Gods (or hospital consultants)

What you have to realise as a patient is that however important you are outside hospital, however many lackeys jump to your call, inside hospital you are merely the patient in Bed 10. You are no more important than the patient in Bed  11. Or 12.  Yes you’re the reason the whole place exists …but  the man or woman who calls the shots, for whom everything stops on the ward, is the consultant.

Not surprising then that some of them have God-complexes.  The worst one I ever had  used to stride into the ward with his team of junior doctors, medical students and the ward sister scurrying after him.  He’d barely look at me…and would call me Mrs Brown throughout,  much to the consternation of everyone else around him.   But contrary to popular belief,  my experience is those types are few and far between and actually it’s us, the patients who have a tendency  to put consultants up on a pedestal.  The highlight of our hospital day is when they appear at our bedside. We listen intently to their every word, desperately trying to remember what they’ve said so we can repeat it at visiting time.  We assume they are all-knowing and all-powerful in their ability to heal.   Sadly that’s not always the case.

It must be quite hard not to develop a God-complex if you’re a consultant.  They live in a world where the patients are desperate for a word of wisdom from their lips, and in a hospital hierarchy which places them firmly at the top.   They are always surrounded by at least two or three  minions to take notes, hold the stethoscope, or pass them a pen.  They test their minions all the time too.  What does this C4 complement result mean Junior Doctor?  What’s your diagnosis Lowly Medical Student?  Watching from the bed as the Gods torment their minions can be most entertaining …… or agonizing.    And of course consultants have the ultimate God characteristic.  Their decisions can decide if someone lives or dies.   What power ……and responsibility.

In reality even they can’t perform miracles.   Sometimes the superheroes just don’t know why your body is functioning so poorly or what to do to make it better.  The realisation as a patient that your doctor doesn’t know everything, that he or she is actually human, can be pretty depressing.

I now have a  consultant who having decided in an outpatient appointment that I needed to be admitted straight into hospital, zoomed across town on his motorbike to get my medical records from one hospital to another.   As he strode into Accident and Emergency in his leathers with his helmet and my notes under his arm, in my head I gave him superhero status, right up there on a pedestal  where he’s pretty much stayed  ever since.  It helps that he’s super brainy and has saved my life on a fair few occasions.  He also always remembers the names of my kids, and was the only person in a long stream of doctors to ask me how I felt emotionally after five days under sedation.   I used to think I was special, that my complex medical needs (or alternatively my witty personality), was why he remembered me but over the years  I’ve eventually worked out he’s like that with all his patients.  Somehow in that God-like way, he makes us all feel special.

So hospital consultants, if you are reading this, it’s simple.  The best consultants keep their God- like tendencies (and egos) firmly in check, just bringing them out to dazzle us when we really need their  healing powers.  And us patients hang on your every word.  We live for that 3 minutes every other day, or once a week, that we might see you.  We all like to think that we are your most important/medically interesting/favourite patient – so please be nice to us and if nothing else, make an effort to at least remember our name.

Cost of NHS treatment (or Why you shouldn’t complain about the toast)

There’s a photo of a hospital bill from the U.S. doing the rounds on Twitter this morning.  With the comment ‘The cost of my c-section’,  it details charges like $10,353 for Room and Bed, $7,275 for nursery, $2,270 for pharmacy, $326 for blood storage and processing.   Total bill for giving birth $42,347.  40 thousand dollars.  About 23 thousand pounds.

One of the great virtues of the NHS is that patients don’t need to worry about the cost of their treatment.  But perhaps our complete lack of knowledge on the subject makes us somewhat ungrateful for the amazing service we have.   A junior doctor told me recently he had to wait until the consultant came on the ward before he could write the prescription for a treatment I was having.  I naively thought it was to do with the fact it’s a fairly serious drug ..but no. It was of course the cost that he wasn’t allowed to authorise.  He left my bed and (having nothing better to do) I began to work out just what this particular bout of illness was costing the NHS.

About 3 weeks in intensive care.  At £1500 a day roughly.  About £31,000.  Then another six weeks on a normal ward at £250-£300 a day.  At least another £10,000.  That’s before I start having any investigations or treatment.  Plasma exchange – about 10 or so of them.  No idea what they cost ( and Google isn’t helping me)  but the nurse reckons it’s a few thousand each time, so even being conservative, that’s probably another £20,000 on the bill. Several courses of a pretty expensive drug ( Rituximab) – at least another £10,000.  I’m up to about £70,000 pounds before I even start on blood tests and transfusions, pills and ambulances.  It certainly makes me less inclined to complain about the food.

I wonder though whether the NHS should make more of this.  Maybe we should all be given a fake bill when we leave.  Here’s what it would have cost you.  So instead of us complaining when someone comes to take yet more blood from our arms, we’re grateful  a decision has been made to spend a bit more money on our care.

One of the nurses giving me a plasma exchange was from India. Quite rightly she pointed out  to me that if I lived there, plasma exchange  just wouldn’t be an option, because I simply wouldn’t have the money to pay for it.    And the same is true in so many other parts of the world.  It doesn’t mean we shouldn’t complain when things go wrong in the NHS. And we are of course paying for it in our taxes.  But thinking about the cost of NHS treatment might make us a little more understanding about there not being enough nurses on the ward, why the hospital charges us to park and why the toast is cold by the time it arrives at our bed.

 

What would you pay to see a GP

In my experience, visitors to GP surgeries fall in one of two patient camps.  The first bunch, a small minority, are those who are often cited in articles about NHS lack of funding.  They’re the ones who run to their GP with their cold, their cut finger, or occasional tummy ache, taking much more of NHS times and resources than they actually need.     (I actually think these are such a small minority of the population that they’re almost mythical – GPs please feel free to disagree.)  The rest of us sit doggedly in what I would call the ‘Oh it’s probably nothing’ camp, otherwise known as the ‘I’m sure it will go away ‘camp, the ‘I don’t want to bother the doctor with it’ camp or the ‘I meant to get round to making an appointment but I just haven’t had time’ camp.

If we add a few more of us saying ‘I don’t want to pay a tenner to be told there’s nothing wrong with me’, then many of us will never quite get into our GP waiting room at all.  And yet that is an idea which is currently doing the NHS rounds.  First proposed (and rejected) at the British Medical Association conference last month, it’s being raised this week at the Royal College of Nurses conference.  No doubt it’ll be soundly rejected again, as nurses staunchly uphold the principle of free NHS treatment.   The arguments against it will cite discrimination against the poor, crowded Accident and Emergency departments, more red tape – all probably good reasons to reject the idea.

But there’s another basic flaw.  Just like Michael Gove’s policy on family holidays in term time, this idea will not target those it’s aimed at.  The patients with a mild cold will think it’s well worth a tenner and pay to see a GP in the same way that the truants still miss school.  But it will give those who probably really do need to see their doctor, another reason not to go.  Even for those of those think nothing of spending 4 quid on a latte, ten pounds is a lot of money which frankly we think we could use for other things, whether that’s a good decision or not.

Sit in any GP waiting room nowadays and you will find yourself surrounded by posters encouraging you to spend more time at the doctors not less.  Feel bloated?  It could be ovarian cancer – get it checked out.  Feeling thirsty all the time? It could be diabetes – go see your GP.   The fact that the NHS and various charities spend so much money on these campaigns suggests to me that far from us being a country full of whinging hypochondriacs who bother their GP with the slightest ailments, we’re actually much more likely to ignore potentially dangerous symptoms.

In November last year, I had what I thought was a bad cold, got very breathless, realised I was quite poorly but never quite got round to getting a GP appointment.  I was up to my ears in work, Christmas shopping, school concerts and just didn’t fit it in.  I coughed through the festive season, but then on 4th January was blue-lighted into hospital after collapsing with double pneumonia.  That’s my own stupid fault.     Of course I probably would have ended up in hospital anyway, but the experience did make me realise that I am one of those who will only get round to making an appointment when I really, really need one.   And I probably should make them more often, not less.  Charging me a tenner for the privilege won’t encourage me to do that, though it might make me sit there for longer with my GP and make sure I get my money’s worth.    For those who are really counting their pennies though and face a choice of going to the GP or paying for the school trip, this isn’t just a daft idea but a dangerous one.    Let’s stop talking about it.

A single room in hospital

 

Okay, let me first of all put you straight on a notion that I was once stupid enough to hold.   You might think that being allocated a single room in hospital,  i.e. a room to yourself, is good news.  In most cases, it’s really not.

I remember  being wheeled on a stretcher to my first single room.  ‘Never mind love.  At least you’ve got a single’ said a kindly porter.  Oh yes, I thought, how lucky.  Privacy.  No snorers. No other patient listening in on my so-called private conversations with my consultant.  All true.  All good.  But completely offset by the following.   Unless you are very,  very lucky, there are generally only two reasons why you might be given a single room in the NHS today.

1) You are deemed to be officially just too irritating for other patients to bear.   You can of course take advantage of this premise.  Find yourself in a mixed ward with a snorer on one side and an incessant talker on the other, then by all means have a go ….pretend you’re a nutter for a couple of days and you might just get moved (or sectioned).  But singing Kylie on a loop for 48 hours or taking off all your clothes every time a nurse comes in, can be a bit debillitating in itself.  And the staff aren’t daft.    Anyway watch out for the other patients if you decide to take this path.  We’re an unforgiving lot what with our confined space and bad food.  I once found myself in a single room opposite another single room whose occupant  had such issues.    At first I was sympathetic  to his shouts of Help every 3 seconds.  When it continued remorselessly for 24 hours, I was less sympathetic  and raging at the system that had put someone with drastic mental health issues in a room next to me.  When ‘Help’ turned into racist taunts of the staff, smearing his excrement on the food trolley, and throwing furniture into my room once a day, I lost all sympathy and am ashamed to admit I spent the days that followed planning a detailed operation to pass on my superbug by spitting into his water jug.  (Didn’t actually carry that one out).

2)  Single room in hospital equals superbug.  Most commonly MRSA or C Difficile (which I had).   OK so you might be vomiting for England but hey, at least you can do it in peace.  And you get to amuse yourself by watching the various means the staff come in and out of your room.  First we have what I call the Stormtrooper approach.    Masked, hooded, gloved – is there a nurse in there?   You watch the major dressing up operation just outside your door and wonder if you’ve actually got leprosy rather than a vomiting bug.    Then we have the Indiana Jones types.  Minimum apparel, a quick push on the handgel, and then before you have chance to say MRSA, somehow Indy has got across the room, retrieved your full bed pan and got it outside with barely any surfaces touched and  nothing more than a whipcrack of the plastic gloves.    And then sadly we still very occasionally get the parliamentary candidate approach.  Press the flesh as much as possible without thinking of the consequences and then sally forth into the next ward, without so much of a glance at the handgel, to press yet more flesh.   In my years in the NHS I thankfully see fewer of these types but they’re not extinct quite yet.

I’ve always felt quite isolated and vulnerable in a single room.  The reason you’re in hospital in the first place is because you’re pretty poorly and you need some attention.   In a single room, unless you’re in intensive care,  you will spend large swathes of the day alone, trying not to be a needy type and pressing the call bell too much.     If you’re on a ward with other people at least you can grab a nurse as she walks past, have a bit of conversation with the other beds, listen in to everyone else’s ward round consultation.    And the staff glance at you when they walk past, a quick check to make sure you’re ok.  I once spent three weeks in a single room.  I’d got into the habit at night of shutting the door so I could ignore my mad neighbour and sleep. Then they let me home for a night during which I had several seizures, fell out of bed and had to be blue lighted back to hospital.  My husband was there in the room with me.   Had I been on the ward in my single room, I’m not sure anyone would have found me until the next morning.

So when you’re sat on your bed, desperate for some privacy,  irritated by the woman in the next door bed,  fed up of sharing a loo …just be careful what you wish for.   A single room in hospital isn’t always worth a supplement.

Company at the Bed – the hospital visitor

Always a tricky one this.  We all want hospital visitors.  Let’s face it, if we’re so bored that we’re reduced to putting down Take a Break to watch someone empty the bin, then it’s pretty clear someone from the outside arriving to actually talk to us will be the high point of the day.  Or will it?

The problem with visitors unless they are your nearest and dearest, conversations run dry pretty quickly.  Here is a typical example:

Visitor:  Hi! You’re looking well (blatant lie).  How are you doing?

Patient: Oh not so bad (another blatant lie).

Visitor:  How did the test go/what did the doctor say/when will you be out?

There will then follow three minutes of conversation in which you draw out in great detail the one minute conversation you had with the doctor this morning.

Pause …….

Patient: So how are you?

Visitor: Oh fine, fine.

Patient: Any news?

Visitor: No not really.

Pause………

Right so now you’re at most six minutes into your visit and you have at least another 30 before your hospital visitor can reasonably leave, safe in the warm feeling that they’ve done their duty by coming in to cheer you up.

And then there’s the tricky issue of what they bring with them.  Because they want to bring something.  To arrive at a hospital visit without a gift is a bit like being invited to dinner and not bringing a bottle.  Except they can’t really turn up on the renal ward with a bottle of Sauvignon Blanc.  Flowers?  Well that used to be the easy option, but nowadays most wards don’t want them. They’re apparently a hygiene risk.  Along with a load of other hygiene risks that most people ignore of course …but frankly flowers are messy, require vases, drop petals …and when you’re ill any strong smells can tip you over a vomit inducing edge.  So no thanks to flowers.

Magazines?  Newspapers? Books?  Yes please. But be prepared, as a patient to see your hospital visitor in a whole new light.   You expected the Daily Mail, he brought the Guardian.  You thought you’d get Vogue, you got Chat magazine.  Their choice of what they bring you to read says something about them …or about what they think about you! No pressure then Visitors.

Food.  Ah yes.  Even worse. They won’t know what special diet you’re on.   So if you’re on low salt, they’ll bring crisps, low potassium you’ll get bananas and ‘I thought you’d be missing your skinny lattes’,  restricted fluids you’ll get a nice big bottle of lemonade to wink at you from your bedside cabinet.  With every visit your table piles higher and higher with forbidden food until the nurse comes over and tells you in no uncertain terms that if you don’t  sort your diet out, they’ll stop the IV insulin.  (*IT WASN’T MY FAULT.  SOMEONE BOUGHT IT ME!!!!*)

If you’re in for a particularly long spell, you may find your gifts get more and more imaginative (or bizarre).  I recently got a Lego campervan, two origami kits, a paint by numbers, and a Rubiks cube.  Think I may have been doing some moaning about being bored.     I didn’t finish any of them while I was actually on the ward ….but it did give us all something to talk about.

Expect many pauses.  Some will be extended while you both listen intently to what visitors to the next bed have to say.  And what the doctor said to them on the round.  And to see what gift they got.

And of course your visit ends with more blatant lies.

Patient: Good to see you

Visitor: You too.  I’ll tell everyone how well you’re looking.

Anyone got a funnel? The joy of providing a urine sample

Without wanting to put too fine a point on it, when us ladies have to provide a urine sample, it’s a tad more difficult to do so than for male patients. Put it this way, without a fair bit of limbering up, arm gymnastics and serious danger of an unpleasant splash zone, I have very little chance of hitting that specimen pot.   Luckily someone at some point had the bright idea of a specially shaped cardboard container to help. Made out of cardboard, small and triangular with a helpful handle and a pouring edge to get it into the bottle once you’ve done.    So far so good – except they’re like gold dust.  You can get the great big bedpan type ones, but getting your precious sample from one of them into a small sample jar without a funnel  is like trying to pour a large glass of red wine back into the bottle.  You’re heading for disaster and likely to end up with the urinary equivalent of a red stain on the carpet.   No, it’s the small ones we need but they seem to be in very short supply.   I once had an outpatients nurse look furtively around the department saying “Quick take that before anyone sees.  I’m not supposed to hand them out”.

Anyone know how much they cost? 3p? 4p? Surely not 10p? Tell you what, NHS, I’ll buy one off you.  It’ll save me getting wee on my best jumper.   How about a vending machine, strategically placed next to the loo? Or put them in as a free gift with Take a Break magazine?   Until this changes, women all over the land will continue to use kitchen bowls, saucepans,  flower vases , whatever comes to hand really.  Then we’ll watch silently in horror as our families make gravy in the measuring jug we last used in the bathroom.

Nurses as Angels (…and agency angels)

Now let’s get something quite clear from the start.  Nurses aren’t angels.  They used to be in the 1950s.  And  a bit later in those Sue Barton books.  You know the ones where Sue always tenaciously saved the day despite mean colleagues, a monster matron and an uninspiring love life.   And of course nurses are still sometimes angels in the tabloids, or occasionally angels of death if they’ve done something very wrong.  But in the main part they are actually human…and consequently have the same foibles and good or bad days as the rest of us. Some are cheery, some are grumpy, some are super efficient, some forgetful and disorganised, some are thoughtless, some can’t do enough for you.

The problem nurses (and us patients ) have though is all of these characteristics are magnified simply because of the job they do. When you are vulnerable, possibly at your lowest ebb in life, the actions and attitudes of the people around you can lift you out of despair or pin you firmly down at rock bottom.   Like many patients I’ve had both extremes.  I’ve had nurses talk over my head complaining about their shifts while they prepared me for a biopsy, not noticing I had tears pouring down my cheeks.  I’ve had nurses carelessly give me the wrong medication or ‘forget to give me lunch’.  I’ve heard nurses with strong accents shout at elderly patients just because the patient couldn’t understand what was being said.  But for each of those angels who failed to live up to even the smallest of expectations, I’ve met plenty whose humanity and thoughtfulness made my life in hospital much more bearable.

These days there’s alot more expected of our nurses too.  Most of us still think of them as people whose job is to hand out pills, make  good hospital bed corners with sheets and extremely  thin blankets and say “there there” when we need it.  They do all this of course but for some, nursing has become an extremely technical and specialist career.  I was blown away by the expertise of many of the nurses who looked after me during three weeks in intensive care.  I’d been extremely ill and on a ventilator for 5 days.  I had numerous issues, a rare immune system condition,  and many symptoms and blood results that were baffling the doctors.  Julie looked after me for several days after I had been brought out of sedation.  She did all the ‘normal’ nursing things for me, gave me bedpans, rolled me over to stop me getting bedsores, got me eating and drinking again.    But after a few days I realised she was doing so much more.    It was Julie who was really keeping across my condition minute by minute in the day, examining me and looking at blood results for any discrepancies.  It was Julie who was  constantly checking the many machines I was hooked up to, keeping them working and checking the readings.    It was Julie who would effectively kick off  the discussion during  the doctors round at my bedside, expertly summing up the latest results, sounding as if she was a consultant with many years experience.  And then when the doctors left she would gently offer to wash my hair to make me feel better.   She was an extraordinary human being  with what felt like encyclopaedic medical knowledge and an angelic touch.

And while we’re on the subject of angels, let’s not forget those who fly in from an agency.   Brought in often at the last minute to cover a shortfall in staff, some of them from outside the UK with not so perfect English.  Not got a great reputation outside hospitals – and I suspect  among permanent staff within hospitals.  I don’t buy it.  A good nurse is a good nurse.   The agency angels might not know the systems on the wards  or have been on the compulsory course run by the hospital trust to allow them to give you your pills, but they are just as capable of making you feel better or worse as a patient.  One of the best nurses I ever had was from an agency.   Rupinder had come on a night shift and found me sat up straight in my bed with an oxygen mask on.    I’d spent three long nights in that position, feeling unable to lie down to sleep because I couldn’t breathe.  My kidneys were not working as they should, I was bloated with many kilograms of excess fluid and when I lay down it felt as if the water would rush into my lungs drowning me.  I was scared and gasping for breath.   The nameless registrar at the end of the bed had looked at me quizzically and told me there was really nothing to worry about.   He prescribed me oxygen, and disappeared leaving me to spend yet another night bolt upright, awake listening to the beeps and snores around me.  Rupinder could have left me that way too.  Looking back, rather than there being a specific medical problem, I think I was probably experiencing panic attacks and she recognised that.  So instead of retiring to the nurses station like the rest of the staff when the lights went out,  she came back to my bed and got me up.  She took me out onto a fire escape and got me doing relaxation breathing exercises over and over again.  She did it the following night too, after which I lay down for the first time and slept.

And mostly it’s alot simpler than that.  Nurses- if you’re reading this, it’s a cliche but guess what , that cheery smile and a two minute chat does make a difference.  It’s like being singled out for attention by the most popular girl in class.  It makes us feel better.    And as a nurse, surely that has to be the main aim of your shift.  To help make us better.  We will be pathetically grateful to you when you do.