THE GESTAPO-ESQUE AUTHORITARIANISM OF THE UNIT MANAGER

I watch the sun rising through a distant mist as I gaze through the panoramic windows of St Patrick’s Ward here in the Spinal Unit of Stoke Mandeville Hospital. It is 7:45 AM. The night staff have just left. The day staff are now on duty. I’m laying on my left side, leaning on my elbow and looking around the ward when Adrian appears. He is a healthcare assistant (HCA) from Poland. Adrian is easy to talk to. I like him. He has a quirky humour which fits in nicely with the spinal ward. “Any chance of turning me onto my back? I ask. He approaches my bed with a smile, closes the curtains and flips me over. No problem.

“Would you like some breakfast?” he enquires with perfect diction, despite his broad Polish accent.

“Yeah, please, I’d love a piece of toast with Marmite and a cup of strong coffee.”

To my right and still asleep, is a patient called Brendan. He is laying on his back in a sand bed, the motor softly purring as it forces air through millions of sand like silicone particles, keeping him afloat and encouraging the healing process by relieving pressure on his ulcerated bed sores. Brendan is of southern Irish descent. He is in his middle forties. His hair is thinning and he has a long goatee type beard, which gives him an air of distinction — distinction bordering on eccentricity. When he is up and laying prone on his wheelchair trolley he wears a black trilby hat and thick, dark glasses, which intensifies his unconventional appearance. I am amazed when he tells me he has nine children. Most of them come from previous marriages or partners. He has just two biological children. The others, who are all grown up, prefer to live with him rather than their own mothers. That speaks volumes to me. Brendan is a good man and I like him immensely. His quick wit and fluent Irish banter makes me laugh.

To my left is an Asian guy called Ben who is very ill. The curtains around his bed are always half closed. The only time I ever see him is when I’m up and able to wheel round to the other side of his bed. The curtain on that side — which faces the nurses’ desk — remains open. Ben is also on a sand bed. He never speaks to other patients. Nurses and hospital staff classify him as “antisocial”. He’s a virtual skeleton, laying on his back and barely able to breathe or eat let alone talk. The only time he ever says anything is when he is in pain or needs assistance. Ben receives constant attention from nurses and doctors, who always seem to be at his bedside. Along with his wife, they all try to cajole him into eating and drinking more.

Adrian arrives with my Marmite toast and coffee. He puts the coffee on my side table and pushes the Marmite toast, which is folded in half, between my fingers and thumb. We chat briefly, then he walks off to attend to another patient. As I bite into the toast, I hear a doctor speaking to Ben. She tells him his wound is still bleeding profusely. He also has a deep vein thrombosis in his leg. She says there are two options open to you. We give you warfarin to thin your blood and break the clot up, but it would cause the wound to haemorrhage, possibly uncontrollably; or we don’t administer the warfarin but you then risk of the clot breaking away and forming a blockage in one of the main arteries in your lungs, heart or brain. I hear Ben mutter something. His voice is barely audible. I strain my ears but it’s impossible to make out what he is saying. The doctor, however, replies with a clear voice that it is a tough choice but it is his choice. Some choice! I reckon the guy is a dead man either way. He doesn’t want to eat and he doesn’t want to drink. His kidneys are failing. He is barely hanging onto life as it is. Yesterday I heard his mother sobbing to a nurse: “Please try to get him to eat something.”

As I chomp on my Marmite toast, savouring the flavour and texture, I look around the ward. Opposite and one bed to the left is a guy called Gareth. His hair is short and thick. He is slightly overweight. Right now he’s flicking through his iPad, which is propped up on a large pillow placed on his stomach. An HCA approaches his bed and asks him if he wants breakfast. Gareth cannot feed himself without help. He is a technocrat, up-to-date with modern technology. His house is full of electronic devices controlled by an Amazon Alexa. He is pleasant individual and can convers on a range of topics. Gareth is in his forties and recovering from a deep pressure sore. He is unmarried. His mother travels up from Plymouth twice a week. When she’s here she cares for him as only a mother would — selfless devotion.

Opposite and to the right, is a gentleman called Brian. Like Brendan, his bed is close to the window. The sun is beaming in on his face. Brian is a motorcycle enthusiast in his fifties. He doesn’t say much, lays in bed with his headphones on and watching the twelve inch television monitor, which is attached to an adjustable arm and hovering in front of him. I believe he is also recovering from a bed sore.

I push the remains of the Marmite toast into my mouth, hook my left hand over the monkey pole hanging above me and lean to my right. Stretching as far as possible, I am just able to suck on the straw that is placed in my coffee cup. I glance out of the window. The sun has risen above the horizon. It is now a huge, bright sphere, its brilliant light beaming through the window and illuminates the whole ward. Looking through squinted eyes, Brian asks a nurse to close the curtain enough to block out its rays.

Opposite is a lovely man called Derek. He suffers from motor neuron disease, has an oxygen tube clipped to his nose at all times. Twice a day he wears a special oxygen mask, which helps him to breathe. Derek is in his late forties, maybe early fifties. His facial expressions rarely alter due to atrophy of nerves and muscles. As I bid him good morning, I detect the faintest hint of a smile. Derek gets exhausted very quickly, yet he never complains. He is a mine of knowledge where music is concerned. I feel strong emotions when I look at him: empathy, concern and compassion. Life is cruel and horrible things happen to good people. There seems to be no rhyme or reason to man’s existence, other than to live one’s life to the full without harming anybody. If I were Christ, and Christ were able to perform miracles, I would put my hand on Derek’s head and declare him cured.

Joy enters the ward with the drugs trolley. Recruited by the NHS from the Philippines, she is a kindly woman, small, maybe in her early thirties, nice-looking with dark hair clipped back. I like her. She is pleasant, always willing to help.

Marvin — senior staff nurse — strolls up to my bedside and asks if I’m ready for a wash. He is about 5’9” tall, in his late thirties or early forties, black with a mop of frizzy hair. A carefully trimmed moustache lines his upper lip. If the pharmaceutical companies were able to invent an anti-self-important pill, he would be on two tablets four times a day. He is overbearing, and obsessively pedantic. One cannot get through the barrier of pomposity that seems to surround him like a force field. “I’ll get Adrian and we’ll wash you right away,” he says and then walks off with a straight back and his head held high.

A few minutes later Marvin returns, accompanied by Adrian. They have a trolley with a couple of bowls of water on top. They pull the curtains round my bed, then strip my bedcovers off and remove my top. I lay there naked. There is no embarrassment. I’ve been through this procedure many times before. I wash and dry my own face while they wash my legs. Marvin washes my torso and left arm. Adrian lifts up my right arm and washes my armpit, then the whole of my arm. I hook my hand over the monkey pole and lift my body up as far as I can, propping myself on my right elbow. They wash and dry my back, then roll me onto my right side and wash my bottom. We chat as they swish the flannels around.

“Were you joking when you said you had three wives, Marvin?”

“No I wasn’t joking.” “But it’s against the law in this country to have more than one wife.”

“In whose culture?” he asks, his voice sounding mildly indignant, as if I have offended him.

“In this culture, Marvin. You are only allowed one legal wife but you can have as many partners as you wish.”

He shakes his head, as if my question was awkward or too trivial to bother answering. I sense it’s time to stop prying into his private life. I would have liked to ask him what religion he was but I thought it best not to pursue the matter. Didn’t want to pour fuel on the fire. Who cares anyway? Maybe it explains why Marvin is as he is. “Do you need a clean top, Michael?” Adrian asks.

“Yes there’s one in the cupboard.”  

Opening the cupboard door, he removes the white long-sleeved vest which is hanging from a coat-hanger. The pair of them help put it on. When I’m comfortable, they pull up the bedlinen, turn the sheet over the blanket and smooth it all down. Marvin folds the towels up, puts my soap back in its dish and then in the draw. Finally Adrian adjusts my pillow and hey presto I’m done.

I look across at Brendan’s bed. He is not there. He’s obviously up and about. Brendan gets around on a specially built trolley. It’s a long padded board with four wheels, two large ones at the front and two smaller ones at the back. The patient lays flat on their stomach, legs stretched out behind him. The trolley is propelled along by pushing the front wheels. It’s an ingenious device designed to allow patients with pressure sores on their backside to get out of bed and move around.

By now it’s nearly lunchtime. Suddenly Brendan is frogmarched back into the ward by two security personnel, a sniffer dog and the Unit Manager. Laying on his wheelie trolley, he has a fatalistic look on his face, one of inevitable gloom. The security personnel open his locker and pull out his belongings. I lay in bed quite shocked at the Gestapo-esque behaviour of the security team and in particular the Unit Manager, who stands there with his arms folded and overlooking the proceedings. This is a full blown Shawshank Redemption cell shakedown, the Unit Manager acting like the despotic warden of the Shawshank prison. Brendan remains on his trolley, chin resting on his folded arms. His eyes stare down at the floor. He says nothing. The security personnel plunge their hands into his large bag of peanuts, his teabags and then begin to strip his locker, the dog sniffing everything they turn out. I ask the Unit Manager what they are doing. He tells me — with an air of fanaticism — that we’re searching for cannabis and other drugs. “We have video evidence of drug dealing,” he declares and adds that “People are in hospital to be rehabilitated and cured, not to take drugs or drink alcohol and be abusive to staff.” It was a breath-taking display of authoritarianism and officialdom. “You mean to tell me patients can’t enjoy themselves, have a bit of pleasure,” I say. He doesn’t answer. His face is a mask of pretentious determinism, as if he were some high-ranking police official in charge of a major drug bust. He seems haughty and domineering. Brendan is the enemy and not a patient, guilty before charged. After a thorough ten minute search, the security staff find nothing. One of them shakes his head, as if to say “There’s nothing here boss.” The Unit Manager looks disappointed. I’m sure he was hoping to pin a drug charge on Brendan. They hastily leave the ward, taking the dog with them. We later hear they turned over the spinal gym and even the children’s ward. Now I really do believe the Unit Manager has morphed into the Shawshank prison warden. The whole drug bust scenario could have come straight out of a J G Ballard or Hubert Selby novel.

I have to squeeze my eyes shut and open them again to remind myself that I am in a hospital and not some kind of internment camp. Looking through the window, the sun now out of view. I imagine the perimeter of the hospital being surrounded by rolls of razor wire with warning sirens erected at intervals on huge posts. This then is the new Stoke Mandeville Hospital. Ironically it’s letter heading and leaflets are emblazed with the words: “Hospital of Excellence”.

I can hear staff nurse Paul joking at the desk, his infectious laugh bringing a smile to my face. Thank God for nurses like him, and Alex, a guy who is friendly, decisive and efficient. There are good things about Stoke Mandeville and St Patrick’s Ward and in truth there is no other place I would rather be when I need help. But things have changed and patients are no longer seen as people who need emotional as well as physical care. From what I have witnessed, the Unit Manager is concerned only about the physicality of patients rather than the whole person. It would appear that one must not experience pleasure whilst in hospital. That will bring on the wrath of the Gestapo-esque brigade.

Ironically there have been cannabis studies in the hospital and I took part in one back in 1995. I was prescribed a cannabinoid called Nabalone, which had a higher THC content. It was an experiment to see if cannabis helped people with spinal injury. I was treated like a guinea pig, given three and four times the maximum dose to see what effect would have. My brain was literally obliterated in that trial. Although I was deliriously happy, I can hardly remember the weeks and months that went by. There was a similar trial not so long ago in which a cannabinoid spray was used. And yet patients are condemned for smoking small quantities of the drug, a drug which is proven to help pain and sensitivity caused by jangled nerves.

I agree that there have to be controls and that dealers who peddle drugs have to be dealt with, but condemning spinal patients for having small amounts of grass or solid cannabis resin is counter-productive. It is not only pleasurable but it is a medicine. Not long ago the hospital turned a blind eye to patients who smoked or ingested the drug. In fact, it was unofficially recommended. The Unit Manager has well and truly destroyed that ethos. He has buried it in a lead lined coffin, just as all reference to Jimmy Savile who built the spinal unit from funds raised by charitable events, have been buried. There is no reference to him whatever in any part of the hospital, no acknowledgement of his achievements. All that remains of his plaques, pictures and commendations, are holes in the wall where these fixtures once hung. The evil that men do lives after them, the good is oft interred with their bones (Shakespeare’s Julius Caesar, act 3, scene 2).

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