Hospitals and Budgets

It’s 23:29 on Sunday, after a weekend of eventfulness. At 20:05 yesterday, Grete got some chest pains, pretty severe and sudden. We gave it a few minutes, and after they weren’t getting any better called an Ambulance. The ambulance team were fine, arrived quickly and calmed Grete down, took some ECG’s and other measurements and suggested it was probably pretty bad but non-fatal acid reflux.

I’d already packed a bag of stuff after calling them, had the cat in, everything locked. After about 40 minutes it looked like we weren’t going anywhere, but then the pain flared up again and quite rightly the ambulance team weren’t prepared to leave it at that. At 21:25 we arrived at the QMC.

I like the NHS, I think I’ve said it before, and I sympathise with their situation of massive underfunding, massive overspending on stupid stuff imposed by their structure and the general complexity of running and funding an organisation their size.

But that sympathy vanishes when I’m on the receiving end of their under-staffing and lack of involvement of the patient in their activity.

It turns into anger when it’s my wife on the receiving end.

We waited in the initial A&E area, with nurses (excuse my lack of NHS knowledge, anyone who isn’t a doctor or a porter is a nurse) wandering by, the ambulance guy with all the paper work just standing with us. Grete on a stretcher in pain. Me looking dumb. No one seemed to have a process for ID’ing new arrivals or starting the process of getting people looked at. Eventually a nurse asked, in passing to our Ambulance guy, has anyone done ob’s (observations) on your patient? He said no, so she looked over the sheet he had, and said ok I’ll do some, he asked her to sign so he could hand the patient over, and she agreed after checking she was allowed to.

So she signed, and our Ambulance guy headed off, it was around 21:50 by now. Why is the process for getting signed in so random? I can’t believe it’s intended to be ‘just turn up and stand around and hope someone who passes by says hello’. Anyway, she read the sheet, took some obs and rolled us into a cubicle. Chest pain sets off about a thousand alerts in the NHS, so I’m sure we got seen quicker than most people in A&E. Another nurse came in to get some blood samples. It’s a small thing, but the difference between, “Hi, I’m here to get some blood” and “Hi, I’m here to get some standard blood samples, we do them as standard for everyone who comes in with chest pain, nothing to worry about”. We got the former, I asked why, she gave us the second response. I know they’re busy, understaffed and short of time, but people need the second, it’ll help them get better quicker. The first nurse came back and did another full ECG (or that may have been before the blood tests, I’m a bit unsure).

We sat around for a bit more, waiting for a doctor to review the obs and check Grete out. Not enough doctors in A&E. Plenty of nurses, all busy, but not enough doctors. I’m sure if they had more doctors it may not help because there’s no where to ship all the patients to anyway, but it would probably increase the throughput for those patients who don’t need moving on to another ward.

Eventually the doctor came to see Grete, she was nice, explained everything she was doing. She listened, took more obs and concluded that the measurements suggested it wasn’t anything heart related, but all the symptoms Grete described suggested it was. They’re advised to treat the patient not the readings so she suggested an overnight stay. There’s a blood test they do 12 hours after heart-trouble which reveals if the heart released any chemicals indicating heart trouble. She suggested a chest x-ray and then left.

We got moved down to x-ray, pretty quickly, they did the job and sent us back to A&E. And this is where it gets really frustrating. It’s about 1am now. The whole process has taken 3 and a half hours. Most of that spent waiting for the doctor, getting more obs, etc.

So we’re now standing in A&E, Grete on a stretcher, me standing. She’s still in a little pain and now getting uncomfortable (from 9pm to 1am on a stretcher). She needs the loo, but we’re not sure what’s happening, if she gets up and goes, will they try to move her while she’s not there, etc., etc. Finally I grab a nurse and ask, she says “just waiting to move you to the ward, go to the loo, no problem”. So, we head to the loo and back. And wait some more. Eventually I ask another nurse, 2am or so by now. Grete is marked as discharged on their chart (i.e. discharged from A&E). So he scurries around for a bit to find out why we’re still here. The first nurse comes over, agitated now and says ‘yes yes, we’re just moving you now’. She wheels us to the AMU (acute medical unit).

You know, myself and Grete are the patients, we didn’t ask to be ill, we didn’t ask to be in hospital, we didn’t ask to be admitted, we didn’t ask to need treatment. We’re being admitted because the doctor thinks it’s necessary, because of an illness we had no control over. We get wheeled into the AMU, it’s a small ward, about 8 treatment rooms, it’s darkish. Most of the people already here have been our neighbours from the A&E. Our nurse wheels us into a little cubicle and then hands the paperwork over to a stressed colleague behind the desk. There’s no chair in the cubicle, Grete’s oxygen which she’s been told to use has run out, the AMU is behind a locked door, and the nurse has told us nothing.

No idea how long we’ll be there, what ‘being there’ entails, how I get in or out, if there is a chair I can use, where the loo’s are, nothing. So I stand at the desk, while she and her colleague discuss how busy they are, and how it’s a crazy night. They ignore me. Eventually they stop, our nurse leaves. The colleague continues going through the paperwork, ignoring me. I’m pretty agitated now. I ask, in agitated tones, “Excuse me, can you tell me why we’re here, how we get in or out, if there are any spare chairs, you know, include us actually in the process”. She’s obviously pissed off by my need to know what’s going on, blurts out something about just finding a spare chair (which means going into occupied cubicles and taking chairs), explains the method of getting in and out (ask the receptionist, buzz back in) – reception is around the corner, not visible from where we were, and no signposted. I mention the oxygen, she looks hassled.

She comes over and sticks the heart rate monitor on Grete’s finger ‘to see if she still needs to use the oxygen’ and then wanders off, to spend 10 minutes talking to another nurse in the room about how busy they are. Grete is dozing at this stage, and it’s about 2:30am. I take the heart rate monitor off her finger since it’s restricted her movement. Finally the nurse remembers what she was doing and comes back, sighing that I’d removed the monitor and puts it back on for 40 seconds, announcing that she doesn’t need the oxygen since her heart rate is fine.

I settle Grete and try and find the loos and a drink of water. The water machine in the AMU is out of order, after walking most of the floor in the QMC trying to find some free water, I fail so I head back, buzz in and ask the receptionist. She points at the out of order water dispenser and then notices it. “All the taps are drinking water”, she advises. I wait, and then ask “so do you have any cups”, she sighs and goes to get me a plastic cup. It’s not her fault the water dispenser is out of water and cups, but neither is it mine. She has cash and access to the staff facilities, I have no money on me, no idea where anything is, a wife who may be having heart trouble and wants some water. I’m sorry, it’s not good enough to sigh and make me feel like it’s my fault or too much trouble.

Other people in the AMU are confused, several people ask the same questions I did when they get abandoned by their nurse. A couple ask if their daughter can have a blanket ‘why, is she cold?’ asks the nurse. Who cares! Get the girl a blanket! Other requests for pillows and water follow, and the nurses look more and more stressed. I’m sorry they’re under staffed, really I am, but the people in the room are scared, lost, ill and need taking care of for which the national health service is responsible!

More time passes, I’m vaguely aware we’re waiting for a move to the final ward. Another new nurse comes and takes regular measurements from Grete, BP, heart rate, etc. It’s around 3am now. We’re both trying to doze. She’s stuck in an uncomfortable stretcher, and I’m stuck on a horrific plastic chair. It’s too warm in the AMU.

At 4:30, they come to move us to the ward. It’s about 100 feet away in the same section. Grete finally gets a bed, I finally get a chair which is padded. It’s getting light outside. We stayed because we wanted the blood test, because although we both feel Grete is ok, we want the final all clear on the heart result. But the stress of being a patient is almost worse. I understand they want to make sure Grete is ok, but they’re making her more sick than if they’d sent her home and sent the results to the GP.

We have to ask for painkillers at some point between 3am and 4:30am because her back is sore from the stretcher. The nurse at least doesn’t seem to blame us for that, and brings them without complaint.

Anyway, time passes, we both doze, at about 6:30am the ward is woken up by the tea lady offering drinks. Grete gets a coffee, we doze a bit more. At around 7:30am they take the blood test, the nurse is efficient although we’re both so sleepy we’re really not aware of much. The day-nurses seem less stressed, one of them takes the time to explain that the doctors usually come around between 8am and 9am, and that she’ll review the blood test and see how things are. I doubt the results will be back by 9am, but we nod, and she wanders off. At around 7:45am they come to change all the bed sheets, I take the chance while Grete is resting in the chair to go and find some food.

I get back around 8:10am, Grete gets offered some toast and the doctor(s) arrive at 8:30. The rest results aren’t back, how silly, but the doctor is virtually convinced it’s acid reflux, the chest xray is clear, now they just need the results and they can discharge us. We asked a nurse how long it’s likely to be, and she gets defensive, “It’s Sunday these things can take a while …. etc.”, I explain we’re just trying to get a rough idea so that we don’t need to sit on the hot ward, we can go for a walk, let Grete have her first cigarette in 12 hours, get a drink and some food etc.

She doesn’t know, at least 2 hours. We spend an hour or so wandering the QMC, getting some fresh air. Grete’s a lot better, no pain although her chest is tender (probably from all the prodding). We get back to the ward at around 10am. At around 10:30am the nurse says the results are back and clear, and a doctor is just writing a note for the GP. We’re relieved. Another few minutes pass and a doctor comes over to tell us the same thing. After a while, the nurse comes back and tells us again.

I make a joke to Grete about how they ignore us for 11 hours but now they’re all telling us stuff and she makes the connection, it’s good news, everyone wants to bring good news.

Eventually at 11am they sign us out, remove the stuff from Grete’s arm, and send us on our way. We walk outside and straight into a cab, get home about 11:30am.

It’s been a surreal weekend. And it’s confirmed one of the things that I feel is weird about the NHS, although I can probably understand it. The ambulance crew said acid reflux. The nurse said acid reflux. The doctor said acid reflux but too risky to let you go home. Then 8 hours pass where you receive no treatment. The new doctor said, acid reflux lets make sure with the blood test results. The blood test results say acid reflux.

No one during the process had the confidence to say ‘it’s acid reflux, go home, if it gets worse, or comes on again, come back or see your emergency GP’.

I understand why, I’m not griping about making sure, staying to find out for definite, but when staying to find out makes you feel like it’s your fault the NHS is busy or short staffed, then resentment builds.

If YOU tell me I need to stay, then YOU should take care of me during that process.

Some of the NHS issues can be solved by throwing money at them. I’m sorry that the NHS is so big and inefficient but more staff, more beds and more buildings would mean you could treat more people during the A&E process. Two doctors instead of one would have doubled the rate cases would have been seen, although whether there were any beds to send them to is another question.

Finally, seeing policemen wearing stab-proof vests in the A&E room is a sad sight. But it’s not as scary as wandering the QMC at 3am, wandering into staff restricted rooms (mostly tea making facilities) and not being questioned by one person, and not seeing one person related to security.

I suggest that,

1. as soon as you move into A&E someone takes your details, gives you wrist tags (to patient and family) and gives you a number so you know when you’re going to be seen and free’s up the ambulance crew.
2. every single location after reception is behind a set of access restricted doors.
3. the NHS should employ more staff
4. the staff should try and remember, hard as it may be, that their patients don’t choose to be there on the whole, and they and their family are probably scared and tired.