Category Archives: NHS Staff

When an NHS relationship ends

Oh how sad it is when a relationship ends.  The pain of losing that one person who understands you more than anyone else.     No more chats as you lie in bed.  No-one around who you really trust as much as you trusted him.   Having to start a new relationship with someone else who might not prove to be as reliable, or thoughtful .

I have lost my consultant.   And I am grieving.

It sounds daft doesn’t it?  But for us NHS patients, having a long term  relationship with a doctor who we really trust makes a  difference.   I met my consultant  11 years ago.  I’d spent 2 or 3 years being passed around the NHS, short term dates with doctors who knew very little about my immune system problem and often couldn’t even remember my name.   I remember hearing his voice for the first time outside my  room, telling a cluster of junior doctors about my condition.   ‘This might actually be someone who can help’, I thought.

And he did.  I’d been warned to have no more children, but he said I could.   I’d been told there was nothing that could be done to stop the damage to my kidneys, but he said there was.  I’d been left with no hope but he gave me bundles of it.

Over the past decade, he has fought to get me the best,  and often very expensive,  treatment.  He has rushed me into hospital on a few occasions, insisted I got a bed on the right ward.   He’s overridden hospital procedure when it’s not in my best interests.   He’s been blunt with me about the future when I’ve been scared about new therapies. He’s given me his mobile for whenever  I needed to talk directly to him ( I’ve used it twice in 10 years).  He’s been the only person in a long line of medics who asked me how I felt emotionally after being put under sedation for five days in intensive care.  Without doubt he has saved my life on a couple of occasions, and without him my cheeky, lovely 9 year old son would not be here.

And now he’s gone.    And unlike most normal break-ups, I’m given no warning and no reasons.  I turn up to clinic a few times and he’s not there.  I ask and I am told that he’s taking leave, and then it’s extended leave, and then it’s ‘no we don’t think he’s coming back’.

It has to be this way of course.  Anyone is free to move jobs, retire, take a break.    You can’t have patients knowing about a doctor’s personal life.  It’s just not appropriate for anyone in the NHS to tell me why he’s no longer my doctor.  I completely understand and accept that.

But I am bereft.  And worried about him and his sudden departure.  I hope he is well.  I can’t even write him a note to thank him.  To point out to him the immeasurable effect he has had on our family.

Instead, somewhat wearily, I start the search for a new relationship.

Careless Words

I have an amazing friend.  After years of struggling with alcohol, she’s managed through a great deal of pain and endurance, and a little help from AA, to stay off the booze for 4 years.  She pointed this out to her GP recently.  His response? “Good .  Now you need to lose some weight.”

Another friend tells a tale of talking to a doctor about fibroids.  They discussed whether it could affect her fertility.  On finding out she was 35, the doctor said, “Well, what have you been waiting for? You need to get on with it.” She promptly burst into tears.

I can tell a couple of stories too.  The time a midwife gave me an injection just before I was due to have a D and C to remove my miscarried baby.  ‘Injection done.  That’s the worst over with.” Really?  The time a doctor berated me for putting on weight before realising I’d been on a large dose of steroids for six months.  The time a consultant who’d never met me before insisted I was facing the rest of my life on dialysis.  He was wrong.

Everyone can put their foot in it now and then.  I’ve dropped some right clangers in my time.  But I think working with patients requires an extra effort in choosing the words you use.

I have another story of a junior doctor, who came across me in tears after I’d received bad news.  “Fiona,” he said.  “This time will pass.”  He was right, and like the ill chosen words above,  those 4 words he uttered have stuck with me and helped me through the darkest of times.

Dear NHS staff.  Us patients are really vulnerable.  We’re often at one of the most difficult points in our lives.  Our conversations with you are about intensely personal subjects.   We’ve waited for hours for the doctors round on the ward.  Or months for the outpatient appointment.  You are the person who we think can cure us.  Or who we trust to care for us when we can’t care for ourselves.  We hang on your every word and analyse them after you’ve gone.

Careless words might not cost lives, but they can cost peace of mind.   And a loss of confidence in those who are treating us.   But well chosen words can bring hope too.  Remember that when you talk to us , and remember that your words will stay with us long, long after you’ve moved onto the next patient.

 

 

A visit from St NHS

‘Twas the night before Christmas, when all through the ward,

Not a patient was sleeping, just one who snored,

The charts were hung on the bed end with care,

In the hope a consultant soon would be there,

We shivered cold under thin blankets in bed

While visions of warm toast danced in our head

One overworked nurse and a health care assistant

Ran ragged while machines beeped with relentless persistence,

I lay in bed wondering if sleep would arrive

The night stretched ahead, so hard staying alive

When out in the car park there arose such a clatter

I sprang from my bed to see what was the matter

Away to the window I flew in my gown

Gaping cotton, bare back, with loose ties hanging down

When what to my wondering eyes did appear

But a tinsel-clad ambulance with lights blue and clear

With a little old doctor so lively and quick

I thought for a moment he must be St Nick,

But with a voice full of cheer he did loudly proclaim

‘Santa’s old hat.    St NHS is my name!’

Then with garb crisp and bright as the new fallen snow

His troops from the sky he did call to come low

‘Now Doctors! Now nurses! Now healthcare assistants!

Come cleaners. Come caterers.  Give your commitment!

To the ward! To the ward! Give it your all!’

And with that,  they all flew right through the wall.

And then, in a twinkling, I heard by the stair

A clumping of boots; St NHS was there.

He was dressed all in white from his head to his foot

With a stethoscope hanging down from his hood

A bundle of pills he had flung on his back

A thousand new treatments peeping out of his sack

His eyes – how they twinkled! His dimples how merry

A hundred clear drip tubes tied round his belly

A glistening syringe he held tight in his hand

To pump us with painkillers if we’d so demand

He spoke not a word but went straight to the job

His troops filled the ward, armed with pillow and swab

They tended, they cleaned, the doctors knew all our names

The toast on the trolley was warm when it came

Three pillows appeared at each of our heads

A duvet was laid with care on the bed

In a flash waiting lists were a thing of the past

And the dirt in the washroom was cleaned up at last

Even the ward nutters stopped shouting their ills

And for once everyone in there got the right pills

We all had our own nurse, firm but kind as can be

The TVs were working, the car park was free.

And then with a nod, and a burst of hand gel

He was off with naught but a short farewell

His blue lights flashing and tinsel glistening

Patients asleep, just me still listening

And I heard him exclaim ‘ere he drove out of sight

“Happy Christmas to all, and to all a good night”

 

 

With a little help from Clement Clarke Moore (1779-1863)

 

 

 

 

 

 

 

 

 

It’s time to talk about the NHS

So ’tis the season when those who run our country fight over the NHS. Like a girl ignored all year by the good looking boys, she is suddenly surrounded by suitors offering to take her to the prom. ‘I care about you more than him,’ ‘No I’ve always cared about you!’ ‘I care more! He hasn’t got enough money to look after you anyway!’

As patients it’s almost impossible for us to make sense of what’s on offer. GPs available seven days a week versus a guaranteed GP appointment within 48 hours? Erm.  I’ll have both please.  £400million versus £2.5billion?  Oh I’ll go for the £2.5billion  please….. but hold on a minute, where is the money coming from?

We look helplessly from one offer to the next while those really in the know warn us that none of these plans will stop the crisis we’re heading towards.   The NHS in her too-tight dress and faded corsage is looking for a hero to fly in and rescue her.   She needs radical action, a combined effort by all her suitors and some new shoes so she can dance all night.

She’s probably not going to get it. As much as the politicians try, they are bound by us.  Patients on the one hand, tax-payers on the other.  We all want a wonderful NHS, we’re not all willing to pay for it.

But at least we are giving the old girl in the corner some attention and that has to be good.   Maybe, just maybe, we could turn things around for her. She is still well loved, trusted and utterly brilliant to most of us on most days.  We don’t want to lose her.   Maybe a fierce election debate is just what she needs.  A national debate where all of us, patients, policy makers and staff demand more for the NHS.  One where we agonise over choices while being inspired by new ideas.   It shouldn’t be about party colours.  It should be about keeping the NHS at the party.  Bring it on.

Dr Who (or the Physician Associate)

One of the things I’ve always found confusing in hospital is trying to work out who’s who. Is the person taking my blood pressure a nurse? If he or she is the same person who makes my bed, then possibly not. Is the person making decisions on my care a consultant with many years experience or a registrar who has only just stopped being a student, possibly more knowledgeable about Minecraft than medication?

Well now the government plans to confuse us patients even more with what they are calling ‘ a new class of medic’.  The Physician Associate.  A sort of Doctor’s Assistant if you like,  with fewer time travelling duties than Sarah Jane ,Rose or Clara, but with the responsibility of examining us, deciding on our treatment and admitting and discharging us from hospital.  Sitting somewhere in the hierarchy between nurses and doctors, the Physician Associate will be a science graduate with two years intensive training. They won’t be able to prescribe drugs.

Inevitably my initial reaction to this, along with most of the other patient groups, is one akin to Clara when she sees her doctor change from a youthful Matt Smith to a grizzly Peter Capaldi.  I want a real doctor please.  With seven years training, a stethoscope and notches in his or her belt of complicated cases.  And while you’re on my case, NHS, can I also have a proper nurse to take my blood pressure, an eagle-eyed cleaner with obsessive qualities, and a Michelin starred chef to make my toast?

Ah. My Utopian NHS. We all know the NHS hasn’t got enough money and unless we fancy paying a load more taxes, that isn’t going to change. It doesn’t mean we shouldn’t all be entitled to see a doctor when we need to of course. Mark Porter, chairman of the British Medical council,  is right when he says these posts cannot replace doctors. They can ease the burden though, so that when we do need to see one, they are able to give us their full attention for more than a couple of minutes.

But it is absolutely vital that we patients are completely clear about exactly WHO is standing at the end of our bed, something which is a tad hit and miss at present. Then, if we’re not happy with the level of experience of our Physician Associate,  we can ask to see a real doctor.

So NHS, here’s what I propose. For a start make everyone wear a name badge with their rank on it. No, I mean really make them. It seems to me it’s a rule followed by some nurses and healthcare workers but not all, and virtually no doctors. Make it a disciplinary issue if they don’t. Us patients need to know who they are.
Then in every ward put up a notice explaining the different levels of experience that different staff have. That’s right – there’s plenty of space between the Clean your Hands posters and the leaflet telling us your survey showed everyone was happy with the food. And when you do it bear in mind barely anyone outside the Health service knows what a registrar or a house officer is. And don’t kid yourself in thinking that we can tell who someone is by what they wear. Thats a sort of NHS secret code that us patients generally can’t decipher. Frankly a white coat can mean the person is a doctor, a pharmacist, a dietician, a physio, a student nurse, an agency nurse or that science kid from Cloudy with a Chance of Meatballs. How are we supposed to know?

So by all means bring in your Doctor’s Assistant. The physician associate might be able to get on with some of the routine stuff leaving my doc to scratch her head over complicated issues. Just make sure I know who I’m dealing with. More Dr Know please. Less Dr Who.

 

Sleep in hospital

Sleep.  The great healer. The time when our bodies recharge and mend themselves.  Without it we quickly feel poorly.  Scientists have linked lack of sleep to, among other things, diabetes, obesity, and even speeding cancer growth.  It is without doubt a great natural cure for our ailments and the reason our doctors, and our mothers, tell us to ‘Get a good night’s sleep.  You’ll feel better in the morning.”

Why then does the NHS put so little value on it?

It’s a recognised fact among us patients that we won’t get much sleep in hospital.  The staff from consultants to porters seem to recognise that too.  The cause is generally put down to other patients, snoring, the crazy ones who shout all night, those who simply weep, loudly.

But as much as other patients do sometimes keep me awake, without doubt, it’s more often the hospital staff and procedures that leave me tossing and turning in frustration at 3am.

Let’s talk about last night.  Lights off about 11pm.  I’d shoved in my headphones to drown out the sound of the two elderly, confused ladies alternately crying for help and ranting at the poor care worker on shift.   Then I’d managed to drop off to sleep.  Until, at 11.58pm,  I heard a voice. “Fiona.  Sorry love but can you wake up?  We need to move you to another ward.  Can you get up and pack please? The porter will be here in a few minutes.”   I travelled down some cold corridors, porter commiserating with me, (“It’s not bloody fair love, they shouldn’t move you at this time”), and probably woke everyone else on the new ward as I clumsily tried to unpack in the dark.  I was not surprisingly then a tad unrelaxed and didn’t manage to get to sleep until about 4.30am.  And of course they woke me at 6.30am to take my blood pressure.

Now if this was a rare occurrence I’d accept it as inevitable in a busy  hospital that has to admit patients through A and E in the middle of the night.  But in some wards, in some trusts, it seems to be an  acceptable, common way of behaving.  The night before last I’d been woken from my slumber by first one patient moving out at 2am and another moving on half an hour later.

And it’s not just the procedures but sometimes the staff themselves. There are those who seem to understand that it is in fact nighttime, who get on with the stuff they have to do but at a lower decibel level than they’d use during the day.  But there are many who carry on as if it’s the middle of the afternoon, switching bright lights on, talking in hearty, loud voices, waking us all up to ask a patient a few questions which could perhaps wait a few hours until morning.

So, NHS, here’s what I propose.  Let’s introduce sleep-protected time zones in the same way we have protected times for meals.  A period between midnight and 7am when everyone talks in whispers, lights are dimmed and no-one should have to move beds.  Of course there will be times when these rules will have to be broken for essential medical care.  Most patients would recognise that.   But if it’s not essential, let’s keep the ward quiet and dark so we can get a few hours uninterrupted kip.   We’re ill for goodness sake.  We need our sleep.

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.

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.