ABSTRACT

Early in our observations, a Senior House Officer (SHO) from the Trauma and Orthopaedic department invited us to leave these wards and wander the wider hospital with him. It is his Friday night on-call shift. ‘Bring your notebook!’, he instructs. It was already dark. Outside, in the town centre that flanks the outskirts of the hospital, the shops had already closed and the bars were starting to fill up. Walking past the bank of waiting ambulances and the huddle of smokers in dressing gowns and slippers, following a trail of cigarette stubs, we meet him in the small public entrance at the side of the main building leading towards A&E. We follow him up to the third floor and he swipes us through an unmarked door to the backstage of the hospital. The main public corridors are brightly lit and starkly institutional, but this very long corridor is poorly lit and feels unloved. After a few turns, we arrive at the very shabby and harshly lit on-call room. Threadbare and frayed swivel chairs are lined up in front of a bank of old computers, each linked to multiple screens. To one side the large windows face out onto the small atrium, with the other wall a bank of whiteboards listing the surgical schedule. The two Registrars are already there, along with the SHO from the day shift, ready for ‘handover’ and the chance to go home. Once this is complete and the night shift SHO has the handover list (a very basic printout of key patient details - name, hospital number, and location) and pager (most hospitals still use pagers, commonly referred to as ‘the bleep’), we head back out… ‘BLEEP’, to the paediatric ward to check on a young boy with a fractured arm. His parents are frustrated at the length of time taken over his admission, and the SHO explains the concerns about potential swelling and the importance of monitoring his arm… ‘BLEEP’, into the surgical assessment unit to meet a man in his 50s who had been covering his ulcerated toe with sticking plaster. It may need amputating… ‘BLEEP’, into ‘minors’ (the minor injury unit is the part of the emergency department that treats urgent, but not life-threatening injuries and is often called the walk-in, urgent care, or urgent treatment centre) to meet a young woman experiencing numbness in her arm and a woman in her 40s whose fingers had been trapped in a sun lounger… ‘BLEEP’, next door to A&E, where we arrive at cubicle 19 to meet June who is living with dementia.

It is midnight and June is alone in the cubicle. She is clearly in a lot of pain, and extremely distressed. She is a tiny woman with pale skin and soft silver-grey hair, and her very large beautiful blue-grey eyes are unblinking, staring up at the bright lights overhead. She looks rigid, almost locked in a twisted position on the trolley and appears terrified. No one from the care home where she lives came with her in the ambulance and the two very tall medics standing over her are calling her by the wrong name (the A&E team continue to do this throughout the night).

June is one of the many people who make up one of the most significant patient populations in our hospitals. A key contemporary transformation is the increasing numbers of people living with dementia within our hospitals, with their care constituting an increasingly significant part of the everyday work.