Split back nighties, Buxton chairs and the 'Bath Book'

I stayed on Blackthorn Ward for a month before being moved to a permanent ward called Lilac, an elderly care ward with 26 long-term female patients. All the wards were named after plants or trees; Lavender, Beech, Ash etc. The one above us was Lime and it housed the male elderly care patients. Far more hands on care required was required in the elderly care wards than in Blackthorn so all the nurses wore uniform. The female state registered nurses (SRNs) wore white dresses, belts and shoes and the ward Sister, who also wore white, had a dark blue shoulder cape to distinguish her from the rest of the team. Male staff wore black trousers and white tunic tops. Napsbury had its own laundry where in addition to patient clothing, towels and bed sheets the staff uniforms were washed and pressed on site. Once a week we would collect our laundered uniforms from the laundry front desk where they were returned to us on an automated hanger system, beautifully ironed and carefully wrapped in a protective plastic bag just like a modern dry cleaners. 

All ward shifts were organised on a rolling rota, the simplest one I have ever worked on where weekends off could be worked out months in advance and ‘doing the off duty’ was a doddle. There were no rotational shifts, staff worked either day or night (although many worked additional shifts to earn extra money). The hospital ran its own bank nurse system and agency nurses were unheard of.  
The majority of the women on Lilac had lived their lives exclusively within the walls of the institution and what faculty they might have had was long since lost after years of hospital routine, limited stimulation and virtually no contact with the outside world. Some  were mobile, able to eat, drink and go to the toilet with relatively little help. However, most were dependent on the nurses for help with moving, washing and feeding. Some would punch and scratch you whilst being washed and others would lie rigid as stone. Sadly, conversations on Lilac were mostly limited to the absurd, repetitive or obsence. Sometimes the patient files gave some insight into what the women's lives had been like before coming to Napsbury which helped in understanding their attempts to communicate and occasionally a small photograph clipped to the folder edge would show a black and white, younger version of themselves, a glimpse into a life lived some 50-60 years before. 

To be in an institution like Napsbury for the best part of a life, with its locked doors, fixed routines and unchanging landscape, would be bound to bring difficulties. Institutionalism was inevitable and no less so for staff. Many people worked at Napsbury for years and had partners or children working there too; there was staff housing on site and a social club too. In many senses it was one big family and although the days of self-sufficiency had long gone, there was still a feeling of belonging to a very singular (somewhat exclusive) community as you drove through the entrance gates each day.
Looking back it is shocking to think how task driven we were but I didn’t know what I didn’t know and because patients were fed and clean and safe I never questioned whether we could do things a different way. In the mornings we washed patients in the dormitory with a screen placed around the bed area. Then we took patients into the day room. We had a few incontinent patients and they were dressed in dresses or nighties with a large slit down the back, so that the garment could be lifted aside as the patient was sat on a draw sheet tucked around a chair. Every two hours the patient would be stood or lifted and the draw sheet beneath changed if wet. They were then sat down again. Patients who were immobile might be sat in a tilt back Buxton chair to prevent them sliding down onto the floor. On Thursday and Friday we bathed all the patients and there was a large book in which we ticked off who had been 'done'. Patients were walked or wheeled to the old fashioned high ceiling, tiled bathroom with a big bath in the centre of the room and a (very antiquated) hoist to one side if needed. Two nurses bathed, one or two dried and dressed. Patients were back in the day room for supper at 6pm. It was horribly task orientated and completely lacking in dignity but in our (pathetic in retrospect) defense, patients were at least clean and pressure ulcers, even in the bed bound patients were unheard of.

Amazingly, we often had a sit down meal on a Friday night if all the work was done early enough. There were two particularly good cooks in our team; Romana, a Spanish nurse and Lily, a Filipino. I remember Romana cooking a wonderful Mediterranean casserole one Friday and her husband, one of the night nursing officers, coming to join us later in the evening when his rounds were done. Another time, Lily showed us how to make roast belly pork, cabbage and noodles, a dish I went on to make many times over the years (until being wholly overcome by vegetarianism). We would put together the tables in the day room, pull across a clean white sheet for a table cloth and sit down about 8pm when all the patients were settled. At seventeen and  a half I made my first ever Boeuf Bourguignon for my friends on Lilac, inspired by the continental creations of my older colleagues.

The patient food was less international in flavour. Breakfast was made on the ward; porridge or cereals and buttered bread. Other food was sent to the ward in covered metal trays to be plated in the small ward kitchen. Scrambled egg, bacon and black pudding were all regular fare in the morning. The ward domestic, Donna, doled out endless tea and coffee; after meals, mid-morning and mid-afternoon. As the youngest pair on the ward, she and I became good friends and not long after I left she also moved on, to train as a mental health nurse. As well as Donna, Lily and Romana, there was also Eileen, an older nursing assistant, who befriended me in the early days. It was Eileen who I worked most closely with; she showed me how to wash and dress the patients, how to feed those who couldn’t feed themselves and how to make beds quickly and tidily.

It was like having an extended family, and despite the heavy work I settled in quickly and felt very much part of the team. Strange then to think then, that Napsbury was the place where for the second time in my life I was to experience bullying. It is something we have heard much about in recent times as staff in the NHS have struggled to cope with increasing pressures and variable standards of care. Where staff have talked about feeling co-erced, harasssed and bullied to achieve the impossible with chronic staff shortages and diminishing resources. Thank goodness my own experience affected nobody but myself and certainly had no implications for the patients. 

I left secondary school in 1981, seventeen years old and unsure of what work I wanted to do. I wasn't old enough to work in a general hospital as a nursing assistant or to start nurse training and 'A' levels and University held no appeal for me (and as an average student at a  standard comprehensive school, nor was I encouraged to aim in that direction). Both my grandfathers had been milkmen in the days of the horse-pulled milk cart and I had a vague notion that I ought to follow in their footsteps so I enquired at the local dairy for a job but (fortunately in retropsect) I received no response. I also enquired at the Post Office because I was quite keen on the idea of sitting at a counter dolling out stamps and travel cheques and occasionally pulling down the 'Gone to Lunch' side in the face of an awkward customer. I don't think I mentioned this in my letter to them but they didn't reply all the same.

 

Then somebody told me that the '18 or older rule' for working in a general hospital didn't apply to psychiatric hospitals, so I turned my attention to another big employer in my area, Napsbury Psychiatric Hospital. To my delight they did answer my letter of enquiry and after a fairly laid back interview, I was appointed to work there as a full-time nursing assistant.

 

Napsbury was about 20 minutes from where I lived in St.Albans. It was one of a cluster of hospitals established between the 1860s and 1930s in the South of Hertfordshire to house the mentally ill of Middlesex and the surrounding area. Contemporary documents describe the hospitals (Napsbury, Shenley, Harperbury, Hill End and Leavesden) as providing care for those people of the district who were mentally defective, socially unacceptable, poor and neglected. During my time there, I saw the records of patients who had been admitted for conditions such as nervous indisposition, hysteria, fainting fits, insanity without reason and nymphomania. Several had been admitted with child and in disgrace.

 

Napsbury was built on the outskirts of St.Albans, close to the village of London Colney (now reputedly one of England’s largest villages). It was designed in ‘country estate’ style by architect Rowland Plumbe in 1900 and it’s easy to see how its spacious corridors, high ceilings and impressive breadth emulated the grand estates of earlier eras. The hospital stood in its own extensive grounds, large enough to grow food and keep animals as well as house various workshops and the staff residences. Although the farm was no longer working when I was there, some patients did still work in the gardens or carried out general maintenance jobs like collecting rubbish. There were lovely open green spaces with mature shrubbery and trees dotted around and whatever the weather, there would always be a patient or two standing around under the canopy of a spreading Horse Chestnut, masturbating al fresco.

Napsbury opened its doors to patients in 1905 as the Middlesex County Asylum. Originally designed to accommodate about 1200 patients, a further 600 beds were added only a few years later so presumably demand for beds was high. Over the years many patients and staff passed through its doors but by the time I went to work there in the early 1980s the trend for mental health services was already moving toward smaller care settings with much better integration into the local communities.

With six O’levels and just my experience of Cell Barnes to draw on I arrived on my first day of full-time work to be sent to Blackthorn, the admissions ward, for an induction period. Dressed in standard NHS beige (without injurious cap, badges or jewelery) I arrived on my first day in this most unfamiliar of environments. All the wards had open dormitories, bathroom, toilet, kitchen, linen storage and day room areas. Windows throughout the ward were big but with many cross bars so panes were relatively small, keeping window breakages to a minimum. Floors were tiled or laid with shiny linoleum and all the wards smelled; urine, faeces, sweat, saliva and food – all the base smells of human life. Doors were solid wood, painted with heavy gloss and paned with thick, wire-meshed glass. Entry doors were locked with a hefty metal key and if a patient went missing an immensely loud alarm rang out right across the hospital grounds. 

Most patients were housed in the open dormitory with each bed being fenced by a small wardrobe for personal effects. Personal effects were cleansed of all potentially dangerous items (combs, nail scissors, laces, belts etc.) on admission and were usually fairly minimal. Some patients had single rooms for closer observation or quiet and most wore their own clothes as did some staff, making it hard to know who was who sometimes.

Smoking was a feature of hospital life. Cigarettes were highly prized with many patients smoking the less expensive roll-ups. In the small shop at the hospital’s man entrance cigarettes were sold in singles so even the poorest of patients could get a smoke fairly easily. Patients would typically eke out their cigarettes until the very last shred of tobacco had burnt away. You could tell the hard-core smoker by the dark brown nicotine stains between their fingers. Any discarded butt would be quickly picked up by another patient and pulled apart just in case anything useful was left to re-roll. It was also common for both staff and patients to smoke, again making distinction between the two groups really quite difficult at times.

Patients were admitted to Blackthorn for observation before being discharged or being moved onto a more suitable ward. I was shown a strait jacket on my first day but whether for effect or not I was never sure, I never saw it used. Clinical management included a padded room which I did see used several times. Early on in my time on Blackthorn I also accompanied a patient who going for electro convulsive therapy (ECT).

With the patient on a trolley and me walking alongside we went with the porters down the long corridor to the ECT suite. The corridors were all long and wide with plenty of window light. The walls were tiled half-way up with highly glazed, chestnut brown tiles above which the walls and ceiling were painted a non-descript green/blue colour. Walls were often hung with pictures and paintings by patients. The occasional patient would be seen shuffling down the corridor, sometimes chatty or maybe on the scrounge for a cigarette, other times head down, eyes averted; nearly always alone. On one occasion I saw a male patient standing to one side of the corridor chewing earnestly on a mouthful of Maltesers, some of which had dropped to the floor. As I got nearer, a foul, faecal smell hit me and I realised the Maltesers were just balls of faeces which he was carefully rounding in his mouth then spitting out.

When we got to the ECT suite, I watched whilst the doctor sedated the patient and applied the electrodes, the patient was then strapped onto a raised narrow bed. There were other people in the room at the time and we were all asked to stand back before the treatment started. When the current was applied I saw the patient’s hair start to rise up and his body started to twitch. When it was over, we pushed the patient back to the ward and transferred him into bed to sleep. I found the whole experience quite disturbing but nobody said a word about it to me either before or afterward. In fact in all my time at Npasbury (which by the way I ended up loving) I don't think anybody ever talked to me about what we were doing there or why.

Next week, working on the female elderly care ward, with split back nighties, buxton chairs and little thought to privacy or dignity...

"But that is rolling dust Sister, we can't do anything about that"

Following on from last week...

On the gynaecology ward, where I worked as a Saturday morning domestic, the bed covers were pale pink, the bed wheels all faced the same direction (toward the middle of the ward) and the open end of each pillow case faced away from the door (yes, really).

The main ward was designed to the Nightingale layout with a separate and smaller ward area at one end for the convalescing patients. At this time, the early 1980’s, patients usually stayed in hospital to convalesce after their operation or period of illness. This resulted in a mixture of acutely ill and recovering patients on the ward, making for a very different ward dynamic to the one that exists in hospitals today. Staff had more time to get to know their patients and the patients had time to get a head start on the recovery process before going home to pick up work, domestic duties and family life again, as is often the case today. The mix of ill and recovering patients resulted in a different atmosphere to the ward as well; the convalescing patients would be able to chat to each-other, move around independently and even help with tea and coffee rounds if they wanted. The recovering patients often cheered up the sicker patients on the ward, giving them hope for their own recovery. For the nurses, the chance to work with the ‘convalescents’ was also a welcome break from the more stressful and demanding work with the acutely ill patients. 

As well as the mix of patient dependency, the number of patients having operations was fewer. The main operating days were weekdays with only emergency cases being handled on Saturdays and Sundays; this meant that weekends were quieter for everyone, with less acute activity on the ward and a generally more relaxed atmosphere all round. Later on, when I became a student nurse, weekends were to be looked forward to as a time to emotionally re-charge, a time to prepare both ourselves and the ward for the busy week ahead. Nowadays operating lists are no respecters of weekends, and Sundays can be as busy as Wednesdays whilst convalescence supposedly takes place after discharge, when life at home for the patient quickly resumes its normal pattern and demands. The rapid throughput of patients, if poorly managed, can impact negatively on their psychological and physical recovery with the potential for rapid re-admission for un-resolved issues such as wound healing and infection. Many patients in today’s National Health Service (NHS) would find it hard to imagine a time when post-operative patients stayed in hospital for several days or even longer after surgery or could go to a convalescence home near the sea to recover from their operation if they wished, as indeed some of ours did.

Peggy and I made a good team. She was funny and kind and despite our age difference we had a good laugh together. We also worked hard to keep the ward looking spick and span. I often think back to those times; goodness knows what the care on the ward was like but it was certainly very clean. Years later, as a ward sister myself in the mid-1990's, I watched the responsibility for ward cleaning being handed over to cleaning contractors and saw first-hand the loss of pride in cleaning that came with moving domestics out of the ward team. I'll never forget asking our ward domestic to clear the huge balls of dust behind the clinical waste bin in the sluice only to be told "But that is rolling dust Sister, we can't do anything about that" (!). On John D’Marinas, we were answerable to the ward sister and although she might not have known what to do with a cardiac defibrillator she certainly knew the importance of keeping the ward spotlessly clean.

 Next week, my first job as a nursing assistant in a pyschiatric hospital - what an eye opener for a 17 year old!

 

 

 

The ward looked good but what of the patients?

Iris took me under her wing and taught me the ropes of being a ward cleaner, which mainly comprised keeping out of the way of the doctors and nurses and not looking under the covers of any bedpan sitting in the sluice (it was a gynaecology ward and the sluice was sometimes home to the sadder side of women's healthcare). Co-incidently, Iris had a younger sister, Alice, who lived in Cell Barnes Hospital (where I'd had my first experience of hospital work as a volunteer). Alice's legs had been severely burned as a child when a flaming log rolled out of the fireplace and set fire to the hearth rug on which she was playing. After the accident Alice became almost entirely mute and developed frequent and disabling anxiety attacks. Her parents couldn't cope and she was eventually admitted for long term care. It happened at a time when plastic surgery options were limited and specialist psychological support rare. That she had survived at all was probably unusual in itself given the rarity of specialist burns units before the Second World War. After Iris and Alice's parents died, Iris continued to visit her sister regularly although she said her condition remained unaltered over the years and she rarely spoke. By then I had stopped visiting Cell Barnes but our common knowledge of the hospital fuelled many conversations in the kitchen as we washed up.

The ward was run by a Sister who was close (not close enough some might say) to retirement. She was German and ‘old school’. She purred after the consultants and shouted at the junior doctors. She rang the visiting bell in the visitors’ faces if they didn’t leave exactly on time and she insisted that all the bed wheels faced in the same direction so that the ward looked tidy. She was also well known for hiding in the large walk-in linen cupboard during a cardiac arrest call (fortunately rare in our area) and for delegating all difficult tasks to her very accomplished deputy.

The main ward was set out in the traditional ‘Nightingale’ fashion, with beds lined up either side and a table and some waist high storage cupboards in the centre. This was in the days when visitors could still bring in flowers which would then be left in vases in various stages of decay until we went and sorted them out. Although against hospital regulations, Sister insisted that we use spray wax polish on all the hard surfaces to keep the ward looking and smelling clean. We were supposed to use the damp dusting method as this was ‘proven’ to keep dust and dirt under control so we kept a spray can of polish and some dusters hidden on the ward to use when the supervisors weren't around. Despite Sister’s antipathy toward damp dusting she did allow the ward floor to be polished with the buffing machine, a big heavy machine with a mind of its own that took some mastering. Though difficult to control, the floors were left looking beautiful, slippery as ice mind, but beautiful all the same.

 

So the ward looked good but what of the patients?

From the floor up - working in a hospital at last!

I was born in 1964, just a few roads away from St.Albans City Hospital, an average sized general hospital serving the people of the city and surrounding villages. My Dad was at work and my Mum was helped by my 'Auntie' Mary, our next-door neighbour and later to be my Godmother. It was still common then to be born at home and virtually unheard of for the father to be in attendance; no mobiles to call them back home either (he wouldn't have come anyway as he had a deep dread of hospitals and all akin to them).

Throughout my childhood I was very aware of the hospital which was set on a higher ground than we were in our little cul-de-sac. Because of its height, I could see much of it from my parent's bedroom window which was upstairs at the front of the house. There was an annual firework show in the grounds (good view of Roman candles and rockets) and a very tall single stack chimney with a thick black ring of brick around the top. I was fascinated by the chimney and the dark grey clouds of smoke it puffed out. For some reason (possibly something to do with the high level of WW2 interest in our house) I imagined it was fed with amputated limbs daily to keep the fire burning hotly and the smoke at the top gusting across the roof tops on a windy day.

I visited the hospital on several occasions. The most memorable time was when I fell on a rake which was lying across our concrete garden path. I whacked my nose hard as I fell and it started bleeding heavily, a real 'pumper'. However, the bleeding was of little concern, I was a serial bleeder and well used to having wet cloths on the back of my neck and a one of my Dad's big white hankies clutched to the bridge of my nose. Still this time, it didn't stop and Mum had to take me over the road to the little hospital casualty. The casualty Doctor packed my nose with yards of ribbon gauze; a hideous experience which should have put me off hospitals for life. Having jammed the gauze hard into the back of my skull, it was then left to dry rock hard. Several days later it was removed by the doctor, who caught hold of the loose end sticking out of my nostril and pulled...hard. Anyone who has had one of these or an iodine pack or a wet to dry dressing knows exactly what it is like. To say it was an eye watering, gut wrenching experience just doesn't do it justice but in spite of this (or because of it) I remained fascinated by all things hospital.

Perhaps it was inevitable that I would end up working in a hospital one, one day and so I did. It was a part-time job, Saturday morning, three hours every week. I was a domestic on the gynaecology ward, with a woman called Iris. A foot in the door at last.