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Last Updated: Thursday, 15 June 2006, 09:09 GMT 10:09 UK
The trick of solving boredom on wards
By Daniel K Sokol

Card trick
'Pick a card, any card'
For the restaurant magician, no remark is more often heard than "can you make my wife disappear?".

It is a chorus that punctuates an evening's work.

It is also a cue to release a well-rehearsed repartee ("well, it'll cost you extra!") and a mutually appreciative guffaw.

As a hospital magician, the most common witticism is "can you make my cancer/disease disappear?"

Or alternatively, "can you make my leg/arm/any other appendage grow back?".

I have not yet found a suitable response. I just shake my head and smile regretfully.

For a few brief minutes, I strive to pull off my greatest trick of all: to make them forget they are ill

Since April last year, I have been the volunteer hospital magician in a large London hospital.

As the hospital has no paediatric department, I perform exclusively for adults.

Lack of excitement

Once a week, I wander from bed to bed, entertaining patients for five to 10 minutes: a large silk scarf vanishes and reappears, a £10 note changes into a £50 note, a pen seemingly melts through a borrowed note, a signed card appears in the zipped compartment of my wallet, and other minor miracles.

I wonder why the NHS, ostensibly so patient-centered, does not do more to improve the patient experience in hospitals?

When I first started on my 'rounds', I was struck by the stultifying sense of boredom that pervaded the wards.

The prolonged silence was interrupted only by the turning of a page, the intermittent groan of discontent, the shuffling of tired feet to the bathroom, or the scribbling of a pencil on a crossword puzzle.

The arrival of a wayward fly would constitute the epitome of excitement.

My aim was to tackle this epidemic of chronic boredom, ward by ward, patient by patient.

For a few brief minutes, I strive to pull off my greatest trick of all: to make them forget they are ill.

I wonder why the NHS, ostensibly so patient-centered, does not do more to improve the patient experience in hospitals?

Why, for instance, are most hospitals so drab and unimaginatively decorated?

Perhaps it is a deliberate choice: if patients are bored and have a rotten time, they will want to leave at the earliest opportunity, thus saving money for the cash-strapped NHS.

On the other hand, changing the décor and encouraging magicians and other artists to volunteer may well increase patient and staff satisfaction and reduce the number of complaints.

That would make for an interesting study. Furthermore, a better mood might boost patients' immunological states (recall the 'placebo' effect) and reduce time spent in hospital.

Ups and downs

The life of the volunteer hospital magician is not as glamorous as that of other magicians.

Trick
'I'll turn this into a bunch of grapes'

The spectators are often old and usually ill, the setting is depressing and malodorous, and the remuneration even lower than that of a University lecturer (the hospital reimburses the cost of my playing cards).

I have nearly vomited twice on my rounds, once from an unbearable stench of unidentified origin and the other upon seeing horrific wounds on a patient's leg. I have also made mistakes.

One day, I told a patient that he looked too well to be in hospital.

His face beamed with joy. I made a mental note to use that line more often.

The following week I performed for a patient who really did appear healthy.

"You look too well to be in hospital," I observed.

The reply was unexpected. "Actually, I've got incurable cancer". I had forgotten I was on the cancer ward.

In the old days, doctors usually diagnosed an illness by the patient's sickly appearance.

Today, diagnostic tests are so sophisticated that they can reveal a fatal illness before symptoms appear.

Too cruel

Another time, I performed a classic trick for a middle-aged man.

I showed him five envelopes and placed a £50 note in one of them. I sealed and shuffled them.

One clearly insane lady was so entertained by the show that she insisted on giving me the contents of her wallet

"You have four chances to pick the envelope with the £50 note. If you get it right, you can keep the money". Excitement filled the air.

After three wrong guesses, he chose one of the last two envelopes. Just before he opened it, I asked if he wanted to swap it with mine.

He refused, and found his envelope empty. As I tipped the £50 note out of my envelope, I looked at his face and feared that he might cry. His disappointment was obvious.

"I can't believe you take advantage of vulnerable people like that!".

I felt terrible. The trick is no longer in my repertoire.

But there are ups as well.

Occasionally, patients will tell me that I cheered them up or that I've made their day.

One woman with a tracheostomy looked at me with pitiful eyes when I made a rose using a napkin for a nearby patient.

When I offered her one, she picked up a piece of paper and wrote "I can't speak. I'm a gardener. Thank you".

When I next visited, the rose was still by her bed.

One clearly insane lady was so entertained by the show that she insisted on giving me the contents of her wallet (I managed to escape before she had time to find it).

And as I leave a ward which I had found morose, I dance a mental jig when I hear patients share their theories on how the tricks were done.

While most magicians and volunteers cannot make wives disappear or limbs grow back, they can alleviate the disheartening symptoms of hospital-induced boredom.

  • Daniel Sokol is a medical ethicist at Imperial College, London.


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