Goin to leave this Brokedown Palace
On my hands and my knees I will roll roll roll
Make myself a bed by the waterside
In my time – in my time – I will roll roll roll
I was dreaming when the surgeons woke me from the anaesthetic. I can’t remember of what, but it took me many moments to understand what they were talking about. The doctor told me the time, said something about it being a long operation, and that it was successful. Good… wait, what operation…?
I was wheeled to the orthopaedic ward and deposited near the door in a large, bright room. There seemed to be hundreds of people, all talking, all moving. They pulled the green curtain around me and I closed my eyes.
The noise of the room – the machinery, the voices, and the clatter of curtain runners – droned on; it would become a constant, incessant cacophony of stress and distraction, day and night. I opened my eyes and the surgeon was standing next to my bed. He looked exhausted. He gave me a moment to wake up, then reported the details of the surgery: It had taken three attempts to piece my elbow back together (elbow…?). In the first two attempts the bones fell apart in their hands, but on the third try the construct – made of plates, screws pins and wires – seemed to hold. My arm was stapled up and fixed in a ‘backslab’ plaster – a bent half-pipe supporting the backside of my arm and swathed in clouds of gauze. I looked at my arm, a giant log awkwardly propped up at my side (oh… yeah… bicycle). The surgery had taken nine hours, from nine pm Sunday night to six am the next morning. He warned me of his doubts as to whether it would hold, and his fear for infection. He touched my hand, lightly dragging his fingers along mine. “Can you feel this?” he asked. “Good. That’s very good.” While I recuperated in the hospital they were going to pump me full of antibiotics. Did I have any questions? I shook my head numbly. “I’m going home now,” he said. “I’m pretty tired.” I guess. I thanked him.
He left my curtain open and I looked around the room. There were three other beds, each occupied by elderly women. The one on my left was nearly flat on her back, sleeping with her mouth wide open. On the opposite side of the room were two other women, one in her bed and the other propped up in a chair. Her face – I wasn’t wearing my glasses – had dark badger-stripes of bruises on her cheeks and forehead. They both were staring at me, assessing me. “You’re not so bad,” said the bruised lady. “Not looking as bad as me.” I would have rolled over if I could.
I slept all morning. Someone lifted the back of my bed, and a tray of food appeared before me: meat in brown sauce, white mash and orange bits. A little tub of custard sat on the side, and I was given a box of Ensure “mountain fruit flavour” nutrient drink. There was a slip of paper which said “this meal prepared for…” and listed a name which was not mine. I asked the woman across from me if this was her meal; this wasn’t my name. “No, that was for the lady who was there before you. You can have it – try the drink, it’s quite tasty.” I considered the meal before me. And so it begins, I thought.
I gummed a little of the potatoes and pushed the cart away. A nurse brought me two large white tablets (Panadol, or paracetamol/Tylenol) and one small brown pill (Diclofenac, a non-steroid anti-inflammatory like Ibuprofen). She put a large pitcher of water next to my bed, and a cup with a straw. “Try to drink lots of water,” she said. “Your urine is quite concentrated.” Is it? She pointed to a catheter bag hanging off the end of the bed. Oh. “Would you like something for the pain?” I looked at my arm; it hurt, not too badly, but hummed from top to bottom. I agreed, and she turned to leave. “I’ll be back soon, it’s time for your antibiotics anyway.”
When she returned, she brought a second nurse with her. They verified my name from the wristband, and took notes on my chart. She gave me a brown-and white pill. I asked her what it was. “OxyNorm,” she said. “Oxycodone, a codeine medicine.”
Over the next two days I began to comprehend and adjusted to my hospital routine: Two Panadol and one diclofenac every six hours, starting at six a.m. Two IV antibiotics, flucloxacillin and gentamicin, three times a day, with saline flushes between and after. I was allocated one pain pill every four hours, according to the pain management nurse, but I had to request it at each period. They would have considered a more frequent dose but since I hadn’t asked for it earlier when I arrived they figured I could manage my own pain pretty well. Opiate medications like mine required two nurses – one to administer and the other to witness. You could tell when someone was requesting drugs by a special bell (which sounded just like a bicycle bell) that was wrung from the pharmacy, calling for the second nurse. Breakfast was at eight, lunch at noon and dinner at five pm sharp. Visiting hours were between ten and noon, and two and eight pm. The morning nurses came on just after dawn, the afternoon shift started mid-afternoon, and the night nurses took over around ten pm.
As I understand it, the ortho ward has thirty-two beds in eight rooms, and eight nurses are on staff during the day; essentially that means each nurse is assigned as a primary carer to each room. At least four of those nurses, usually more like six, are recent graduates of the local nursing program, denoted by their white smocks. Most of the time they work in pairs, to deal with lifting and shifting patients. At night there are only two “blue-shirt” (experienced) nurses, or maybe four, which presumably means that while their charges are all snoring away snug in their beds, their patient load is double or quadruple that of the day shift’s.
What follows, I don’t mean to be a condemnation of the nursing staff. They are wonderful, caring people who do their best to give their patients comfort. But at least at Fremantle Hospital, and probably in the rest of the Australian Health system, these poor folk are understaffed and overworked, and it shows.
The ortho ward is dedicated to the rehabilitation of those who have broken bones so badly, they can’t just get a cast and go home. What this really means, it’s essentially a geriatric ward. Being old and frail, most of the patients there can’t shower or go to the toilet unassisted. The entire ward is necessarily an undignified and painful place. The lady across from me had blacked out as she was getting into her car (it had happened before, and this wasn’t the first of her recent hospital stays), resulting in a smashed face, broken teeth, and several fractured vertebra in her neck. Fair enough, she was worse off than I was. Her neighbour had had hip replacement surgery, and there had been complications. During my first night in the room, her bed had to be changed four times; a recent change in her antibiotics had disturbed her bowel. She was mildly delusional (not from any brain disease, I think, this place would just do that to you) and kept calling out all night that the staff had left her on her bedpan, even though it had been removed. My neighbour was relatively quiet, but unable to move on her own. She would be shifted in the middle of the day to a recliner, tucked in with blankets and left to stare out the window towards the Fremantle Harbour. Every time a nurse entered the room, she would call out in a little-girl whisper, “Neeeeehrse, neeeeehrse”.
The bruised-blackout lady was actually quite spry. She could scoot about in her walker and neck-brace, much to the consternation of the staff. She wasn’t very needy, medically, but every time a nurse would pass, she would ask them to shift her pillows, ratchet up or down her bed, or pick up the newspaper she had accidentally dropped. To which the nurse would reply, “I’m busy right now, but I’ll come back in a moment…” the list of needs would get longer and longer in the course of an hour, and the nurses would scuttle past her, flat-out ignoring her. She was surrounded by beautiful flowers and received many visitors. While she struck me as a lovely lady to have a cup of tea with, she talked incessantly about suicide and death. She told all of her friends, “when I came to in the ambulance, I thought, ‘I’d be happy if this were the end. We live too long these days.’”
She had struck an alliance with her neighbour, the hip-replacement lady. They would keep their curtains open to each other, chat and gossip about the nurses, and share the television (while each bed had its own TV, you had to buy your service from a machine down the hall with a credit card. I never bothered) and discuss their own nursing home options. The hip lady wasn’t as chipper as the bruised lady, and much of the day involved wheeling her to and from the toilet, which involved a selection process from the nursing staff as to who was free and capable of lifting her. I don’t blame her for her depression and pessimism. She had been there for four weeks, apparently. One white-shirt nurse told her, “I can’t lift you myself, or even with an assistant. I’ll throw out my back and I don’t want to do that.” I hope that nurse lives to be a hundred and two and has four hip surgeries.
As for my neighbour, she left in the middle of my stay, on Tuesday, I think. She believed she had been abused by one of the nurses, who had spoken rudely to her and jabbed a needle into her hand (this happened before I arrived). She wanted to go to a private nursing/rehab home. For my first day, Monday, there was a flurry of hospital admins speaking to her, documenting the incident and trying to convince her to stay. The white-shirt mentioned above had said, regarding the abusive blue-shirt, “she thinks she’s so superior, because she’s been a nurse for thirty years. I’m the one with a university degree…” Despite the abuse by the RN, I wanted to throttle the idiot trainee. I’d take experience over study any day.
When my neighbour left, the other ladies suggested I take her bed (eww… wait, how many people have been in my bed?), so that I get the window view; I considered making the request but before I could another elderly lady was wheeled into the empty bay; she had just come out of knee surgery, and spent her first day moaning in pain from her arthritic back. Later, I heard her weeping over her bedpan.
Suffice it to say, it was depressing. I felt so sorry for these women. They spent their days counting the attentions of the nurses. At the same time, I couldn’t bring myself to chat with them. I thought if I just lay still and didn’t move and didn’t need, I’d get out of there sooner.
About thirty-six hours after entering the ward, two drain lines were pulled from the surgical site of my arm – a very odd and painful sensation – and the catheter removed, equally odd. The nurses changed my bed sheets while I was still in the bed. A physiotherapist, a young man who kept sniffing and wiping his nose (Hello! Germophobe with a degree in Microbiology here!) came around to practice-walk me the 10feet/3m to my toilet. Now that I was “independent” (as now written on my chart, and which I think I’d like to have engraved on my tombstone) I could move about as I liked. Which I didn’t want to do: The surgeon and his chief had visited me again that morning, Tuesday, reiterating the fragility of my arm and their concern for infection. They gave no indication of how long I’d be in plaster, let alone remain in hospital. After the plaster is removed, I might wear a different brace, and another surgery may be necessary in the next few months, and additional ones possibly as I age. Maybe, possibly… The health of my arm depends entirely on me never moving it again (until this plaster comes off) and then moving it as much as possible (as prescribed by the physiotherapists) before rigidity sets in, and on keeping down inflammation so that the blood flow will bring on the healing power. One word: Shit.
Four hours after the catheter was removed, I needed to go to the toilet. It was midday, around the time when the nurses’ shifts change hands. It was very quiet on the floor, although this is the time when everyone needs something. I was locked in the bed with the guardrails up; I couldn’t undo them by myself (I tried). The bell to call for a nurse had dropped onto the floor, even more out of reach than the bed-guards. I sat for a few minutes, listening for footsteps. I asked one of my roommates to bell the nurse for me – a service we would come to do for each other frequently, a sort of sisterhood of patients. Twice she rang for a nurse. Maybe ten minutes after the last bell, I started yelling for help. The other women joined in. Eventually someone walked in and when I asked them to release me from the bed, they did, and walked away, the other patients calling “Nurse, would you…”, “Nurse, I need a…”, and “Neeeehrsssse”.
At first I found it hard to ask for anything, but over time I realised that persistence was the only method for getting any care. Being young and independent, I was low on the priority list. Which was fine with me, most of the time. On several occasions I’d have to ask repeatedly for my pain meds, so much so that I’d have to wait an hour or so from my initial request. The pain was never painful so much as present and insistent, and it was hard to sit so long, so alone, with that constant discomfort.
On Tuesday night, when the night nurses were on and the whole room was asleep, I was enduring a course of IV antibiotics. My left hand was so swollen from the multiple injections that I could feel the fluid leaking back out the cannula and down my fingers. I rang the nurse – I don’t want a single drop of these antibiotics wasted; an incomplete course could mean bone infection and that could mean amputation. I waited, and rang again, giving two short beeps. Shortly a nurse arrived saying, “You don’t have to ring twice, I heard you!” I pointed out the leaking drip and she reduced the rate. As she left the room, the other women woke up and again the requests began: ““Nurse, would you…”, “Nurse, I need a…”, and “Neeeehrsssse”…
One of the nurses told me on Wednesday morning that I would be discharged. Huge sigh of relief. A phlebotomist arrived to take my blood. Because of the difficulties the night before, she avoided my hand. There was a second cannula in my left elbow, but it had gone manky from all the bending I’d had to do with this one arm. After much poking and prodding, she was able to pull a line from a random vein on the side of my arm. She left me to my lunch. About an hour later, another phlebotomist arrived to take my blood. “Again?” I asked.
“Has someone already been here?”
“Yeah, about an hour ago.”
“…Oh.” She said, and left.
An hour later, another phlebotomist arrived. “You’re the second person to come back for my blood,” I told her.
“…Oh.” She said. I told her she could try and take more, but the last successful phlebotomist had probably taken the last workable vein. She took another go at my elbow, and pulled another vial. Doesn’t matter, I told myself, I’m going home.
The day cranked on. Feeling philanthropic, I started chatting with the other ladies in my room. Dinner arrived. The sun went down. The night shift came on. One of the nurses – a firecracker from Florida who wore pearls and white cat’s-eye glasses – gave me my meds. “I thought you’d be gone,” she said. When I asked her if she knew why I was still there, she paused, then replied carefully, “Before you could be discharged, the Occupational Therapist and the Physiologist needed to see you. But before that, Infection Control needed to verify that you were clear of infection. Infection Control didn’t release your status until after OT and Physio had gone home for the day.”
As she moved on to her other patients I realised that the “infection control” results would have come from tests done on my blood drawn earlier that day. The vial of blood drawn by the first phlebotomist must have got lost, and the vial drawn two hours later by the third phlebotomist was not tested until late in the day.
I lost it.
It was a dark night. I tried very hard to cry quietly. I didn’t want to wake anybody, I didn’t want to invite the nurses back into the room, or excite the other patients. I wanted to go home, I wanted to know that I would walk out of this place with both arms pumping. I wanted my mom.
I thought about finding a quiet lobby somewhere where I could phone a friend and just cry. I thought surely there’s a chapel in this building, somewhere. I ended up sitting on the edge of my bed watching the street scene through the window, across my roommate’s bed. The buses that would take South Terrace to South Street to Kardinya, past my house, were still running. I could have left the hospital and not be missed for a few more hours, easily.
My neighbour woke up and saw me; she asked if I was having trouble sleeping. I said yes. She asked if I would ring a nurse; she couldn’t reach her bell and needed assistance. I sat awkwardly on my bed as the night nurses returned, closing her curtains and cutting me off from the window’s view. The woman needed a bedpan; as she lay farting loudly into her bowl, I flattened back into my bed, and waited for Thursday.
Published in 1970, American Beauty is the Dead’s fifth and probably most approachable album. I wouldn’t call myself a deadhead, but I’m deeply attached to these songs. They’re always on my ipod, and back when I had a car, the CD was required listening material for roadtrips. Some of these songs instantly take me back to Nevada, Utah, SoCal…
