Leonardo Da Vinci Pilot Projects (2001 - 2004) – True Stories
5 out of 89 in four hours
Monday morning, 7 o’clock – the alarm clock rings. It’s time for me to get up. “No, I can stay a bit longer, the alarm will ring again,” I say to myself. Ten minutes later, the alarm clock rings again and I slowly get up, slowly go to the bathroom and slowly get ready for breakfast.
Everything has to be done calmly – it’s the only time of the day I can allow my brain and body to go slow, marvellously slow!
I listen to the news on TV, then go and have a shower. I realise that I should hurry up because the service opens at nine o’clock and by then I have to be at work with a smile on my face, ready to give a warm welcome to 70-80 people. I need to avoid making mistakes in administering narcotics to participants; I must be careful of the authenticity of toxicological assessments, make sure that data are correctly put in the computer and prevent other colleagues from making mistakes. I must be vigilant in adhering to certain procedures, particularly those whose omission could lead to the cancellation of the therapeutic programme and pay attention to what participants say. I also have to answer the phone and to colleagues who keep on entering the room. Even if they don’t speak, I can easily guess from their expression that what they mean is: “Well, then? How long will it take you? There’s people queuing outside!”. I would like to reply “Leave me alone!”, but in the end I decide to smile and answer “Just a minute, I’ll call you as soon as I’ve finished with him!”
I come out of the shower, dry my hair and apply some moisturiser automatically because I’m too busy thinking about how to best get organised at work. Monday morning is dreadful for everyone – the participants are eager to get in because they are in a hurry and everything seems urgent. The only thing I can do is hope that my colleagues – four or five if I’m lucky – have arranged a training psychologist answering the phone for them and are therefore relaxed enough to create an atmosphere of collaboration rather than tiredness, frustration and aggressiveness.
I get dressed, put on the make up and run off. It’s 8.30. Ten minutes later, at work, I meet Giacinta who is reading the messages left by the colleagues of the Sunday shift.
Her remark “Good morning Paola” shows she is quite relaxed. I answer with the same energy and start to work. I check that everything is in order and make sure we have enough drugs in the drawer and narcotics in the strong-box. According to my calculations, two 8-mg tablets of buprenorphine are missing. I curse and say to myself: “...that’s a nice Monday start!”. I do not have the time to check possible mistakes because it is nine o’clock and the surgery starts, so I put the notebook under the phone and postpone the problem till later in the morning.
Participant: “Good morning, I need eighty milligrams of methadone.”
“Hello,” I answer, trying to remember his name while skimming through the list, “well, the list shows ninety milligrams.”
He says aggressively: “Yes, I know, but I want eighty. The doctor must have forgotten to write it down. It’s always the same old story!”
“Do you have a minute, so that we can double-check it?”
Participant: “I have to go to work and don’t have time to waste.”
“OK, take eighty mg if you want to, but it would be better if you speak with your doctor to agree on the dosage.”
The door opens and a colleague enters and tells me to be quicker. I nod and the door closes. I ask the participant no more questions and go on.
“Next, please!” I say.
“Hello Paola, how are you?”. He says while sitting himself down.
“I’m all right, and you?”. I answer while writing and not even looking at his face.
“Fairly well. Listen, I need to take the doses for two days”.
“Yes, I know, but not today, I don’t feel I have to pee.”
“All right, then. In the meantime, take these” I say, passing him the tablets.
“Thanks”. He puts the tablets under his tongue. “I’ll go now, bye.”
“No, wait! You know you have to wait a while and then...”
“But there are people waiting outside.”
“Of course, but I cannot let anyone come in while I’m treating you. So stay here a bit. Besides, I need to double-check if you are actually taking the dosage and the tablets need time to melt, as you know”.
The phone rings. It is G, who asks if it is possible to have the methadone delivered at home because she has a temperature. So, while she goes on telling me about all her illness and emphasising that she needs the methadone immediately because she feels sick, I concentrate on better understanding why she has lately begun to ask for unreasonable requests. In the meantime, while colleagues keep on entering and leaving the room, talking loudly, the guy sitting in front of me takes advantage of the situation and leaves. Another one comes in immediately. I keep listening to G’s requests and try to reassure her, explaining that she is not in danger of any methadone withdrawal syndrome. She keeps asking me to go to her place immediately, but I answer I cannot because I am in the pharmacy, and tell her I will report her phone call to the afternoon-shift group so that they will certainly ring her. I come across convincingly enough and manage to end the conversation. In the meantime, the guy sitting in front of me is showing signs of impatience and my colleagues are still talking loudly. They enter the room to see what I have got up to.
I look at the guy. I know him quite well, as he is cared for by my group. His face is rather drawn, his eyes are bulging out. I ask him how he is but he does not feel like talking. In the meantime, I’m distracted by the thought of the people outside and by the colleagues opening the door continuously. He asks for the methadone and leaves, hardly saying goodbye.
I barely notice my colleague Elena arriving. She apologises for being late and she asks me repeatedly who’s next.
With the two of us, the work should be easier, but it is not and I do not understand why.
The pharmacy is not very large and its structure is meant to let the participants stay at one end of the room. Sometimes it gets full with two or even three participants, each one of whom talk to a different staff member about his/her personal situations.
The next participant is E. She does not seem well at all, but Elena has already involved the doctor in a problem with another participant therefore I try to listen to the girl’s requests, even though I immediately realise the situation can’t be solved by me in a few minutes. So, I apologise with a shy smile and tell her I will be available later on if she needs to talk. She answers “OK, I’ll call you”, but I think she won’t. My thought is interrupted by a colleague who self-confidently enters the pharmacy, as if everyone was waiting for her to arrive, and asks for the dosage of a participant who is waiting in another room. The girl I was talking to leaves.
Then, checking the list, I realise that my colleagues have forgotten to account for the dosage administered, so I look at Elena and she looks back at me enquiringly, adding: “We cannot work at such a pace”.
I do not answer. I know she is right, but what can we do about it? I try to remember the names of those who came in and double-check if they have actually been registered. I decide to postpone the problem and say: “Elena, let’s go ahead with the three people waiting outside. Then we’ll concentrate on the list”.
A colleague comes in and says: “Shit, there are no cars available! I have to go to the General Hospital with L. Where can I find the car keys?”.
“In the cabinet” I answer.
“There are no keys there”, he says.
“Have a look in room 4. You’ll find the afternoon shift’s keys”, I say. I then turn to a new participant who has to collect his medical report and who is ready to go to the toilet to have his urine tested. I’m very brisk with him. While Elena is dealing with the last participant, I start checking the list, hoping nobody will come in and interrupt me. The colleague who was searching for the car keys comes in again, cursing because he has not found them yet. I look at him and answer in a sharp tone “Look, I can’t do anything for this problem. Do you want the keys of MY car?”.
He smiles, and maybe thinks I’m dealing with too many things at a time.
The door opens and a voice says: “Can we let T come in?”.
“No, there is a mismatch. I’ll call him as soon as I’ve finished”, I answer resolutely without taking my eyes off the list.
“All right!” the voice says. The door closes.
Once I have finished checking and updating the list, I let the next one come in.
“Hi, my doctor wants me to have my urine tested and to collect the results.”
“Hello, can you remind me which group you belong to? Who’s your doctor?”
“It’s the third group, then.”
Meanwhile, Elena reports to doctor Gianni his list of participants. He answers in a raised voice, “I cannot do everything! My nurses – your colleagues – haven’t done anything, so now it’s up to me...but I need time because I’m doing other things that are just as important.”
While I am filling in the referral form for the guy sitting in front of me, I think that Doctor Gianni’s nurses can’t physically do everything – nor know what he has in his mind – and that he can do things himself without shouting that much. The guy waiting in front of me observes the scene and smiles. We must seem all pretty mad to him. I show him the way to the toilet.
The smell of urine fills the air. Someone hasn’t flushed and someone else has missed the toilet. Having to observe a urine test – what a sight! In order not to make mistakes, the men’s toilets are also equipped with mirrors that are similar to those used at crossroads with poor visibility.
The guy tells me: “There’s plenty of people today, isn’t there?”
He has the relaxed tone of someone who’s having a coffee with a friend and is used to be watched over without feeling uneasy by my presence.
“Yes, a lot” I answer with an almost indifferent tone.
“I’m not too bad, I’ve got some relapses from time to time, but everything is under control”.
Such conversation takes place in a toilet, with him trying to pee in the glass and me standing two metres behind him, trying not to look at the mirror but paying attention to the noise of the urine dropping into the glass.
“How’s your child?”
“Well, he’s growing, he’s lively, he attends the nursery school... Sorry, I need to concentrate, otherwise I cannot pee.”
After a while I can hear the unmistakable noise, then he hands me the glass and says “here you are”. He goes on with what he has just started doing. I take the sample and close the door saying goodbye. I do not have the time to think about anything else when I see the fed-up looks of three or four people who have been waiting for five minutes. As I enter the pharmacy with the next participant, we suddenly hear shouts and doors slamming. It must be someone who does not feel well or who has not got what he was asking for. I can hear the voices of some colleagues trying to answer him and to cool him down, while the upset participant goes on shouting. Elena and I exchange an inquisitive look, we do not know what to do, we are ready to go out, but then we hear them speaking in a lower tone and order seems to be re-established. We think “thank goodness. We didn’t really need someone starting to break things or to attack someone! At least we don’t need to call the police”.
We keep up this pace and do not realise that time is passing by, nor do we take a break to have coffee or a glass of water. We don’t even go to the toilet. I realise that it’s one o’clock just when A comes in. He always arrives after he has closed up his shop for lunch. I say “It’s one o’clock. Thank goodness! Are there any other people waiting outside?”
“Two more people.”
“Thanks. You know what I mean, don’t you? I mean, with your job!”
“Yes I know what you mean, but there are always some latecomers... like me, for example.”
“You have a good reason for being late! Usual dosage?”
“Yes,” he answers “and I’d also like to have the urine tested today.”
“That’s a miracle! And ... how will it be?”
“Opiate-negative, and I’m sure about that because I haven’t used the drugs for more than one week.”
“That’s what you say all the time. But today I want to trust you. You can go to the toilet, Alessandro is coming with you.”
Alessandro, a doctor working with us, isn’t very happy about its duty but he complies anyway. I am pretty fed up to be the urine woman.
It is ten past one and more people arrive. I walk out of the pharmacy reminding my colleagues the service is closed. There are always some latecomers or some colleagues who kindly ask “would you be so kind as to deal with this person, since you are still here? I’ve got something else to do...”, but I answer rudely: “Today yours truly doesn’t feel like being kind and has got other things to do herself and would like to finish her work in peace and within her working hours!”
The colleague, surprised by my reaction, mutters: “Sorry, I’ll do it myself”.
Elena and I try to clear our minds. There is obviously an inconsistency between the list and the actual methadone in stock. We start skimming through the various lists. I am irritable and cannot concentrate, so I say: “I’ll go to the toilet and have a glass of water, so when I come back I’ll be able to concentrate better.” So does Elena.
Walking out of the pharmacy, I look at the faces of the colleagues who have spent the morning in the waiting hall and ask them how many people have come in today. Giacinta answers “Eighty-nine in total!”
“Bingo!” I answer and go and have something to drink.
Five minutes later I come back to the lists. I feel relieved. We start again from where we left off and find some mistakes, until Elena points out she has to leave because her working hours are over. She is a part-time worker. She says she is sorry for leaving me in such a mess. I reassure her, saying I will sort it out.
Finally I’m alone in the pharmacy and can concentrate on my work, but after a few minutes I notice I have been surrounded by other colleagues, some needing the lists, some looking for documents they cannot find, some talking on the phone and some who have just arrived to start the afternoon shift. I am about to burst out screaming. I am on the verge of a nervous breakdown.
Fortunately someone comes to rescue me and sits down next to me to help me in my work.
We finish the morning work two and a half hours late. By now, it’s four in the afternoon.
I’m sick, exhausted, embittered, frustrated by an assembly-line job where you do not have the time to talk to any patient. The concept of properly receiving a patient and listening attentively to their needs is one that everybody described when I began working here. I’ve been spending the whole morning working with adrenalin flooding through my veins, running the risk of making mistakes in drug administration. I did not have the time to better estimate if a certain dosage suits a participant or not. How many people expressed problems, discomfort, inadequacy during these last four hours? Many.
How many times did I react adequately? Never. I can improve. I have always tried to meet the participants’ requests, but I have not always achieved it.
I haven’t given enough time to listen to anybody and I have not helped anybody approach a problem in the right way. I have always given a rather quick, brief and apparently resolutive answer with the wrong tone. I have always considered the participant as a drug addict rather than a person. In other words, I have adopted the quickest approach. I have seen the person as a number rather than a human being. I have not listened to people’s most intimate needs. I have merely met the need of the moment, but that was only a false need. Therapy yes or no, more or less methadone, urine test required yes or no, positive or negative urine tests etc. Above all, my working conditions have not been professional at all.
I should require to work professionally, to be acknowledged for the work I have been carrying out and to have time to think about what I am doing.
I should leave work with the feeling I have done a good job in terms of quality rather than quantity.
This day-to-day uncertainty has been demotivating me and as a result I have been going to work with less energy and enthusiasm.
Another certainty I have is that we are all caught up in a whirl where anyone tries to do the least he/she can. We, the nurses, are particularly good in justifying ourselves, maintaining the problem lies in the top management. Top managers have their responsibility but it’s our fault not to make them aware of the problems we are facing. This flawed system is creating a negative situation. We will have to pay for not facing the problem, for not coping with our ineptitude, for succumbing to the overwhelming power of an excessively bureaucratic system and for not realising the negative impact of such system.
It’s seven o’clock in the evening, I’m home at last. I look around, have so many things to do – washing, ironing, cooking, ringing Alessandra and see how she and her children are, ringing Bruna (I haven’t heard from her for ages) and Cris to arrange for a coffee and a chat. I wish I could invite friends for dinner. I wish I could make a list of the Christmas gifts. I wish I could read a good book.
I WISH, I WISH, I WISH, but I am so exhausted and deprived that I do not do anything and the only diversion I allow myself is cooking a quick dinner, lying down on the couch in front of the TV and watching a not-too-serious programme or film, which is not difficult to find nowadays. Maybe I should choose a film which is able to relax my mind and to take me to a refreshing sleep that usually arrives before the end of the stupid film. But it does not matter. The ending is usually far too predictable.