Dying bit by bit

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The Independent Culture
This book chronicles the lives of 12 nurses working in a London hospital, combining inter-views, documentary evidence and analysis. What a good idea, how interesting; but surely not fascinating reading. Worthy, yes, but a bit of a bore, no?

No. Handle With Care is a beautifully crafted book and extremely readable. It should certainly be read by anyone thinking of going into nursing. Liane Jones has succeeded in the most difficult of tasks. Mixing interviews with analysis is difficult, and this is the kind of book, with its many variations of time, place and theme, that might have ended up all over the place. However, Jones has woven it all together with such skill that the result is immensely satisfying and illuminating.

The hospital where Liane Jones's nurses worked is pseudonymously referred to throughout the book as "St Alphege's", but is surely the doomed St Bartholomew's.However, the cutbacks, the shortage of resources and the effect of both on staff and patient morale, the determination not to drown in flagging spirits but to deal with the work in hand today, the resilience and the peculiarly British sang-froid which Jones captures reflect the story of the Health Service everywhere.

There are 630,000 qualified nurses in the UK today, and 400,000 of them work in the NHS. Those who do are paid scandalously low wages. After three years' training a qualified nurse will earn between £150 and £250 a week. Student nurses earn far, far less, and usually top up their wages with agency work, which they cram in between training and study. Not only is it not fair that they should have to work so hard, but often, as in the case of the exhausted nurse who removed a drip from the wrong patient, it's not safe.

The job satisfaction is high, the work varied and the responsibilities heavy. Nurses learn on the job, which most find nerve-wracking, but at least it's a challenge and usually brings out the best in people. Nevertheless, Liane Jones heard many tales of woe. Not enough money for resources, not enough time to provide the kind of care they wanted to give. Inefficiency was not rife, but where it did occur, it was almost always the result of communication problems between staff on different rungs of the professional ladder.

In order to present fully-rounded pictures of the 12 nurses, Jones documents many of their patient cases; in paediatrics, geriatrics, acute wards, HIV wards, and terminal wards. She builds up a real sense of the job's complexity, of its different demands and attractions, from the high pressure of Accident and Emergency to the long, slow burn of "reminiscence" therapy with the mentally ill.

Its lessons are hard ("You never lie to a child because they'll never forget and they won't trust you again if you've lied to them.") Its rewards are enormous: a coma patient coming round after several days; a geriatric patient losing enough weight to walk again; a baby born healthily to happy parents. Even death can bring job satisfaction, of a sort. Says one nurse: "It's an enormous privilege to know that you're sharing the last hours of someone's life. I've got to make these good hours. I've got to make a difference because I'm the only one whose going to do it."

The disappointments are equal in measure. Cancer, Aids, old age and accidents all take their toll on the nurses, and each one remembers their first real shock. One nurse is depressed for days after the death of an elderly patient she had grown to love. Another describes the useless demise of an adolescent boy: "He was vomiting blood. His hair was coming out; his fingernails were dead. You just looked at him and little parts of him were dying."

The same nurse has "a terrible dream" after the hospital's closure has been announced by Virginia Bottomley: "I dreamed that it was a Monday and the hospital was due to close on the Wednesday and I was thinking, how can we move these people? They're not ready to go. Do we just close the doors and hand in our uniforms and let the patients get themselves out if they can . . .?"

Not much of a dream, poor woman. That's the NHS, you see. You just look at it, and little bits of it are dying.