The system was slick and efficient. It had to be. Apart from
the regular arrival of ambulances, a steady stream of people came via other
means – on foot, in their own cars, in police vans. There were many more
arrivals than departures with the inevitable result that the place was full
when we arrived and it stayed full. Way beyond full really. They have shifts
but no hours of opening. It never closes. And there is no regular amnesty
period where people stop getting ill/beaten up/ hit by cars and so on, where it
could empty and start afresh. The miracle is that they keep piling people in,
keep the line moving, keep everyone scheduled and looked after. But they do. It
was pretty much a miracle to see this unending line of people treated medically,
but became almost surreal to see everyone treated politely and well; including
the heroine addicts climbing the walls, the confused and frightened who lashed
out and screamed and the drunks who groaned and moaned and wanted to roll off
their trolleys on to the floor. And also the majority who were content simply
to wait.
G’s trolley was parked by the magnetic whiteboard for a
couple of hours so we spent the time working out the system. At first glance it
looks low tech – magnetic cards, marker pens, handwritten lists on whiteboards,
but the lists were cross-referenced using various codes (we didn’t crack them
all) and no one gets forgotten. There was a computerised list, too, and
terminals and paper notes. Eventually we managed to work out when we were next
due for attention and what would be done. Another miracle: the listed actions
happened to time, sometimes up to 10 minutes early, then the cards would be
wiped and rewritten, the lists reordered.
Whoever designed the A&E Department with wide corridors
probably had something in mind, but I doubt it was deliberately done to allow
three trolleys to pass. I say that because if that had been the original aim,
the design would have been just a tiny bit wider. Nonetheless, this
full-to-overflowing world made good use of its wide corridors. Trolleys were parked
down either side and in every corner. And there was *just* enough room for
traffic down the middle. Waiting relatives had to cram into gaps to allow the
system to flow. No chairs of course. No room. After several hours standing I
hopped up on to the trolley with G. It got the weight off my feet and eased the
traffic flow, but I wondered if it might be contrary to the rules. It probably
should have been in terms of infection control but the place was so crammed
that it could hardly make a difference. Saying that, there was plenty of
hand-washing going on and alcohol rub everywhere.
We had been one of the ones who arrived by ‘other means’.
The surgery wanted to send G by ambulance as an emergency, but G who had only
gone there because his shoulder injury was playing up, could not be convinced
he was ill. Of course, this wasn’t the first time he’d called into the surgery
for something routine and been carted off by ambulance. It was the fourth. On
all the other occasions he’d turned out to be OK after a night in hospital and
he got stubborn. Even the fact of the mega-aspirin having magically cured the
pain wouldn’t convince him. He felt a bit of self-medication (Guinness in the
Queens) would sort him out.
In the end, he agreed to go to A&E but not in an
ambulance. So I drove him and had strict instructions to drive right into the
ambulance bay and to register him as an emergency. [I did. I was convinced I’d
get clamped, but didn’t]
Then began the long and interesting journey through the NHS
system. He was triaged and given stabilising treatment more or less straight
away. Fairly quickly after that we were allocated to the Acute Assessment Unit
for an overnight stay, but remained in A&E awaiting a bed. As it turned
out, all the overnight obs were done in A&E because the bed didn’t become
available until nearly midday the next day. The intensity of the unit was
unbelievable. 12 hour shifts at this work rate must simply fly by and at the
same time must be incredibly stressful and draining. But there’s a system to it
that keeps it running smoothly, that keeps managing the impossible, and (despite
all the recent bad press) does it all in a caring and good-natured way. No lack
of compassion here, but I wonder how people interpret what they see.
There’s the guy who keeps shouting out at random; the other
one curled up on his trolley. The nurses and medics bustle past, back and
forth, no eye contact other than with each other. A beeline to the specific
patient who is next on the list for treatment. Ostensibly they pay no attention
to anyone else. On the face of it, it seems a little cold. What’s the harm in a
reassuring smile or quick word on the way past? A couple of hours close
observation (not a lot else to do whilst perched on the end of a trolley) and
the potential harm became clear. With so many patients and more arriving all
the time, 5 seconds, even 2 seconds, paying attention to those who wanted the quick
word or reassuring smile would very quickly add up. There are only 30 lots of
2-seconds in a minute; many more than 30 patients crammed in. Lose a minute on
every trip down a corridor and the system will soon snarl up; obs won’t be done
to time, things will be missed. And the lack of attention turned out not to be
that at all. One patient twisted on his trolley and let out a low groan (of the
sort that I would have expected to be drowned in the racket) but there was
something about the sound or the movement that signalled ‘could be serious’ and
had a nurse there in a second.
The only thing they didn’t provide for G that might have
helped him was sleep, but no one there had the power to make extra beds and
extra staff appear. That’s in the politicians’ hands. I’m sure many politicians
are honest and hard-working. I know some personally who certainly are. They
didn’t all fiddle their expenses and they don’t all carp about working long
hours, but sitting in the midst of this chaos, seeing the NHS distinguish
serious from trivial, save lives, move people through the system smoothly and
humanely as far as they could with the tools they’re given, I couldn’t help
thinking that it’s the politicians who need to learn something from the NHS and
not the other way round.
The Acute Assessment Unit was quieter, but still pretty
chaotic, trolleys arriving, people being hustled back and forth. By the time G
was allocated a bed, it was the following day, he had been told he was being
sent to a different hospital and in fact already had a bed allocated there. All
he was waiting for was an ambulance. He
was reluctant to spend any time on the newly allocated bed. He felt it was a
waste of the clean bedding and that he might as well sit in the waiting room
with me.
The nurse was tenaciously insistent and got him into bed.
She was also amazingly good-natured with everyone whilst keeping them all to
their routine. G wasn’t the only absconder. One of the others was a confused
patient who wasn’t properly ambulant. I started out agreeing it was a shame to
waste the bedding when we wouldn’t be there for long, but again it soon became
clear why G should be with his bed.
The only way the system can work when it’s so overstretched
is to have processes and procedures and stick to them. Betty Macdonald put it
well in The Plague and I when she described the rigid routines at the Pines
Clinic. It’s the only way to keep an overstretched system working. The big
difference was that at the Pines in 1930s America the nurses were instructed to
be cold, clinical and unsmiling. Here they were quite the opposite, but equally
strict and for good reasons.
The cardiology ward at the new hospital was like a different
planet. A good-sized room with its own phone, TV and bathroom. Not only one
patient per bed, but one bed per allocated space for a bed (as opposed to one
bed and several trolleys). In a way it was like being in a peaceful sunny
meadow, with small groups of people dotted sparsely about the grass enjoying
the peace and quiet. And towering above the meadow a huge dam, a great mass of
people waiting to burst through. A&E was the mass behind the dam. AAU was
the overflow. The cardiology ward was the meadow.
The analogy broke down a little on the peace and quiet
front. The 5-legged obs machines beeped and screeched their way up and down the
ward like busy little robots. Blood pressure and so on was taken every couple
of hours night and day, so sleep was periods of dozing off and being woken. G
was alarmed one night to be woken by a doctor who put a stop-tap in his arm. There’s
probably a medical term for it, but G used the plumbing equivalent. Later that
same night he became aware of activity down by his side and opened his eyes to
see a nurse with a torch, who said not to worry, she was just changing his
battery. He had to puzzle himself to full wakefulness to realise it was the
battery on the mobile ECG machine that he was attached to throughout his stay.
He was allocated to the surgeons after 3 days but then
delayed a few hours by the arrival of 2 emergencies. The medics arrived in
teams and interrogated him on every aspect until they had the story straight
and could make it fit with the observations charts. There was an air of quiet
confidence and competence about every aspect that was very reassuring. We knew
it was considered an A-team in terms of cardiac care and it showed.
If we’d been private patients in a private hospital, what
would have been different? Maybe none of that scrum to start with, except that
there’s no such a thing as private A&E because there’s no way to make it
pay in the narrow way that defines profit. And anyway, within that scrum was
the medical expertise we needed. And it’s hard to imagine a private hospital
being much better appointed than the one where we ended up, though I guess
there might have been flowers and carpets; maybe the TV would have come for
free; the car-park might have been big enough. But there wouldn’t have been the
medical expertise on tap. It’s the
medical care that costs a lot of money. We might have had earlier treatment but
if anything had gone wrong, the specialists would not have been on hand because
when money’s the only focus, you don’t keep expensive expertise hanging around,
you buy it in parcels for specific purposes. It’s why private complications end
up in the NHS.
That stretched-to-the-limit feeling was always there. G’s
bed was being readied for the next patient almost as soon as he’d been wheeled
down for treatment. And after a night on the close observation ward, he was up
and in the day room at 7.30 AM so someone else could have his bed, though we
didn’t get to leave until the afternoon because someone needed to find the time
to bring new medication and a discharge form – which are things that can easily
and understandably be knocked down the priority list. But we were offered tea,
coffee, snacks and lunch while we waited and we had a stack of DVDs. We watched
French & Saunders and Porridge.
On the way home, we stopped for a wander round the shops in
Cottingham because G was desperate for some fresh air. Then home and a lot of
sleep to catch up on. There are many ways to get from our house to the
hospital. We’re one side of the city and it’s the other. The shortest route
isn’t the quickest in the rush hour and there are several longest routes that
are sometimes quicker, but they all converge to cross the railway at some point.
I was late a few times, often caught at the level crossing, and twice by taking
wrong turns. It’s a route I know well but a bit of inattention can go a long way. One time I headed for the
wrong hospital. That put half an hour on the journey. Another time I simply
took a wrong turning, thought I was further along the way than I was so turned
left and found myself in a narrow winding unfamiliar road with a large vehicle
close behind and no obvious place to turn for an annoyingly long way.
The car windscreen now has frilly edges where all the car
park tickets flutter side by side. I should have removed them instead of just
adding more every day, but somehow I didn’t. Apart from the large one that
appeared on the outside admonishing me for parking on the grass. Sorry about
that. It pained me to leave tyre tracks on such a wonderful hospital, but there
wasn’t a spare inch anywhere else to put the car.
Where are the photos? I took one. G thought it would be nice
to have a record of him looking cheerful to show the family as reassurance. But
despite the fact that he was by then relaxed and feeling fine, none of that came
across. In the photo he looked ghastly, wires and machinery everywhere,
battered and bruised. We decided not to scare anyone so no photos on this blog.
