Lady Sleep

Life with a Chronic illness involves a lot of waiting. Be it for new tests, or medication, or in doctors waiting rooms. Today has been spent waiting for energy that never came.

I'd promised myself that I'd get up early to start my new out of hospital routine, but when the alarm went off at 1030 as planned, I couldn't quite bring myself to wake up, so turned over to drift back into the comforting arms of sleep.

By the time I next came to, the clock had struck 1300. I leapt out of bed like a cat on a hot tin roof. Well, I say leapt. Truth is, I can't "leap" anywhere. It was more a crawl with the enthusiasm and speed of a sedated snail. My limbs felt heavy, uncooperative. Like they belonged to someone else.

I felt incredibly guilty that I'd given in and slept when I should have been awake and starting my day. My Brain was not my friend. It was muddled and foggy. Truth be told, I was wishing the hands on the clock to hurry round, counting the hours till I could wrap myself up in my favourite purple blanket and snuggle up with my hot water bottle and sleep.

"Brain Goes Sky Diving" an original cartoon by Rosie P 

But when that time does come, sleep does not. Instead my Brain is busy telling me all the things that it wants to do. Sky diving. Kayaking in Scandinavia. Exploring the Pyramid's in Giza.

Then it hits me. I cannot do those things anymore, so I mourn.

Before I know it, it's 0330 in the morning and I've not had a drop of sleep. I worry that I won't be able to get up again. The cycle will begin a new. Striving to achieve routine, yet always failing. The clock ticks. "One second less sleep". My Brain comments. The more I count the seconds, the further away from me sleep gets. My breathing quickens, panic setting in.

Just breathe I tell myself. Slowly. Focus on the cool air rushing in through your nostrils, flared and tense. Then the air leaving through your open mouth, lips pursed, the freshly warmed air tickling them. Feel your chest expand and contract.

Focus on the miracle of breathing.

Calmer, sleep starts to creep forward. She's like a shadow out of the corner of your eye. As soon as you look at her she vanishes. Gradually, with my attention focused on breathing she approaches, gently wrapping me in her warm embrace.

"Tomorrow is a new day" she whispers gently "what will be will be".

Home is where the heart is...

It's harder than you think, the transition back to "normality". Well, I say normal, the whole dropping everything out of the blue at less than a moment's notice to be transferred to hospital to stay for weeks at a time IS my normal. That transition always goes without a hitch. The first night is hard with the sudden increase in noise and light, having to always ask and wait hours for pain relief, but within a day or so it's as if I've never left.

"Sleeping" an original cartoon by Rosie P

Like slipping on an old pair of gloves. Warm and familiar. Coming back to the flat takes a lot longer. It all has an effect. The weeks of sleeping with one eye open all the time. The constant uncertainty over medication. I sleep like the living dead for the first day. Not even a nuclear explosion could wake me up.

But that uncertainty doesn't leave. It just hides. Like the monster under the bed. Lurking until you think you've settled back in to a routine, then it hits you like a tonne of bricks...

.. Usually in the middle of the night. It feels wrong lying in my own bed I the dark listening to the silence. This is my house. I'm in my own space, meds are on time, I have control of my own movement, my own light. I get my TPN reliably. I don't have to fight for the basics. So why do I feel so lost and disoriented? I should be this way when in hospital. But it's not. There I have a routine. I wake at 6, have meds and start my day as the ward comes to. 10 is when the doctors arrive. Then self enforced rest at lunch time to avoid the smells and the sounds of food. Visitors arrive at 4pm. They stay till 7. After handover at 8, it's films whilst I wait for my night time meds.

"Heart Returns Home" an original cartoon by Rosie P

Home is the unknown. The unexplored frontier. I don't know where I am. The freedom is too vast. The choice of what to do too broad. Home feels like the dream. I'm not usually here long enough to form a proper routine. These things take time. And most of mine is spent away from my castle, in a distant land. From there the grass surrounding my home and castle looks greener, more luscious. But then again, things in dreams always seem brighter and shinier than they really ever were.

Home is scary because it should feel right and it doesn't. Home takes time to adjust to. Like a tiger used to its cage, suddenly released back into the wild. There's a million and one things to do and worry about. Is nursing and care cover sorted for the week? Do we have enough medications to see us through till the next trip to the pharmacy? When is the next batch of uni work due?

Oh god uni work. I'm behind. I tried to keep up in hospital, but resistance is futile so they say. No. I must keep fighting. Home wil become home again sure enough, and a new routine will form. Change is scary. And change happens AT home in my castle. Hospital is always the same. Predictably unpredictable.

The Flat of Rosie IS where my heart belongs, even if it does take it a while to get there.

Better late..?

I glanced at the clock, half an hour had passed. Time to poke the sleeping tiger again. If I was lucky, I might be able to catch my night nurse before she handed the keys over to the day staff at hand over. Spotting my nurse, I called out to her. She stood out in her agency scrubs like a sore thumb. Glancing up, we locked eyes, before she promptly buried her head in the folder, as one might do if they are trying to hide in plain sight.

"I can see you you know" I called coolly. Still she ignored me. Muttering darkly, tummy throbbing, I fumbled under my pillow for the ever elusive call button, trying hard to avoid touching any of the patches of silicone plastic that are scattered about its smooth surface. As the Orange call light flashed above my head at the entrance to the bay, and unable to ignore me any longer, begrudgingly she started to approach. 

"Yes?!" She snapped, lips curled in a snarl. Slightly taken aback at her tone, but aware time was marching ever forwards, I replied b politely, "sorry to disturb you, but I asked for some pain relief over half an hour ago?" The muscles in her clenched jaw twitched so much, I thought they would jump right out off her face!

She rolled her eyes skyward, reluctantly slouching off in the direction of the controlled drug room. Erghh! I know her type like the back of my hand. She had been nothing but rude, dangerously lazy and insolent all night, right from the moment she had first arrived on shift. Consistently late with medications, and refusing without a bitter debate to use proper sterile technique when handling my Hickman line. 

As far she was concerned, my life line required no more special treatment than a standard peripheral cannula... I mean that is what it is isn't it, a rather large cannula?! No. It's not. One can last years and will give you a life threatening infection in minutes, (such as sepsis) if mistreated, the other does not. 

"Handover" an original cartoon by Rosie P

I was jolted out of my thoughts by the tell tale rumblings of the computer trolley. Since their introduction last year, they have been at best cluttering up the ward, and at worst preventing patients from getting their medications, by amongst other things, deleting drug charts and running out of battery. At last I thought, some pain relief. Half an hour late, but better late than never. But when the trolley approached my heart sank. Three nurses stood crowded round it, so close they seemed to move as one. 

Handover. And they were 15 minutes early. I howled, mouth open in a silent scream of frustration. Now at best it would be at least another half an hour at the earliest until I would get some relief. The plethora of nurses stopped at the end of my bed, hand over began in earnest.  

"This is Bed 32..." said the nurse, waving her hand vaguely in my direction. I huffed indignantly, "I HAVE A NAME", I screamed internally. "She requested oxynorm, but I'd already given the keys to another nurse. It's fine though she's not in that much pain". In couldn't stand it any longer. 

"And how do you know that? Are you in my body? Can you feel the saw like pain in my joints? And stabbing spasmodic pain throughout my abdomen? Just because I am not screaming the place down like some people, (I glanced towards my neighbour), does NOT mean that I'm finding my pain difficult to bear!!" The accompanying hard stare I gave turned her a spectacular shade of crimson. Paddington would have been proud. 

32 hours and counting: A Transport Story

"What?!" My jaw dropped. I couldn't believe my ears. This can't be happening. Not for the second day in a row. I looked at Dad, my mouth opening and closing like a fish out of water. For once, my insatiable voice had been silenced. Everything that could be said had already passed my lips. So I just sat there. In dumbfounded silence blinking back bitter, angry tears.

"Dreamer" an original cartoon by Rosie P

"I'm sorry, but we've tried contacting the bed manager, and transport won't be here before 9 tonight at the earliest. Would that be too late? It's really difficult to book for a stretcher ambulance on a weekend. Plus you have far to travel..." it was only when her voice trailed off that I became aware my eyes were throwing daggers. I snorted in disbelief, shaking my head, resisting the urge to grab her warmly by the throat.

Panic started to rise I my chest. I can't do another night. Not here, with meds so infrequently, with the constant screaming and moaning from the old lady next door. My eyes widened as another realisation hit me, like a punch in the gut. Oh god. What about my TPN?? Yesterday I got lucky as they'd over ordered my prescription, leaving me with a spare bag. The fight for fluids could take hours! My head sunk into my hands, the light stabbing my eyes like a thousand white hot needles. A migraine was brewing. The calm before the stress induced storm to come.

Sound went distant. Colour started to drain. I could hear Dad. He was talking to a gaggle of nurses: "So 10am tomorrow, for definite?" The resounding silence said it all. The cracks were beginning to show in earnest. "Your bed manager said that he'd arrange and pay for a private crew for tonight." Dad hissed, "We had even given him the name of our regular private ambulance company, only to be told that G4S have made there own arrangements. That was nearly two hours ago. So, once again, where the hell are they?!" He growled.

"Fire Breather" an original cartoon by Rosie P

"Stretcher cases are more complicated than you understand, sir." exclaimed the nurse. Dad's laugh was more like a howl. If humans could spit fire, she would have been roasted alive in a nano second. Big mistake nurse, big mistake.
"I have travelled in more stretcher ambulances than you have had hot dinners, NEVER ever has it taken this long" he seethed. "That award you have on your notice board, for your ability to organise patient discharges is clearly not worth the paper it's written on!", and with that we set about dismantling my care for the second night in a row, leaving the nurse and gawping Carer to chew wasps alone.

I felt utterly drained, as if I'd run a marathon up Everest. With Dad busy on the phone, and another nurse placing my meds back in my bedside locker, I glanced at the clock. Time was not on my side. 8 o'clock. The night shift had started to arrive for handover. Amongst them was my favourite nurse. Dropping her bag in the corridor, she made a beeline for me, embracing me in a bear hug without a word. Grateful and emotional, I squeezed back. "I'm so sorry" she soothed.

"So am I", I whimpered, tears finally running. "So am I".

Get 'em out by Friday? Lol!

The more I glance at the clock, the slower the hands seem to move. All the willing in the world, only seems to prolong the agony of waiting. The ward is quiet for a Saturday. That's part of the problem, nobody sensible to have their cage rattled. I check the clock again. The minute hand hasn't even budged an inch. I let out a long drawn out sigh, the sound reverberating around the silent ward.

*Tick, tick, tick*. The bedside tv chatters away to itself through my headphones. I watch on with vague disinterest as an ice trucker tries to free his load from the thick snow.  My eyes loose focus, I force myself to focus, attempting to remember some small innane detail, but it's no use. My gaze slips down to the digital clock instead, and begin counting down the seconds till the number flips over. 1458... 1459... 1500.

Pumpkin time: 3 o'clock in the afternoon. Officially 24 hours spent waiting for transport to take me home. I glance at Dad, catching his eye, I break out into a manic grin and laugh. At least I think it was a laugh. It was loud and made my sides shake, and my belly ache. My face hurt from the effort of the smile. Dad rubbed his chin, his jaw tense, the muscle twitching. Without a word he hauled himself to his feet. He looked tired. Grabbing his phone from the bedside table amongst the plastic bags full of medications, he left.

Bored stiff... Literally!

The laughter came to a shuddering holt. Footsteps, followed by a heavy rumbling. I sat up, ears pricked towards the sound like a jackal preparing to run for its life. The sound came closer. My heart began to beat, and the sweat started to build on my brow. Maybe... just maybe the wait was over. Trust Dad to go now! The rumbling grew, deep like the booming voice of thunder. My shoulders slumped as a Peter bearing a metal cage laden with goods approached. My eyes shot heavenward in silent despair.

As the cage rolled by out of sight, my tongue shot out in futile rebellion. Bitterly disappointed, I lay back down, muttering darkly under my breath. Familiar footsteps. I didn't bother glancing up as Dad approached, I was too busy sulking. We sat in silence, listening to the hushed chat of the other patients and their visitors, ears straining unconsciously for any sign of the missing ambulance and their crew.

1615. Medication time. My nurse shuffled in, head down, hoping against hope to get in, deliver the meds and leave again without attracting attention. With a deep sigh, she placed a hand on the curtain. The game was over before it had truly begun.
"Are, they you are." Said Dad, rising to his feet. "Did you manage to speak to transport again?" The nurses eyes widened, like a deer caught before a hunter.

"Ah. Er yes." She replied trying hard to hide the tremble in her voice. "They say they will definitely be here by 1730" I chocked on thin air. Dad was turning a worrying shade of red, the veins standing out on his temple. Drawing himself to his full height, he coolly replied, "another hour and a half?! Are you kidding? Have you not noticed a pattern? Every time we call it's the same. We'll be another hour a half. At this rate we won't be going home tonight either." He paused drawing breath. The nurse opened her mouth to respond, before thinking better of it.

"I have spent hours sat in this chair. I love my daughter, but this is intolerable." The dam keeping in my emotions burst and cascaded out of my mouth in a torrent of anger.
"We have better things to do then sit here and be lied to, fobbed off and blanked." I hissed. "You keep telling us they're coming, but where are they? I was meant to be seeing my best friend today, who I haven't seen in nearly 4 years. And instead, I'm waiting on you lot to get your bloody act together! I'm sick of you telling me that you can't do anything. That nobody in this hospital can do anything. I don't believe you!" Dad nodded fervently, continuing the barrage.

"Before you think you don't have an interest in this, you might like to consider the fact that we are trying to think of positive things to say about the wards conduct in our official complaint to the chief executive. However, that can very easily change" the colour drained out of the nurses face. "Now: whose in charge?!"

Too little, too late

I'm floating on an ocean of comfortable nothingness. Its silent except for the gentle lappng of the water. Calm. Peaceful. I can hear a voice in the distance. So far away it's almost inaudible above the waves. I strain, trying to work out where it's coming from.

"Rosie", I awake with a start. I'm on the ward in T9, the nurse is leaning over me, her hands resting gently on my arm. I try to rub the sleep out of my eyes, temporarily confused as to my whereabouts. "Walk up sleepy head, transports here".

A wave of anger hits me like a train, knocking the sleep out of me once and for all. "What, now? Buts it's too late! I've cancelled my nurses and Dad's gone home. What time is it anyway?"
She glanced at the clock. "Nearly 11pm" at this, a disgruntled man stuck his head round the curtain. "It's she ready or not?" He moaned, starting daggers. "We don't have time to be hanging about".

A tidal wave surged inside me, flooding me with hot adrenaline. I tried to swallow it back down, but there was no room. My volcano of frustration would not be contained. "We don't have time to be hanging about?!" I repeated, turning phasers to death con one. "Who the hell do you think you are?!" The man opened his month to reply, but my razor sharp gaze stopped him dead in his tracks. The colour drained out of his face, turning him a rather peculiar shade of grey. 

"I have been waiting for you to turn up since 3 o'clock this afternoon, and have spent my day being continuously lied to and fobbed off by your useless bloody company. As a result, I have been unable to return home and wil have to spend another night incarcerated with no sleep". The man gulped, shrinking back against the curtain, desperate to find some kind of relief from the intolerable heat of the death stare.

"So what do you want us to do?" Croaked the ambulance driver, eyes resolutely fixed on the floor, a shadow of his former bolshy self. I contorted my face into a smile and replied in little more than a whisper, "I want you to go back to your controllers and recant my immense displeasure. They shall be hearing from me with a formal complaint in due course".

His frantic nodding reminded me of one of those nodding dogs. The nurse and I watched in cold stony silence as he desperately tried to find his way out of the small gap in my curtains. Then like an animal being returned to the wild, he disappeared out of sight as fast as his short legs would carry him.

Going, going... gone?

"That's not good. I can't feel the cuff." Said the specialist nurse. Her brow furrowed with concern and concentration, as her fingers moved deftly up my chest and neck probing the skin for the tell tale lump. "When did you notice the line looked different?" She asked suddenly. 

"This morning when I was getting changed, I noticed that the junction where the lumens part was outside the dressing. It wasn't in that position yesterday."

Starting to slip. Not that I knew it then...

The nurses frown grew.  She pulled off her gloves, the soft slapping sound broke the increasingly tense silence. I knew what she was thinking, it had crossed my mind the moment I first saw my line. I was the first to break the silence, "it's falling out isn't it." The words stuck in my throat. Hot tears began to form, making my eyes sting. The nurse glanced at her college, who had been hovering so close to the curtains I'd forgotten she was even there. The look they exchanged told me all I needed to know.

She nodded. "It certainly looks that way, but we won't know for sure until I've reviewed your post opp measurements and have given the line a full visual examination. I'll get the sterile measuring kit" My heart sank. Just my luck. Two days post op and the damn thing is already slipping out. I wish I'd just put up with the allergic reaction from the stat lock* after all. Anything is better than this, even red hot rashes and blisters the size of ping pong balls! And with that thought, my heart sank further. The stat lock. Oh god! Is that why it's falling out?! No, can't be. I shook my head. No. Much more likely it was this morning's nurse tugging it whilst giving meds. Thank god I held on to it!

Triumphant. Line redressed.

Lost deep in my musings, I hadn't noticed the two nurses leave until the rattle of a metal trolley barging through my closed curtains announced their return, dragging me back to earth. I landed with a bump. The metal trolley was laden. A full sterile dressing pack lay open, gloves, syringes, alcohol wipes and several measuring tapes spilling over its surface. Hands sterilised, I began to peal of the dressing covering my new life line with the same care you would afford a live grenade.

Gently taking the weight of the line with one gloved hand, the nurse carefully began her examination to decide my fate. Her other hand was a whirl of measuring tape and prodding. You could have cut the tension with a knife. I closed my eyes. Willing everything be ok? "Hmm... yes it's out by at least 3 cm. Stitches look good though" she mused. Her fingers probed deeper into my bruised and swollen tissue. The pain was sharp as a dagger. It took my breath away.

Suddenly, the roaming fingers stopped. Another hand joined the poking, it's fingers pressing slightly harder, more furtively. "Aha!" Exclaimed the nurse. Her partner was as startled as I was, jumping in surprise. "What?! What is it?!" But the nurse was on a different planet, eyes closed.

"Yes. It's defiantly there. The cuff is still in a reasonable place. It's moved, but it will still be able to do its job and tunnel into your vein over time." I couldn't quite allow myself to believe it.
"So it's still ok to use?" She nodded, smiling. The relief on her face was obvious. "And I'm still ok to go home today?!" She nodded again.

"As long as you're happy. Just make sure you keep an eye on it until the stitches come out in 5 weeks time".

I hadn't realised until then that I'd been holding my breath. Slowly I exhaled, relief seeping through me like a warm liquid until every nook and crannie was glowing. It's not often you dance with the devil and come out on top.

*A small clamp like devise that adheres to the skin, holding the line in place.

"Manners maketh the nurse"

Manners cost nothing. I understand you are tired, that you have worked a long and difficult 12 hour shift. That you want to go home to your bed. But having a go at a patient because they are in agony and have had the sheer audacity to ask you yet again for their medication, which they originally asked for well over an hour ago, is not conducive to the situation.

You are not in charge here. The patient is not your subordinate. You are both equals. A nurse is a patient's hands and legs when they cannot move. They are a comforter and soother when pain is out of control. Respect is earned, and works both ways.

When pain relief is asked for, from the perspective of the patient, the message, (and the nurse), often seems to vanish into the ether, never to be heard of again. If no one has appeared by the half hour mark, doubt creeps in. Have they forgotten? Are they doing it? Am I not due it yet? We only press our buzzers to find out what's going on, not to offend or upset you. That is after all why they are there.

To misquote a character from the film Kingsman, "Manners maketh the nurse". 

Hospital buzzer

New life line

My hearing is always the first to come back after a General Anesthetic. The soft but insistent beep of the heart tracer, the melodic tone of a pump declaring that it had finished running

Me recovering back up on the ward.

fluids into its patient, the hushed tonnes of nurses checking vital signs. Sensation is next. Dry lips. Sore throat from the breathing tube. Stiff joints from lying in one position too long. It's confusing at first. Where am I? What's happened? I feel like I'm gonna be sick.

A searing pain across my chest washes over me. I groan . Hearing footsteps I try to see where they're coming from, but my eyes won't open. My muscles in my arms and legs are growing tighter, as if someone is winding them up.

"Rosie?" The owner of the footsteps calls. I try replying, but my tongue won't move. "Rosie, can you hear me?" The mystery voice is soft and kind. I feel a hand on my eyelid, lifting it up and suddenly the warm darkness disappears into a blaze of unfocused colour and shapes. The twitching in my limbs has turned to full blown kicks and thrusts, my arms taking on a life of their own. My chest spasms, breathing becoming shallow and laboured. The colour drains back to black, I can hear frantic footsteps, but they're growing fainter- like trying to listen to a whisper through cotten wool. "She's seizing, get the aneasthatist. She needs medazalam. Rosie? Can you hear me?"

I'm floating on an ocean of nothingness, and there's no one around for miles.

*******

Pseudo Seizures are a regular thing for me after a procedure. The doctors are still not sure why. The current theory of my neurologist is I have a condition called Functional Neurological Disorder. A fancy name that means "something's not working but we're not sure what". He thinks my nerves don't read the messages my brain sends them properly. As with any condition, it is made a lot worse by stress, and having an operation is about as stressful to a body as it gets. 

Diagram depicting placement of a Hickman line

Anyway, I digress. Yesterdays procedure was to replace my

broken Hickman* line, a flexible plastic tube that goes through the chest directly into one of the large veins that lead to your heart. It can be used for all sorts of things, but for me it delivers much needed medications, and all my hydration and nutrition for the day. I guess you could call it my life line.

The operation to have it placed is fairly straightforward. Whilst I'm out of it, dreaming away under General Anesthetic, the surgeon uses an ultrasound to find a suitable vein in my chest before making two small incisions: one just under the collarbone, the other in the chest wall. The new line is then threaded through the later into the vein under live X-Ray, the end of the line ending up under the collarbone and in the opening to my heart. Once the line is flushed and the surgeon is satisfied it is working correctly, the old line is pulled out (it takes some force, as it is designed to burrow into the wall of the vein over time to prevent it falling out by accident), and the two remaining holes are stitched.

By the time I fully came round yesterday I'd spent an hour in theatre, had had two pseudo seizures and had spent just over three hours in recovery. I felt like my chest had been used by an elephant for trampoline practice. But I know the worse is over now. The next few days will be tough, but I am tougher. 

* Hickman Guide from Guys and St Thomas Hospital

The dangers of washing in doctor infested waters

Footsteps. I freeze, razor in hand one armpit shaved. The heavy foot fall comes nearer. I glance at the curtain, preparing to throw my towel over my chest the moment that curtain should even twitch. The shadow passes the end of my bed space, stopping by my neighbor instead. False alarm. 

Washing set up

That was too close. Adrenaline pumping, I hurry on. Deftly painting the other arm in foam. I lift the razor once more. I should have seen it coming. Suddenly my blue curtain shifts and disappears. I sit their half starkers, boobs out, arms up a metaphorical rabbit in very real headlights. A young male doctor and their patient gawped back open mouthed. An eternity seems to pass before I manage to smile and mumble that he might want to close the curtain. His crimson face vanishes as he pulls the curtain shut with such force it nearly comes off the rail. 

Mortified I abandon the deforestation. The sooner I finish the more likely I am to leave with most of my dignity intact. I squeeze shower gel onto the flannel, scrubbing the foam from my body. The scent of strawberry is much nicer than the smell of boiled cabbage and fish emanating from the kitchen down the hall. 

Doused in deodorant and body spray, (hundreds dead thousands homeless as my Dad used to say), and moisturiser drying, I could see the end in sight. Eyes on the curtain, I changed, hands working feverishly. Just dressings to do and I'm home and dry. 

No sooner had I kicked my trousers off, they came. I recognized the voices. My nutrition team. Shit shit shit! I grabbed for the trousers, knocking them of the bed. The voices came nearer. Abandoning hope for them, I tried grabbing a towel, knocking my head on the tv instead. They were outside. "DON'T COME... in" my voice trailed off. 

Too late...

Rush Hour

Blissful sleep finally embraces me, too little and far too late. Someone is grabbing my arm, my heart sinks- blood pressure time. Reluctant to completely loose touch with the comfort of the dark at this ungodly hour I don’t open my eyes, I know the routine well enough to do it blindfolded, and I do, lifting an arm up into the air, finger out stretched. I can feel the coolness of the blood pressure cuff as its wrapped around my bicep. The monitor begins to whir, tightening the cuff till I can’t feel my fingers. Painfully slowly its snake like grip loosens, the nurse makes a comment. Low blood pressure for them, normal for me. As sensation in my hand returns, I pull the oxygen saturation probe off my finger. The nurse mutters, but all I can think about is getting back to sleep before the ward wakes.

Like a flower opening in the first showers of rain in the desert, the sleepy world of T9 explodes into life. Somewhere, someone flips a switch: let there be light. The comforting darkness vanishes into myth. Disjointed voices and footsteps of nurses pass by, loud greetings from friends ready to change shifts. The jangle of passes and keys from those already on duty as their tired feet carry them through the last of the morning medication round. Outside of my thin curtains, the cleaners gather by their cupboard. Chatting loudly in an oral tapestry of languages. They load their carts with mops and bags of supplies, shutting the stacked compartments with a bang. The metal lids of the bins opposite my bed crash closed, their plastic sacks rustling in the cleaners hands.

A low rumbling catches my attention, rising above the general melee. I can feel the vibrations through the floor. Gradually it builds to a crescendo until it stops dead outside the end of my bay. A small wizened man unloads its cargo- water jugs. Every inch of the trolley is covered in a small watery forest of green lids. With the care a parent would take in holding their new born child, he gently ferries his load one by one, depositing each on a patients table. The HCA sat at the desk next to my bed hums tunelessly, as the laundry cage stuffed to the brim with gowns and sheets rattles by. Fragments of conversation float over me. Doctors comparing cases, patients chatting with their nurses enjoying their last moments of freedom before hand over, their keys grinding in the locks of the medication cupboards.

I glance at the clock. 7:50. Breakfast is late, but on its way. I can smell the toast. A gaggle of nurses rounds the corner, gathered so closely round their mobile computer system they seem to move as one. Handover. The strange arrangement of uniforms stop at the end of my bed. I put my headphones on, pretending not to listen as their leader explains: allergies, tubes, observations, abilities and disabilities. No stone of my nursing existence is left unturned. It’s a tight squeeze, a gaggle of surgeons arrives. They want to get to their patient. Gathering like predators before a kill, they circle around the trolley of notes opposite my bed. They close in on their prey- the woman sleeping soundly to my left, gently snoring, doesn’t see them coming.

The ward seems to let out a collective sigh, quietness briefly regaining the upper hand. The cleaners are gone and the nurses away. The first wave of doctors and surgeons are off finding the next unfortunate on their lists. An endless procession of footsteps, dull and rhythmic takes over- the heart beat of the ward.

Ward supplies being delivered.

How do you solve a problem like Maria? Escape...

"Get your f**cking hands off me"

She wrenched her arm from the carer's grip, her hospital gown whirling behind her.
"Calm down Maria", chastised the carer. "You know you aren't allowed down stairs. Not after yesterday." Her voice may have been calm and her body language assertive, but the beads of sweat on her forehead, and the slight shake in her hands, still raised, betrayed the sudden rush of adrenaline hitting her system.

She'd been in this situation before and recognised all the signs in her patient. This had all the hallmarks of turning nasty, just like yesterday's attempted escape. Maria had made it as far as the ambulance bay, the carer in hot pursuit, before being dragged back inside by security, kicking and screaming.

Maria's eyes now burned bright with that same defiance under her furrowed brow and wild tangle of shoulder length hair, assessing her opponent. She needed a smoke like a fish needs water, and no one especially HER was going to stop her. Maria turned, and headed back to her bed space. The carer watched her, her guard relaxing. She didn't see it coming.

Light on her feet, Maria wheeled on the spot and ran, arms outstretched, shoving the carer with all her might. Falling back against the wall, the carer watched helplessly as the doors to the lifts banged shut.