The Language of Teamwork: St Mary’s Hospital March 2017

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When a terrorist attack took place in Westminster on 22 March 2017, a BBC television team happened to be filming for a ‘fly on the wall’ documentary at St Mary’s Hospital in Paddington. The film they made of the hospital personnel preparing for and then treating the badly-injured casualties made for compelling and moving viewing (shown under the title ‘Hospital’ on BBC2 on 20 June 2017). Just as impressive as the medical expertise shown was the execution of logistical planning and the calm mutual cooperation of staff working under practical and emotional pressure.

Watching the programme, it is clear that one thing that binds the team together is the language that is quite specific to it. In particular the individuals use what is known as metonymy, that is, they refer to a person or other entity by naming one aspect of that person or entity. An often-quoted example of metonymy is when servers in a cafe refer to ‘the ham sandwich’, meaning the customer who has ordered a ham sandwich rather than the food itself (as in ‘The ham sandwich wants his bill’).

My colleague Professor Jeannette Littlemore has emphasised that metonymy is often specific to a particular group and serves to cement relations in that group. That is certainly observable in this programme. The hospital team refer to patients by their injuries, perhaps as a mechanism that distances the staff from the horrors they are witnessing (this is an injury, not a person with an injury):

  • ‘the gunshot wound’,
  • ‘the scalp laceration’,

or the room they are currently occupying:

  • ‘resus 1 is unstable… resus 2 is going upstairs to the major trauma ward, resus 3 is coming back from CT, resus 4 is just on their way to CT’ (= the patient in resuscitation room 1 etc).

In the case of a deceased patient, they use a phrase associated with death:

  • ‘the RIP’.

They also refer to themselves and colleagues using metonymy:

  • ‘I have specific questions for each site’ (= for the people at each hospital site),
  • ‘Make sure all your night shift can get in for duty tonight’ (= all the staff who are on night duty),
  • ‘can we get hands in’ (= can some people go into the room).

They use the terms ‘gold’, ‘silver’ and ‘bronze’ to indicate levels of authority:

  • ‘Lesley’s taking silver and Judy’s taking bronze’
  • ‘Are you happy to be the bronze anaesthetist again’

A particularly intriguing form of metonymy – and I am grateful to Prof Littlemore for pointing out this special category – is ‘action metonyms’, where an action rather than a person is referred to. Instances include

  • ‘Can you see if they can make us a bed’ (= can they move another patient so that a bed becomes available)
  • ‘we’re getting a fair bit of ambulance activity going on outside now’ (= several patients are arriving by ambulance).

The most vivid metonym of the programme, however, comes when the operating theatres are being cleared of any patients whose surgery is not immediately urgent and has not already started:

  • ‘anyone else who was elective for today who hasn’t gone knife to skin they need to be sent home’.

Metonymy cements a team working together, but the hospital is also a hierarchical team and, during an emergency, directives are constantly given. As the term is traditionally used in linguistics, directives include orders, requests and suggestions. There are a number of striking things about the directives in the ‘Hospital’ documentary. Out of 50 directives noted in the first half of the programme (when the emergency was at its height), seven use imperatives (‘Go to your major incident positions’; ‘get switchboard to stand us up formally’;  ‘listen in’), but mostly these are accompanied by something that softens or mitigates the directive, either ‘please’ or a phrase that diminishes the extent of the request (‘just’, ‘two seconds’). Examples are:

  • ‘Everybody just be quiet in resus for a moment’
  • ‘Guys, hang on two seconds’
  • ‘Ok guys, please listen in’
  • ‘If you’re in a trauma team please sit with your team’

Secondly, statements of need and passives are common. The person who is expected to take action is often not named or addressed directly. ‘We’ is used in preference to ‘I’. Some examples:

  • ‘they need to be sent home’
  • ‘we need a collation of A&E receiving spaces’
  • ‘we need to make sure all your night shift can get in for duty’
  • ‘We just need to start getting the beds vacated’
  • ‘We need porters to override the lift’
  • ‘I need more space in resus please’
  • ‘We just need to keep moving’

There are directives given using the familiar ‘can’, again often with ‘we’ as a mark of solidarity with the team:

  • ‘Guys can we make sure we’re all signed in’
  • ‘Can I just make sure everybody actually has a role’
  • ‘Guys can we get hands in to get him off the trolley’
  • ‘Can you stand us down St Mary’s for the major incident please’

‘Can you’ is the usual form of directive when a patient or interpreter is being addressed:

  • ‘Can you move your left leg for me’
  • ‘Can you explain to him…’

Once the pressure is off a little, directives are phrased explicitly as suggestions:

  • ‘My suggestion is people reasonably have a think about what they need to do for us to get into business as usual and just to check staffing tonight’

The directives issued, then, get the job done while maintaining solidarity. They are instructions given with an emphasis on the team rather than on the hierarchy.

In the filmed event there are other participants than the hospital staff. Armed police officers are to be seen in the hospital corridors, and the film crew themselves are present, though mostly out of sight. This leads to an encounter that is an excellent example of both ‘solidarity’ and ‘deference’ politeness being used to accompany an instruction. A police officer speaks to the film crew:

  • ‘You can’t film this mate’
  • ‘It’s a counter terrorist incident sir’

The first utterance is a firm order, though expressed indirectly in grammatical terms (i.e. ‘you can’t film’ rather than ‘stop filming’). It is made oblique by placing the authority for the order elsewhere and softened by use of a solidarity marker, ‘mate’. The second utterance offers a rationale or warrant for the instruction and a marker of deference, ‘sir’. The police officer seems to be hedging his bets in conveying the urgency of not filming alongside using both deference and solidarity to avoid giving offence.

All the participants in the programme demonstrate their expertise in many ways. Everyone knows exactly what they are doing, not only in medical terms but also in terms of organisation. As one of the hospital staff explains, a temporary hierarchy is established (gold, silver and bronze) to make sure that roles are clear. The staff work professionally, keeping their emotions distant from what they are doing. Several comment that the full impact of what they are doing would hit them later but that they need to keep focused on the job in hand. The hospital staff probably would not identify language as one of the key ingredients in handling the situation, but as shown here their language use is an integral part of achieving a professional, efficient and effective team.

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