Some of what follows looks like melodrama – I can assure you that it is not.
The perceptive among you will have seen that I’ve been in hospital recently. Arrowe Park Hospital, Wirral or, to give it its full, ticked-all-the-boxes name, Wirral University Teaching Hospital NHS Foundation Trust. Shame we don’t have a Wirral University, but there you go…
It all started in the early hours of Thursday, 20th, when I woke up feeling as if I’d been shot in the left-hand, back ribs. Fuzzily, I put it down to a sudden cramp from sleeping awkwardly, but by morning I was in agonising pain in my left lung, which appeared to have almost no capacity at all. I was breathing very fast and very shallow – faster, in fact, than my heart was beating, just to get enough air to remain conscious, and that was touch and go.
I got up, fired up my PC and faxed the GP surgery, detailing what was wrong and pointing out that I was faxing because I couldn’t speak. So what did they do? The clueless bastards phoned me back to say I should call an ambulance! Er, hello! Can’t speak – why didn’t you fucking do it?
Anyway, I managed to phone – one word = one breath – and the paramedic arrived about 5 minutes later, followed rather more slowly by an ambulance, and shortly after 10.00 I was in the Majors section of A&E, shoved in a room out of the way, where I was destined to remain for far longer than seemed sensible (as it turned out, I could easily have died unnoticed), with breaks for x-rays, ECG and bloods.
Once the results came back – well into the afternoon by then – I finally saw the A&E doc, who told me I had bacterial pneumonia (so much for that bloody vaccine!), plus pleural empyema in my left lung. Pneumonia I’ve had so often I’ve long since stopped worrying about it, empyema I knew was nasty, in a sort of vague way. I’m just glad I hadn’t previously looked it up, or seen this gruesome pic first.
For those unfamiliar with empyema, the space between the pleural sac and the lung fills with pus and assorted crap (on the right of this pic), and the lung is unable to expand, with a knock-on effect on the “healthy” lung, which won’t expand either.
It was also discovered that I have severe, COPD-related heart failure. Oh joy… And, as it turned out, whoever made that diagnosis dropped the ball and failed to enter the fact in my records – I have a copy and once I left A&E no worthwhile information was recorded by anybody.
So I was promptly supplied with 24% oxygen (later upped to 100%), written up for an assortment of drugs and shipped off to the slightly Orwellian-named “Clinical Decisions Ward” – “Tell me, Mr. Smith, do you really deserve treatment, you prole-loving scum? Off to the Ministry of Love with you!” In reality it was just a holding area while they try to find you a bed.
While there I was seen by no less than three different doctors, and each one got their ear chewed** about analgesia, and promised it immediately. What I got was bugger all.
**There was a slight problem – you know how staccato and angry Japanese can sound? Well, because I could only pop out one word per breath, with precious little in the way of modulation or volume, that’s how I sounded. I do wonder, with hindsight, how many of those who promised meds simply did so just to placate someone they saw as furious, rather than the terrified guy they should have seen? And if so, however did they think that was going to improve matters?
I was with the last one, when, struck with a coughing fit I involuntarily tried to suck in a deep breath – and screamed in agony when there was nowhere for it to go – she leaped about a foot in the air and dashed off promising “really effective drugs”. Never saw her again, or the promised drugs.
I was there overnight, and the only bright spot was the realisation that every junior doctor was a total babe. Sadly, though, none of them came to see me until a day or two later. Still, it cheered me up – nothing like a little applied lechery when you’re feeling down. (Er, Deborah, that’s a joke!)
In the next bed to me was an old girl who appeared to be about 100 years old (though just being there probably put years on her). The staff, displaying a stupidity that was soon to become a trademark, thought her name was Pauline. It wasn’t, but let’s call her that anyway. During the day she was plagued incessantly, for the most trivial of reasons, or even none at all (as it turned out, anyone old and vulnerable quickly achieved victim status – and guess who they were victimised by…).
Anyway, night fell early, as night tends to in hospital, and shortly after lights out it started. “Pauline? Hello, Pauline, wake up!” A fuckwit junior doctor, a bloke this time, bellowing down her ear, and mine, and the rest of the bay. It took a good half hour to wake her (partly because she was doped, but also because she’d had no bloody peace in the day, either, so she was seriously zonked), repeated every couple of hours. Why? So he could take blood to check her O2 and CO2 levels.
Now then, he could have done that without her even being awake – or us! Every patient had an i-v cannula in one arm or hand. They’re used for administering i-vs, obviously, but if they’re not being used for that, they can be used for taking blood. That’s how they got about half a pint of mine down in A&E. (I actually found out, during a subsequent admission, that they have to insert a needle deep among the wrist bones to tap an artery for oxygenated blood – there really MUST be a more accessible artery somewhere! Hurts like a bastard too!)
However, once you hit the ward it’s completely ignored, and if they want blood they blithely poke more holes in you, which is why numbnuts needed Pauline’s groggy and bemused permission, which generally amounted to “Wha’? Go ’way and leave me alone,” and which was always interpreted as “Certainly, young man, feel free to stick all the needles you like in my old and fragile veins!” All the way though the fuckin’ night! O2 and CO2 levels never seemed to be an issue during the day, oddly.
The following afternoon, I was, I was told, being shipped off to the respiratory unit. Where I wound up was in a general ward, in a bay of six beds, in a part of the hospital that appeared to be in the process of being shut down around us. When I finally got a doctor I could ask why, it was because the resp ward was taken up with swine-flu cases, so I was well out of that, at least.
And, rather than keep repeating this every few paragraphs, let me just say that not one of us in that bay got the meds that had been prescribed for us, not once. As the only one there with a potentially fatal condition, I can tell you I was mightily pissed off by that, and twice a day, at drugs rounds, there’d be a blazing row. But only involving me – no-one else would make a stand. Bunch of pussies!
The only time I got the drugs I should have had, was once I’d been discharged.
Then there was the subject of personal drugs (rather than hospital-prescribed). You are instructed to bring in all your own meds. When you do, they try to take them away and lock them up. WTF?
I said, as soon as I arrived on the ward, look, these are the drugs I have to take, according to my personal routine, which starts at 05.00 and goes through to midnight. My routine, therefore, is not your routine (nod), and my routine takes priority over your twice a day drug rounds, which are no use to me other than for hospital-prescribed drugs (nod). So we’re all OK? (nod).
Right then Ron, pass your drugs over and we’ll lock them up for you – you can have them back at rounds (explosion of profanity). Christ! No wonder hospital staff are so often beaten up – they simply do not listen! And I will swear, hand on heart, that at least one staff nurse was on speed.
Oh, and to whoever it was said that my drugs were a danger to the many disturbed patients – that’s your problem. Don’t try to make it anyone else’s – do your job properly.
Every day, 4 or 5 times a day, I’d have the same argument with the same fuckwits. Seriously – it was as if they’d never even seen me before. Or maybe they were call-centre rejects, afraid to stray from the script. I don’t know. What I do know is that, on this showing, British nursing, once the best in the world, is in deep shit.
Then on the last morning, while I was talking to the new staff nurse (new on shift, that is), Kerry, the only person I encountered who actually deserved to be called a nurse, and she warrants a name-check – the rest seemed to be just killing time and abusing the old folks – a large woman in a plain blue uniform, with no insignia that I could see, so for all I knew she was a janitor, descended upon Kerry, demanding to know if she’d locked up this patient’s drugs yet.
I said, “Hey, the patient is sitting right here, he’s getting sick of this eternal bloody argument, and if you or anyone else touches my personal property you’ll be explaining to my lawyers, not to me!” As I’ve said elsewhere, a bluff, but not one they could risk calling
At which point the janitor, or whatever the hell she was, flounced off.
Nevertheless, I kept my drugs, and took them whenever I needed to, according to a routine which has been established for at least 15 years and, more importantly, kept me stabilised.
I’ve since been told that hospitals have no right to appropriate patients’ prescription drugs or any other personal property, without their permission.
Compare that with my experience in Machynlleth, in mid Wales, when I was admitted to the chest hospital there, also with pneumonia, in 1985 (I used to get it the way others got colds). I explained about my routine not being the same as theirs just the once. No problem after that – twice a day they’d stack my table with all the meds I needed, and I never once felt hassled.
And then there were the injections. Now I’m a firm believer in effective medication, and as much as may be necessary, but it has to be necessary. If it’s not, I have no interest in it. So, umpteen times a day, at drugs rounds, shift change, tea break – whenever it took their fancy, there they were:-
“I’m going to give you an injection now!”
Really, what makes you think that? (It’s the bloody attitude that gets me, as if they have a perfect right to inject you with drugs without your consent or anything in the way of explanation! )
It’s for your own good.
How so, what’s it for?
It’s to stop you developing clots with all the sitting around.
Well, I’m housebound and I do at home exactly what I’m doing here – sit around all day – sorry, but I just don’t see a risk. I’ll pass, thanks.
I’m afraid I can, and I have, now please take it away because I’m not accepting it.
This, of course, was when I was still being polite. Eventually anger and expletives crept in. And, you know, it was the same nurse almost every time, but it was if she’d never even seen me before in her life. They sent a male nurse once, he just got told to bugger off and stop disturbing me with something I’d no intention of having – and would somebody write up my file to that effect FFS! OK, I didn’t actually say FFS, but it was clearly implied! Anyway, I was far more active there than here at home, as it was at least 20 times as far to the toilet!
And yet the other five guys never even asked what it was for, just mutely accepted it. I just don’t understand. OK, I’m not your usual compliant patient, I know that – I insist on being kept informed, and if I don’t like something I reserve the right to reject it. Almost everybody has that right, almost nobody exercises it. That’s pathetic in the 21st century (wasn’t much better in the 20th ). The patient, as long as they’re conscious and in full possession of their faculties, has the last word in saying what can be done to them.
Yes, I know the nurses are only doing what they’re told, which is why I took the trouble to explain why I didn’t want or need it. Initially, at least, before I started to lose it after god knows how many repeats! But whatever happened to initiative? Why did we have to go through the whole song and dance routine every bloody time?
And roll this farce out across the hospital – across every hospital in the land for all I know – and how much money is being squandered on this needless injection alone? Only a small proportion of patients will actually need a clot-busting injection (which, by the way, had to be repeated every day, with the warning Hey, this is gonna hurt – I paraphrase slightly).
And here’s a gem of fuck-uppery – on the second night, while I was mostly asleep, for a wonder and a short while, some genius decided to slip me 2 litres of i-v saline, while, during the day they were feeding me Furosemide (a diuretic), to reduce the fluid in my lungs. It had been working too. Unbelievably, I’d actually had to suggest to a doctor that a diuretic might actually be useful for encouraging drainage – that’s just so wrong on so many levels – the patient really should not have to suggest a course of action.
When I woke up, with my breathing even more impaired, I raised hell made them disconnect the i-v. I know it’s pretty paranoid, but any half arsed doctor would know that too much fluid, when lungs are already full of puss and fibrin debris-loaded fluid, was dangerous (not to mention the oedema from heart failure, or overloading the kidneys). I know it’s paranoid, but I can’t avoid the feeling that some bugger was trying to harm me for being an awkward bugger, for being unreasonable enough to demand the meds I knew damned well had been prescribed, and reject a pointless (ha!) injection.
Anyway, as I said, in one bed was a old bloke. He had a new hip, he was diabetic, and I suspect he had a touch of dementia. He was also drugged to the eyebrows. So, talking to him was difficult, but NOT impossible if you gave him a about 30 seconds to answer. Screaming at him three at a time, as happened all too frequently, accomplished nothing.
He was also physically abused by being pointlessly woken up throughout the day, and at night (George, George! Are you asleep?!!), or moved about the bed for no better reason than someone had 5 minutes on their hands which, judging by the screams, caused him great pain.
He was directly opposite me, and I could see exactly what was happening, and someone had convinced his consultant that he was dehydrated, so as a result he was constantly plugged into an i-v yet, from where I was sitting, he drank as much as anyone else on the bay. Everyone’s fluid intake would have been helped enormously if the drinking water hadn’t tasted as if it had recently passed through 12 other people
Anyway, one day he just lost it, and told them pretty much to fuck off and leave him alone. So they did, not least when he needed his pee-bag emptying, or wanted the commode. I observed, in as loud a voice as I could muster, to the guy in the next bed, that if anyone treated me like that, sick or not I’d punch their lights out. That transferred their anger to me but, by then, they’d figured out I wasn’t having any of their crap, so there was nothing they could do. Still, at least they let up on him for a while.
Now, let me backtrack to my first night in this hell-hole of a ward (32B if you’re ever unlucky enough to be there). The ward phone was at the end of the bay – not a great sleep aid as it mostly rang and was mostly ignored – and the first night there was an angry exchange between a consultant, and his opposite number at the Clatterbridge Oncology Centre, down the road a ways.
They were discussing a patient, whose team had pronounced him terminal, and come up with a drugs package to ensure a painless send-off but, because it included a controlled drug (doesn’t that often happen with cancer?), some jobsworth wouldn’t sign off on it.
So they had a low-grade row, which culminated in the guy at my end saying, in effect, look, if you’re too much of a pussy, send him by ambulance to me, I’ll see he gets what he needs. A pause at the other end.
Of course, said my guy, you’ll have to be sure to tell his family that, because of your actions, he might easily die in the ambulance, en route. Very long pause.
My guy repeated what he’d already said, and kept repeating it, apparently running up against total intransigence, until he just sighed, hung up, and walked a way.
So if you had a male family member die in great pain at Clatterbridge, on or just after January 21, that was probably why.
And then there was the noise. As anyone whose been in hospital knows, during the day it can seem like barely controlled bedlam – this went on around the clock. Apart from the time when they slipped me the i-v, I slept not at all, day or night, for 4 days straight.
The snorers I could sleep through, even though it was like a chainsaw festival, but add in the shouts from badly under-medicated surgical patients on the bay every time the staff pestered them and poked them (about every half hour by the sound of it), not to mention the screamers on the psych unit down the passage, were a whole different ball game.
Then to top it all off, there was the mad fuckhead in the next bed, yelling at everyone making a noise to stop! Like that’s gonna help! Then there was me yelling at him to shut the fuck up!
Then the phone would be going, or someone a couple of bays down died, and someone else, very close by, would scream Nonononononononononononono! every hour or so – god knows what was going on.
I stuck it until Monday morning, then just cracked. One more night, I was sure, and I’d have killed somebody – quite possibly me.
Anyway, that morning I gave Kerry, the ward staff nurse, a barely-intelligible ultimatum – I was way beyond the ragged edge by then, with nothing holding me together but what was left of my will-power, and damn little of that** – I either slept somewhere quiet, where I actually could sleep, or I walked. I mean, fuck me, sleep deprivation is banned by the Geneva Convention as a form of torture!
**Being told, the previous day, by the “speed-freak” staff nurse that I had near-terminal heart failure did nothing for my equilibrium either.
Within an hour she had the whole medical team around me. I explained what I needed, the doc said if you discharge yourself, you’ll die or be back here very quickly – I said if I spent a fifth (counting the one I’d already had at home, it would have been the sixth), sleepless night I’d be so unravelled I wouldn’t care – I was so emotionally fucked up I could barely keep it together then. It sure as hell wasn’t going to get any better.
We kicked it back and forth and, in the end, they said if I was determined, they’d discharge me properly, with enough back-up drugs that I should be OK – which is what happened. That was at about 11.00 Monday. Took until 20.00 to scare up all my meds (and they still had to taxi out more steroids 2 days later), and organise a taxi home (on the hospital).
Anyway, while I had my doc’s attention, I asked why he’d written me up for 3 doses of DHC (every 8 hours), while the ward drug rounds operated at 10.00 and 22.00, so I was told I could only have 2 doses. He was seriously pissed off about that, and prescribed DHC 4 times a day to take home. As it turned out, I needed it, too – the pain of empyema is worse even than a coronary (been there too). I also asked why I was constantly hassled over taking my own meds to my schedule, because the ward schedule was no good for my needs, and I was getting sick of the constant arguments. Again, he came down on my side, and said I should take what I needed as long as the staff knew (which they did – I gave them a list – several in fact – and it was printed up and attached to my file). Every evening they’d come round with the list and ask what I’d taken. I’d always say, truthfully, everything but Amitryptilline, and that’s not due til much later. Easy enough to understand, right? Wrong. Every one had to be queried and ticked off individually, for no better reason than petty vindictiveness as far as I can see. A process that could have taken five seconds was run out for 10 minutes or more, with supplementary questions and superfluous bullshit.
So, anyway, I got loads of dihydrocodeine (DHC), to play with at home – the only pain control after 4 days of agonising pain** – 60mg 4 times a day. It’d be nice if I could get stoned on the stuff like everyone else seems to – it’d help me over the hump – but I don’t even get a buzz. Seems a bit unfair!
**I had slow-release DHC, and had tried it. It’s OK for my arthritis, but not for this – might as well have taken Smarties.
It’s now Thursday evening, a week from my induction into hell, and I still feel, as a result, that sometimes I’m still not that far from a breakdown – emotionally labile doesn’t even come close as a description. Because I know, all too well, that where I should be, to maximise my chances of survival, is in goddamned hospital.
I also know that, had I still been there, in Arrowe Park, I’d have just quit, and stepped out of the world by now.
When it comes to personal illness, I’m a hard bastard; I’ve had to be, or I wouldn’t still be here – but everybody, and I don’t care who they are, has a limit, a breaking point, and mine is way behind me and fading into the distance.
Is there a plus side anywhere here? Well, I am recovering, slowly, with no thanks at all to the Arrowe Park nursing staff, except Kerry, who organised my escape, and the unnamed doc who gave me the bag of drugs to take home. I don’t have enough, though, and will have to get more antibiotics, at least, from my GP – and yes, I’m expecting an argument there too, because the hospital might not have written to him yet. We’ll see tomorrow, though I should really have done it today. Not really firing on all cylinders yet, though, and it got forgotten.
My suicidal inclinations are fading, too (except that writing this hasn’t proven as cathartic as I’d hoped – quite the opposite, in fact – maybe it’s all still too close), and my appetite is returning to normal, which I badly need – I really don’t know how anybody heals on hospital food.
In fairness, the foods has improved dramatically since I was there last, but all too often, despite meals being ordered 24 hours in advance, they’d run out by the time they’d got to us, and when you’ve been fantasising about sugar-loaded ice cream all day, a low-fat yoghurt really can’t hack it! There’s just no excuse. Oh, and on the menu, some dishes were flagged as “prepared by the leading chef”. As what they let him or her loose on most was mashed spuds, it wasn’t that reassuring.
And a mystery. As many people know – the literature is out there, it’s not secret – grapefruit juice can interact adversely with quite a few drugs, and the list is growing all the time. So what the hell was it doing on the menu at every meal?
One final point – steroids. I was prescribed Prednisolone, 30mg. Standard practice for many years has been to automatically prescribe the enteric-coated version (or, according to the speed-freak**, the terra-cotta version!), as the uncoated version causes gastric bleeding in very short order, and serious gastric pain even sooner.
**I may be wrong about that – some of her colleagues said she was just nuts.
There’s a school of thought that says just having steroids, or even NSAIDs, in your system is enough to cause a gastric bleed, rather than the direct erosion of the gastric mucosa as was previously thought, but I’ve never seen a convincing explanation of the mechanism by which that might happen. And, frankly, it sounds like a crock.
But be that as it may, Arrowe Park will only dispense the uncoated, instant-ulcer version – because they’re cheaper. They are, marginally, but if NHS buyers can’t get a good price on the coated version, taking into account the sheer volume they’d be contracting for, plus the savings accruing from NOT giving patients gastric bleeds, they’re definitely in the wrong job.
And that Arrowe Park – in fact, I was told, the entire Wirral Hospitals estate – should have such a cavalier attitude to the health of the people in its care, who might realistically expect to be made better, not worse, is simply criminal.