The price of truthBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6970.1700 (Published 24 December 1994) Cite this as: BMJ 1994;309:1700
- Graham Pink
- Manchester M16 9RE.
“Truth,” wrote Emily Dickinson, “is such a rare thing, it is delightful to tell it.” I cannot agree. Telling the truth of what I witnessed and was unwillingly party to has been a wretched, distressing, and costly business.
For three years, from August 1987, I worked as a charge nurse on night duty with overall responsibility for the care of 72 desperately ill and dying men and women on the short stay, medical, and geriatric wards at Stepping Hill Hospital, Stockport. Patients were admitted only if critically ill from a stroke, heart attack, chest infection, kidney failure, cancer, other life threatening illness, or, more usually, a combination of such conditions. Those few able to move alone were liable to wander. Often patients would end up on the floor and injure themselves. Incontinent patients required regular bed changes; the rest needed frequent toileting during the night.
On admission most were in shock, frightened, and often in despair. A sick or disabled spouse left alone at home would give them cause for great concern and worry. Others were completely alone in the world, perhaps grieving over the loss of a lifetime partner or in fear of impending death. Each was highly dependent. For example, the statistics for ward A14 (a 26 bed male ward) show that on average in 1989 each night over seven patients (28%) fell into category III (highly dependent) and 11 patients (42%) were in category IV (totally dependent). Total dependency means all care with feeding, hydration, turning, toileting, medication, treatment, close observation, etc. A typical handover report would contain liberal use of such words as incontinent, confused, unconscious, paralysed, distressed, aggressive, depressed, collapse, suicidal, moribund, very poorly, fell out of bed today, anxious, dysphagia, dementia, observe closely, wanders, vomiting, and tender loving care—an inelegant and often totally inappropriate …