It was a cold, bleak Sunday in January. The trees were bare, the sky colourless and the ground had that bleached look it gets when it’s cold enough to see your own breath. A grey, tired landscape, devoid of colour after the Christmas holiday.
Inside the ward was a different story. It was stiflingly hot, and the stench of disinfectant was overpowering. Sensory overload seemed to be the order of the day, as the garish red flowers in the cubical curtains clashed with the background colour, an ugly yellow. How anybody breathed freely, let alone slept was beyond me.
The bay was crowded and cluttered. I was not the only visitor but I was the youngest, and caught between clock watching to make sure I got my train back to medical school where I was in my first year, and making sure I made the most of this last visit to my mother before the term began, I couldn’t settle.
Her bed was at the end of the ward, sandwiched ironically between the food trolley which had been parked there, by the door, and the visitors chair where by father sat. I say ironically as my mother was not eating so it seemed especially cruel that it was parked beside her. I perched awkwardly on the end of the bed, somewhat adrift in the noise of the ward, separated from her, beyond her reach.
“Are you OK with me going back?” I asked her.
Of course she said yes. She was so proud of me, proud I was in medical school, a glittering career ahead of me. I could see the pride in her eyes, and felt what? Relieved that she supported me? The weight of parental expectation to succeed? I don’t know. It was years ago now. What I do remember are those horrific curtains. And the food trolley.
It was bothering me. Sitting there on the side of the bed that I wanted to occupy. Squatting like some stainless steel toad, encroaching on our space, an uninvited guest in what little privacy we had. Giving off stale smells that were fighting with the disinfectant and making me feel queasy. A surreal environment. Alien as the monochrome winter landscape outside.
The hour arrived for me to leave, and I stretched out my hand to my mother. Blew her a kiss. I couldn’t get in to hug her because of the squatting menace of the food trolley so I bid her farewell and left to catch my train.
My mother died the following Friday. I had had no idea that she was so seriously ill.
And although much time has now passed since then, I cannot forget the garish curtain, the smell of the disinfectant or the threatening presence of the food trolley. For it was a barrier, the barrier that stopped me from hugging my mother one last time.
I wonder now, why did I not move it – it had wheels, that’s how it travelled around from bed to bed. Why, as I approached my time of departure, did I not move the shiny metal monster out of the way, and embrace my mother as I had wanted to do?
And I think the answer is because we don’t. At least not at such a tender age. We assume that things are where they are for good reason, that there is a law behind their placement, that the environment we find ourselves in is fixed and has careful intention behind it. And yet now, as a GP, I look around my practice and realise how many artefacts of our environment are acting as barriers, or as temptations, as dangers. Or are randomly dumped, without thought of the implications. The bright yellow sharps container in my room, a magnet for any toddler attracted to the child friendly colour, and since the departure of the furry toys under the health and safety legislation, little jungle rebels in the ever present fight against infection control, what else is there for small children to play with?
And what of the waiting room – hard, plastic chairs, wipe down, uncomfortable for anything more than three minutes, crammed together, patients virtually sitting on one another’s knees – what price infection control there? And on the walls, posters admonishing people to stop smoking, drink less, exercise more, cut out sugar, test their faeces, forego antibiotics, ensure they update their addresses, turn up on time, cancel appointments they don’t want, behave with respect and patience at all times, even if kept waiting for over an hour….all punitive, pejorative, paternal. Patronising. By the time you get into see the GP you feel as welcome as a Christmas tree on twelfth night.
My experience as my mother’s daughter, my regrets over not moving the food trolley, my acceptance of the rigidity of the environment of the ward have plagued me over many years. I was prevented from hugging my mother the last time I saw her alive. What else does the carelessly constructed, clinician accommodating environment of our medical settings do to patients and their families? If every time you experience a healthcare encounter you feel admonished, diminished, prevented from being who you really are, what impact is that having on your health and well being?
I want my patients to feel that the practice is their space, their safe environment. I don’t want them to be belittled or scolded every time they come to see us. We are part of their world and it needs to feel that way.
A patient at my practice has cultivated a little area of garden outside and has a small yellow watering can for the children who visit. So instead of going to the surgery to be hurt with a needle, which is often the first experiences small children have of the GP practice, they see their visit as an opportunity to water the plants. Many primary schools have garden areas or at the very least window boxes, so why shouldn’t we? Imagine what else we can do if we change those early experiences from punitive to pleasant?
And a watering can is so much safer than a sharps container.
Let’s pause for a few moments and think about the patient experience, look at our environments through their eyes. What messages are they receiving from us? What barriers are we putting in the way of their care? How are we unconsciously undoing the good we strive to do, through the subliminal and environmental details around us? Ultimately, let’s address the physical signs of organisation, institutional supremacy, and remember who we work for.