An Historic Day in Scotland

Truly a Red-Letter Day

Today is the day that folks in the UK put their clocks ahead by an hour for British Summer Time. The most important deadline in Scotland today, however, is that as of 6 a.m. this morning, smoking was outlawed in bars, hotels, and restaurants thanks to legislation passed by the Scottish Parliament last year. (I can hear some of you cheering all the way over here.) We will breathe easier the next time we go to the Royal Hotel for a pub supper because, until now, if a group of smokers sat next to us, our only option was to move table or to eat quickly and leave if the place was crowded. No one we know smokes anymore but in these public places, it was never a sure thing that the atmosphere would remain smoke-free. In fact, we've been fortunate that a number of establishments we frequent had already declared a smoke-free policy for their dining rooms, but now the force of law will render all such places smoke-free. Three cheers for the MSPs (Ministers of the Scottish Parliament) who proposed, argued for, held the line, and passed this groundbreaking legislation. Our thanks must also go to Ireland for breaking this particular ground before us; I can't tell you how many times I've heard people say "If Ireland can do it, surely Scotland can."

About Hospitals

It occurs to me that many of you might like to know what it's like to have a stay in a hospital in the UK, something I didn't think to tell you that much about when I first came home as I was so focused on answering all your notes of well-wishing. I really can only speak to what it's like to stay in a Scottish hospital because even though it's all on the National Health, what I hear is that Scotland's situation is a bit better, especially outwith the major cities of Edinburgh and Glagsow, because the problems that come with overcrowding are not so severe. In fact, I should only speak about what it's like to stay at Ninewells since my previous (good) experience at PRI (Perth Royal Infirmary) was strictly outpatient.

First of all, because it's all on the National Health Service, there was no central registering when we arrived at the hospital. Rather, we were instructed to go immediately to the plastic surgery ward where my surgery would be done. Once we arrived on the floor, a nurse took us to my bed, showed me where things were, and left me to settle myself in.

The floor had a suite of patients' toilets, showers, and wash rooms. In our case, we had 2 toilet rooms, 2 showers, and 2 wash rooms (wheel-chair accessible sinks with mirrors) which we shared with 2 other wards of 6 patients each. I'd have to say the only complaint I'd have is that although I never had to wait to get into a toilet room, the cleaning crew seemed only to come twice a day (at 12-hour intervals)--much too infrequently for that many users.

Most patients over here are put in a ward. There are some private and semi-private rooms, but one's stay in one of these is determined by the nature of one's condition. In UK films I've seen, wards were huge, often windowless rooms with what looked like 30 or 40 patient beds arrayed on either side. I don't know if that is no longer the case or if it's that way in some hospitals and not others. My experience at Ninewells in Dundee as well as that of the people we've visited in PRI is that in a given department (orthopaedics, plastic surgery, and so forth) there are a few small wards on a given floor, each in adjacent rooms or a sections of their own and each with approximately 6 beds. The same nursing staff serves all the wards, much as a department's nursing staff in a U.S. hospital would serve all the private or semi-private rooms. My guess is that one or more other nurses served the private or semi-private rooms, but I don't know this for sure.

Nursing staff wear formal uniforms. No longer do the women wear white stockings, shoes, starched uniforms, and caps, but in any hospital they do all wear the same uniform (with a few variations). This may vary by hospital and within a hospital, nurses' uniforms may vary somewhat according to rank and seniority. Staff nurses in our ward wore navy trousers with white tops, the tops having certain trim and logos in navy. They wore regular street shoes and sweaters with their uniforms. This is in sharp contrast to nurse get-ups in the States where, these days, they often look like they have gone to work wearing their pyjamas and running shoes.

Meals were a bit better overall than those in the U.S. hospitals I've experienced. I will say that at least the food was easily identifiable (not always the case in the States!). Over here, there is nothing like tea to make you feel better. Three times a day, the nursing staff would prepare and serve us tea: mid-morning, mid-afternoon, and at about 9 p.m. Usually toast would be offered along with the tea. Patients could buy sweet biscuits at a very nominal cost.

Visiting hours were strictly observed from 3 p.m. til 8 p.m. Each patient could have 2 visitors at a time. There was a TV room with chairs for ambulant patients. One of our wards had a large TV at one end, but the other two did not. (I believe the one that had the telly had mostly bed-bound patients.) I can't tell you what a relief it was not to be forced to watch--or worse, listen to--what someone else wanted to watch on the telly! There also was a day room with a pay phone and lots of magazines. Our wards were along an outside wall and so at one end of each ward was a wall of windows overlooking the River Tay and the Wee Kingdom of Fife across the river. (The Wee Kingdom of Fife is not a theme park but rather the equivalent of what we'd call a "county" in the States, but a royal, albeit a small one.)

Each patient's area consisted of the bed, a bedside table, a rolling tray, and one comfortable leather upholstered chair (pretty similar to those in most hospitals). Of course, curtains could be closed around each bed. In each ward, only one bed was automatic. The rest could be raised by a nurse using a foot crank. To raise up the head of the bed required pulling out and propping open an adjustable height metal rack from the headboard and then propping pillows on it, much like a poolside chaise lounge. The person in each ward who needs the automatic bed with the thicker mattress is the one who gets it.

Nurses seemed very responsive, caring, knowledgeable, helpful, encouraging, and compassionate in addition to being skilled and efficient. Most exhibited a good sense of humor and a ready laugh. I felt that one or two seemed particularly adept at anticipating a patient's needs, almost before the patient herself knew what it was. I saw no nurses being impatient or short with anyone else and heard none of them griping to one another about their working conditions, although I don't doubt that some of them do.

Doctors and student doctors (Ninewells is a teaching hospital) made rounds each morning and, like doctors everywhere, especially surgeons, were running late and didn't give patients much time. Having said that, however, I must say that my two doctors (the specialist plastic surgeon, Mr Munnoch, and the registrar [intern] Dr Anderson) had very good bedside manners and were particularly good at making full eye contact and causing me to feel that for the moments they spent with me, they were fully in attendance. Unlike my experience with their opposite numbers in Washington, who seemed focused more on their own handiwork, importance, and schedules, these two men seemed genuinely concerned with me and how I was feeling and in reassuring me about my condition and prognosis.

We patients wore all our own clothes and only had to wear those little skimpy open-backed hospital-issue gowns for surgery. Our charts were kept at the foot of our beds in plastic binders and we were told on more than one occasion that, of course, these were our records and we could read them if we wished. As soon as I had settled in, each patient in my ward introduced herself to me. This was a very interesting phenomenon as it was a bit more like being at summer camp than in hospital. In the States we don't think of being in for a hospital stay as being an occasion for social interaction unless we're in a semi-private room. We became like a team and looked out for one another. Those of us who could bend over would pick up dropped items for those who couldn't, and so forth. One of our number was very deaf, despite 2 hearing aids. We sort of took it in turns to serve as "translator" for her to shout out what one of us had said that she didn't catch. When one patient left and another arrived, we initiated the introductions and made the new one feel "at home" just as the others had done for us when we arrived.

Two women in our ward spoke broad Dundonian Scots. Fortunately, I have read and heard enough of Scots and Auld (old) Scots that I could follow their conversations with no trouble, but it was really interesting to listen to, especially when the two of them were talking together. In a future blog I'll give you some Scots vocabulary. Actually, we hear words and phrases of it around us all the time, but these two women spoke it exclusively and I enjoyed the experience of being more or less immersed in it for 2 days.

In reflecting on this, I was thinking about how much of the literature about hospitalization in the U.S. often talks about the "isolation" and "infantalization" of the patient. It occurs to me that perhaps the ward setting may go some distance in combatting such feelings. Don't get the wrong idea, I'm not anxious to go back into the hospital but the stay wasn't without its positive aspects--especially the lack of a bill at the end of the stay!