Dear Mary

To: Ms Mary Harney, Minister for Health & Children

I’m writing to let you know my views on the public health service. Having spent three days last week residing in the busy A&E department of a large teaching hospital, I feel qualified to comment. The experience has left me wanting answers to many questions. Please listen to what I have to say.

Last Friday my doctor sent me to A&E for emergency care as I’d developed a serious complication following surgery some weeks earlier. On arrival in A&E, I was rapidly processed by a triage nurse and seen by the registrar on-call. An immediate decision was taken to admit me to the hospital. I finally reached a ward on Monday afternoon! During the 3 days and nights spent in A&E, I was extremely well-cared for but the conditions were hell. The staff were so busy, patients had long waits for help. It was like being in a war zone, people lying on trolleys everywhere with further casualties arriving by the hour. It was also extremely noisy with little or no privacy. These conditions do not aid recovery.

My first question to you, Mary,  is this… why must sick and injured people be exposed to these awful conditions in order to be admitted to hospital? Where are the 1,000 extra beds you promised when you took over as Minister for Health 5 years ago? I sure could have done with one of those beds last Friday.

It was a great relief when I was finally transferred to a 4-bed semi-private ward where I remain. I’m receiving excellent medical and nursing care here. Thankfully, this hallmark of Irish healthcare remains intact despite the inadequate funding of our public health service. I’ve no doubt that this is due to the dedication of the staff who work in frontline services. The unit I’m in, has been recently refurbished and is beautifully fresh and clean. I’ve no complaints really except I’d obviously prefer to be in my own howm. The catering is good, plenty of good nutritional food and frequent offers of hot/cold drinks. I’m very aware that this aids a speedy recovery and subsequent discharge from hospital.  I’ve not always hit this lucky.

Over the years,  I’ve spent many weeks as a patient in this same hospital, on the public wards.  It has always been a grim experience in terms of patient comfort, lack of facilities etc. I don’t think much has changed although I have heard that hygeine levels have improved on the big wards. My medical history is extensive so I choose to hold private health insurance to ensure that I can get care when needed. My case is complex and so I cannot be admitted to one of the smaller private hospitals for treatment although I’m fully insured to do so. These smaller hospitals cannot provide the care I require.

I want you to know, Mary, that it’s distressing to observe your clear policy of starving the public hospitals of funding while you promote the development of co-located private hospitals. The staff who work at the frontline in our public hospitals, are fantastic but they are being stretched to the limit to provide the care needed in our under-resourced public hospital system.  I plead with you to stop bleeding our health service to death while you continue to promote an inequitable health service. Give us a break, Mary.

The semi-private unit I’m in, is excellent. I do not need for anything better as all my needs are being met here. I’ve hit lucky on this occasion as this is the most comfortable unit in the hospital. However, the WHOLE hospital should run like this unit. Instead, the majority of the rest of the hospital is no longer fit for purpose. It’s time to put our health resources to proper use. Surely everyone deserves fair and equitable healthcare?

I look forward to hearing from you.

Steph @ The Biopsy Report

Where There’s Hope

Daffodils are one of the icons of Spring. Sitting at my mother’s bedside in the nursing home where she lay motionless, I gently whispered in her ear yesterday that Spring is on it’s way. I told her about the first daffodils of the year beginning to peep their heads above the freezing ground. On hearing this news, my mother opened her eyes and rewarded me with a huge smile.

This conversation brought me back to a time when I was in a little hospital room in the UK, recovering from major surgery. My husband had returned to Ireland to sort out a business problem leaving me to fend for myself for a couple of days. Being in hospital was bad enough but being far away from home meant that I had no visitors. My beacon of hope during that time, was a huge bunch of daffodils in the corner of my room. They had been given to me by a doctor from a nearby hospital whom I’d never met but who I knew to be an old school friend of my husband. When he heard news of my operation, he picked the daffodils for me from his garden to brighten up my stay in hospital. I’ll never forget this kind gesture. Those flowers represented a world with which I was familiar, unlike the lonely surroundings in which I found myself at that time.

My mother has always loved garden flowers and although now severely disabled, she welcomes any opportunity to be taken outside in her wheelchair. We made a pact yesterday to mount an expedition outdoors as soon as the first flowers of Spring appear.

Where there’s life, there’s hope and where’s there’s hope, there’s life.

Vive la France

Okay, so here’s how the Irish health service could/should operate if it was properly resourced and managed. The following article was published in the Irish Times and documents the experience of an Irish person who required emergency care in a hospital in France.  I’ll leave you to draw your own conclusions.

Vive la Différence

“No waiting room, no trolleys, no queues, no admission fee and free parking. It was very strange indeed”, writes Michael Foley

“It is 1.30 in the morning, the first night of the annual Feria, when Beziers, in the south of France, goes en fete for a week of partying. Getting to A&E through streets thronging with revellers is a feat in itself, but arriving at the hospital is an even more unusual experience.

I rushed to hospital, with what later turned out to be a blocked artery.

Where is the waiting room? And where are all the corridor trolleys gone? Well, there is no waiting room and no queue, no line of people drunk or groaning with pain, and facing a 12-hour wait, just a woman at a desk and a sliding door that lets you straight into your own single-occupancy examination room. Parking is free and there is no €60 admission fee either.

Very strange indeed. It is so strange that we waste valuable time assuming we are at the wrong place. Why no waiting area? Goodness me, said a French nurse, urgence, the French name for the A&E, means someone requires urgent treatment; you could hardly expect someone in need of immediate treatment to wait, now could you?

It has to be said that when I last attended a Dublin hospital, eight months previously, I did not have to wait either. As I pointed to my heart and handed over the €60 casualty charge, a wheelchair almost buckled my knees as it wheeled me into triage, but behind me were others who would be waiting and waiting and waiting – unlucky enough not to have chest pain.

Back in Beziers, and two-and-a-half hours later, I had blood taken, a brain scan, a chest X-ray, and all the test results returned, and was tucked up in bed. At no stage did I see anyone on a trolley in a corridor.

Trolleys were used to ferry people. Patients slept in beds. My room, in a public ward, was for two patients, with a toilet and shower en suite. The equipment was new and worked. The bed was high-tech and moved in almost every direction.

What followed were days of tests, done without delay, and all ordered by specialists, who personally delivered results, usually within the hour. I was given scans, X-rays, MRIs and investigations I thought I might have been given eight months previously in Dublin. “Should I have had this test before?”

The doctor was non-committal.

The first specialist was a neurologist. The Centre Hospitalier de Beziers has three (as opposed to a dozen for the whole of Ireland). The doctor was a quiet, respectful woman who was available throughout the day, and who delivered the test results she herself ordered.

There was no entourage, no one to fawn and laugh at her jokes. She even had office hours when family could call in for information or advice – no need for intervention, divine or otherwise here.

We kept checking as to her status with the nurses, because her availability was akin to that of a registrar or a junior doctor in an Irish hospital, but yes, she was everything one could possibly want in one’s neurologist – professional, available and attentive. Extraordinarily, if a test was required, it was done immediately, and she delivered and discussed the results in person.

The second specialist, a vascular surgeon, again was one of three. When surgery was decided, I was moved to another floor and opted for a private room. Cost €40 a night.

Surgery was successful and after a period of recovery, I was out. When discharged, I was given a slip that was officially stamped, this is France after all, and that was it; I paid not one cent.

Under the EU health insurance regulations, I received the same treatment as a French person – 80 per cent of the cost borne by the state – and like a French person, my insurance (in my case, the VHI) paid the rest, including the cost of the private room.

One of the most remarkable features of the hospital was the level of hygiene. And not a nun in sight. The corridors were completely clear. The cleaning trolleys, with their colour coded buckets for every individual surface, plied up and down the corridors.

Masks and sprays were used as appropriate, from one patient to another. Head-to-toe disinfection twice before surgery . . .

In the Dublin hospital I attended recently, there was one shower for some 50 patients. This was in a room with a bath fitted out for disabled use. There were cracked tiles around the shower. The bath/shower room was also used as a store. If you were able to walk, you washed and shaved at a row of washhand basins, like a 1960s boarding school.

The VHI was amazing, constantly phoning me and my wife to see if I was alright. Did I want a second opinion? Was I was satisfied with the doctor? Was everything explained adequately? It also had a French-speaking doctor contact the hospital doctors who came back to explain what was going to happen.

Isn’t it extraordinary that the VHI pays no such attention to the interests or concerns of their members in Irish hospitals?

Would I have returned home for treatment if it had been feasible? Not if the advice I was given was to be taken seriously. Proof of the serious lack of confidence there is in the health service in Ireland was evident in the number of calls I had, from friends, colleagues and family, telling me how lucky I was to be sick in France and not Ireland: “Stay where you are. It’s the best place to be.”

If I returned, they thought, I might not get a bed, and if I did, I would be at risk from MRSA. “MRSA is a given,” said one friend, whose mother recently contracted it.

For the next two weeks, a local nurse visited to clean the scar and eventually remove the staples holding the surgical opening together. Cost for a home visit, €5.50 a day. But it is not just money that is the main difference between the two systems as experienced by patients. I was treated as a critically ill patient, the same as if I were French, by nurses, doctors, specialists and home visits,

I even have a GP in France now, who gave me a free consultation, just to get to know me. I only hope we don’t get to know each other too well.”

With thanks to the Irish Times for their online publication.

Need I Say More?

Orla Tinsley suffers from cystic fibrosis. Earlier this year, Orla received a People of The Year award for her campaigning in the Irish Times on behalf of cystic fibrosis sufferers.

Ireland has the highest incidence of CF in the world and to it’s shame, it can also claim to have the highest mortality rate and the lowest life expectancy for CF sufferers. The critical issue here is the limited availability of suitable isolation facilities in Irish hospitals. For optimum management of cystic fibrosis, patients require isolation in individual en-suite rooms to prevent cross-infection occurring but CF patients are being denied this opportunity. Instead, these vulnerable patients must present themselves to A&E where they are exposed to high risk infections while they await admission to a hospital bed. They are then transferred to a mixed ward to be nursed alongside mainly geriatric patients with a variety of illnesses. This practice beggars belief. The high rate of MRSA infection in Ireland has done little to ease the plight of the CF population. Not only is MRSA a constant threat to immuno-compromised CF patients, it’s prevalence has meant that the extremely limited supply of isolation rooms have instead been prioritised for MRSA infected patients.

I’ve written about Orla before to document the appalling hospital conditions which she and many other cystic fibrosis patients must endure.  CF patients have been waiting for more than a decade to have a dedicated CF unit built at St. Vincent’s Hospital in Dublin and they are quite literally sick waiting.

Here is her account of her recent visit to hospital as published in today’s Irish Times.

“Dear diary: It’s Tuesday and I’m back in hospital for another blast of treatment for my cystic fibrosis, writes Orla Tinsley

I … ENTER St Vincent’s hospital in Dublin as I need treatment for an exacerbation of my cystic fibrosis. I have two options. I can go to A&E and wait on a trolley for a bed, or I can go home and wait on a waiting list.

Although my home is safer, I choose the A&E. I can’t continue in college or do the things I want to do if I am unwell, so I wait on a trolley.

A special type of needle, called a gripper, is used by most CF patients who have frequent infections. I need one now, but no one in A&E is qualified to put it in. A nurse from the designated CF eight-bed ward is called and comes down to put it in for me.

I am on a trolley in A&E and this procedure requires a certain amount of exposure. The porters are nice, the nurses are nice – they are both busy.

We ask if there is somewhere private for me to get my needle put in. There is nowhere. The specialised nurse and I think of what to do, she decides to take me out of A&E to try and find a room in the main hospital.

The A&E nurse stops us.

For a procedure that requires the utmost cleanliness, she says we can use the bathroom. The toilet in a busy, infection-ridden A&E is open to us.

We leave the department for the main hospital. It is after hours, treatment rooms are closed and wards pose a cross-infection risk. We eventually find an open door in a room that we know is clean and use it.

I go back to my trolley in A&E wishing I could have slept in that room. In A&E a nurse comes to give me my nebuliser through an O2 cylinder. I tell her that there are nebulising sets on the CF ward; if she could just ring them up she could get one. I’m sorry I didn’t bring my own, but she doesn’t understand what I’m saying. I explain twice more, then a porter who had been listening steps in. He tells her to leave it and goes up to the ward to get it.

There is no plug near the trolley I am on and so I have to wait before I can have it. I get moved to another square of the wall so that I can take my nebuliser. I then get moved into a curtained area for the night, and I am relieved.

The next day I am moved out to another curtained area. The nurse minding me is nice but busy, and late giving me one of my drugs. I ask her three times over the next few hours. Being on this drug long-term can affect kidney function, so the morning time is the best time to have it.

I use my mobile to call my CF nurse, who calls the A&E department and asks them to give me the drug. I still do not get it. I try calling my CF nurse again, but then my battery dies.

I walk up to their office and they call again, frustrated for me. They should not have to sort this out. I go back to A&E and get it.

Late that night I get a bed on the semi-private ward. It’s Wednesday night. I am in a room with a young girl, a lady with cancer and two elderly patients.

I am aware from the time my aunt was dying with cancer that I am not allowed to be around immune-suppressed cancer patients. Over the next few days I find out that the lady is in fact immune suppressed.

I am a danger to her, and I don’t think it’s a good thing to tell her.

One night the breathing of the elderly lady in the bed beside me gets worse. The next day her family are by her bedside and they keep apologising to me that it’s happening in my room. They are so, so sorry.

I tell them please, it’s not your fault. And I feel guilty that they feel so bad about it as they watch their mother die.

Another woman comes in, a new patient replacing the young girl. She is coughing violently, but seems pretty happy. She makes a phone call to a friend to tell her that at least she doesn’t have double pneumonia, like her neighbour, she only has pneumonia.

I feel the room shrinking.

She tells her friend on the end of the line: “Don’t get the sliced melon from Marks and Spencer . . . It’s right inside the door, I want the diced one,” she giggles down the line.

At that same moment a relative behind the curtain of the lady beside me says: “Is she gone? Yeah? Oh God.”

The other woman continues to talk on her phone. After the lady passes away her body stays in the room for three hours.

That night, another lady with cancer moves into the bed beside me. Her temperature has gone up so she had to come in. Both ladies with cancer are so much fun to be in a room with.

The lady who had just moved in is only starting to lose her hair, the other lady had already lost hers. She wants a “Posh Becks” hairstyle, like Victoria and David Beckham when her hair grows back. We giggle at the thought.

At every opportunity I leave the room to talk to the nurse about trying to get moved. Bed management are aware of the situation, but there is nowhere to move any of us.

I talk to the ladies about it and tell them I might write about it. They are meant to be in isolation, but they are not. I am a risk to them, and then there is the lady with pneumonia in the corner, who poses a risk to us all.

I try to sleep with a mask to protect myself and the people in the room, but it is sweaty and a bit restricting for breathing.

On Monday I am given the option of moving to a two-bedded room on the same ward. I accept and find myself in a room with one the kindest, most vivacious elderly ladies I have ever met. She is chatty, but knows when to leave me alone. She is a pleasure to share with, but even our camaraderie can’t disguise our different needs.

As she is unable to leave her bed, she needs the commode two or three times during the night. She is the nicest woman in the universe, but my cough is already making it difficult for me to sleep.

The rattle of the commode at 12.30am, 4.00am and 6.30am rips into my ability to rest. There is a smell too. It is not her fault, but I cannot sleep properly.

One day she is complaining of discomfort and extra swelling in her legs. I only become aware of it because this woman is not a typical patient.

She never complains, even though she has a chest drain in, which makes it impossible for her to walk around. That morning she complains a lot about her feet.

It is three hours at least since someone has been at her chest drain and I notice that it is clamped. I tell the nurse, he comes in straight away and deals with it. I ask a medical person about it later – chest drains should never be clamped unless they are about to be removed.

She feels better, we’re getting on well, but I’m still not sleeping well. We keep in good spirits chatting, and she tells me about how her handbag was taken while she was in hospital. Luckily her daughter was with her to cancel her cards and keep her afloat.

It wasn’t her bank card so much, but being without her reading glasses really upset her. She was told a member of security would come back to investigate the situation, but they didn’t.

There are 28 cystic fibrosis patients in as I write this, and there are eight single en-suite beds. The beds are allocated on the advice of the microbiologist. There is a long list to get into them. The eight single en-suite beds are on a new ward, but there are also general beds on that ward too for patients who do not have cystic fibrosis.

In February this year former junior minister for health Pat Gallagher said 14 single en-suite rooms would be available by the end of the summer for CF patients. I remember being told early this year that there would be six more, in another area in the hospital.

I ask a person in officialdom what is going to happen with the six other beds we desperately need until our unit comes at the end of 2010. This person tells me that there are no plans for six beds, that they have heard nothing about it. They have no funding; they have other things to sort out first. They want to see how the eight single rooms work.

Meanwhile, the winter months are coming, the number of cystic fibrosis patients needing inpatient treatment will rise. Some will refuse to go into hospital and risk damaging themselves, some will come to A&E, and risk damaging themselves.

Others can be treated at home, but if that doesn’t work they will have to come in anyway. Those who are not in the eight beds will continue enduring cross-infection, exhaustion and fear every time they are in hospital.

We will all think of the recession and what that means for us. We will comment to one another that 2010 seems like a lifetime away, and feel sick to our stomach that some of the 1,100 people in Ireland with cystic fibrosis will not see it.”

This article is published courtesy of the Irish Times online.

Some Day…

Do you have health insurance or is this something you’ve put off until another day? If you’re young, fit and healthy, the chances are you’ve never really given your health much thought. Why would you worry when you haven’t had to face huge medical bills? With the rapid privatisation of our health service, health care in Ireland is becoming more like the 2-tier system in the States. Those with insurance will get top dollar care while those without, will suffer.

About five years ago, my GP sent me urgently to the A&E department of our local public hospital as I had developed acute abdominal pain. I was processed by the triage nurse and allocated a trolley in a cubicle so that the doctors could assess my condition. Once my blood tests had come back from the lab, the decision was made to admit me overnight in case I needed to go to theatre. I was put on a drip (nil by mouth) and lined up on a trolley in the centre of the department along with scores of others, in a queue for a bed. I hit lucky on that particular occasion and was transferred to a ward in the middle of the night. By the following day, my abdominal pain was severe (my intestine was blocked by an abscess) and it was decided that a CT scan should be performed to ascertain if surgery should be performed. I was started on intravenous antibiotics while I awaited the scan but kept fasting in case surgery was required. This was bearable until a harassed looking junior doctor appeared at my bedside to announce that the CT scanner had broken down and was awaiting repair. By the following morning (day 3), the scanner was still out of action and my situation was beginning to look very bleak. Around lunchtime, the same doctor rushed in and asked me to confirm that I had private health insurance. I did, thankfully, so the decision was made to transfer me to the private hospital, to avail of their scanner. The scan confirmed a diagnosis of acute diverticulitis with obstruction of the bowel but it was seen to be resolving so I could finally be taken off the emergency list. Had I not had health insurance, I hate to think that I may have ended up having investigative surgery as no scanner was available to make the diagnosis. Please don’t get me wrong here, I received excellent medical care during my 10-day stay in this public hospital and was very grateful for it. However, the system was clearly in overload and patients were suffering as a result. My insurance was worth every penny to get the care I needed when I needed it most.

Health insurance is a complicated business. It’s designed this way so that the insurers are protected against excessive charges by private doctors and also to restrict patient benefits. There are three main insurance groups in Ireland and they each purposely have slightly different health plans so that it’s almost impossible to compare like with like. I have spent vast amounts of time over the years, trying to work out which plan offers the best deal for my family. It was years before I realised that each member of the family can hold a different policy to meet their individual needs but don’t expect your insurance company to tell you stuff like this, ‘cos they won’t. I review our policies every year to see how we can reduce costs yet still retain adequate cover for both emergencies and day to day care. There are all sorts of clauses to catch you out, so be careful what you change. And remember, it’s too late to look for insurance when you’ve already become ill because penalties will abound. You have to put in the work yourself if you want to see improved benefits. I long ago gave up hoping that an apple a day would keep the doctor away.

Sleep Deprivation

Ever heard of sleep apnoea? The most common form of this is known as obstructive sleep apnoea (OSA). It is a chronic condition which causes poor quality sleep and results in excessive tiredness during waking hours. OSA can affect people of any age and of either sex, but it is most common in middle-aged, somewhat overweight men, especially those who use alcohol. During inhalation, the airway will collapse causing pauses in breathing for about 30 seconds, then the person usually startles awake with a loud snort and begins to breathe again, gradually falling back to sleep. OSA has the potential to have serious negative effects on a person’s quality of life and many people go undiagnosed. In order to confirm the diagnosis, it usually requires an overnight stay in a specialized sleep laboratory where sleep is monitored and measurements are taken while the person sleeps.

In Dublin, there is only one sleep apnoea clinic available to patients in the public hospital system and this is based in St. Vincent’s Hospital. There is a delay of at least two years for an appointment to see a specialist in this clinic and if sleep apnoea is suspected, the patient is referred on to the specialized sleep laboratory at the hospital to be monitored overnight. Again there is a long waiting list for an overnight bed in this unit. At present the sleep apnoea unit in St. Vincent’s Hospital is undergoing renovation and the old casualty unit at the hospital is being used as a temporary sleep laboratory.

A recent radio programme exposed major flaws in this temporary accommodation. The conditions sound horrendous. Firstly, the one toilet in the unit, is filthy and unfit for purpose. The unit is used as a pain management clinic during the day and by evening time, it’s unsuitable as a sleep environment. The windows cannot be opened due to noise outside in the corridor and patients complain that they cannot get to sleep due to the heat and lack of air. It is a shared unit for men and women, with little or no privacy. It makes no sense whatsoever to call it a sleep laboratory if the conditions are so bad that patients cannot sleep. And remember, these are patients who have been waiting for years to be monitored. Frankly, this is sleep deprivation of a different kind and it could even be called obstructive.

Just another example of bureaucracy gone mad, while patients continue to suffer.

You can listen to a podcast of the programme by using the link below.

www.rte.ie/podcasts/2008/pc/pod-v-130508-27m42s-liveline.mp3

Public or Private?

Do you have private health insurance? I do, as does over 50% of the Irish population. I have no problem in admitting that it offers a welcome safety valve in an otherwise chaotic system of healthcare. I can think of lots of other useful things to do with the money I spend on health insurance but I choose to make healthcare my priority. It’s not a decision I take lightly. I firmly believe that the way forward for our health service is a system of universal health insurance, funding a single tier health delivery model which promotes equity of health care. However as our health service is in such complete disarray, I feel I’ve no other option other than to continue to invest in health insurance. I’ve certainly had reason to be thankful for it over the years though it has proved at times, to be a bit of a double edged sword.

In late 2004, I was told that I needed some complex surgery carried out to arrest a chronic frontal sinus infection. I was under the care of a consultant surgeon who operated a private practice as well as a public service contract. With my health insurance policy, I’m fully covered for surgery in a private hospital with accommodation in a single room. However, my choice of doctors and hospitals is limited as I have a complicated medical history. On this occasion I was informed that the surgery would have to be carried out in a large public hospital where the necessary back-up facilities would be available. I was duly given a date for surgery and booked for post-op recovery in a high dependency ward. Two days before the operation, the hospital phoned to ask me to report immediately for admission. I initially protested at the stupidity of taking up a bed for two days pre-op but was told that a bed could not otherwise be guaranteed. I had no option but to agree to this crazy plan. By the time I had my overnight bag packed, the hospital phoned again to say that the bed was no longer available due to an admission from casualty. This process was repeated several times over the following two days until eventually, my surgery was cancelled due to the failure to secure a bed. The surgeon was furious as an operating theatre and a surgical team had been booked solely for my lengthy operation and it all went to waste that day. Frustrated by the restrictions imposed, the surgeon suggested that a stop-gap procedure be carried out in a small private hospital. I was duly admitted the following week and underwent some relatively minor surgery. However, this action also backfired as the surgery was unsuccessful and within months I had to return to discuss the bigger operation. The surgeon again insisted that the surgery should be carried out in the large teaching hospital and in order to secure a bed, he put special arrangements in place to allow me to be transferred to the nearby private co-located hospital, to recuperate. This was only possible because I had health insurance. It should not have been necessary.

I duly checked into the co-located hospital early on the morning of my operation and within hours, was whisked away to the operating theatre in the main hospital where I remained for the rest of the day. When I next came to, I was back in the private hospital in a shared room with three other women. I now had a sophisticated stent in my skull to facilitate drainage and a surgical wound over my right eye. I received good post-operative care and was discharged home feeling extremely lucky that all had gone so smoothly. About two weeks later, my post-operative pain began to worsen and I developed severe swelling around both eyes. I was asked to report to the busy A&E department in the main hospital where I was assessed and admitted. My health insurance again secured a bed for me in the private hospital and I happily settled into a 5-bedded room, secure in the knowledge that I was lucky to have a bed at all. Three days later, it was discovered that my surgical wound was infected with MRSA and thus began a lonely journey which continues to this day. The following week while I was longingly gazing out of the window of my isolation room, I spotted a woman I recognised in the car park. I’d shared a room with her in the private hospital a month previously, immediately following my operation. I waved frantically to attract her attention and she came over to chat to me through the open window. That’s when I learnt that her problem had turned out to be an MRSA infection and that’s when the penny dropped!

The airwaves are constantly buzzing these days with sad stories about the failures within the public health service but private hospitals are not the answer to the problem. They are selective and only serve to perpetuate the upstairs downstairs model of healthcare in this country. They do no offer A&E services which means that all patients requiring emergency treatment must be processed through the chaotic system in the public hospitals, regardless of their insurance status. Those with complex medical/surgical conditions generally cannot be treated in private hospitals because the medical back-up there is too limited. And anyone who takes out health insurance in the belief that they’ll be entitled to a single room, is in for a big shock if they are hospitalised. There is a huge shortage of isolation facilities across the country and single rooms quite rightly, have been prioritised for infectious patients and those who are dying. Our public health service is expected to provide all these service yet it’s on it’s knees through years of neglect and inadequate funding from the Government. Unfortunately, our Minister for Health continues to believe that the way forward is to promote the present unsatisfactory public/private mixture of healthcare by encouraging the development of co-located private hospitals. You have to question the wisdom of backing a policy that further perpetuates inequity of healthcare. We have a booming economy in Ireland but our health service is failing the most vulnerable people in our society. This is not about public versus private healthcare, it’s about saving lives.

A Sting in the Tale

It’s almost ten years ago since my daughter had a big operation in the Children’s Hospital. There were a few unexpected set-backs along the way but otherwise she sailed through the experience with the benefit of youth on her side. If only everyone could be lucky enough to enjoy this kind of outcome.

My 8-year old daughter was admitted to the hospital the day before surgery to undergo routine pre-operative tests. She was accustomed to being in hospital having required frequent treatment throughout her childhood for chronic kidney disease. On this occasion she was delighted to be allocated a bed beside the window where she and her all-time favourite teddy bear, called LoveBear, could watch the world go by. I was given the key to a very small, sparsely furnished cell-like room in an adjacent building and this was to become my home for the following ten days. Early the next morning, my daughter was wheeled off to the operating theatre bravely clutching LoveBear, her loyal companion. Several hours later she was returned safely to the ward sleeping soundly despite all the paraphernalia associated with complicated surgery. When she came to, the only thing she wanted was her adored LoveBear but to everyone’s horror, he was nowhere to be found. His trip to theatre had not gone according to plan and there was now great concern for his welfare. After a frantic search, he was eventually located in the hospital laundry looking a lot worse for wear. He had accidentally been put through an extremely hot wash with some sheets and now needed urgent resuscitation. He survived the ordeal and was soon tucked up in bed back with his loyal owner.

The following days went relatively smoothly and I, like all the many other parents there, spent long hours keeping watch at the bedside. Whenever my daughter slept, I would return to my own sleeping quarters for a few hours rest but I found it very difficult to sleep there. I had to keep the window shut because of noise in the street below and this left the room far too hot and stuffy. As the days went on, I developed an intense headache that wouldn’t go away. I put it down to the heat in the hospital and continued to take medication every four to six hours to dull the pain. I finally woke one morning to find that one eye was hugely swollen and had completely closed over but at long last, I had relief from the intense pain in my head. The hospital staff soon sent me packing to see my own doctor and later that day I was admitted to another hospital for an emergency surgical procedure to drain an abscess in the frontal sinus of my skull.

I awoke the following morning feeling somewhat sorry myself having been told that I had to stay in the hospital to undergo a course of intravenous antibiotic therapy. I was worried about how my daughter would cope in the children’s hospital without the help she needed. Of course, she was absolutely fine as her Dad took over the role bringing welcome new energy to the equation and they got on famously together. My own surgeon appeared before breakfast at my bedside and informed me that I’d had a lucky escape. The constant headache of the previous week had been caused by a large abscess in my skull which had been pressing on a very thin wall of bone between it and my brain. Luckily for me, the abscess had pushed forward as it expanded causing the swelling in the eye. Had it gone in any other direction, he said, it’s likely I wouldn’t be here to tell the tale. As I looked at my surgeon in disbelief, I noticed that he looked totally exhausted and close to tears. Surely the news wasn’t all that bad? He then told me that he’d spent the whole night in the operating theatre trying to save the life of a close relative of his own who’d been knocked down by a hit and run driver. The young lad, very sadly, did not survive the night. This news cast a whole new light on our family situation. In time, I made a full recovery and so did my daughter. LoveBear, while looking a bit worn these days, still has pride of place. We were the lucky ones.

Do you think I’ll get the job?

With the New Year upon us and my health now stabilised following surgery last year, I’m thinking about returning to work. I got out my CV recently to bring it up to date but there are a few gaps in it which will take some explaining.

I first entered the workforce thirty years ago, full of enthusiasm and ready to take on the world. Since then my career path has veered a bit off-course but I reckon I’ve got some damn good statistics to show for it. I did the figures today.

Since leaving school I’ve been admitted to hospital 42 times (approx), not counting day surgery or days spent in A&E. Some of these stays were for lengthy periods, 12 were emergency admissions and I’ve arrived by ambulance on three occasions.

I’ve undergone 30 surgical operations under general anaesthetic, again not counting day surgery and I’ve been the sole candidate on the operating list three times due to the extent of surgery.

I’ve had 2 post-operative haemorrhages, one requiring a transfusion and the other necessitated an emergency return to the operating theatre.

I’ve had 9 separate admissions to hospital for intra-venous treatment with a combination of antibiotics. The longest period on continuous I.V. treatment was 4 weeks and that was spent in an MRSA isolation unit.

And that’s just my in-patient record. Otherwise, I’m in fine fettle

What do you think I should say at interview presuming I get that far, when I’m asked to explain the gaps?

The Hospital Patient

I was reading an interesting blog the other day and it started me thinking about life in hospital – from the patient’s perspective. This excellent blog is written by a medical student who details a first encounter with a ‘real’ patient. It was an insightful glimpse into the world of student doctors and clearly demonstrated how they learn from direct contact with patients. While ‘real’ patients are important for medical education, it’s also important to remember that patients are ‘real’ people too.

It has to be said that life in hospital is incredibly boring – the days can be endless and the sleep-disturbed nights are even longer. A hospital environment is alien to most patients – in fact it could even be described as ‘territorial’. From the moment a newcomer arrives on a ward, they become public property and remain on display for the duration of their stay. The boredom factor in hospital is such that a new admission provides a welcome distraction to the other ward occupants. Every detail is observed and scrutinised and before long, the interrogation will begin. “What are you in for? Oh, that’s terrible – my friend had that too!”. The new patient must divulge sufficient information to satisfy everyone’s curiosity and then they will be left in peace to settle into their ‘new home’.

The majority of patients in acute hospitals today are admitted through A&E where they will have been processed for many weary hours and often days, before being transferred to a ward. A small proportion of patients are admitted directly to a hospital bed to undergo elective surgery or thorough investigation and these are what are known as ‘elective admissions’. All patients, no matter how they arrive in hospital, are placed under the care of a specific medical or surgical team. Over the course of their stay, each patient will get to meet many variations of this team ranging from the most senior, the consultant, right down to the most recently qualified, the intern. Those with a complicated medical history may be put under the care of several teams and this inevitably multiplies the number of doctors seen. Medical students are an add-on ‘bonus’ in all teaching hospitals but only patients who are deemed to be a suitable case-study, will be asked to consent to undergo interrogation.

The ritual of ward rounds is another great source of entertainment for bored patients. While usually terrifying for the patient involved, they still provide great entertainment for the rest of the ward. The doctors swarm in and surround the bed of some poor unsuspecting individual who is then subjected to a barrage of questions, all delivered at an audible volume to the rest of the ward. The patient is then used as a ‘demo model’ before decisions are made and a care plan is put in place. The whole team then moves on in search of it’s next victim leaving behind a bewildered and often humiliated, patient. This is when the room mates come into their own. Within minutes, the other patients come to the rescue with reassuring anecdotes and invariably, the doctors will each be analysed in detail. No stone is left unturned! Patients in general are hugely protective of one another – everybody is in the same boat in hospital and it’s a natural instinct to look out for the welfare of others. This is particularly evident in the case of elderly patients who are unable to fend for themselves and who do not always get the respect or the attention they deserve due to short-staffing on the wards. Nurses too, are by no means exempt from a patient’s analytical skills. Favourites are quickly identified while others will be given nicknames appropriate to their behaviour. Humour is a great weapon in hospital – it often succeeds where reality fails.

There can be no doubt that patients will always be indebted to doctors for their in-depth skills and knowledge but doctors should never forget that patients are REAL PEOPLE who possess a unique talent to spot REAL DOCTORS