I have just spent a few days in Barcelona. My first trip there. I was enchanted by the place. It has an easy way about it that I warmed to. I particularly enjoyed the Old Quarter with its narrow streets. Plus, of course, the Gaudi Cathedral ,which defies logic. How does something so big manage to feel so light and delicate? Almost fragile. What I also came to know again was how bad I am at navigating. So my wife and I walked to her office in the commercial part of the city. It took us about 30 minutes easy walking, stopping to look at various sights en route. I left her and decided to walk back to the centre. I had a couple of maps and my mobile maps app-the one that will talk you to your destination. Two hours later I was still walking, trying to find my way. I eventually sat down near one of the cathedrals and tried again to make sense of where I was. I sat down next to some major road works with a digger, pneumatic drills, lorries etc. I sat forlornly trying to put together the map; the street that wasn’t marked; the street that was and where our flat was situated. I sat for about 20 minutes feeling like a lost six year old. Eventually I found a passing taxi , showed him the bit of paper with my address and sat back. My wife got home about half an hour after me-hving successfully found a shortcut from her office.
“How was your afternoon?” she asked.
“Not bad. I got a bit lost but made it home comfortably enough. And you?”
“Fine. I wasn’t sure about exactly how to get back, since you had the maps. But it was ok.”
We chatted a bit more and planned our evening.
The other thing I’ve been doing this week is marking exam papers. Students had to talk about the care they would give to a young man who had been admitted to hospital in a psychotic state. He had been hearing persecutory voices and had been smoking pot in an attempt to self medicate. All the essays I’ve marked describe the interventions they would use as nurses. Medication, Risk Assessment, diet, fluid intake, Observations etc. Most students mentioned some kind of talking therapy. The essays were acceptable descriptions of nursing care. But what bothered me was that the patient never felt seen. I kept on asking “Have you seen this man? Does he exist anywhere in your imagination? Do you know him?” All the essays did “unto” the patient. Nobody stopped to tell me they had spoken with him. To tell me that he worried them. Or had touched them. Or was in any way real to them.He was a ghost about whom nothing was really known. (I fear for the future of nursing, nurses and patients. These are not slow students. They are doing an Honours degree in Nursing at a University. But the gasp between Emotional Intelligence and Intellectual ability is worrying.)
What connects these two incidents is being lost. Despite all the aids I could need I still got lost. The information I had somehow didn’t include me. I mentioned this to a friend who commented “But your phone would have got you back.” I didn’t say “But my phone tells me to walk so many yards East and then proceed some more yards West. And I have no idea which way that is!” Sitting by the building site with the noise inside my head feeling as loud as the noise outside my head, I came to a closer understanding of psychosis. Inside my head were the cries of a lost six year old me. The critical voices of my friends who seem to be able to navigate in a blizzard at midnight. My fear of being lost forever with no way home. The adult me who kept on wondering how I could be in this state. The me who wanted to kill someone because that would at least let me vent my fear, rage and terror.
The connection with my students’ exam papers is that nobody seemed to write about how they would work with a real person. It is fairly straightforward to “do” nursing. One follows a checklist of interventions and one sees a patient improve. But to “be” in this situation is much harder. It means living with not-knowing. It means trusting that one can find a way to be with one’s patient. That it is possible to walk together and, together, try and find a way home. The interventions described by my students seem too like the nursing equivalent of Apps. Very helpful when you can make use of them. But no substitute for a real person.