There was a gap...

In which we explore those strange moments when we don’t quite know which reality we’re in - or how we got there

She’d left me in the hands of the Emergency Department folks, who’d gently bundled me into a wheelchair and rolled me into the department’s triage area. They hadn’t taken my name, though, or any details, or checked me in at the triage-registration desk. I was parked at the end of a row of seats, and settled down to wait - to be as patient as a patient. The rules in this reality make it one in which ‘emergency’ seemingly has no sense of emergency. Festina lente, I suppose? - ‘make haste slowly’?

Time passes. There’s a man who’s supposed to be in the respiratory clinic who keeps coming back and back and back to the desk-area, seeking attention. He’s in his late twenties, maybe. Wearing his COVID mask below his long aquiline nose; eventually, below his chin. He comes out to the review desk: “Michael, you need to wait in the clinic”, the nurse says. He returns, but five minutes later he’s back, a different desk, a different nurse, always the same reply. Five minutes later he’s back again; five minutes later, back again. Eventually the nurses ask the assistance of a sleeping patient behind me to to my left to help them keep him there and let them get on with their jobs.

Triage does happen, slowly, one patient after another. At least no-one’s screaming in pain; no-one’s bleeding out over the floor. Instead, like me, all just quiet emergencies, each in their own way and need.

Two hours later, still in the same place, same position, same wheelchair, later arrivals having long since come and gone, I’m starting to panic that that they really have missed me. I lurch out of the wheelchair, trying to get to the desk so that I can at least be registered as present. Activity happens, fast - a different reality. They get me back in the wheelchair, get my name, my details, the context, take a look at lobster-red lobster-textured huge swollen leg, set things in motion, and get me wheeled to the far side of the waiting-area. Definitely a change in reality: different rules.

This time, not long to wait. Not many minutes later, a quick shift into another reality, I’m called by a young male nurse, cheerful, chatty. We crash backwards through the too-aggressive self-closing doors into a treatment-area full of small booths, which I recognise as the place I did my first COVID test some months ago. The booth we roll into is one specifically set up for children - colourful, toys, a small-child-sized comic-hero doll presumably set up to help children explain where something hurts, silly jokes on whiteboards on the walls. Chatting along, he sets to, removing my boots without needing to cut them off, blood-pressure, blood-oxygen, all the usual stuff in a first-steps-of-treatment reality. A doctor comes past, briefly; we all chat about the details. I comment that I don’t know which reality I’m in: for a moment, unfortunately, the doctor thinks I’m serious; I have to explain there’s no mental fragmentation, I’m merely joking about all of these changes.

The same reality continues for a while: still in the same wheelchair, the same booth. The nurse fits a canulla to my upper wrist to make it easy to insert medication, he makes a bit of a mess of it at first, a fair bit of blood around but no big deal. Another male nurse pops his head round the entrance to say that a child has come in so they need this booth. Of course we can, that’s easy, just remember my bag, please, I think it’s just behind me? I turn in the wheelchair chair to look for it.

There was a gap…

I’m not on the wheelchair any more. I’m lying flat on my back on a treatment-gurney, in what I guess must be that next booth over, but certainly still the same treatment-area. My upper-body is bare: no idea what happened to my shirt and and sweater and over-jumper. I’ve acquired another canulla, this time into my inner right elbow, that wasn’t there a moment ago. The booth is crowded, at least half a dozen nurses in here, putting sensor-stickers all over my chest, trolleying all manner of devices in and out of the space. To my left, there’s a brash, loud, cheerful doctor, in her mid-forties, perhaps, bright ginger hair and a north-English accent to match. She’s mostly facing away from me, rolling an ultrasound-sensor over the left side of my chest and observing the results on an enormous trolley-mounted screen. Yes, that’s my heart in the picture. But I came here about a problem with my leg - what’s going on?

I’d passed out, it seems - just at that moment, as we were talking about moving along to the next booth. Unexpectedly. And completely: not just a gentle fade and faint.

Not something they like to see happening in a hospital. Suspected Code Blue and all that, demanding instant response from everyone around.

But in my case, fortunately, no, nothing serious there. No arrest, nothing wrong with the heart. Just passed out, that’s all. Some people do, sometimes.

Return to the previous reality, but in the same new place. Alone again, waiting. That first male nurse drops in and out of the booth a few times, chatty, comforting. A doctor arrives, with his record-keeper and other entourage: he draws a line on my leg, to mark the current limit of the infection, tells me he’s sending me to the Short Stay Ward for a couple of days so that they can do initial treatment and keep me under observation. Then he’s gone, and I’m alone again for a while, the stable, empty reality of the now in-house patient.

A hospital porter arrives. Another change, another shift in reality, from static to movement. Rolling me on my gurney through the passageways towards the lift, “Short Stay Ward?”, he says, “You’re going to the penthouse suite!” And it sort-of is, I guess, because somewhere in there there’s a window with a view out over the city from several stories up:

Yet another reality now, with its own rules - not least that a hospital ward is almost incredibly noisy, all of the time, day and night, and that there’s no real time there for either recovery or rest. Oh well: work with the reality that I have, I guess.

Reality after reality after reality, each with their own rules. In each case, except one, there’s a clear linkage between them: I know how I changed from one reality to the next, I know how I got there, and why.

Yet for that one case, in the treatment-booth, there’s no such identifiable transition between realities. Instead, there was a gap…

Not even a fade-out and fade-in. Not even a sense of ‘nothingness’. Instead, more like an unnoticed cut in the flow of time: a gap in reality, that can’t even be seen as a gap.

I’ve no idea how long I was out, back there. It couldn’t have been all that long. But it also couldn’t have been all that short, either, because it needed enough time for the nursing staff to see what was going on, get me out of the wheelchair, onto the gurney, clear my chest, move me from one booth to the next, fit that second canulla, and get all that equipment into there and all those sensors onto me. An indeterminate chunk of time, that for me does not seem to have existed at all; and yet must have existed somehow for the realities of the world to have changed as they did.

There was a gap…

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In that case, yes, a gap over which I had neither choice nor control. But too often, there are other, simpler gaps that arise only because I’ve failed to pay attention to the changing realities of the world. Far too often now I’ll wake up from some kind of half-stupor, at work or elsewhere, and finding myself struggling to make sense of the immediate world: “Which reality am I in?” Unlike in the emergency-room, those gaps don’t arise from a medical context, but from sheer laziness, a lapse of mental discipline. All too easy to let that happen, of course, for all of us - but let if we let those gaps happen too often, we risk fragmentation of our awareness of the world. Seems to be a lot of that around these days, though. Oh well.