A record of my two-year residency at Lime, an arts and health organisation. The residency gives me and three other artists free studio space and access to equipment and resources, in exchange for working for Lime one day a month.
I’ve now had two abortive attempts to interview staff on the gynaecology ward. I’d booked in two dates this week, two half hour sessions when I could catch people during handover. But yesterday my visit clashed with the ward meeting. I sat in on that, and it was very interesting to find out more of the practical details of running the ward, but it took the whole half hour and then staff were back to work.
I discovered from the meeting, that the ward is very understaffed due to sickness and maternity leave. It’s got so serious that senior managers are being drafted in to work on the ward! So that’s one reason it is hard to catch people.
Today I turned up and the ward co-ordinator told me she couldn’t spare anyone because of staff training and a some complicated clinical issues. So I haven’t got any further. I’m going to try one more time, and have booked another half hour in 3 weeks time when the extra staff should be in place. Otherwise I might have to rethink.
It occurs to me that I might have to abort the idea of interviewing people off the ward, and do the ‘interviews’ while I shadow staff. It is proving impossible to get dedicated one to one time.
On a brighter note, the three of us Artists in Residence at Lime got together yesterday for the first time. We all shared a bit about ourselves and then talked about how we are approaching the residency.
James Bloomfield is an established painter, and has begun to explore conceptual art. He is planning to do a series of paintings for the hospital, and is also using the residency to work on a project about the Afghan war.
Nicola Colclough has been working in community arts for a number of years, and wants to use her residency to develop her skills in this area. She is starting by getting a feel for the hospital environment and will be shadowing staff in the therapeutic play unit.
They were really supportive about the problems I’ve been having with the Gynaecology project, and James reminded me that I mustn’t get caught up with other people’s expectations, but am allowed to work at my own pace. Thank you James!
While I’ve been mulling over the Gynaecology project, I’ve been getting on with other projects. I’ve got two things on the go at the moment. One is a artist’s book about Hulme which I’m hoping to get ready for the Manchester Artist’s Book Fair in October. The other is 108 garments, which is based on research I did during a residency in 2009. I was looking at the history of the Methodist Church in Manchester, and discovered in the archives, information about social projects they ran in the 1890s, including a women’s refuge and a rescue home for destitute girls. I found lists of the womens belongings, which were literally just the clothes they stood up in. 108 Garments is a response to that, but I’m not too sure where it is heading. I was at Platt Hall Costume Museum a few weeks ago, and these are a couple of drawings I particularly like.
With such a long gap between visits to the gynaecology ward, it is hard to get a sense of continuity. Other projects, holidays and illness have got in the way and I’m finding it difficult to focus. I have given myself a deadline of Christmas to get this project completed, but I still have little idea of what it might actually look like! My plan for this visit was to start interviewing staff and possibly patients, and begin to collect ideas and phrases to work with, but when I arrived at the ward, I discovered that the emergency treatment ward I visited last time was closed and all their patients have been moved to the other ward.
The new ward also deals with gynaecological problems but has had a completely different rhythm, catering for longer-stay patients in hospital for major surgery. They are mostly older women, with more complex conditions and a different care regime. It seems likely that the two wards will amalgemate in the near future so I suggested it would be better to do another session of shadowing to get to know this new environment.
This new situation puts me in somewhat of a dilemma. My main interest was in working with women experiencing miscarriage and terminations, but they are almost exclusively day patients, who spend very little time on the ward, and don’t have much time to interact with their surroundings. The people who spend time there, and who would appreciate some art to look at, who are encouraged to walk around as part of their recovery, are the women having major surgical procedures. But those are not the patients I came to the project wanting to work with. And I’m not sure that my initial ideas will work for these patients.
My second day on the Gynaecology Ward was spent shadowing a late shift. It begins with caring for the morning’s surgical and medical cases, most of whom will be discharged the same day. Then at 5pm when the Emergency Gynaecology Unit closes, all the EGU cases are transferred to the ward, as well as any new emergencies that come in during the evening.
The afternoon was very quiet, only three patients were still on the ward. It was a bit boring. But when 5pm arrived, everything changed.
All cases have to be seen and dealt with within 3 hours. If this is exceeded, it is recorded on the ward’s waiting time target. If the case is not seen and dealt with within 4 hours, there are financial penalties, and it all gets very serious.
At 5pm five patients were brought in from EGU, and at the same time, two emergencies came in that had to go straight to theatre. With the consultant and senior registrar both busy, the Senior House Officer was the only doctor on the two gynaecology wards, having to see all existing patients, the EGU transfers and any new emergencies, a huge responsibility for the most junior member of the medical team.
The nurses got on with the assessments, and I sat in on one for a patient who was in for an early scan following 5 miscarriages. She wanted reassurance that the pregnancy was still going well. The nurse was very kind and understanding, but the computer system ruled the interaction, and meant the nurse had frustratingly little time for real contact with the patient.
The staff kept returning to the screen that tracked the patient’s progress through the system. Some needed to be seen by the doctor before being discharged, but he was still on the other ward, and time was passing.
When the doctor was finally available, there was a lot of pressure on him to get patients out quickly. But he needed to discuss some of the cases with senior staff who were still in theatre. After examining one patient, he had to tell her that she had lost her baby. She wanted some time with her husband before deciding how to manage the miscarriage. Meanwhile, the staff watched as the clock ticked over the 4 hour deadline and into the red zone.
I felt that there was already enough pressure on the staff without the additional stress of meeting artificial deadlines. Of course patients get fed up with waiting, and perhaps there has been a culture of lethargy in the past, but there must be better ways to deal with it.
After two shifts, I know a lot more about the work of the ward, and the rhythm of their days. It is a hard place to spend time in. One of the nurses said to me, ‘there is no joy here’ – and it is true in a way. The successful deliveries take place somewhere else.
One of my difficulties is that the space is shared by women with very different agenda’s and I need to find a common point of reference for my work. My next step is to spend some time doing one to one interviews with staff and patients. I’m looking forward to seeing what comes out of that.
I haven’t got any images to show but my head is full of them.
Yesterday I did my first session of shadowing on the Gynaecology ward. My first exposure was the early shift. The patients come in from 7.30, and by the time I arrived at 7.45, all my nurse’s patients were admitted and in beds waiting for their operations.
I was shadowing C, a young nurse, only 6 months out of college. She said she found women’s health fascinating and this was the job she had always wanted. She had two patients waiting for gynaecological operations, and two for terminations and I was able to follow her as she did observations and went through checklists with the patients to ensure that the correct information is recorded about existing health issues and current procedure. With the termination patients, she also has to ask if they are sure about their decision.
Both C’s termination patients were having a surgical procedure, but other women on the ward had opted for a medical procedure, where they are given medication that brings on a miscarriage. They are given private rooms while the others are in 4-bed bays.
The paperwork is a mixed blessing. It guards against mistakes, but then it becomes the focus and leaves little time for the nurses to talk to the patients. This was particularly clear with a young termination patient, who said she was sure she wanted the procedure. But shortly afterwards, she left the ward in tears saying she needed some fresh air, and didn’t return. Her doubts weren’t evident in the interview and C was quite shocked.
There is also little time to spend with patients having operations. The ward is treating women with problems in the most intimate and private parts of their body, and a gynaecological procedure touches much more than the physical. It is inevitable that nurses have to be businesslike and practical, and I’m not faulting them for their commitment and professionalism. They are very caring, but there is not much space for it to be expressed.
The remaining termination case was still in theatre when I left, after having been bumped from the morning list because of a longer than expected procedure, much to her distress. Today I’m back on the ward, following the afternoon shift, where the focus is on discharging the morning’s surgery cases, and dealing with out of hours emergencies.
Deep breath …
My work is grounded in presence and absence. I unearth the hidden and forgotten and look for traces of human stories in particular places. My recent practice has focused on the history of Manchester and the social impact of urbanisation. I work in a variety of media, most recently film, textiles, painting and site specific work.
