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Orla Tinsley: The safest dialysis experience I have had at this hospital . . . I just had to get Covid to have it

In those transitory spaces in the hospital, where you think you can breathe a sigh of relief, don’t

When I am rolling to dialysis in the wheelchair no one is wearing a mask in the lift. I wonder if I should say what’s going on, but these complete strangers have chosen to walk around a hospital maskless.

If it was me, I would like to know that I was standing face to face with a potential killer.

An instrumental, courtesy of Curb Your Enthusiasm, plays in my mind just for me. During a panel discussion at The Paley Center, Larry David himself says: “It just sort of introduces the idea that you’re in for something idiotic.” Feeling overwhelmed by the spirit of the idiotic, I speak into the void, “sorry, just to let you know I have Covid”.

That I preface this announcement with an apology frustrates me, this mode of communication is so culturally interred within our ways of connection in Ireland. In New York, someone would say, what are you apologising for? Don’t apologise. Own it. I imagine a burly American footballer standing in the middle of a stadium shouting proudly: I’ve got Covid!

Is this a Covid hallucination?

It is the first morning and I know there is nothing to apologise for. But still, how else to warn them?

One head turns and stares, but the rest of the bodies stay gazing into some impenetrable spot on the door. No one exits the lift. No one pulls a backup mask from their wrist or pocket. Maybe the able-bodied Covid forgetters are right, maybe no one cares.

Only once in the two weeks does someone – besides the porter and I – mask up. It is a former doctor of mine who says: “Thanks for letting me know.” She pulls a mask from her wrist. I wonder about how this works. Sometimes, exhausted, I say nothing in the elevator. Indeed, it is a hospital. People should expect sickness and deadly viruses and thus protecting themselves is their responsibility. It is not, for example, a nightclub posed for debauchery and wild abandon. And yet, those I meet in the elevator don’t seem dialled in. Perhaps they have forgotten how viruses spread or that hospitals are filled with sick people. Or perhaps, it is the very concern for those sick people they love and are visiting that keeps them from noticing the potential invisible dangers around them.

My meals are left outside my door by the kitchen staff who are not allowed to come in. I am in total isolation because of the virus. When a nurse is free, she brings each meal into the room while wearing a yellow sterile gown, an FFP2 mask and, sometimes, a visor. The ward is busy with high-risk patients who need support. Sometimes, the food sits outside for up to 30 minutes before someone is free and I can consume it.

One lunchtime, I ask for assistance. I had been in the radiology department when the food came up and it was now iceberg cold. Before ringing the bell I brace myself for the possible pushback depending on who answers and how busy they are. It was a student nurse. “I don’t work in the kitchen so I can’t do anything,” she says. Oh, I realise I will have to let her know what the medical part of this issue is and why her advocacy matters. I wonder if maybe she has not been taught this at university.

“Please let them know I need a new hot meal because I am a transplant recipient in renal failure who was in radiology when this meal was delivered and now it is unsafe to eat,” I say.

This sentence translates as two very particular medical needs.

  1. That the food cannot sit out for long as there is a risk of bacterial growth.
  2. That renal failure requires a definite meal plan where meals must balance perfectly throughout the day or the risk of elevated levels of toxic food ingredients from the wrong foods or pain in dialysis can occur.

“But we have no control over the kitchen and it’s not my job,” says the student nurse. She is right – it is probably not her job – but it has now become her job as nurses have to advocate for many services patients need adjusting to their own individual treatment schedule. Realistically, this is a reality for a high number of patients. One of the weird misreadings of a hospital stay by those who have never had one is that it’s a kind of holiday where you are waited on hand and foot, it’s more of a gladiator match with some occasional peaceful lulls.

At that moment I was still assigned to my room and I could not, for example, take a stroll to the hospital shop to purchase something to eat. I also could not have any visitors who could bring me food later. All I had was what entered the room and the dietitian has given me parameters around pushing if the correct items do not come up or, like now, if there was a food safety issue.

I am tired. I have to let this nurse know why it is part of her job to ensure the food is there. I wonder would life be easier if my care was not in a teaching hospital. I am in kidney failure and I am a double lung transplant recipient so I have to have the appropriate food and it has to be hot because of the risk of foodborne illness and death otherwise. Please go back and tell them or ask them to come to the door.

This is just a reminder that in those transitory spaces in the hospital, where you think you can breathe a sigh of relief, don’t

Luckily, a few minutes later, I am told it is resolved and the kitchen staff member says, “no one told us so it’s not our fault”.

Of course, it is not. I am not blaming anyone, I just want nutrition. There are four opportunities for food in the day. The first is breakfast between 7am and 8am. Next, between 12pm and 1pm when lunch arrives. But it is not lunch, it is more a heavy dinner with meat, potatoes and veg. You could try to switch this up, but the next hot meal of the day comes between 4pm and 5pm and that is it then, for the whole day. In the night time, around 8pm, tea and biscuits are offered. Maybe a sandwich. That is the layout of the culinary day.

Additionally, there is a policy in the hospital called “protected meal times”. This advocates that patients are given the privacy and time to eat their meal in peace. Surprisingly, this is a nourishing and calming anchor in a day filled with uncertainty, urgent interruptions with everyone whose time is always running out and boredom.

The treatment is part of the symptoms too. In renal failure, I have a daily fluid restriction. That means 1.1 litres is all I can consume in liquids – coffee, soup, jelly, drinks or milk in cereal. If I go above this, the fluid puts pressure on my organs and my body has to fight harder to stay alive. I need extra treatment to remove the fluid.

Because of Covid, I need intravenous antibiotics which amount to over 800ml a day. In order to fight the Covid infection, I must overload my body which also risks flooding my lungs. A kidney transplant could not come quick enough. Despite this painful and arduous additional treatment, there is one comforting element – the act of dialysing people with Covid requires everyone to wear PPE and that the patient is kept in isolation. It is probably the safest dialysis experience I have had at this hospital.

I just had to get Covid to have it.

My mind drifts back to the people in the lift as I am wheeled from one isolation room and one PPE-wearing nurse to another isolation room and another PPE-wearing nurse.

And so this is just a reminder that in those transitory spaces in the hospital, where you think you can breathe a sigh of relief, don’t.

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