The Essence of Care

You probably heard the NHS turned 70 and throughout the year there have been numerous celebration events, articles, TV programmes and endless personal accounts in praise of the NHS. This - unapologetically - is another of the latter. I owe it this.

In recounting my particular tale, I’ve worked hard not to plunge into a lengthy preamble: evoking life before and after the NHS, comparisons with the profit-fuelled abomination that passes for ‘heathcare’ in the US or disecting the understated brilliance embodied in the NHS’s (paraphrased) founding principles, “free at the point of delivery, based on need, regardless of means”. It’s been said that how a society chooses to care for its sick and vulnerable is the most revealing thing about that society. That notion of care - in its seemingly simplest forms - is what this is about; but bear with me a wee bit. Some background.

Like most in the UK, I’ve benefited variously from the NHS since birth. In particular, post September 2008, I’ve used it more than most my age. That was when I was diagnosed with Myeloma, a rare-ish blood cancer. It’s incurable, but treatable, meaning as long as you respond to drugs and whatnot, it sort of becomes a chronic condition, managed for a chunk of  time by throwing expensive drugs and procedures at the thing to repeatedly kick it into the long grass. Given that median survival when I was diagnosed was about 5 years and that was 10 years ago, I’m lucky. I am. Behind that luck, of course, sits the dedication, skill and care of numerous amazing doctors, nurses, radiologists, porters, auxiliaries, cleaners, lab technicians, GP receptionists. Many more. Also, a great big pile of money. Lots. In my case, back of envelope calculations reached half a million over 10 years before something akin to embarrassment kicked in and I stopped adding. Maybe there’s less luck than I presume?

Anyway, my story. I recently recounted this to an old friend, Mike. A Scot now living in Canada who fled the US with his family post Trump. The rotten orange wasn’t his only reason; US healthcare was too. We had lengthy chats about healthcare, the US, the NHS and unpicked the essence of care over some rum. I recounted the following memory to Mike, having not previously thought of it as relatable. I sensed in the telling it had an effect on him as by the end, we couldn’t quite make eye-contact - men, what what.

In 2014 I underwent my secong stem cell transplant. About 3 weeks are spent in an isolation room. You’re initially pumped full of something akin to domestos that begins the process of killing you. A couple of days later you’re reacquainted with a small batch of stem cells that hopefully take root, multiply and stop the imminent domestos-based death scenario whilst sending myeloma back to the start line. All in, it’s a reasonably boring process but a risky one. Isolation is required due to having no functioning immune system and visitors have to scrub up, glove up, gown up and no touchy (though the occassional blown kiss is tolerated). Freedom comes when platelets and red and white blood cells rise to acceptable levels - about 3 weeks.

That second SCT took place in Aberdeen Royal Infirmary’s then new Medical Care Centre, Ward 112. A large, roomy, bright, modern building. My room on the top floor had panoramic views across the city that eclipsed those of the best Aberdeen hotels, though that’s not too hard. Though food was terrible, facilities were excellent, making the whole ordeal much more pleasant and contributing to a more rapid recovery. 

Still, it’s a hospital and can be unsettling. Each night, I’d be woken a couple of times by nurses or auxiliaries taking bloods and checking my stats: blood pressure, temperature, heart rate, political bias etc. The room had a positive air pressure system which produced a constant swooshy drone. Lights went on and off, buzzers and bleeps sounded here and there. I learnt to ask for a couple of sleeping pills each night, which helped. More than once I awoke in the morning to see from my chart that I’d been tampered with in my sleep, unroused.

One of the best things about the new ward was its blanket warmer. Many NHS hospitals make use of a pretty thin, but apparently thermally efficient blanket. They work ok, but seem lightweight and can leave you imagining yourself colder than you probably are. Due to the nature of the patients on the ward, many of whom are very sick and prone to shivers and fevers, the ward had a cupboard that specially warmed blankets. If a 3am visit by an auxiliary to check I was alive woke me up, I’d become conscious of feeling chilly and ask if there were any warmed blankets available. Requesting this put the poor nurse/auxiliary through the onerous protocol of de-gloving, de-gowning, fetching the blanket, returning, scrubbing up, gloving up, gowning up (again) before entering my room. Normally, I’d be sound asleep before they returned and only vaguely aware of a sudden, all-embracing warmth and happier dreams as the blanket’s heat soaked into my snoring mass. 

One particular night, I was more conscious than normal. The auxiliary on duty was a lovely, elderly woman who’d been staffing the 12hr night shift for the past 3 evenings. Short and lean with neat grey hair, she was quietly spoken and precise; warm and friendly without being overy ebullient. As usual, I was roused from sleep by the room door opening and the dim night-light coming on. A whispered, “Sorry Joe” was met by my slurry “soa-kay”, whilst my barely conscious brain trod a delicate line between lapsing immediately back into deep sleep or hanging on till the end of the stats to ask for a blanket. My active participation in the stats process was negligible; stick an arm out and proffer an ear, which I probably did instinctively as soon as the night light came on. The auxiliary did the rest. Measurements were taken with a light touch, speed and a concluding “Goodnight”

“Any warm blankets left?”. 

“I’ll go see.”

“Ta”

Night light off, de-glove, de-gown, exit. I go back to sleep. 

I woke again as the auxiliary - who had returned, re-scrubbed, re-gloved, re-gowned - was carefully unfolding the freshly warmed blanket over me. Though now conscious, I kept my eyes closed, doubtless appearing asleep. Starting at my feet, she unfolded the blanket a bit at a time. With each section, she took care to support the weight of the unrolled bit so it wouldn’t lay too heavily and potentially disturb me. When she got to the end of the blanket, she brought it close to my neck but avoided anything that might wake me. Each movement was slow, considered and exact. With the blanket fully unrolled and starting from my shoulders, working down to my feet, she delicately tucked the blanket snugly around me, the blades of her hands woking in symmetry, pausing at the end of each ‘tuck’, before advancing down a hand’s length, tucking again. I was soon encased in the blanket and its warmth. At that point, I felt a hand rest lightly on my shoulder, just for a second, before she quietly left. I lay there, still, tears welling behind closed eyes. For reasons I couldn’t immediately understand, I felt overcome.

I’ll concede, a few weeks in isolation, unable to touch loved ones, terrible food, watching your blood numbers with nervous optimism whilst walking the tightrope of neutropenia - it produces an emotional hair trigger. But regardless, now as then, the feelings that memory evokes put a very humble lump in my throat and a glassy sheen in my eyes. I know now why. What I felt then and understood later was the profound, moving impact of care: of being cared for. Actually, more than that: I felt what it means to have an underpaid, overworked stranger come to you in the middle of the night and deliver care so absolutely that it moves on from being a process and becomes a tangible thing. Care was the blanket, neatly shaped around me and the heat that flowed from it to my bones, my heart, my soul. Care was the visceral memory of hands, lightly and methodically tucking me in, bit by delicate, sleep-preserving bit. Care - the type I felt that night - was more than that she was paid to provide. A very, dedicated, professional person wasn’t just looking after me: she was caring, in all its meanings.

I’d called this, “The Essence of Care” and afterwards thought I’d better google that, just in case. Transpires it’s also the name of a government strategy for nursing in the NHS. To quote their header, “Essence of Care is the government's strategy to improve the quality of the fundamental aspects of nursing care. It provides process for sharing and comparing practices, enables nurses to identify best practice or develop action plans to remedy practice that is identified as needing improvement.” - Sure. Aye. But sometimes it’s also a hand, placed briefly on a shoulder, in the middle of the night.