TV fairies at the end of the bed

There was a photograph in last week's British Medical Journal of a young woman "chasing the dragon" - that is to say, smoking heroin. In the background a television is on: so it seems that these days even chemically induced nirvana has to be accompanied by televisual entertainment.

There's no escaping telly, even in hospital. When I was a child, strictly enforced silence was regarded as an essential part of rest, which itself was regarded as an essential part of treatment. No longer: compulsory television is more like it.

As someone who has not had a television in my home for nearly 30 years, my only contact with the medium is through the snatches of the morning programmes that I see in the six-bedded ward where I work. They do not encourage me to go out and buy a set. They seem to consist mostly of people complaining hysterically about misdiagnoses, nervous breakdowns and the high cost of funerals. I don't see how any of this can be very encouraging for the patients.

Whether it is or not, however, they have to put up with it. There is no known method of ensuring that the television remains off. I suspect that there is something like a television fairy who lives on our ward: whenever I turn the telly off while I am trying to make my rounds, the television comes on again as soon as my back is turned, and I can never discover who switched it back on. No one will own up to the dreadful deed. Short of video surveillance to answer this difficult question, a television fairy is the only possible explanation.

Of course, I admit that in the old days, before our ward had a partitioned-off area where doctors and nurses could discuss things in private, the television served a useful purpose: while it was on, doctors and nurses could talk without being overheard. But now it serves no such function, and seems more a sign that modern man cannot tolerate being left to his own, unguided thoughts. I have noticed also that, these days, nurses don't seem to be able to concentrate at their desks without the aid of pop music. The combination of chat shows in the background and pop music in the foreground is for me a foretaste of hell; the fires will be quite redundant.

The television in our ward raises interesting questions of political philosophy, however. What if five people want it on, but one doesn't? Or if five want it off but one wants it on? Does the right of one person to silence trump the desire of five people to entertainment, and vice versa? Are the concepts of majority rule appropriate to the running of wards? Personally, I always side with the person or persons who want silence: which is to say, I am always on the losing side.

The whole problem might be solved by giving each patient a pair of private headphones, so that he or she could listen to the drivel if he so chose. But this is the National Health Service; we don't do anything for the comfort of the patient, otherwise he might stay glued to his bed too long. Besides, we're not allowed to do anything unless there is objective evidence that it works; that is to say, it either cures people or cuts costs, preferably both. And who is to say that private headphones in my ward would cause an improvement in anyone's health? Certainly they would cost money, which is a bad thing.

For myself, television is the reason I have private health insurance. I don't want to wake up from an operation to the sound of chatter or a race in a supermarket, as contestants push their trolleys up and down the aisles to the sound of synthetic laughter and excitement. I did once have a plan to defeat the television fairy in my ward, however. Patients with delirium tremens often incorporate whatever happens on the screen into their frightening hallucinations, as a result of which they smash the television in self-defence. At first I recommended that the television be switched off when there was such a patient in the ward (my recommendations were seldom carried out, or not for long). Then for a time I made no such recommendation, in the active hope that the patients with DTs would smash the television. What I didn't realise, however, was that the management would regard a smashed ward television as an emergency, unlike most other damage to the hospital, and replace it within an hour. The show, after all, must go on.

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