Freud’s mystic writing pad was the metaphor he used to describe the way in which infinite traces of our internal landscape are inscribed in the psyche.
So one can only imagine the indentations on Nora Joyce’s writing pad when she sat down to write to her husband from Visinada, Croatia.
It’s plain that Nora was not having fun.
Mrs Joyce (1884–1951) had gone to Visinada – popular for its healthy climate – with young Giorgio and Lucia.
In a 10-line letter, unburdened with commas, apostrophes or full stops, she lets “Jim” know that Lucy had been ill since they got there and that Georgie “… was vomiting all night and is feverish today I did not sleep a night since I came ..”.
After signing off, she adds a two-word postscript: “still continues”.
According to Nora’s biographer Brenda Maddox, in Nora: A Biography of Nora Joyce (1988), this cryptic phrase referred to her (Nora’s) vaginal discharge.
No wonder she asked her husband not to “... bother sending me pocket money and I dont intend to stay any longer than Monday...”.
Perhaps Freud would have demurred, but it seems to me that when she wrote her letter, Nora’s psyche was untroubled by anything more mystical than annoyance at the fact that her ongoing gynaecological condition was not being helped by being in a foreign country – “... there are no shops here can’t buy anything ...” – with two kids who were unwell.
For the honesty of Nora’s letter, which hints at something of her inner resilience, its inclusion in Irish Women’s Letters: compiled by Laurance Flanagan (1997) is welcome one.
A more recent letter, which hinges on a holiday gone wrong, similarly testifies to its author’s resilience, but in contrast to Nora’s unlimited outpouring, this elegant piece of prose, by virtue of its calm restraint, hints at a greater frustration, if not anger, at what she had to endure.
My guess is that consultant microbiologist Dr Stephanie Dancer sat down in front of a computer terminal, and didn’t tear out a few sheets of Basildon Bond, when she penned “Infection control ‘undercover’: A patient experience”, in press (at the time of writing) for the Journal of Hospital Infection (JHI).
Dr Dancer, former editor of the JHI, dislodged three intervertebral discs following an accident while holidaying in Italy.
As a result, she had the unscheduled opportunity to observe at first-hand “… the ward-based impact of infection control in hospitals in two countries”.
The acute trauma ward in Italy had, inter alia, no privacy curtains, no nurse call button and no alcohol gel.
But while the Italians virtually ignored hand hygiene, basic cleaning was carried out with gusto, thus allaying “... any fears of encountering long-lasting dirt (and microbes)”.
Transferred to a Scottish hospital by air ambulance, Dr Dancer found that her room was grubby “ … with litter on the floor and a waste bin containing clinical dressings”.
The cleaners devoted more time to cleaning, and re-cleaning, toilets, and often ignored hand hygiene.
And as far as the prominently displayed advice to patients that they should challenge staff over their hand cleaning: “Brusque attitude from nurses intimated a less than welcome response if anything had been said ....”
As Dr Dancer put it: “If a Journal of Hospital Infection editor could not remind staff about hand hygiene, how do other less-informed patients manage?”
Dr Dancer’s experience has “changed forever” the way she thinks about and practices infection control.
The weight of evidence confirming the failure of doctors, nurses and other healthcare staff to keep their hands clean threatens all but the sturdiest of book shelves.
In which case, if the staff aren’t bothered, it seems a logical step for concerned patients to sort it out themselves.
This was uppermost in the mind of Jonathan Sayeed when he launched PatientPak in September 2008.
Containing sprays, soaps, wipes and body wash, its aim was to arm patients with some measure of protection against the hospital bugs that hospital staff were failing to eradicate.
This prompted GP Dr Margaret McCartney to write to the BMJ (2009, 338: 506–507), asking “Are NHS superbug fears turning patients into hospital cleaners?”
I feel that gimmicks such as PatientPak are wrong (besides, I distrust daft spellings such as “pak”, when “pack” is intended).
It is not the job of patients to be hospital cleaners, it is the job of hospital staff.
The fact that staff with expensive educations and advanced qualifications continue to flout basic infection control principles, makes it difficult to put the blame on poorly paid and often poorly educated cleaning staff.
But notwithstanding this, in my view many hospital cleaners have little or no motivation to do a good job.
Why?
Part of the answer may be hinted at in the title of an article by Zuberi and Ptashnik, published in the journal Social Science and Medicine (2011, 72: 907–911): “The deleterious consequences of privatisation and outsourcing for hospital support work: The experiences of contracted-out hospital cleaners anddietary aids in Vancouver, Canada.”
I can’t help wondering what James Joyce’s attitude to hand hygiene would have been.
When a stranger approached him in Zurich and asked “May I kiss the hand that wrote Ulysses?” he replied “No. It did lots of other things too.”
