What killed so many of the residents of the Grenfell Tower? In the weeks after the tragedy in London, it’s becoming clear that it was more than simply toxic fumes and flammable cladding. These marginalised and oppressed people were not listened to as they campaigned for improved fire safety. Two residents in particular, Mariam Elgwahry and Nadia Choucair, were threatened with legal action and branded ‘troublemakers’ as they campaigned to make their homes safer – and they are now feared dead. It could be said that racism and classism really finished off the poor and the voiceless who called Grenfell Tower their home.
I’ve also been branded a troublemaker as I speak out for patients who aren’t listened to in my role as a nurse. I once upset some specialist wound care nurses, persisting in trying to get them to visit an elderly woman with a severely infected wound. They had refused to attend, I had continued to call them; the lady died from sepsis. Another life lost because pleas for action were ignored?
As well as racism and classism, my role as a care home nurse has exposed the fact that ageism is also a killer. “Frailty and futility” are two valid reasons why treatment is often terminated, but for some elderly people there is a real chance of treatment success and it’s my role as a nurse to advocate for this when it’s withheld.
Meet Mr Nobody
Arriving at my nursing home shift, I was introduced to a desperate wreck of a man so swollen that it took two staff to move each leg to reposition him in the bed. He struggled for every breath and frequently motioned towards his chest with a look of pain.
We had not received a medical report on this man so had to piece together his medical history from what we could see. We couldn’t ask him what had happened as he spoke no English, though we later discovered he spoke a little French (with a very strange accent). We rang the hospital that had sent him but were told that nobody was available to speak during the busy early morning drug round. He had no family.
Here was a man with nobody and nothing; yet he was not nobody. I will never forget the moment I looked into his big desperate eyes: I made a silent vow to do whatever it took to help this man. I would be his voice.
Urine began trickling from a fold in his lower abdomen: he’d obviously had some sort of bladder surgery and had to suffer the indignity of us care home staff trying to work out how best to manage his continence. We tried to stand him up but five of us together were unable: he groaned with pain and his legs didn’t come near to standing.
I called the head nurse, I called the GP. The head nurse was new to the role and had never worked in a care home before; he printed out a list of kind facial expressions that might help us communicate with the man. The GP was horrified at the man’s state and agreed to find out more about him – but she didn’t have time.
Screaming at deaf ears
Just then Mr Nobody screamed out in pain, clenching his chest. We called the paramedics. Unfortunately for Mr Nobody, the team dispatched to him were the rare type that disrespect nursing home staff (and residents), seeing us as uneducated and over-reacting, and the residents as too frail to help. I could not believe it as a young paramedic stood, arms folded, at the end of the bed glaring from me to Mr Nobody. Using my high school French I endeavoured to translate significant words such as pain and heart to the attending team. Reluctantly, after much pleading, they transferred Mr Nobody to hospital.
Hours later, he was back with us, hardly any tests done. He wouldn’t let go of my hand; he needed no words; his whole body cried out for care. This man knew that something was gravely wrong. Were more tests needed? Is it possible that doctors had taken one look at this very old man and decided not to treat? Mr Nobody died the next day.
In a world of limited resources, such terribly hard decisions do sometimes have to be made, and some people genuinely are too frail to treat. But I’ve seen too many examples where the patient is written off purely because of their age. One elderly lady sustained a fractured arm after a fall and was rushed to hospital. She was sent back to the care home with inadequate pain relief despite begging to be admitted.
Voice for the voiceless
Throughout my nursing career I have spoken out for those who cannot. I clashed with a cardiologist once, who wanted to send an elderly lady home alone late at night; I’ve pleaded with physiotherapists to provide specialist seating for elderly residents with poor posture; I’ve sought out social workers to speed up provision of care packages. As a new nurse, unqualified in catheterisation, I once persuaded a passing consultant radiologist to catheterise a young stroke patient in acute urinary retention. His blood pressure was rocketing and the blocked bladder was causing a severe headache. The junior doctor was busy elsewhere: he rebuked me afterwards for collaring his colleague.
Troublemaker or tender-hearted? I was once told that I care too much for patients. The tragedy at Grenfell Tower serves as a stark illustration of what can happen when voices are not listened to. In memory of Mariam and Nadia, I will continue to speak out for the marginalised.
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Well done for putting patients’ needs first. The GMC’s guidance on good medical practice states that doctors must, amongst other things, make the care of their patient their first concern, and take prompt action if patient safety, dignity or comfort is being compromised. I know health professionals are overworked, but this shouldn’t eclipse the fundamental basis of all health care work – to care for patients.