Read the introduction to this series
A day after walking home with Celia and Oliver, we have to return to Elizabeth Garrett Anderson, as the bub has a bit of jaundice and weight loss. Nothing serious, but they have to keep an eye on it. So it’s back into hospital, and I do the 10-minute journey between Gower Mews and Huntley Street maybe 20 more times over the next 3 days. Here’s the final approach up Huntley Street, indicating the fine new building I noted earlier, and the Cruciform with the new UCLH behind it, before turning left, in off the street, into Elizabeth Garrett Anderson:
EGA’s Transitional Care Unit has about 12 beds, across 2 open wards and a few amenity rooms. This time we’re on a ward, which is another new experience. It is of course a fairly open space, with frequent good attention from midwives and nurses, and then further visits from various specialists. Privacy is occasionally sought, so that Celia can get some kip and the curtains on rails around the bed provide temporary walls. These really are curtain walls.
A ward is a public place, providing random cross-sections of society. Like a park, a public library or a school. Actually, more like a park, given the way schools increasingly tend to focus around socio-economic groups and public libraries increasingly tend to disappear, sadly. Parks, libaries and hospitals – as well as some streets – may be the few places where all socio-economic groups are present. (At least in the UK, or in other nations with a strong tradition and practice of public health care.)
In the 4 beds immediately surrounding us we get another glimpse of the flavour of London, as with the antenatal classes. Celia and I are Australian x British Anglo-Saxon in origin, and I’d guess that the nationalities immediately surrounding us are: Bulgarian x American; American-Polynesian x British-Lebanese; French/Asian x White French; British Anglo Saxon x Japanese. This mix is only likely to happen in a major world city, and it gives me such pleasure. It’s that fundamental point of the city. The condition that makes the city the greatest of all human inventions: ensuring people encounter diversity and difference in the space that they inhabit.
"Cities are places where learning to live with strangers can happen directly, bodily, physically, on the ground. The size, density, and diversity of urban populations makes this sensate contact possible – but not inevitable. One of the key issues in urban life, and in urban studies, is how to make the complexities a city contains actually interact." [‘Capitalism and the City’, Richard Sennett, Zentrum für Kunst und Medientechnologie Karlsruhe]
The hospital ward is one such place where the complexities inherent within a large city actually interact. And despite its erosion in public life, as with libraries, it was still alive and kicking at Elizabeth Garrett Anderson.
In the few days we’re on this ward, we learn a lot about having a baby too. The public ward affords many opportunities for asking midwives and nurses, as it has the essential properties of a corridor. It’s the kind of space that architects like Gehry try so hard to carve into spaces like the MIT Stata building. A thoroughfare, with pockets of people dotted along it, maximising the possibilities for informal interaction.
It actually makes us think that we’re out of hospital too early in the UK. It’s usually within 48 hours of the birth. My mother had to be virtually kicked out of the hospital in Zürich I was born in, after 9 days. It was too good. Our Finnish neighbours report you’re in hospital for 4 or 5 days after birth in there. That seems better system, in terms of both care but also informally gaining parenting skills. I don’t know if this is a philosophical decision or a pressure on hospital beds in the UK.
The staff are generally fantastic here. Yet midwives and nurses are working 12.5 hour shifts on average, with one nurse saying she’d done a 15-hour shift the day before, unable to get away. Given shift patterns, and these long hours, patients receive sometimes apparently contradictory advice from different people on different days. A few of our fellow residents on the ward reported this too.
There are a couple of possible fixes here. Celia suggests a simple visible communication of what patients have been told, affixed above the bed, even on a whiteboard. There are written notes, but they’re kept away from the patient, and only scanned by the practitioner in real-time. That would certainly help.
Another is to do the shifting cast of players. There are nurses, neo-natal nurses, midwives, doctors and consultants. And different ones each day. All work across the ward, and all have different areas of expertise and levels of authority. You have little idea of which is which, and as each is dressed in civvies, you’ve no way of knowing who is who.
One small improvement might be a return to uniforms. (Obviously that’s also an opportunity to design a beautiful series of uniforms, and the NHS should ask Akira Onozuka accordingly.) This would enable you, at a glance from 20 metres away, to spot a midwife approaching and direct your midwife questions to her. Again, not exactly IDEO rocket science, and hardly with the prevailing mood in terms of workwear; but it’s common sense and could be done creatively The creative challenge would be to do it in ways that didn’t run counter to the active birth philosophies mentioned earlier – to convey a sense of hierarchy and specific expertise. Though by the time you’re on a transitional care ward, you’re perfectly happy with the idea of medical intervention.
There are some other things about this space you’d fix – the only source of drinking water is behind the door entry system, which fails numerous times in the few days we’re there. Put one in the ward.
But again, this is Elizabeth Garrett Anderson – a very old hospital, which is about to be moved. And despite the above and more, thanks to the energy and expertise of the staff and Oliver’s improving health, we’re happy with our few days there.
Other pieces in this series:
A birth, in 13 places
1. Scan; Private clinic, Harley Street, Central London
2. Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
3. Active Birth Centre, Tufnell Park, North London
4. Antenatal classes; 1A Roseberry Avenue, Central London
5. Bloomsbury Birthing Centre, Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
6. Delivery Room 1, Labour Ward, Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
7. A&E, UCLH Main Building, Gower Street, Central London
8. Amenity Room 6, Nixon Suite, Elizabeth Garrett Anderson Hospital (part of UCH), Huntley Street, Central London
9. Café Deco, Store Street, Central London
10. Transitional Care Unit, Elizabeth Garrett Anderson Hospital (UCLH), Huntley Street, Central London
11. Home, Gower Mews, Central London
12. Bloomsbury, Central London
13. Registry Office, Camden Town Hall, Central London
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