Tag Archives: nhs

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)

 

 

 

 

 

 

 

 

 

Thoughts of mortality at the kitchen sink

I always thought the hardest thing about getting older would be having to confront your own mortality. Turns out I was wrong. It’s confronting the mortality of those around you that causes the dagger to your heart.

You’re forced to confront death in hospital. Sometimes it’s a conversation you overhear about making the woman in the next bed ‘comfortable’. Sometimes you’re still there, in the next bed, when she dies and the nurse suggests ‘You might want to go to the day room for a bit while we sort things out.’

It’s upsetting when these things happen..but strangely it’s mostly because you feel you know her family. You’ve never really spoken to them of course, just the occasional ‘Are you using that chair?’ conversation. But you’ve seen them, every day for three or four weeks, coming in, straightening mums’ bedclothes or changing her nightie, hushed conversations as she sleeps, disappearing from the ward for a half hour and returning with red eyes. They don’t notice you but you know them. And you grieve quietly for them – and her – when she goes.

Somehow the thought of my own death gets easier the more time I spend in hospital and the older I get. In intensive care this year, under sedation for five days, I slipped in and out of consciousness, vaguely aware that I was close to death. I found in that moment that I was quite at peace with the idea. I remember thinking ‘Well 45 years wasn’t as quite long as I’d have liked….but it’s been a really good 45 years. So be it.’

I certainly didn’t rail against it. I was very happy to go gently into that good night. And yet, when confronted with the idea that someone close to me could die, my heart falters, my stomach turns over, my head tries desperately to think of something else. And the terrible thought of how those closest to me would feel if I did die, is enough to have me fighting with every breath to survive.

In my teens and twenties I used to look at ‘old people’ and wonder how they could bear the idea of death. The nothingness that awaits. I used to imagine them screaming inside, violently struggling internally against the inevitable while placidly doing the washing up. Either that, or they’d filled their lives with so many distractions, a hundred to-do lists, that they’d forgotten the brutal truth of what awaited them. But as I stand here, with my hands in the kitchen sink, when I allow my mind to wander away from life’s distractions, I know the real dagger that awaits is in losing those I love, not in losing life itself.

It would be so much easier if we lived a life alone wouldn’t it? Except with no one else to worry about, I suspect we would indeed be obsessed with our own mortality.

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.

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.

 

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.