Each morning on the oncology ward at Singleton Hospital in Swansea there is held what’s called ‘the morning briefing’. This is a gathering of nurses, doctors, occupational therapists and anybody else who is involved with the care of the patients. Unlike the more formal Multi Disciplinary Team (MDT) meetings, wherein a group professionals who each provide specific services to the patient come together to decide on a treatment plan, the briefing is a more general meeting to discuss the ongoing day to day care of the patients on the ward according to their individual and immediate needs. The events of the weekend or of the night before are reported and discussed and everybody is made aware of new patients admitted and of those discharged.
On my first day of the residency it is obvious to me that it would be a good idea to attend the briefing, and indeed the ward manager invites me without hesitation. Nevertheless, as I enter the room it is not without some trepidation. I’m concerned as to how my presence on the ward will be seen by members of staff who, at least for the moment, are unaware of the Cancer Ward 12 project, and who may regard me – a non-medically trained visitor with ideas about interacting with patients and observing the day to day life on the ward – with suspicion. Such suspicion, it could be argued, might well be understandable. The stresses of ward life in general, exacerbated in a situation where both staff and bed shortages have sadly become a norm in the modern NHS, may not accommodate too much scrutiny, especially from an outsider, and I am conscious therefore of the fact that in all the work I do in medicine I need to not only to earn the trust and respect of the patients but also of those who are caring for them.
Any fears I have are quickly put to rest. I am welcomed as ‘one of the team’, both by those I met previously while working on the Medicine Unmasked project and by everybody else. Even when, after briefly introducing myself I take out my sketchbook, everybody present seems perfectly comfortable with my being there.
The meeting begins with some banter and cheerful irreverence. (So much so that after the meeting the ward manager takes me aside to express her own concern that this may have seemed a strange way to interact in a meeting about such serious issues!) For me, far from being strange, this seems a very natural and ‘human’ way of coming together as the professional team that they are. I relax, make a quick sketch of the scene, and determine to focus on learning as much as I can from what is being said once the formal briefing begins.
It is conducted swiftly and efficiently with minimal but nevertheless very precise discussion. The primary focus is on bringing everybody up to date with the current situation as regards each individual patient on the ward and disagreements or queries as to proposed or continuing treatment plans are few. When they do arise they are dealt with in a ‘democratic’ manner, but, and as becomes clearer to me as the meeting progresses, even within in the layers of meaningful and collaborative effort towards the welfare of the patients there is always a hierarchical sub-stratum, an intractable layer upon which the ultimate responsibility for decision-making depends, and which remains a tacit basis for all of the interaction.
The list of patients is long and the severity of some of the case histories is daunting. Discussion moves on rapidly and I scribble notes both in my book and on the list beside patients’ names. These notes include unfamiliar medical terms which I will need to look up (I’ve no right to interrupt the briefing to assuage my ignorance!) and I realise that, as in all of the projects I work on, the learning curve here will be sharp!
Later that morning, after the meeting, I am in the hospital cafe having a coffee and to writing up some thoughts. I am strangely worried about how I’m going to approach the patients back on the ward and at the same time castigating myself for being so. This hesitation is not something I recognise in myself…perhaps its the warnings I’ve been receiving from various people around me that being on the ward is a challenging, if rewarding, experience. It is experience however that underlies and informs everything that I do. In the public toilets across the concourse, before going back to the ward, I stand in the queue with a woman who has blonded, thinning hair and a very large angry-looking scar across her forehead. We discuss how having just two cubicles in the ladies toilet in such a busy place may have been a miscalculation.