I had spent the morning travelling to a GP clinic for the pleasure of obtaining a tuberculosis immunisation. I needed the shot for work, and hadn’t received it prior, despite my working in health in Australia, because in most first-world countries TB isn’t a particularly common disease. In fact, if I was working outside of London, just a few kilometres out, I wouldn’t need the shot either. It’s only here, in Central London, that tuberculosis is prevalent enough to warrant protection against it. I’m not sure what that says about the health conditions of Central London, but I’m choosing not to think about it too hard in case I ditch health altogether and go work in a supermarket.

(Actually, I’ve worked in a supermarket — I’d probably be more likely to catch something there. Between the customers and handling money, it’s basically a petri-dish of communicable diseases. Thank god the days are gone when I have to accept sweaty money pulled from an obese woman’s cleavage. Now I just shower the obese woman. Maybe a supermarket isn’t that bad? Moving on…)

The TB immunisation is unique in that it’s not injected deep into the muscle like most vaccines, but is delivered just under the skin. Long story short, I now have a cute little bubble of inactive tuberculosis in my upper arm. The doctor told me that this cute little bubble will decay into a sore, and not to worry when this happens. He said some people see the red swollen skin and leaking pus and think something’s gone wrong. I said this was a fair reaction to purulent muck leaking from an injection site. He said it was completely normal and could take six months to heal. So I have that to look forward to.

After leaving the clinic I walked to the closest township (my exercise has increased dramatically without access to a car. It’s amazing how having no other option can really motivate you to walk). My new room more closely resembles a cheap hotel bedroom than a warm familiar place in which I can tuck myself away, and this is solely because it’s without ornamentation. While I remain unreasonably proud that I moved overseas with nothing more than a fourteen kilogram bag, it did leave little space for personal items. I decided I needed to put something on the very white walls so headed to a store to print some photos. There was an hour wait while the photos were printed so I bought a sandwich from a supermarket and went for a wander around a nearby park.

It’s important to note that I had headphones on and was listening to a podcast while taking my meal and stroll. And not little earbuds that could be hidden in ears and under hair, but big proper headphones, the sort that engulf your entire ears and block out all other sounds.

The reason I point this out is because, whilst leaning against an outside table-tennis table in the park and enjoying the sun, I realised someone was talking to me. There was a black blur at the edge of my vision that was vaguely human shaped, and I could just make out the murmur of words outside the noise vacuum of my headphones. I turned and found a short squat middle-aged woman talking to me. Apparently unperturbed by my back being to her or the presence of my headphones, she happily nattered away, needing very little prompting to keep the one-sided conversation going.

I slipped my headphones around my neck and faced her, and discovered that she was talking to me about immigration. Let me give you some more information about my new friend and see if you can guess what her opinion was on this delicate topic.

My new friend was in need of a shower. Her black hair looked like something that had been pulled out of a clogged drain pipe and her clothes were of the caliber most people would delegate to rags. In fact, it looked like her clothes had been used as rags for many months, but then, desperate for an outfit, she decided to reverse her decision and upgrade them back to clothes before leaving the house.

My new friend was also in need of teeth. To give her credit, she did have a full set along the bottom, although they were black and a little worn. But where her top set should have been was nothing but pink gum. It was grotesquely mesmerising to watch her talk.

What she wasn’t in need of was a drink. I was happy to see she was remaining well hydrated, and happier still to see that inside the brown paper bag clutched in her fist was a 500ml bottle of Guinness. She was Irish, so I feel she’s entitled to this one. The woman was clearly a patriot. And for an adorable little touch, she was drinking her beer with a straw. Maybe lacking upper teeth makes drinking from a bottle a messy process.

Have you guessed what her opinion was on the complicated and human issue of immigration? That’s right, contestants, she was against it!

This woman’s opening statement in an attempt to broker conversation with a young man she didn’t know was racist comments. Isn’t that an incredible topic to use to break the ice? You have to admire her confidence.

My immediate thought was: “I don’t want to talk to you.” Followed quickly by: “I definitely don’t want to talk to you about immigration.” But I had twenty minutes to kill and rather than give in to the instinct to mutter something about buses to catch and making a get away, I decided to commit to having a conversation with this person. In my work, conversations with people outside the normal sphere of society are common, and given that I will be commencing work again soon, I saw it as a good easing in process. She was also a woman lonely and desperate enough for interaction that she approached a stranger wearing headphones for a talk. The least I could do would be to give her that. It would cost me nothing but time, and being currently unemployed, time is one thing I have in abundance.

Firstly, I had to change the topic away from immigration. While I was happy to converse with my new friend, I didn’t need to sit through her biased and ill-informed opinions on this topic, and didn’t think she’d appreciate my conflicting views, so I said, “It’s a complicated issue,” and then commented on her accent and asked how long she’d been in London.

By the end of our conversation I learnt these facts:

  • She’d been in London for thirty years. No, forty years. No, wait, thirty years (she was a bit unsure at first).
  • She was married to a dope addict.
  • She believed dope to be as addictive as hard drugs, and that it was a habit that could severely affect the people living with the addict. I was glad we’d found something we could agree on.
  • Her husband was currently in a jail, although she wasn’t sure which jail.
  • She was in the park today waiting until two o’clock when she could enquire after which jail her husband had recently been taken to.
  • She was a Catholic (she was Irish, so this wasn’t exactly surprising).
  • She was in the habit of swearing profusely, then apologising profusely for her swearing, before immediately swearing profusely once again. And then apologising profusely.

My watch ticked over to two o’clock which meant my photos were ready to be picked up. I looked at my new friend and said simply: “I have to go.” I wished her well with her hunt through the penitentiary system for her husband, and she spilled religious blessing upon me as I walked away, to which I replied: “You too!”

I gave her a wave and she smiled a half-toothed smile, and we parted ways.

Despite the obvious unpleasant aspects of talking to her, her body odour being just one, I don’t regret making the effort to converse. One thing working in health, and even in a supermarket, has taught me is how to talk to people. And more than that: how to empathise with them. A small dose of genuine empathy from me could change this woman’s day, and give me an insight into a life I’ve never, thankfully, had to live. A show of empathy is like a ticket into a deeper part of a person, where they keep the small truths and vulnerabilities they usually mask over. It’s easy to think that this woman was undeserving of empathy, that she is the product of life choices she’s made and is living the consequences of her actions, but this isn’t true. She is a person, and one who has had to face choices I’ve never had to think about. And while I wouldn’t want to maintain an ongoing relationship with her (as a drinking buddy, I’m pretty sure she could drink me under the table), I don’t mind sacrificing twenty minutes of my day to hear a slice of her story.

Anyway, that’s the tale of how I made my first friend in London. It can only go up from here.


I decided that, now that I’m back in the UK, entries from a travel journal aren’t really justified when, technically, I’m making a new home here in London. Even though this still feels very exotic (there are red double-decker buses everywhere!), and may feel like exploration, it is in fact a form of nesting. Of constructing a new home. And home, by definition, isn’t travelling.

But, invariably, by being in a new country and attempting to build a new life, things will happen that I want to write about. I imagine most of these will centre around me fumbling through the challenges of assimilating into a new culture. Subtle and delicate things like saying pants instead of trousers and having British people laugh at me. It should prove quite entertaining.

So in light of that entertainment, welcome to the first edition of Life in London.

Appropriately, the first entry in this segment involves my recent entry into London. It seemed like a good place to start.



I flew into Gatwick airport last night from Vienna, and planned to use public transport to make my way from the airport home. City mapper is an app that formulates every possible route from one location to another within London, be in via train or bus or tram or bike or walking or hover board. This isn’t me being witty, by the way. The trip from home to the nearest train station takes approximately eight minutes via hover board, according to city mapper.

I had checked the route earlier in the day while still in Vienna to get a feel for how long it’d take me to get home, and knew that a train, then a tram, then a bus would have me on my doorstep in just over an hour. I estimated I’d be in bed a little after midnight, provided I hadn’t gotten the time difference between Vienna and London mixed up. I had, but that proved redundant anyway.

The first hurdle to getting home was that my plane was delayed by half an hour, putting off the schedule of my planned route. The second hurdle was that, upon landing, I discovered that the internet on my phone wasn’t working. This frustrated me, but I put it down to poor reception and reasoned that I still had the previously loaded route on city mapper, and could follow that until reception improved. The app was offline due to lack of internet, so wouldn’t update, but still showed the path I needed to take.

After a twenty-minute wait on a windy platform, I caught the 12:16 AM train to East Croydon, then headed into the deserted streets towards a tram stop marked on my static map. As I stepped from the station into the night, I passed a cab rank, and prided myself on the money I was saving by using public transport, enjoying a superior silent chuckle at the lazy fools who pay exorbitant prices for a black cab.

I had my first sense of disquiet after about fifteen minutes of walking through the dark deserted streets of East Croydon, admitting to myself that wandering through unfamiliar London suburbs alone well past midnight probably wasn’t the smartest idea. The eight minute walk that my frozen app displayed took around half an hour, and involved a lot of back tracking, sprinting across multi-lane roads, and feeling incredible exposed as I wound through alleys with nothing but my small pack back.

Eventually I found the tram stop, a small island of light in a junction of empty streets, and stood, praying a tram would appear. I didn’t realise it at the time, but the flight delay and my own indirect path to the tram stop meant I had well and truly missed my tram, but as the internet in my phone continued to hibernate, I happily boarded the first tram to appear, giddy with relief that a tram had appeared at all. This relief soured after about ten minutes when the tram came to a stop in the middle of nowhere, the tram driver announcing end of the line, and the words “Out of Service” appearing in small lights on the side of the tram. With little options, I walked away from the tram stop and onto a long empty road, devoid of anything but factories and warehouses.

It was one o’clock in the morning (two o’clock Viennese time), and I was stranded in an industrial part of London.


As I stumbled up a seamlessly endless road, the odd truck rumbling past to break up the darkness and the silence, a part of me began to accept this was my life now. I was destined to wander the grid of London streets until the sun rose, and maybe even past then, living off my wits, the items in my back pack, and a phone that refused to cooperate and get me the hell home. I honestly had no idea how I would get from my current situation to my apartment. Without transportation, I was looking at a five-hour walk through unsafe streets. Every car that approached I begged just to drive on because I was convinced that if it stopped it would only to be for the driver and passengers to get out, mug me, beat me, and then carry on, leaving me without my back pack, my only ally. The phone they could have, for all the good it was doing me.

As I approached an intersection, two buses whisked by and I had to bite back a yelp at the joy of seeing a sign of civilisation. They sped around a corner to the left without stopping and disappeared. I knew that left would take me in the opposite direction from home, so faced the decision of following big red buses away from where I wanted to go, or go right, down another long empty street filled with potential rapers and muggers, in the vague direction of my apartment.

I went right (right is right, after all), and prayed I wouldn’t later come to regret this as the moment I made the stupidest decision ever. Actually, it couldn’t be the stupidest decision ever because I’d already passed that point when I confidently and cockily walked past the cab rank into the night, a dumb smug smile on my stupid face. I cursed myself as idiotic tight ass and marched up the right hand road.

I saw foxes scuttling across the asphalt, dimly lit by the street lights, and felt like one of them. I too padded cautiously through the dark, sending furtive glances to either side, shoulders hunched against the cold and an imagined attack. We were creatures of the night, only I was a big dumb animal, vulnerable and unable to scurry into the bushes like my nocturnal companions. They were made for the night, whereas I was made for sitting safely on a couch eating chips.

The road I strode up, which I was sure would stretch on forever, a purgatory road, a Möbius strip road, miraculously came to an intersection, although as dark and deserted as every other I’d encountered. I stood on the corner looking up and down the line of bitumen disappearing to either side and feeling very far from home, and noticed, almost hidden by a scree of trees, a bus stop. A bus stop! It was like finding a sealed bottle of water in the desert, spotting a ship when adrift in the ocean, discovering a chocolate bar in the back of the pantry when you’re really hankering for chocolate. It was salvation.

I trotted to the bus stop, pulling out my previously useless phone and putting it to use as a torch, and stifled a squeal of happiness when I read that it was a 24 hour bus line. This late at night, the bus would come at ten and forty past the hour. It was 01:20 AM (02:20 AM Viennese time). I had to only wait twenty minutes and I would be heading, roughly, closer to home. More importantly, I would be taken off the streets and tucked into a warm metal box on wheels, which would feel like a five-star hotel after wandering dimly lit London industrial streets.

Twenty minutes is a long time to wait in the dark, standing on the side of a road in the extreme early morning, head spinning from sleep deprivation, listening to every sound and being convinced it’s Jack the Ripper. (I know he only preyed on prostitutes, but given how perfect a target I’d made of myself, I figured he’d make an exception).

So I did the only reasonable thing a person can do in that circumstance to pass the time: I pulled out my book and started reading.

Picture me now, backpack on back, standing small and exposed on the shoulder of an empty road in the middle of the night, reading by moonlight. What a fucking idiot.

Eventually twin headlights lit up my ridiculous tableau and the bus pottered to the side of the asphalt, door swinging open like the gates of heaven, and I boarded. I was so ecstatic I could have hugged the bus driver if not for the plexiglass barrier and his complete look of apathy that clearly communicated the sentiment, “Just take a damn seat.”

While riding this bus I realised that if I got off in five stops I could catch another bus from there to Morden station, a fifteen minute walk from home. I had a plan. I was going to get home. I repressed the urge to attempt to hug the bus driver again.

I disembarked at the appropriate stop and looked for the times of the 118 bus line that would get me home. It was upon reading the bus schedule that I discovered the 118 isn’t a 24 hour bus line as I’d presumed. I scanned the list of numbers, desperately searching for what time the bus line terminated. It was 01:53 AM (02:53 AM Viennese time) and the very final bus of the day would come through my stop at 01:56 AM. In three minutes. A difference of three minutes and I would have been looking at a two and a half hour walk through the western suburbs of London, but instead I counted down the seconds and, right on time, the 118 pulled up to carry me home.

I had to clench my fists to resist any physical show of affection to my new bus driver, but couldn’t help giving him a huge grin as I swiped my oyster card and took a seat, to which he rolled his eyes, closed the doors, and pulled out onto the road. My night bus in red shining armour was taking me home.

I got off at the end of the line at Morden station and felt like I floated the fifteen minute walk home. I savoured every familiar sight, running loving fingers over the graffiti-scrawled roller doors of an indian restaurant, smiling at the outline of the post office, and eventually drifting blissfully through the wrought-iron gates to my apartment building. I climbed the three flights of stairs, unlocked the door, and stumbled into my bedroom. As I stood in the light of my room, safe and warm and with a bed beckoning to me at my feet, part of me couldn’t believe I was actually there, that my physical body had somehow ended up in this location. An hour before I had been nervously striding past shadowy factories with no concept of how to transport myself from that reality to this one, yet somehow, through some weird twisting of luck, here I stood, unmolested and intact, with my backpack still on my back at 02:30 AM (03:30 AM Viennese time), in my home.

It was at this point that I noticed the internet on my phone had decided to stir, and city mapper updated to announce that I had arrived at my destination. I glared at it like the annoying kid at school who claims to have known the answer all along and just didn’t want to say it, trying to decide whether to swear at it or throw it against the wall, and then just collapsed into bed.

My last thought before falling asleep was that, next time, I’d take the fucking taxi.


The patient was an eighty-eight year old man who lived at home with his wife, both of whom were surrounded by a perpetual cloud of smoke despite our nurse’s continued requests that they butt it while we visit. He was a man just managing to stay at home by the skin of his teeth – or, more accurately, by a lot of effort from the support services put in place to keep him safe at home, services neither he nor his wife appreciated. They both had a diagnosis of dementia and shared a common lack of insight into their own failing health and poor living circumstances. Neither acknowledged the nicotine-stained walls or ceilings, the carpeting stained with old and fresh dog shit, or their own deteriorating bodies and minds stained with years of neglect and abuse. In their estimate, they were, ‘…doing fine, and we don’t need anyone barging in and taking over!’

But despite his shortcomings, this wasn’t enough to make him one of the bad ones. Once you got past the bluster and opened a window to air out the house, both he and his wife were pleasant in their own confused and belligerent way. The problem was the patient’s GP.

The patient had returned home from a short stay in hospital due to his yo-yoing health, and, as hospitals are prone to do in an effort to prove they did something to help the patient, they had played around with his medications. This slight tweak on their behalf often means a mountainous headache of work for us. Easily one of the most infuriating and frustrating aspects of my job is attempting to get a list of my patient’s medications, complete with the drug’s dose, route, and frequency, and topped off with a signature from the prescribing doctor, so that I may legally administer those medications.

Perhaps you’re reading this, thinking, “Surely, that’s not so hard a thing to obtain. A doctor would have on file the current medications his patient’s are taking.” This world of doctors keeping an up-to-date list of their patient’s medications is one that belongs in a medical utopia, a place where patients are keen to participate in their health and old stoma bags smell like vanilla essence. Unfortunately, I operate outside that sphere, and consider it lucky if the GP I’m corresponding with has a computer on which to type a list of medications. The stereotype of illegible doctor’s handwriting is very real.

The client’s GP was a doctor I was familiar with, and I knew him to be a man resentful of assisting in any way. His choking arrogance always seemed to get in the way. So, knowing this, I rang his office.

‘Hi, this is Jonathan the district nurse, I was just hoping to speak to the doctor regarding Mr X.’

‘Oh, sure,’ his secretary replied, ‘I’ll pop you through.’

*On-hold music* – wait time 30 seconds.


‘Hi, Doctor, this is Jonathan the district nurse. I’m just ringing because Mr X has returned home from hospital. He was diagnosed with GORD while in there and commenced on Nexium, and I was hoping you could add this to his medication authority and fax it through to us.’


He had hung up.

I rang again.

‘Hello, Doctor’s office.’

‘Hi, this is Jonathan again. The Doctor just hung up on me. Could you put me through to him.’

‘Oh. Sure.’

*On-hold music* – wait time 1 minute.


‘Doctor, it’s Jonathan again. We got disconnected. So as I was saying, we just need a new medical authority so we can administer Mr X his new medication.’

‘What is all this?’ he grunted. ‘I’m sick of doing all this work for your company. Why don’t you have your own doctor on staff?’

‘You know how we operate, Doctor, how community health operates. You’ve worked with us for years. You know we don’t have our own doctor on staff.’

‘I’m sick of doing all this over the counter work, it’s ridiculous.’

‘Sorry, I’m not following you. What do you mean “over the counter?”’

‘Well, it’s not face-to-face, is it? I’m not billing for this.’

‘Oh, so you’re worried about your money?’ I chuckled.

In retrospect, laughing may have been the wrong tact to take.


I squeezed my mobile phone, envisioning the pathetic old doctor’s neck, and rang a third time.

‘Hello,’ his secretary said.

‘Yeah, it’s Jonathan again.’

‘ I thought so, it’s why I didn’t answer with the spiel. Is it a connection issues or is he angry?’

‘Oh, he’s angry. Can you put me through again?’

‘I can try.’

*On-hold music* – wait time 3 minutes.

‘Are you still there?’

‘I’m still here,’ I replied.

‘The Doctor’s busy at the moment—’


‘—but tell me what you need and I’ll see what I can do.’

I detailed what was required, explaining that my persistence was only to ensure the patient got his medications and remained out of hospital. I did my best to stay calm and jovial with the secretary, reminding myself that her employer’s childishness was no fault of hers, that she was the only one attempting to help, and that she had to put up with the megalomaniacal wanker for hours at a time. Once I had repeated what I needed and she wrote it down, she assured me that she would have it faxed to me by the end of the day. I thanked her, sincerely, and hung up.

It’s hard to work in an industry full of contradictive people claiming to be there to care for others whilst only caring about themselves. It’s hard to advocate for your patient against the very people who should be helping. It’s hard to remain professional while those you deal with act like children. And it’s too easy to think, ‘Why do I continue to work in this faulted system?’

The secretary was true to her word, and by the end of the day I had a medical authority with the patient’s new drug added to the list. Unfortunately, the previous authority had two medications that, due to the Doctor’s past laziness, had only been scrawled on by hand, and hadn’t come across with the new list. I would have to phone him the next day to have them added.

He was one of the bad ones.


I was visiting to admit him, a skinny Indian man recently returned from hospital. He was sixty, and previous to his recent surgery had been completely independent. He’d had years of back pain and recently gone in for a surgery designed to relieve pressure in his lower vertebrae. Unfortunately, during the operation, damage had been done to his nerves resulting in a neurogenic bladder. He had lost the ability to consciously relax the sphincter between his bladder and urethra, thereby releasing urine. In other words, he could no longer piss on command.

I was there to educate him on the catheter that had been inserted to ensure his bladder could still empty. I went through the usual process of introduction and listening to his recount of events before beginning to detail how to properly care for his new urinary system. He stopped me, and asked instead if I could remove his catheter.

After digesting his request I explained that couldn’t do as he asked, that without a catheter his bladder would continue to fill, that the pressure in his renal system would build and he’d be in extreme discomfort, and, if left unrelieved, could damage his kidneys.

Again, he stopped me, shaking his head and waving his hands, dismissing what I’d said. He told me that if I removed the catheter he would urinate. He assured me that if he could just relax, he could get a flow going.

I begun explaining about his neurogenic bladder, and again he cut me off, eyes closed and head shaking. ‘They have told me this in the hospital,’ he said. ‘But I know my body. If you take it out, I will be able to pee.’

I empathised with his difficulty in coming to terms with his new disability, but felt a bloom of frustration open in my gut. I tried again.

I explained, patiently, that in fact he’d had the opportunity while in hospital to do exactly that, that the hospital staff had removed his catheter and after an hour had scanned his bladder and found a litre of urine inside his body and not a drop out. I reminded him that they done this on two separate occasions, a week apart, and each time he’d been unable to void.

He was frowning now, jaws clenched as he waved his hands in front of my face. ‘I couldn’t do it there!’ he said. ‘There was too much pressure, with their machines, and their waiting. I am home now. I can do it now.’

I bit down my exasperation while requesting he not interrupt me, and to lower his hands, and explained that anyone with conscious control of their bladder would be able to pee if they had a litre of urine pushing down on their sphincter. He interrupted me.

‘No! Take it out and I will show you. I don’t want it anymore.’

This conversation continued for an hour. Despite my argument that it was in his best interest to keep the catheter in, he continued to command me to take it out. I told him that once the catheter was out, and he failed to urinate, he would be in agony. That his bladder would feel like it was ready to rupture and there would be no one around to insert a new catheter to relieve it. That he’d have to return to the hospital, something he insisted he wouldn’t do.

I explained that I wasn’t saying this to antagonise him, only that it was the truth. He rebutted with threatening to pull the catheter out.

By this point, over the hill of vexation and down again, I couldn’t repress a chuckle. A catheter has a balloon in the tip with a diameter of about four centimetres to hold it in place in the bladder. A male urethra has the diameter of about one centimetre. Pulling out a catheter without the balloon deflated is a painful process.

I detailed this, using the simile of pulling an apricot through a straw, and recommend that he not try it. He told me he would do as he liked.

In the end I slumped back in my seat and said I wouldn’t do what he wanted. He told me to leave.

When I got back to the office I contacted the hospital and informed them of the outcome of my visit, and they madly scrambled to have an ambulance and a bed ready if he did remove his catheter. I hung up the phone annoyed that they had to work harder to compensate for this man’s idiocy.

It’s hard to fight to save someone from themselves. It’s hard when their voice is raised and respect is gone, and you’re debating reason while they’re debating stubborn ignorance. It’s hard to keep caring about their wellbeing when they don’t care about your professional knowledge. And it’s easy to think, ‘Why don’t I just leave them to the consequences of their actions?’

He was one of the bad ones.


My brother pointed out to me the other day that I don’t tell the stories of the bad ones, that on my site I’ve shared many stories of the good patients I’ve met, but have failed to document the more sour interactions. He, of course, has heard countless stories of exasperating patients, of those people I visit who have deemed themselves free of the need to conform to the social norms of politeness, respect, and quiet often, hygiene. His observation was accurate — it was with deliberate intent that I excluded those episodes from this site.

But after the discussion I realised that by focusing only on the uplifting exchanges, I’m not accurately portraying my profession, and in a larger sense, my community. Laborious and infuriating personalities make up the web of society as much as, and sometimes more than, the pleasant. By ignoring this branch of humanity I’m also ignoring the insights and experiences that come with them, as distasteful as those insights and experience can be.

So here we go…


The inside of her house was lined with a layer of dust and cat hair, an accumulation of years. It was something I couldn’t just see and smell, but could taste, to the point that simply breathing in the air felt like a fouling act. It was as if each breath was coating the insides of my lungs with its own layer of dried skin flakes and moulted cat fur.

I was there to attend to wounds on her lower legs. She was forty-five years old; young, given the average age of our clientele. She had wounds due to years of uncontrolled diabetes — the consistent high level of sugar in her blood had killed the micro-vessels in her legs, reducing the amount of oxygenated blood delivered to her skin. Without proper circulation, her skin integrity weakened and ulcers developed, which then failed to heal due to the same poor quality circulation that caused them.

It’s importance to stress that in her case “uncontrolled diabetes” isn’t a reference to undiagnosed diabetes. The patient had known of her condition and had had years of doctors and medical specialists educating her on the necessary exercise and dietary requirements needed to manage her disease. She weighed one-hundred and fifteen kilograms and her blood sugar results were perpetually high.

This was not a picture of a woman who had heeded medical advice.

She scooped four cats from her single bed, throwing them out the door, before falling face first onto the mattress so I could attend to her wound care. Her bulk filled the bed, her affected legs sticking out like twin wrapped hams. I peeled away the soaked and soiled dressings while she complained about how her wounds wouldn’t heal. Her limbs were stretched tight with oedema and yellow slimy pockets of broken skin rung her calves, the angry red edges like bruised and swollen lips.

I looked around her house, breathing shallow breaths, focusing on the decade worth of dirt that coated her home. Dirt that a half-an-hour vacuum once a week could have avoided. That a thirty-second swipe of a cloth could have wiped away at the time, but instead, years of voluntary neglect had accumulated into a stain that could only really be cleansed with fire. I took in these details and wondered if it was worth explaining for the hundredth time ways in which she could aid her own wound healing. Ways such as losing weight, eating a well-balanced diet, exercise, and stopping the consumption of soft drinks.

I began, knowing the words would be wasted, but she cut me off.

‘Yeah, yeah, I know all that. Every nurse goes on about it. I’m just sick of it.’

I fought to resist asking why then does she still spend her days eating chips on a couch that has moulded into the shape of her body.

A colleague of mine once decided she would wear this patient down with positive enthusiasm. She went in offering support and encouragement. She sat and talked to her about how we would help her heal her wounds if she would only help us. That we would aid her every day to bring her weight down and correct her diet. That it didn’t have to be a monumental thing, but just small acts done daily. Acts like walking to the letterbox.

Her letter box was ten meters from her door, and my colleague suggested that when she had finished tending her wounds, she walk with her to the letterbox on the way out as a form of exercise. The patient agreed.

Once she had dressed the patent’s wounds and hoisted her work bag, my co-worker said,

‘Come on, then. Walk me to the letterbox.’

The patient sat on the couch, looking at the nurse as she thought about it, then responded with a shrug,


It’s hard to care about another person’s health when they don’t care about it themselves. It’s hard to squat and lift heavy legs, to scrap muck away from weeping wounds, to walk into a home that makes you feel ill when the other party isn’t doing their fair share. And it’s too easy to think, ‘Why am I bothering when they aren’t?’

She was one of the bad ones.