Kafka-esque language of the UK Council for Psychotherapy

In the past few months I’ve been exploring the John Smalley case, a series of cock-ups and calamities befalling a fitness-to-practice hearing with the UK Council for Psychotherapy. The sheer scale of ineptitude has been absolutely mind-boggling, and would be hilarious if the UKCP weren’t trying to regulate a profession that works with vulnerable people. In the past couple of weeks the UKCP have deployed an impressive piece of semantic gymnastics. They now state that Mr Smalley committed several breaches of his Code of Ethics; he just didn’t commit any misconduct.

Got that? Perfectly clear and reasonable? No? Me neither.

Before elaborating, further, it’s time once again to take a quick run-through….

The story so far…The UKCP took over three years to investigate complaints about John Smalley, a Jungian analyst with the Independent Group of Analytical Psychologists. At the end of a long sequence of delays, they decided that seven allegations had been proven. These included smoking during therapy, inappropriately setting two clients up in a business relationship with each other, and making a sexual suggestion about one client to another. Despite this they decided not to sanction him. The fact that he admitted in the hearing that he destroyed his notes doesn’t seem to have prompted a sanction. The UKCP’s laughable response to this is that they didn’t sanction him for destroying his notes because there wasn’t a complaint about destroying his notes.

I last discussed this case in a post on 14th January 2013. In that post I made the following observation about the UKCP’s online complaints archive.

There’s only one entry on it! It’s for Derek Gale, a notorious abuser who was registered with the UKCP as a psychotherapist and with the Health Professions Council as an arts therapist. The UKCP stuck him off in 2009, but only after the HPC struck him off first.

Until recently there were two entries – the other being for Geoffrey Pick, suspended from the register in 2011 for an unspecified breach of boundaries. He’s now back on the UKCP register and his entry in the complaints archive removed. As for John Smalley, the UKCP don’t intend to publish the hearing outcome until Spring 2013, a year after the final ruling.

In the past day or so I looked at the complaints archive again. Since my previous post on 14th January, the page has changed, and the Smalley case is now up online.

Well, it only took them ten months to put it on their website. So, what do they have to say about the case?

Decision regarding John Smalley

Mr John Smalley [Manchester/Leeds] six allegations of breach of the Independent Group of Analytical Psychologists (IGAP) Code of Ethics found proved. No finding of any misconduct and therefore no sanction.

Please find the Decision of the Panel and the Determination of the Panel here

So….six breaches of a Code of Ethics (including smoking in therapy and making sexual suggestions about one client to another) doesn’t constitute misconduct?

Also, there were actually seven breaches found proved, not six.

In fact, from reading the Determination of the Panel that the page links to, it doesn’t even say that he didn’t commit misconduct. Quite the opposite in fact.

Take a look at page 3 of the Determination.

The Panel is of the view that your conduct in relation to the instances of wrong-doing that have been found proven against you did amount to misconduct. Your attitude and behaviour regarding smoking during treatments sessions was indicative of a failure on your part to have due regard to the dependant nature of the therapeutic relationship. Your behaviour in making remarks that were capable of being interpreted as derogatory with reference to other analysands and that were liable to be overheard represented a failure to have due regard to professional boundaries. You demonstrated a further failure to have regard to professional boundaries in the context of your promotion of a gallery at which you were an exhibitor. That failure to have regard to professional boundaries or to the dependant nature of the analytic relationship was further exemplified by your conduct in introducing one analysand to another. The Panel has concluded that the nature and extent of these failures on your part amounted to misconduct which, taken as a whole, could properly be described as serious. [Emphasis added]

So, he did commit misconduct, and serious misconduct at that. But why was there no sanction?

The following pages basically describe the Panel bending over backwards to believe that this was all some time ago (not least because they dragged out the complaint process for three and a half years), that it was probably a one-off series of lapses (if that’s not a complete contradiction in terms) and that he’s reflected on the matter and the world is now lovely and filled with Disney-style bluebirds.

Okay, I’ve started to exaggerate towards the end of that last sentence, but not by much. Anyway, they conclude,

In all the circumstances, the Panel has determined that your fitness to practise is not impaired by reason of your misconduct.

So, in fact it’s not correct for the UKCP website to declare that Mr Smalley breached the Code of Ethics, but did not commit misconduct.

It’s actually correct to say that he committed serious misconduct, but his fitness to practise was not impaired by this.



[EDIT: Since this post was published, the wording on the page has changed. It now reads, “The Panel concluded there was a finding of serious misconduct but no sanction was enforced.”]