Journal INDEX DE ENFERMERIA (digital version) ISSN 1699-5988

ISSN: 1699-5988 In English

Index de Enfermería Digital

ACTION DIARY

The invisible participant

Manuel Amezcua
Jefe de B. de Hospitalización. Hospital Universitario San Cecilio, Granada, Spain

Index de Enfermería [Index Enferm] 2003; 40-41:66-67 (original version in Spanish, printed issue)

How to cite this document

Amezcua M. The invisible participant. Index de Enfermería [Index Enferm] (digital version) 2003; 40-41. In </index-enfermeria/40-41revista/40-41e66-67.php> Consulted

Abstract

A relative of a patient, who is a nurse at the same time, took the some notes when waiting at the door of the operating theatre. He saw the relatives and accompanying persons of hospitalized people behaving as an invisible group in the hospital. This close institution, the hospital, rarely considers formally the presence or utility of the relatives, and some times they are addressed with indifference or even with aggressive behaviors.

There is no waiting room outside the operating theatre located on the second floor of the Hospital General for relatives of patients that are going to be operated on. That is something that happens in many other hospitals. It is common for relatives to mill around the door which denies access to the surgical area and they wait and wait for many hours and during this time they keep silent, asking with a nervous smile. That morning I was not in the hospital where I work so that I decided not to use any professional influence (I do not usually make use of it) so as to experience first hand a lengthy period of waiting while my father was having an inguinal hernia operation.

The place we share is part of an area located near the hall of the second floor, a triangular area of about 25m² delimited by a wall where there is a door that leads to the surgical area, there is also a public phone box next to the door. In right angle there are four lifts for public use and just in front of them there is a circular and semitransparent wall that closes the main stairs. There are thirteen modular seats in both sides: most of them are placed in the round part of the wall so that people sitting there do not see each other. Vertexes are approach points where staff pass by to go to the hospitalization area, to the lifts, to the operating theatre, to the main stairs or to the storeroom.

There are a lot of posters stuck up on the wall, pillars, glass doors, next to the lifts, etc. that look like graffiti with messages addressed to those people who walk around but who never look at them. They are just seen by people waiting outside the operating theatre who learn them by heart because of the time they spend looking at them: "Health: yours or theirs?", "Tell them what side you are on", "Move forward with us", "Change the world to change health", "Come and protect yourself", "If you act beyond your possibilities, you will finish by doing nothing". There are messages asking people to join trade unions as well as bills offering courses for competitive examination, house renting and those that people who want to take care of somebody stick up on the wall.

A variable group of people mass around the entrance where an illuminated sign says "SURGICAL AREA". The fact that the sign is illuminated means that there is activity inside.

We are all relatives or friends of the patients who are having an operation. Just some of them are sitting, as solitaries sharing the same misfortune. Most of them are women and elderly people. When sitting together, women start talking while elderly people keep silent. Those who cannot sit join in small groups, walk in a strange way or lean on the big pillar placed in the middle or on the corners of the wall. There is constant silence, as constant as the expectation of any movement at the door of the operating theatre, which is white and wide enough for beds with wheels to go through. It has just one leaf and it closes automatically when somebody gets through it and when it moves, the heads of those who are waiting mass around so as to be able to see any gust or movement coming from inside that gives them some information about their relatives.

During the first mornig hours, patients are continually getting into the operating theatre, but just a few of them come out so that the number of people waiting increases from one minute to the next. A porter picks them up in their room and he leads them to the operating theatre through a special lift. Relatives follow them and when the patient is going through the white door, they kiss him on his face or they touch his hands while they encourage him. Then, they face endless hours.

The door of the operating theatre separate two conflicting worlds: the hermetic inside world, where we can just talk about suppositions, and the harsh reality of those waiting outside. It is bright and it can be compared to an endless tunnel which separates life, when talking about those who came back from it. Those people dressed in white and green who sometimes wear caps and socks made of plastic bring to our minds a futurist atmosphere which makes us feel confident and distant at the same time. We are confident that everything is going to be right and our relatives, who are being operated on, are going to be safe and sound again. But we also feel distant because we do not dare to ask them what they are doing with them, how they feel and whether it will be long until they finish.

Those who go in and out seem not to be worried about the desperate gesture of those who rush for the door and wait ansxiously. They do not seem to show concern for their crying or their faces covered in tears. I think they do not worry about them because they do not look at them or just because they are used to it and they feel they are invisible. Porters are the only ones who condescend to reply, although their short answers make relatives get impatient: "No, his husband is still being operated on", "It will take quite a long time". Despite that, relatives want to see porters because they know that patients come after them.

Medical bulletins start mid-morning. The surgeon opens the door, stucks his head out and reads the names of the patients aloud so that their relatives get closer to him. He uses sentences he knows by heart to inform them that everything is all right even if they have met some difficulties: "Well, he has already been operated on, he had a big hernia but everything is all right. However, to assure you that there will be no problem we will have to wait for the next 24 hours." It does not mean that the patient is going to come out immediately. While the surgeon informs the family, a less experienced one is supposed to suture the wound. After that, it is necessary to wait for recovery after the anesthesia. In the meantime, staff go in and out and one of the members of the staff turns up with a really strange tray carrying some containers with tissues in formol. We look at each other asking ourselves which family it belongs to.

At last, a patient that has just been operated on comes out lying on his bed and we rush to get closer to the door to see who he is. Their relatives ask him anxiously how he feels and the patient grimaces with pain. Every patient who underwent surgery that day was anesthetized with epidural so that they came out awake.

Activity inside the surgical area decreases from one o'clock in the afternoon and it is from that moment that people dressed in daywear start going out even though last patients would not come out until three in the afternoon.

Furthermore, on the scene there are a lot of people passing by who go from one place to another and who do not seem to be worried about the amount of people staying there. They just try to avoid them the way we avoid tables in an office when we want to go to a different room. Relatives, professionals dressed in white, men wearing ties who look like salesmen, members of staff carrying clinical material, porters pushing beds with wheels carrying patients, they all go in and out the operating theatre and wards, but they all meet inside the lifts. They anxiously stop in front of the lifts whose flashing buttons suffer the consequences or they meet while going downstairs the way ants look for their nest.

Nobody stops, nobody greets, they look like machines which are not capable of looking at each other. It looks as if they had just been programmed to wander around with the speed and certainty of ants.

Cleaners, while sweeping carefully, are the only ones who become aware of all those people waiting when they ask them to move or to put their shoes up so as to pile up the cigarette ends they have thrown on the ground. Nobody uses a lonely ashtray bin placed in a corner. As invisible actors are not seen, they do not seem to be worried about throwing rubbish on the ground. Cleaners are not worried either.

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			ACTION DIARY
			The invisible participant Manuel Amezcua Jefe de B. de Hospitalización. Hospital Universitario San Cecilio, Granada, Spain Index de Enfermería [Index Enferm] 2003; 40-41:66-67 (original version in Spanish, printed issue)

	How to cite this document
	Amezcua M. The invisible participant. Index de Enfermería [Index Enferm] (digital version) 2003; 40-41. In </index-enfermeria/40-41revista/40-41e66-67.php> Consulted