Activating Oscar/ Arno Muskens/ 1

At night, the antiquated lighting system emits a sickly green light that manages to
flawlessly match that pervasive odour of disinfectant and ill health. This is the sweet-
stale air of sterility and medical efficiency. Bisecting the ward is a wide hallway, with
the floor covered in an archaic linoleum which has begun to crack and curl at the
edges. It is a shade of grey made greyer by the decades of relentless grinding-in of dirt
and grime.
At end of the ward- this end, sits the nurse’s station; ceiling and walls are painted
lime-green. Here too time has its influence; constant traffic has faded, dented and
scratched the paint to the point that it dominates the mood of the entire building.
Further along are the ward rooms, they branch off regularly, six beds in each - three at
equal distance from each other, on either side of the room. Each of the four wards is
similarly ordered; the main differences seem to relate to the various orthopaedic
frames and appendages bolted to and hanging from beds. Some rooms cater to leg
injuries, others to arm and shoulder, but one room is reserved for those with spinal
and various non-specific injuries. These people make a far greater demand on space,
staff and equipment constantly. The sole occupant in this particular case requires the
space of two beds for the miscellany machines and electronic drip stands; which off
course also require constant monitoring and replenishment by staff. Indeed the
occupant looks to be permanently unconscious, comatose, but doctors believe this to
be only temporary.
An analogy of Oscar’s predicament is that his brain, to gain release from its
vegetative state, need only a spark to reanimate. But the real issue lay with generating
that initial spark – which is always elusive at best. Conditions must be perfect, like
static electricity, or the build-up of energy, just before the spark when it is prone to
dissipating without discernible effect. This is also the case with the first feint sparks
of consciousness of the re-awakening mind. In medicine, the Greek term koma,
meaning deep sleep, is used to indicate a profound state of unconsciousness. A
comatose patient cannot be awakened, fails to respond normally to pain or light, does
not have sleep-wake cycles, and does not make voluntary movements. Coma may
result from a variety of conditions, including intoxication, metabolic abnormalities,
central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia.
It may also be deliberately induced by pharmaceutical agents in order to preserve
higher brain function following another form of brain trauma. Fortunately none of
these apply to Oscar.

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Doctors generally agree that his prognosis looks good. However, the corner stone
of any neurologic diagnosis is the examination as well as the medical history of the
patient. Unfortunately Oscar’s true identity is unknown; he was brought to the
hospital as John Doe (The staff named him Oscar). As a result they have been unable
to track down family and friends so as to ascertain his medical history.

A major impediment to Oscar’s prognosis stems from the fact that doctors have only a
broad understanding of what happened, that is, they are unsure of the diagnosis. To
properly understand the origin of an injury can greatly assist in judging the degree of
injury. This in turn allows doctors to make approximations with regard to treatment.
For example, a strong predictive factor of whether or not those with severe head
injury would survive involve the pupils. Ninety percent of patients who had bilaterally
dilated pupils (not reacting to light) on admission died. Seventy percent of the patients
with bilaterally "constricted" pupils at the time of admission died. And only twenty
percent of patients with severe head injury who had normal pupil reaction to light at
time of admission died. Therefore, this aspect is used to determine both mortality and
outcome of coma.
But also CT and MRI scans indicate no major swelling, midline shift and mass
lesions. Nor is there enlargement of the ventricular system, that is, the presentation of
open spaces in the folds of the brain that would otherwise be attributable to those less
likely to come out of a coma. Oscar’s injury is considered to be of a serious nature but
in no way critical; all going well, a couple of days at the most, should see Oscar
returned to his physical world.
Indeed early the next morning in the hazy pre-dawn glow Oscar moved his hand. It
was only minor and no one noticed, but it was a seminal moment nonetheless. The
dark, surrealistic mood of the room a stark reminder that each step of recovery, whilst
no doubt momentous, will most likely be witnessed by no one, not even Oscar
himself. Regardless, these first sparks of consciousness remain a pinnacle
development in his recuperation.

During the next twenty four hours he makes rapid progress. Mid-morning nurses
notice rapid eye movement and a slight movement of limbs. By dinner comes the
garbled speech. These developments give rise to the expectation that Oscar’s return is
immanent. Indeed the very next day comes a revelation:

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What’s that smell? It fucking stinks around here. Why’s it

stinking so badly? Fuck.

Oscar is sitting bolt upright, eyes wide and restrained by a plethora of cables and
tubes; his “drip” in danger of ripping out. This sudden explosion of activity by
nursing staff, running tests, does little to maintain his fleeting consciousness.
Regardless though, staff inflict all manner of little painful skin tortures to try and keep
him in the present; but really he went as fast as he came. Oscar obviously prefers the
safety of his sub conscious lair to that of a morbid reality.
But this brief interlude, whilst a step in the right direction, is an expression of his
brain reconnecting the circuitry, a “phantom awakening” they call it. And it provides
few clues as to Oscar’s cognitive state. A few hours later:

I don’t recognise it and I don’t even know if I am smelling a

foul odour or am I tasting it, either way it’s just not right. Come
on people! Let’s do something about it. This is ridiculous. But
it’s not just a smell! I can taste it as well, that’s how bad it is.
And mouth’s so dry; I need a sip of water. Please! And why
can’t I move? And why is it so dark in here? This place sucks,
oh, and hey! I don’t like being ignored you know!

Since his accident, Oscar’s first cognition was not so much of thought; it was more
an emotion, a pit-in-the-stomach sensation of angst and fear. But he passed out as
soon as the sensation hit; but even if he had felt it properly, he would never have
recognised the emotion. His mind is in no way ready for the distressing memory of
what caused the injury. Oscar had a ways to go yet, this was the very first step of
many, to recovery.

Like shards of falling glass, memories threaten to pierce the veil of Oscar’s reality,
but instead they fall to the ground and shatter into nothingness.

Why am I so confused? I feel as though I’ve been pushed out

onto a high remote cliff where air is thin and the light is bright.

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And, why am I in this place? And why haven’t they cleaned up

that foul odour yet, I asked them ages ago. How can they still
be missing it?

His consternation hits a new high when he realises the staff are too busy to do
anything about it. The fact that this hospital sees no threat to hygiene from what must
be a horrific contravention of medical hygiene standards is disgraceful. Something
needs to be done about it.

Come on mate, who ever you are, it’s about time you start making your
presence felt. If they won’t clean that bloody stench up then you’ll just
have to do it. It’s about time I got out of bed anyway. I’ve had my legs
over the side of the bed a few times now and think I am ready to go -
anyway I’m pretty sure those nurses think I’m lazy so I may as just do it.

It is during the long days where Oscar has little to occupy him. While he spends
significant amounts of time engaged in mental exercises (given him by the hospital
psychologist), he finds them of little interest. Some activities Oscar thinks far too
easy, but it was explained that the particular portion of his brain required to engage in
the puzzle, was uninjured and as such seemingly presented no challenge to his
cognitive function. But it is very important to re-establish old neural pathways by
engaging in common and hopefully some how familiar thought patterns. Turning
Oscar toward the mental exercises he was struggling with was a challenge in itself;
instead preferring to gaze idly through old dirty windows.

Anyway who cares about their moronic little puzzles, I have a

much bigger issue to deal with…

Listening closely one can make out the hushed murmur of the nursing staff. Their
squeaking white rubber soled shoes the only indicator of their movements.

Daylight hours are easily the best; staff seem happy enough to
interact with us, but at night it becomes a very different story.
Every time, a pall descends over the ward and completely

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smothers the good efforts put in by the day staff. Night staff act
as though their presence at the hospital, at that moment, was
tearing a massive rift through their families. Nurses especially
are very effective at transferring their guilt onto patients,
especially if some poor soul has the temerity to summon aid
with his or her buzzer.

But sick is sick and injured is injured. By not providing assistance and reassurance
would therefore be a dereliction of duty; all but the newer and naïve staff go about
their duties with a look of resignation. The nurses tolerated us but certainly not in
good humour.

The medical staff, the doctors, on the other hand, is very

different situation. These professionals mostly assumed an air
of good-grace and understanding. Each morning, standing at
my bedside, they ease my protestations with a consoling wink
and a knowing smile. Meanwhile, they plan, give instructions
and engage each patient in dialogue, if only very briefly.

Most other hospital staff are friendly if not belligerent. The orderlies, food staff,
and cleaners all go about their business with a plastered-on bearing of servitude and
tolerance. But nothing can be further from the truth, (I think) scratch just under the
surface and it soon becomes apparent that their minds also are very much elsewhere
(so I’m not the only one!). Just ask them to properly attend to their jobs and see how
far you get, they obviously work according to their own urges; where purging horrific
smells not on their mandate.

In any case, I don’t give a damn about any of these people until
they clean up that damned stench, for god’s sakes, what’s the
matter with them? It’s their job to keep the place clean! Uggh…

OK Oscar, I’m here to clean up your big-bad smell you keep telling us about. Where
is it?

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It’s right here in this room: it’s the foulest of foul smells. How
can you still be missing it?

Arno Muskens
WRIT122 – Assessment task 3
Student id: 3202926
(1896 words)