I have given up pronouncing his name right. It is written as Szymon. Whatever Z is doing after S I’ll have to take a holiday to Poland to find out. The interesting thing is that everyone calls him Simon. He attends dialysis at the new hospital I work at thrice a week. On these days, there is another patient called Simon who comes as well. Whenever a senior nurse sends me to “Simon” I have to ask “which one?”

It has been a few weeks since I was signed off on my Hemodialysis competencies. That means I no longer have to work under direct supervision of a mentor. I get to handle patients with minimal support from the very busy and incredibly experienced senior renal nurses.

The first time we met we immediately hit it off. He has a funny bone in him and he told me his arteriovenous fistula was just an overgrown tattoo.

An arterio-Venous Fistula is a vein which has been surgically joined to an artery on the arm and allows us to draw blood from the body, to the artificial kidney during dialysis and back to the patient. This is with the help of pumps in the dialysis machines.

I was mortified under my face mask and didn’t know how to react to that. He burst out laughing and I felt the humor ooze from him like colours from a rainbow. I call him Simon with the Z. He chuckles himself silly to that. He said he liked it. He says he knows someone from Kenya. A neighbour in his apartment is Kenyan. I am not sure I believe him. When you live in the UK you get to learn how to accommodate everybody.

You don’t act surprised when someone mentions a country in Africa for example; even if you think Africa is one huge country. And China is representative of Asia. Don’t let them know you don’t even know where Nepal is on the map. Do not say you don’t know that Egypt and Morocco are actually in Africa. Act along. Play along.

You just make sure you get the name of the country and then say you know someone (most likely imaginary) who comes from that same country. Or say you know someone who looks like that person but is from Zimbabwe.

Mention Zimbabwe a lot. Zimbabwe is easier to pronounce than Kenya and Namibia. And hey Brits and the rest of the world, it is Namibia not Nambia. President Trump was just having a bad day when he called it Nambia. Nambia is as real as Wakanda is, forever.

Nursing allows me to interact with different people. A dynamic place like the dialysis unit, however, does not give nurses time to bond and have lengthy impromptu conversations. Especially not in Great Britain where everyone believes in timely appointments. In Kenya, appointments, just like traffic rules, are there as suggestions.

Working as a nurse here makes me want to take the juice of British culture and pour it in a clear bottle, add the extract of the Kenyan culture; gently mix them and pour a dash of the fluid to both countries. Great Britain could do with a little bit of what mother Kenya has. Kenya could do with a little bit of what Her Majesty the Queen’s land has. And I am the greedy mammal that does with a little of both worlds.

Simon with the Z wasn’t as chatty as usual. He sounded subdued. Even forlorn. After every patient had been connected to their dialysis machines, I went back to him to catch up about the weekend and hear what he had planned. This is always an icebreaker in Britain. It is in the top of the food chain together with the weather.

If you don’t know what to say in any of the four countries that make up The United Kingdom, say something as innocent as ,”It is a beautiful day today, right?” Or “The weather is horrible today.” Let that sentence hang in the air. Like abandoned roses post Valentine’s, do not pick it up. Your audience will always fall for it hook, line and sinker.

If that sounds cliche, like it did on this Saturday evening, try ,” anything nice planned for the weekend/afternoon/later?”

Everyone and their pets will respond. These are the unwritten rules in this castle. The Brits have unwritten social interaction rules. You just have to know them. When anyone asks about your weekend, they don’t really care. They want to talk. Those are filler words. Whatever you do with them is your business. They are what otherwise? Is to a Kenyan in any spoken speech.

Sometimes I imagine going to Kenya with my new friend Janine. I dream about introducing her to my friends in Nairobi and going for a night out where she would be bombarded with a lot of “otherwise?” The English girl in her would drop down with exasperation. Ha ha.

To those asking, we use otherwise? In Kenya as a filler word. It is an invitation to continue or change the topic. Basically tell us more. Or less. Or hiss . Or meow. Or whatever your type of animal does. Just don’t ask us to explain it. We also don’t understand it very well.

But I didn’t want to fill words with Simon with the Z. I did want to talk.

I tweedled with his dialysis machine for no good reason and made small talk about his weekend and the weather. An avalanche of cliches. Byword onslaught. He took it up.

In a heavy Polish accent, he lamented how he had been advised that the hospital he had been dialysing at before coming to our unit was ready to receive him. He did not want to go back. He had to because it was near his flat and the NHS was not going to keep providing him with a taxi to and from our unit which was about 20 miles away from his flat.

He worked as a checkout officer at Asda Supermarket. He had for 5 years now and the employers let him work only when he was not having his dialysis sessions. He had stopped counting his sick days and the management had stopped counting either.

He had been referred to our unit (it is the Headquarter of Renal Diseases and Management in this part of Scotland) due to social issues. Further, he had been on the Kidney Transplant Waiting list since January 2020. Covid-19 happened and now at 36 years, he felt his hope for a new kidney plummet.

He told me the team from the previous hospital did not accommodate his frequent trips back to Poland. He had had to go to Poland every week for the last six months. There are existing protocols and policies to be followed after a patient returns from another country. It is tedious. It is lengthy. It is expensive for the NHS.It is important. It is life saving.

Having to do it weekly for the same patient may have raised some red flags about compliance to therapy.

Simon with a Z was not being difficult. He was having issues with his Polish passport. For the longest time, citizens from the European Union could live and work in Britain without a problem. Brexit happened and the reality of it all is hitting differently for patients like Simon with a Z who rely on the NHS for their dialysis. They are now required to apply for a right to live and work in the UK which is impossible without a passport.

Poland officials, like any other country in the world, took their sweet time to process his papers so he kept going back and forth.

Poland prides herself in highly advanced dialysis centres. The cost of a session is your entire household and their breadwinner. That is how expensive one session is. Healthcare isn’t funded by the government through taxes like in the UK. Rather, it is purely capitalistic just like her counterpart in Kenya. Same script, different players.

He needed someone to explain to Marion, the coordinator in the other hospital that until he got his passport from Poland, he had to keep flying between the two countries. His manager at Asda knew it. Marion needed to know it too. Szymon was not being petulant or inconsiderate.

My responsibility was passing this to the charge nurse who certainly informed Marion. In the cacophony of task completion and role performance, Szymon’s voice had been buried. His fears and anxieties unrevealed. It took an idle talk about a weekend to get him listened to.

Which makes me sad.

Outpatient dialysis unit is one of the most homely units in the entire nursing profession. Yet it is one of the most short staffed. Not only in Kenya but also within the NHS of the UK. Having worked with a rather smaller team of patients in Kenya, I had gotten used to finding out what each and every one of our patients were dealing with and liaising with different teams to address the issues.

Simon with the Z awakened two issues in my heart. The need for governments all over the world to adopt a publicly funded healthcare system, and the need for NHS to employ more renal nurses.

Our vision shouldn’t be rigidly focused on the disease a patient has. It must go to how that disease is affecting the patient. How that disease or condition has eroded the fabric of his or her coping mechanism. Now that is nursing. That is painting 2020 as the Year of the Nurse and Midwife in colours bold and bright.