1. Wake up your patients very early to take their blood pressure, their temperature and to measure their heart rate. This should never be later than 6am
2. Do not take any notice of previous readings. Pretend this is the first morning you've woken them, not the 27th (In my case. God that's depressing, I wish I hadn't actually counted.)
3. When already low blood pressure reads a smidgen lower - due to the patient's extremely recent sleepy status - panic. Remember it is your duty to report this as though it is an unusual event. Even though it's the 27th time it's happened. And clearly caused by the fact that until 23 seconds ago, the patient was happily dreaming.
4. Repeat blood pressure reading every 15 minutes, every morning, until blood pressure rises. A smidgen, obviously.
5. Only once you are sure there is no chance at all of the patient going back to sleep should you look at previous readings and conclude. "Her blood pressure IS usually very low." As the patient has been assuring you for the last 45 fraught minutes.
6. Remember, if the patient should become in any way frustrated or cross about this and is unable to hide this irritation due to their extremely recent sleepy status, point out that it is for their "own good." In most cases, this will make the patient compliant, however, if they remain upset, you MUST make sure you mark "patient aggressive" in their notes.
7. Repeat daily.
NB : Should patients with low blood pressure suddenly show "normal" readings, you must NEVER take into account that for that particular patient, this means they are around 50% higher than usual. Even when patient is actually having a stroke, NEVER listen to them, simply reassure them their obs are "fine."
Monday, 29 September 2014
Friday, 26 September 2014
Things That Are Disposable
How often do we hear of waste within the NHS? Barely a week goes by where some distant politician doesn't remind us how very inefficient our health service is. In fact, it isn't and the latest international survey found that it was actually the 2nd most efficient health service in the developed world. We spend just 9.2% of our GDP on healthcare, whilst the average in other countries is 11-12% (WHO)
But I don't think I've EVER heard anyone ask a patient about waste. Can you ever remember seeing a panel debate on Sky, BBC, ITV or C4 news discussing healthcare that included an actual patient? Someone who uses the system and sees a different perspective? God forbid we should ask the people who actually have to use the system, what would they know?
Well, actually we know a lot. We see the medicines opened for just one dose, then thrown away. We see the extortionately expensive £1,000 bags of liquid feed thrown away because no-one thought to put them in the fridge, rendering them useless.
Recently, I watched a Netflix documentary about a brilliant brain surgeon who went to give a lecture in Kiev back in the 80s. He was so appalled at the lack of specialism and facilities, that every year since, he has returned to Kiev and carried out as many of the most complicated cases of brain surgery he can fit in.
He crams his suitcases with equipment and devices that just aren't available to ordinary people in Kiev, equipment that we would use once and throw away. He risks the wrath of the Russian authorities with every case he takes on. One mistake and he felt there was little doubt he'd go to jail. The doctor he works with in Kiev has already been suspended twice for helping him.
But there was a moment, when the doctor from Kiev showed the drill he used to get through skulls. It was an ordinary Bosch hardware drill and he explained that the drill bit was one the UK doctor had bought over TEN years ago and he'd been using it ever since. The UK doctor estimated that just on those drill bits alone, each one used once and then discarded, his hospital spent £40,000. That's one instrument of very many used by one surgeons every day, up and down the country.
A few days ago, I finally had the line fitted into my vein that they would feed me through. It is done in theatres under strict sterile conditions. The Dr inserting it mentioned that the scissors he was using were "one-use". They appeared to be very sturdy, stainless steel scissors, very similar to the ones you can buy for home haircutting. Even in the stores, these are expensive, around £12-£20. Anything bought through the NHS - perversely for an organisation with such huge procurement power - seems to cost 3 times more than the high street equivalent. He snipped through one sterile plastic line with them and that was that. They didn't even touch my body or blood.
So why do we do this? Surely things like scissors and drill bits and scalpels can be effectively sterilised to use again? Sure, we don't want surgeons using blunt scissors or drill bits but one-use???
We do it, because at some point, a very serious condition has been found to be transferred by re-using anything used in a sterile environment. The results may have been statistically imperceptible, perhaps just 2 or 3 cases in a million, but because of that, every last implement must be disposable. So, for instance, we might make sure that every single surgical pack used is thrown away after use, because 2 people were infected with CJD ("mad cow's disease") at the peak of the public interest over it. Even when we can be totally sure that whatever bacteria or virus causing a certain condition is killed under sterile cleaning, the chance that somehow just one scalpel or pair of scissors misses the bleach-bath means that we waste another few billion per year.
There have been several studies into how many "avoidable deaths" there are in the NHS every year. Results ranged from 10,000 to 40,000. The most recent was thought to be the most accurate, using the most detailed methodology and it put the figure at 12,000. The majority of those deaths were due to understaffing or under-resourcing. If we could save, say, even half of those lives for the sake of 2 or 3 aren't we peculiar not to?
Ethically, this might be a difficult question, but as a nation, are we prepared to accept risks many, many times smaller than, say, being hit by lightening twice or winning the lottery, to save many billions of our tax money from literally, being thrown away? And if that minuscule risk means that we take much, much smaller risks with lives in other areas by providing a better funded service to every member of the public rather than legislating for the exception rather than the rule, might the public choose to accept it?
Perhaps this isn't something the NHS or it's staff should decide. Perhaps we should have a public debate and allow everyone to have a say?
NHS managers are making difficult decisions every day as they try to cut vast sums from their budgets without affecting patient care. Perhaps very expensive cancer drugs that can only extend life rather than save it become unavailable, or patients are discharged to soon. If this measure could save many billions of pounds every year, should we not at least consider it?
But I don't think I've EVER heard anyone ask a patient about waste. Can you ever remember seeing a panel debate on Sky, BBC, ITV or C4 news discussing healthcare that included an actual patient? Someone who uses the system and sees a different perspective? God forbid we should ask the people who actually have to use the system, what would they know?
Well, actually we know a lot. We see the medicines opened for just one dose, then thrown away. We see the extortionately expensive £1,000 bags of liquid feed thrown away because no-one thought to put them in the fridge, rendering them useless.
Recently, I watched a Netflix documentary about a brilliant brain surgeon who went to give a lecture in Kiev back in the 80s. He was so appalled at the lack of specialism and facilities, that every year since, he has returned to Kiev and carried out as many of the most complicated cases of brain surgery he can fit in.
He crams his suitcases with equipment and devices that just aren't available to ordinary people in Kiev, equipment that we would use once and throw away. He risks the wrath of the Russian authorities with every case he takes on. One mistake and he felt there was little doubt he'd go to jail. The doctor he works with in Kiev has already been suspended twice for helping him.
But there was a moment, when the doctor from Kiev showed the drill he used to get through skulls. It was an ordinary Bosch hardware drill and he explained that the drill bit was one the UK doctor had bought over TEN years ago and he'd been using it ever since. The UK doctor estimated that just on those drill bits alone, each one used once and then discarded, his hospital spent £40,000. That's one instrument of very many used by one surgeons every day, up and down the country.
A few days ago, I finally had the line fitted into my vein that they would feed me through. It is done in theatres under strict sterile conditions. The Dr inserting it mentioned that the scissors he was using were "one-use". They appeared to be very sturdy, stainless steel scissors, very similar to the ones you can buy for home haircutting. Even in the stores, these are expensive, around £12-£20. Anything bought through the NHS - perversely for an organisation with such huge procurement power - seems to cost 3 times more than the high street equivalent. He snipped through one sterile plastic line with them and that was that. They didn't even touch my body or blood.
So why do we do this? Surely things like scissors and drill bits and scalpels can be effectively sterilised to use again? Sure, we don't want surgeons using blunt scissors or drill bits but one-use???
We do it, because at some point, a very serious condition has been found to be transferred by re-using anything used in a sterile environment. The results may have been statistically imperceptible, perhaps just 2 or 3 cases in a million, but because of that, every last implement must be disposable. So, for instance, we might make sure that every single surgical pack used is thrown away after use, because 2 people were infected with CJD ("mad cow's disease") at the peak of the public interest over it. Even when we can be totally sure that whatever bacteria or virus causing a certain condition is killed under sterile cleaning, the chance that somehow just one scalpel or pair of scissors misses the bleach-bath means that we waste another few billion per year.
There have been several studies into how many "avoidable deaths" there are in the NHS every year. Results ranged from 10,000 to 40,000. The most recent was thought to be the most accurate, using the most detailed methodology and it put the figure at 12,000. The majority of those deaths were due to understaffing or under-resourcing. If we could save, say, even half of those lives for the sake of 2 or 3 aren't we peculiar not to?
Ethically, this might be a difficult question, but as a nation, are we prepared to accept risks many, many times smaller than, say, being hit by lightening twice or winning the lottery, to save many billions of our tax money from literally, being thrown away? And if that minuscule risk means that we take much, much smaller risks with lives in other areas by providing a better funded service to every member of the public rather than legislating for the exception rather than the rule, might the public choose to accept it?
Perhaps this isn't something the NHS or it's staff should decide. Perhaps we should have a public debate and allow everyone to have a say?
NHS managers are making difficult decisions every day as they try to cut vast sums from their budgets without affecting patient care. Perhaps very expensive cancer drugs that can only extend life rather than save it become unavailable, or patients are discharged to soon. If this measure could save many billions of pounds every year, should we not at least consider it?
Wednesday, 24 September 2014
Hospital Logic Part 2 : Smoking
1. Ban smoking from all buildings. Because it's bad for you.
2. Ban smoking outside the hospital or anywhere in the grounds. Because it's bad for you.
3. Assue they will give up smoking during one of the most stressful times of their life.
4. Ensure already weak patients with dubious immunity have to walk as far as possible, leave the safety of the security staff and are exposed to all weathers and germ-ridden public. Because clearly, that is much better for them.
2. Ban smoking outside the hospital or anywhere in the grounds. Because it's bad for you.
3. Assue they will give up smoking during one of the most stressful times of their life.
4. Ensure already weak patients with dubious immunity have to walk as far as possible, leave the safety of the security staff and are exposed to all weathers and germ-ridden public. Because clearly, that is much better for them.
Tuesday, 23 September 2014
A Well Run Hospital
From my recent posts and tweets, it's clear some of you are beginning to think I'm staying in a hospital from a Carry-On film without the wit.
However, there are a thousand different clues that tell you whether a hospital is well run or not and I truly do think this one IS well run. For all the faults and mistakes, I'm still convinced they are due to under-funding and under-staffing, not incompetence.
A patient-centered hospital listens to the little things and improves them. Each time you are admitted you notice details that used to frustrate you have been dealt with. I used to wait endlessly for the ward door to be unlocked when I went downstairs for a cigarette. Sometimes I honestly began to worry that I'd have to sleep outside in the corridor. This stay, it is always answered within 6 rings of the entry phone.
There are 2 large TV screens in the foyer. One announces "You told us..... (insert complaint) The other explains what they did to put the problem right.
Last stay, I used to feel quite intimidated if I had to take a lift with a male night worker on my own. Now, unless it's just coincidence, they step out if there's no-one else around.
I used to find some of the guys on the security desk a bit rude. Again, if I wanted to go out for a cigarette at night, I would have to press a button for them to release the door. Sometimes they just wouldn't bother and I'd wait outside indefinitely, although I could clearly see them sitting at the desk. One of them had a little power trip and wouldn't let me go out of the back door to the relative privacy of the taxi rank, but insisted I brave the onslaught of the very main road at the front of the hospital, always busy with passing drunks around about midnight. That has all stopped too. They no longer question me on who I am or where I'm going, which seems reasonable, as I always imagined with frustration that the pyjamas, wild hair and drip stands kind of gave my patient identity away.
Pain relief is an absolute priority here, unlike my old hospital. No matter how busy they are, I rarely wait for more than 15 minutes and it takes nearly that long to find another trained member of staff, find the keys to the controlled drug cupboard and draw it up.
If all goes wrong, the ward sisters (on the whole, apart from my unfortunate experience) are there to be patient advocates and I've often heard them tearing into pharmacy or an unfortunately hapless doctor on our behalf.
I suppose the point of writing this post is to say that if things are so bad for me here at a renowned teaching hospital with a very healthy focus on patient care and improvement, things will almost certainly be worse in most local hospitals around the country. In my experience, this kind of focus on patient care is quite rare. I have refused point blank to go to my local hospital for many, many, years now and have made 2 or 3 hour journeys vomiting all the way, just to avoid putting myself at their mercy.
I think it's too easy to blame poor management or lazy staff. If the staff don't appear lazy, they can't be. If the hospital seems well managed, it probably is.
But the NHS has been ordered to save £20 billion over the course of this parliament. Most people don't stop to think about how much money that actually is. It's 20 THOUSAND MILLION POUNDS!! There are only so many biscuits you can cut back on on the tea round. The NHS has never been adequately financed in the 25 years I've been an in-patient. The only time I've been on a fully staffed ward was in 2007 after 10 years of extra Blair money. It runs to the absolute bone. 20 thousand million pounds will affect care and outcomes, there's no way at all anyone can argue that it won't.
However, there are a thousand different clues that tell you whether a hospital is well run or not and I truly do think this one IS well run. For all the faults and mistakes, I'm still convinced they are due to under-funding and under-staffing, not incompetence.
A patient-centered hospital listens to the little things and improves them. Each time you are admitted you notice details that used to frustrate you have been dealt with. I used to wait endlessly for the ward door to be unlocked when I went downstairs for a cigarette. Sometimes I honestly began to worry that I'd have to sleep outside in the corridor. This stay, it is always answered within 6 rings of the entry phone.
There are 2 large TV screens in the foyer. One announces "You told us..... (insert complaint) The other explains what they did to put the problem right.
Last stay, I used to feel quite intimidated if I had to take a lift with a male night worker on my own. Now, unless it's just coincidence, they step out if there's no-one else around.
I used to find some of the guys on the security desk a bit rude. Again, if I wanted to go out for a cigarette at night, I would have to press a button for them to release the door. Sometimes they just wouldn't bother and I'd wait outside indefinitely, although I could clearly see them sitting at the desk. One of them had a little power trip and wouldn't let me go out of the back door to the relative privacy of the taxi rank, but insisted I brave the onslaught of the very main road at the front of the hospital, always busy with passing drunks around about midnight. That has all stopped too. They no longer question me on who I am or where I'm going, which seems reasonable, as I always imagined with frustration that the pyjamas, wild hair and drip stands kind of gave my patient identity away.
Pain relief is an absolute priority here, unlike my old hospital. No matter how busy they are, I rarely wait for more than 15 minutes and it takes nearly that long to find another trained member of staff, find the keys to the controlled drug cupboard and draw it up.
If all goes wrong, the ward sisters (on the whole, apart from my unfortunate experience) are there to be patient advocates and I've often heard them tearing into pharmacy or an unfortunately hapless doctor on our behalf.
I suppose the point of writing this post is to say that if things are so bad for me here at a renowned teaching hospital with a very healthy focus on patient care and improvement, things will almost certainly be worse in most local hospitals around the country. In my experience, this kind of focus on patient care is quite rare. I have refused point blank to go to my local hospital for many, many, years now and have made 2 or 3 hour journeys vomiting all the way, just to avoid putting myself at their mercy.
I think it's too easy to blame poor management or lazy staff. If the staff don't appear lazy, they can't be. If the hospital seems well managed, it probably is.
But the NHS has been ordered to save £20 billion over the course of this parliament. Most people don't stop to think about how much money that actually is. It's 20 THOUSAND MILLION POUNDS!! There are only so many biscuits you can cut back on on the tea round. The NHS has never been adequately financed in the 25 years I've been an in-patient. The only time I've been on a fully staffed ward was in 2007 after 10 years of extra Blair money. It runs to the absolute bone. 20 thousand million pounds will affect care and outcomes, there's no way at all anyone can argue that it won't.
Monday, 22 September 2014
Hospital Logic Part 1
I think I'll make this a series. If you pointed every logic-fail out to the nurses, you'd be talking forever.
So to kick off, Patient Rest Time :
1) Enforce a patient rest time between 1pm and 3pm. Switch off all the lights and close all of the blinds there and then. Even if everyone in the bay asks for them to be left open, do not allow this. Use whatever means necessary to assert your authority.
2) Once you're sure it's completely dark, deliver lunch.
3) Make sure that staff do not modify their behavior in any way and that all 20-30 are having to shout at once to hear one another in the corridor. In fact, this is also a good time to hash over last night's tequila related incidents.
4) Schedule all blood tests, physio sessions and dietitians between 1pm and 3pm
5) Remove lunch uneaten from those who actually managed to sleep through the cacophony.
So to kick off, Patient Rest Time :
1) Enforce a patient rest time between 1pm and 3pm. Switch off all the lights and close all of the blinds there and then. Even if everyone in the bay asks for them to be left open, do not allow this. Use whatever means necessary to assert your authority.
2) Once you're sure it's completely dark, deliver lunch.
3) Make sure that staff do not modify their behavior in any way and that all 20-30 are having to shout at once to hear one another in the corridor. In fact, this is also a good time to hash over last night's tequila related incidents.
4) Schedule all blood tests, physio sessions and dietitians between 1pm and 3pm
5) Remove lunch uneaten from those who actually managed to sleep through the cacophony.
Saturday, 20 September 2014
So How do we Fix the NHS
If you want change, make sure this post goes viral and don't allow vested interests to stop you. The time for talking is over. The time to save the NHS is now. Don't close this post without being the change YOU need.
Following my post earlier on the disastrous understaffing of the NHS at the moment, many people have said to me "But what can we DO?"
Did you know anyone can walk into parliament and demand to see their MP? Whatever debate he or she is sitting in, they must be bought to you?
I would organize as many people as you possibly can in every constituency to turn up at your next MPs surgery and refuse to leave. Thousands of you. With every MP in the country under lock down, the issue would have to be solved and solved immediately.
Anyone who's MP doesn't even hold a local surgery, get up to Parliament (or ask a proxy to go in your place if you're housebound or find traveling impossible), call your MP to the lobby and do the same.
Organisations with good networks like unions, charities, voluntary groups and governing bodies could organize this within a week, the NHS could be safe within 2.
But I can't do everything. If you want this, do it, it's as simple as that. If you really want to save your NHS, get off the sofa and save it.
If you want this enough, send this post viral. RT it, share it, email it - even hand it out at your local supermarket - whatever it takes to spread the word.
All it takes is unity and will.
As dear old Nye said "The NHS will last as long as there are folk left with the will to fight for it."
Following my post earlier on the disastrous understaffing of the NHS at the moment, many people have said to me "But what can we DO?"
Did you know anyone can walk into parliament and demand to see their MP? Whatever debate he or she is sitting in, they must be bought to you?
I would organize as many people as you possibly can in every constituency to turn up at your next MPs surgery and refuse to leave. Thousands of you. With every MP in the country under lock down, the issue would have to be solved and solved immediately.
Anyone who's MP doesn't even hold a local surgery, get up to Parliament (or ask a proxy to go in your place if you're housebound or find traveling impossible), call your MP to the lobby and do the same.
Organisations with good networks like unions, charities, voluntary groups and governing bodies could organize this within a week, the NHS could be safe within 2.
But I can't do everything. If you want this, do it, it's as simple as that. If you really want to save your NHS, get off the sofa and save it.
If you want this enough, send this post viral. RT it, share it, email it - even hand it out at your local supermarket - whatever it takes to spread the word.
All it takes is unity and will.
As dear old Nye said "The NHS will last as long as there are folk left with the will to fight for it."
NHS Meltdown
I really don't think I can put this off any longer. My very reason for being for the last 2 decades has been to expose and improve patient care, to truly show the general public what being a patient is really like.
But some of my longer term readers will remember all too vividly what happened the last time I dared to blow a whistle on my previous hospital. But they only know a fraction of what actually happened, as I was unable to write about it publicly for legal reasons. If I say it resulted in an attempt to threaten the custody of my children, you probably don't need to know the rest.
But I've always believed that fear is never, ever a reason not to do something. (Other than bungee jumping, obviously)
If I listed the catalogue of disasters I've experienced on this stay, this post would be 10 pages long. Possibly 20. So I'll focus on just one area - my nutrition. Just remember that if you think this is bad, every other area of care is equally under pressure.
I came in 18 days ago severely malnourished. My weight had dropped to just 39 kilos - 6 stone. I simply couldn't keep enough calories in before they escaped ferociously from one end or the other. The pain had become constant and intolerable and I could spend whole days vomiting over a bowl.
On admission, A&E set up a drip - my blood results showed I was dehydrated too - unsurprisingly. They put me nil by mouth overnight until my own doctors could assess me in the morning.
The fluids ran into me happily, running out the next morning. Despite constant queries, no new bag went up. For 12 hours. Then 24 hours. I couldn't even get anyone to flush the cannula. The sticker on it said "remove Friday", by Sunday, I couldn't even get anyone to do that and it was at stage 5 of a 6 stage infection scale. I took it out myself.
The first day, I obviously hadn't ordered any food and I tried absolutely every way I could think of to get some. But somehow, I never did. The next morning, still no menu slip and I was determined to get fed this time. I kept on and on until the lunch trolley actually arrived - with nothing for me. Cue meltdown number 1 and a miserable blub to the ward sister. Critically low weight and 48 hours with no food will do that.
The ward sister assured me I could get a "snack box" sent up anytime at all, I only had to say. I asked her why it was that hadn't happened so far, but she couldn't seem to answer.
Every single time I've been admitted at this weight, I've had to be fed into my central vein. (TPN) This time, no TPN materialised. When your bowels are in the kind of crisis mine are, you simply have no choice but to circumvent them. But there are a few catches. Firstly, TPN is eye-wateringly expensive - £1000 per bag, per day!! Secondly, you are at an extremely high risk of infection directly to your heart. No-one prescribes it for fun. But as I need surgery, I simply have to get a balance of nutrients beforehand or I'm unlikely to survive it.
A lovely dietician came and ordered me extra high calorie, low residue snacks to come up - smoothies, hi-cal jellies and mousses. But they never arrived. Today, 15 days later, I still haven't managed to track them down.
There used to be a special menu that people like me could order from with hi cal "extras" to supplement the hospital food. Despite asking and asking for it repeatedly day after day, that didn't appear either. I got a halal/kosher menu, but had to explain that wasn't quite what I meant. Again, 16 days later, it still hadn't appeared.
By the end of the second week, I'd LOST a kilo. A kilo I could ill afford to lose. The only reason I was dragged kicking and screaming into hospital at all was to avoid further weight loss.
I asked for extra salt & sugar sachets from the tea trolley to at least provide my own re-hydration fluid, (I'm extremely self sufficient and where there's a will, there's usually a way) But I couldn't get those either. I asked and asked when I might get TPN, but today, I still don't have it arranged.
By Monday evening I had reached my limits. Still dropping precious ounces, I believed I was safer at home. I walked out, got in a taxi, then a train, and just went home. They'd been promising me I could go home for a few days while I waited for my next procedure for over a week, but guess what? They somehow kept not getting round to confirming it.
I left at 6pm, and left a note to explain with another patient, as I didn't actually want to worry anyone or - God forbid - trigger any police searches. I asked her to give it to a nurse at the 10pm drug round, figuring it would be too late by then to do anything until the morning and I'd get at least 24 hours with my babies. I was all the way back in Sussex by taxi and train before anyone even realised I'd gone.
The landline finally rang at 10.30pm and it was the ward sister. Dave answered the phone as I was way too traumatised to deal with anything myself. She spent an incredible 15 MINUTES telling Dave off for my breach of protocol. She clearly kept interrupting him as he had to calmly repeat several times "Excuse me, I hadn't finished talking." At the end, he asked
"So you're the ward sister, is that right? In charge of my wife's ward?"
She said that was correct
"So in 15 minutes, you haven't asked me once about the wellbeing of your patient? You haven't asked me if she got here safely, or how. You haven't asked me if she has the meds she needs to get through the night, or if she's OK. And most importantly, you haven't asked me what pushed her to such extremes that she walked off your ward, something she's never done before in the 20 years I've know her?"
Funnily enough, she didn't seem to have an answer for that.
I called the doctors first thing in the morning to see when I needed to be back for my procedure (colonoscopy) They finally had a date for it (the Thursday afternoon, it was Tuesday morning) and told me I had to have nothing but clear fluids until then.
On the Wednesday, I dutifully returned in time to drink the 3 LITRES of highly unpleasant laxative you have to take the night before. The sister at admissions told me I could have been eating a light diet right up until then. I asked if there was any reason I couldn't eat something there and then and she said I could. (Another 24 hours of pointless lack of nutrition.) I speedily found a restaurant and ordered a piece of plain grilled fish.
By the Thursday afternoon at about 3.30, colonoscopy done, I was allowed to get back to the ward, and I was so hungry I could think of nothing but food. I asked for one of the oh-so-elusive snack boxes, but the nurse said I had to wait for the supper trolley. (usually about 5-5.30pm) I was so exhausted from the endless battles (not to mention the king-size dose of sedative I'd had for the colonoscopy) that I just accepted it.
When the trolley arrived, I pointed out to the person serving that I didn't have an order in, as I'd been nil by mouth that morning. She told me I had to wait for everyone else to have their food and then they'd see what was left. I said anything but brown bread would be fine. Watching everyone get food was almost more than I could bear, but finally, I saw her coming back with a tray. It was a brown bread cheese sandwich.
Cue epic meltdown. I texted a friend who was in London and due to visit me a little later. Could he come now? I was starving, (literally) had no money and no cash card.
He got to me in less than an hour, let me cry for a full 5 minutes on his shoulder, took me for a hot meal and stocked me up with food I could keep by my bed. After he'd left, I found £20 he'd tucked into my teabag box, the one place he knew I would see it soonest. (I'm rarely more than an hour away from a cup of tea)
So the final question is, what has led to this catalogue of failure? Is it incompetence? Cruelty?
I don't believe it is. I have barely had a single nurse who wasn't competent and kind. There simply aren't enough of them. in the 20 years I've spent an average of a month of every year in hospital, I haven't experienced staffing levels this bad since 1995. They simply don't have the time to do all of the jobs they need to. To be more accurate, they don't even have time to get through the very basic tasks of ensuring patients have nutrition, fluids, cannula care and a referral to a doctor.
Remember, I'm in a specialist and admired teaching hospital with access to funding streams local hospitals don't have.
For the record, David Cameron needs to know that patients are at severe risk. Mistakes are inevitable and it's only a matter of time before our healthcare reaches crisis. Personally, I believe it has already. He has pushed a system that was already at its limits (and quite a long way beyond them) over the edge. Goodness knows what will happen when winter comes and admissions rise.
There is no more time for talking, reviews, conferences and marches. If we want to save the NHS we have to do it TODAY. We must not take no for an answer. If we don't, it will soon be YOUR Mum, YOUR sister, YOUR child or grandson who suffers. Saying I told you so when it's too late, will be no consolation to me at all.
But some of my longer term readers will remember all too vividly what happened the last time I dared to blow a whistle on my previous hospital. But they only know a fraction of what actually happened, as I was unable to write about it publicly for legal reasons. If I say it resulted in an attempt to threaten the custody of my children, you probably don't need to know the rest.
But I've always believed that fear is never, ever a reason not to do something. (Other than bungee jumping, obviously)
If I listed the catalogue of disasters I've experienced on this stay, this post would be 10 pages long. Possibly 20. So I'll focus on just one area - my nutrition. Just remember that if you think this is bad, every other area of care is equally under pressure.
I came in 18 days ago severely malnourished. My weight had dropped to just 39 kilos - 6 stone. I simply couldn't keep enough calories in before they escaped ferociously from one end or the other. The pain had become constant and intolerable and I could spend whole days vomiting over a bowl.
On admission, A&E set up a drip - my blood results showed I was dehydrated too - unsurprisingly. They put me nil by mouth overnight until my own doctors could assess me in the morning.
The fluids ran into me happily, running out the next morning. Despite constant queries, no new bag went up. For 12 hours. Then 24 hours. I couldn't even get anyone to flush the cannula. The sticker on it said "remove Friday", by Sunday, I couldn't even get anyone to do that and it was at stage 5 of a 6 stage infection scale. I took it out myself.
The first day, I obviously hadn't ordered any food and I tried absolutely every way I could think of to get some. But somehow, I never did. The next morning, still no menu slip and I was determined to get fed this time. I kept on and on until the lunch trolley actually arrived - with nothing for me. Cue meltdown number 1 and a miserable blub to the ward sister. Critically low weight and 48 hours with no food will do that.
The ward sister assured me I could get a "snack box" sent up anytime at all, I only had to say. I asked her why it was that hadn't happened so far, but she couldn't seem to answer.
Every single time I've been admitted at this weight, I've had to be fed into my central vein. (TPN) This time, no TPN materialised. When your bowels are in the kind of crisis mine are, you simply have no choice but to circumvent them. But there are a few catches. Firstly, TPN is eye-wateringly expensive - £1000 per bag, per day!! Secondly, you are at an extremely high risk of infection directly to your heart. No-one prescribes it for fun. But as I need surgery, I simply have to get a balance of nutrients beforehand or I'm unlikely to survive it.
A lovely dietician came and ordered me extra high calorie, low residue snacks to come up - smoothies, hi-cal jellies and mousses. But they never arrived. Today, 15 days later, I still haven't managed to track them down.
There used to be a special menu that people like me could order from with hi cal "extras" to supplement the hospital food. Despite asking and asking for it repeatedly day after day, that didn't appear either. I got a halal/kosher menu, but had to explain that wasn't quite what I meant. Again, 16 days later, it still hadn't appeared.
By the end of the second week, I'd LOST a kilo. A kilo I could ill afford to lose. The only reason I was dragged kicking and screaming into hospital at all was to avoid further weight loss.
I asked for extra salt & sugar sachets from the tea trolley to at least provide my own re-hydration fluid, (I'm extremely self sufficient and where there's a will, there's usually a way) But I couldn't get those either. I asked and asked when I might get TPN, but today, I still don't have it arranged.
By Monday evening I had reached my limits. Still dropping precious ounces, I believed I was safer at home. I walked out, got in a taxi, then a train, and just went home. They'd been promising me I could go home for a few days while I waited for my next procedure for over a week, but guess what? They somehow kept not getting round to confirming it.
I left at 6pm, and left a note to explain with another patient, as I didn't actually want to worry anyone or - God forbid - trigger any police searches. I asked her to give it to a nurse at the 10pm drug round, figuring it would be too late by then to do anything until the morning and I'd get at least 24 hours with my babies. I was all the way back in Sussex by taxi and train before anyone even realised I'd gone.
The landline finally rang at 10.30pm and it was the ward sister. Dave answered the phone as I was way too traumatised to deal with anything myself. She spent an incredible 15 MINUTES telling Dave off for my breach of protocol. She clearly kept interrupting him as he had to calmly repeat several times "Excuse me, I hadn't finished talking." At the end, he asked
"So you're the ward sister, is that right? In charge of my wife's ward?"
She said that was correct
"So in 15 minutes, you haven't asked me once about the wellbeing of your patient? You haven't asked me if she got here safely, or how. You haven't asked me if she has the meds she needs to get through the night, or if she's OK. And most importantly, you haven't asked me what pushed her to such extremes that she walked off your ward, something she's never done before in the 20 years I've know her?"
Funnily enough, she didn't seem to have an answer for that.
I called the doctors first thing in the morning to see when I needed to be back for my procedure (colonoscopy) They finally had a date for it (the Thursday afternoon, it was Tuesday morning) and told me I had to have nothing but clear fluids until then.
On the Wednesday, I dutifully returned in time to drink the 3 LITRES of highly unpleasant laxative you have to take the night before. The sister at admissions told me I could have been eating a light diet right up until then. I asked if there was any reason I couldn't eat something there and then and she said I could. (Another 24 hours of pointless lack of nutrition.) I speedily found a restaurant and ordered a piece of plain grilled fish.
By the Thursday afternoon at about 3.30, colonoscopy done, I was allowed to get back to the ward, and I was so hungry I could think of nothing but food. I asked for one of the oh-so-elusive snack boxes, but the nurse said I had to wait for the supper trolley. (usually about 5-5.30pm) I was so exhausted from the endless battles (not to mention the king-size dose of sedative I'd had for the colonoscopy) that I just accepted it.
When the trolley arrived, I pointed out to the person serving that I didn't have an order in, as I'd been nil by mouth that morning. She told me I had to wait for everyone else to have their food and then they'd see what was left. I said anything but brown bread would be fine. Watching everyone get food was almost more than I could bear, but finally, I saw her coming back with a tray. It was a brown bread cheese sandwich.
Cue epic meltdown. I texted a friend who was in London and due to visit me a little later. Could he come now? I was starving, (literally) had no money and no cash card.
He got to me in less than an hour, let me cry for a full 5 minutes on his shoulder, took me for a hot meal and stocked me up with food I could keep by my bed. After he'd left, I found £20 he'd tucked into my teabag box, the one place he knew I would see it soonest. (I'm rarely more than an hour away from a cup of tea)
So the final question is, what has led to this catalogue of failure? Is it incompetence? Cruelty?
I don't believe it is. I have barely had a single nurse who wasn't competent and kind. There simply aren't enough of them. in the 20 years I've spent an average of a month of every year in hospital, I haven't experienced staffing levels this bad since 1995. They simply don't have the time to do all of the jobs they need to. To be more accurate, they don't even have time to get through the very basic tasks of ensuring patients have nutrition, fluids, cannula care and a referral to a doctor.
Remember, I'm in a specialist and admired teaching hospital with access to funding streams local hospitals don't have.
For the record, David Cameron needs to know that patients are at severe risk. Mistakes are inevitable and it's only a matter of time before our healthcare reaches crisis. Personally, I believe it has already. He has pushed a system that was already at its limits (and quite a long way beyond them) over the edge. Goodness knows what will happen when winter comes and admissions rise.
There is no more time for talking, reviews, conferences and marches. If we want to save the NHS we have to do it TODAY. We must not take no for an answer. If we don't, it will soon be YOUR Mum, YOUR sister, YOUR child or grandson who suffers. Saying I told you so when it's too late, will be no consolation to me at all.
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