I’m coming home. I’ve done my time. Now I’ve got to know what is and isn’t mine. It’s been three long years six long days in the UK. I’m ready for home.
I was discharged from the hospital on Saturday and have spent the last few days resting-up at a friend’s house near Birmingham, in preparation for the flight home. It’s been bliss to be able to recuperate in peace and quiet without the constant disruptions of hospital life. My post-operative path has been more rocky than anticipated but the surgeon is now happy for me to fly this evening. Things have already begun to improve following a change in medication so I’m confident all will be well. I return to Notts next Monday for follow-up.
Thanks for all comments and well wishes. I will catch-up with you all once things settle down a bit. So much has happened, its gonna be hard to know where to start. See you on the other side of the pond.
Here’s another excerpt from my little book of Home Nursing. It details the preparation of the patient for surgery…
“On the day before the operation the nurse should ask the surgeon how he wishes the patient to be prepared. If no specific instructions are given the patient should if possible be kept quiet the previous day: he should take only light food, have a warm bath and an aperient in the evening. On the day of the operation he may, if the operation is not to be performed too early, and with the surgeon’s permission, have a light breakfast of tea, with toast and butter, and, three hours before the operation, a cup of tea or bovril.
His preparation begins with a simple enema first thing in the morning. Then he may have a warm bath or be well sponged down. The area of the operation must now be sterilized by shaving and then cleansing thoroughly with either soap or spirit soap, which must be washed off with hot water; the skin must again be washed with hot biniodide of mercury solution, and covered with a compress of lint or gauze wrung out of the same solution: or, after drying, the skin may be painted over with mild tincture of iodine, allowed to dry and covered with a dry sterile towel.
Before the operation artificial teeth, hair-pins, jewellery, etc., must be removed, and if the hair is long in a woman it should be plaited in two plaits tied at the ends. The patient must put on warm flannel clothes which can be removed easily, and long woollen stockings.”
Now that’s what you call pre-operative care. These days, patients are admitted to hospital on the day of surgery and the pre-op preparation is left almost entirely to the patient. I can remember once getting it completely wrong and I paid the price.
I had a young baby at the time and instead of resting the day before my surgery, I rushed around putting preparations in place for during my absence. The following moring I insisted on getting myself to the hospital so that my husband could stay at home to look after our baby. Having fasted from the night before, I travelled by train to the hospital and arrived feeling totally parched and exhausted. I had a particularly difficult post-operative recovery from the anaesthetic on that occasion and it taught me a lesson. In today’s world of conveyor belt medicine, it’s really important to rest the day before surgery so as to optimise your powers of recovery. Allow yourself to be pampered!
UPDATE: I’ve just spotted this letter to the Irish Times from a Consultant in Emergency Medicine, which fits in nicely with the ‘ patient care’ theme of this post.
“And the Minister should focus on the universal need for a familiar smiling face. Let us have carers who have the time to care and the moral support of a loved one in our hour of need. Health economists may have factored these basics out in their many dubious prescriptions, but Mother Nature has not”.
Five surgeons are discussing who makes the best patient to operate on.
The first surgeon says, “I like to see accountants on my operating table, because when you open them up everything inside is numbered.”
The second responds, “Yeah, but you should try electricians! Everything inside them is colour coded.”
The third surgeon says, “No, I really think librarians are the best; everything inside them is in alphabetical order.”
The fourth surgeon chimes in: “You know, I like construction workers…those guys always understand when you have a few parts left over at the end, and when the job takes longer than you said it would.”
But the fifth surgeon shuts them all up when he observes: “You’re all wrong. Politicians are definitely the easiest to operate on. They have no guts, no heart, and no spine, and their head and rear end are interchangeable.”
And Steph says: “Hang on a minute, I’m not an ‘expert by experience’ patient for nothing you know. After years of consulting surgeons, I can see through them all so they must be the easiest to operate on!
A young woman with purple hair styled into a punk rocker Mohawk and sporting a variety of tattoos, arrived in the A&E department.
It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery.
When she was on the operating table, the staff noticed that her pubic hair had been dyed green, and above it was a tattoo that read, ‘Keep off the grass’.
Once the surgery was completed, the surgeon wrote a short note on the patient’s dressing, which said, ‘Sorry, had to mow the lawn’.
On a more serious note…
The Brain Doctors is scheduled for tomorrow night. This is a fascinating, no-holds barred glimpse into the world of neurosurgery.
Having recently reviewed my annual subscription for private health insurance, I considered reducing my level of cover in an effort to reduce the cost. However, having watched the second programme in the 3-part series Surgeons I’ve decided against making any changes. Our Minister for Health is determined to implement new changes in the Consultants’ contract of employment, to meet the needs of our health service. Has anyone ever heard her mention the needs of the patient? Her continuing plans to reform the health service by encouraging privatisation, makes private health insurance cover seem all the more important. And that’s exactly what the Department of Health wants!
The programme featured the work of two neurosurgeons, Donncha O’Brien and Ciarán Bolger in Beaumont Hospital. It was riveting stuff offering a unique insight into the lives of the doctors and patients featured whilst at the same time revealing the workings of a public hospital. Ciarán Bolger certainly doesn’t mince his words about the public health service. “The system is shite!” he says.
The HSE aims to employ 1,500 new consultants many of whom will be limited by the new consultant’s contract, to working in public practice only. There will also be strict monitoring of private practice. At the moment, public patients gain because they have access to the top specialists but this could soon become the preserve of private patients if the HSE continues to dictate to the consultants. Ciarán Bolger believes that a lot of the consultants will vote with their feet and go into the private sector so that we’ll end-up with an exacerbation of the 2-tier system. He believes that many of the existing highly trained consultants presently working in the public health service but who are also running a limited private practice, will opt to work fully in private practice. He says “WW3 would break out if nurses were told they couldn’t do agency work, or teachers couldn’t give grinds, or Gardaí couldn’t do bouncer work for night clubs”. He considers the new consultants’ contracts to mean that “you’re signing over a profession to be controlled by an organisation that can’t organise anything at the moment.” He says that it doesn’t matter how many consultants the HSE employ as it’s not going to make any difference if they don’t have places to work. “We need more beds, more resources, more surgeons, less administrators, and less people telling us how to do our job.” The proliferation in the development of private hospitals around the country at the same time as services in our public hospitals are being cutback, is no coincidence. Private health insurance is rapidly becoming a must.
The title of this post is a hard pill to swallow. It’s particularly offensive to those who cannot afford to ‘buy’ their healthcare. Our government wants to privatise healthcare in Ireland at the expense of the public health service. They want to scare as many people as possible into taking out private health insurance so that they can relinquish their duty of care. Healthcare in this country, is fast becoming a lottery. If you’re not in (insured), you can’t win!
This week’s ‘Surgeons’ programme, the final week in the series, looks at two revolutionary and radical surgeries being performed on children: cochlear implant surgery and limb-lengthening surgery. If the rest of the series is anything to go by, it promises to be excellent.
On reading Grannymar’s post One Armed Bandit last week, I was reminded of a time in my own life when I fought a one-armed battle. I have an inherited connective tissue disorder known as Ehlers-Danlos syndrome (EDS) which leaves me with a tendency to stumble and fall a lot. Being right-handed, my right shoulder has taken many blows over the years but it’s still going strong.
When I was in college many moons ago, I slipped and fell dislocating my right shoulder in the process. Luckily it went back into it’s socket spontaneously but the damage had been done. The anterior ligaments of the joint were torn and my arm needed immobilisation in a sling for many weeks to facilitate repair. From that day onwards, my right shoulder was unstable and certain movements were extremely painful. The joint would easily sub-locate and on numerous occasions this happened when swimming, leaving me stranded in pain with one arm stuck up in the air!
When my first child was a toddler, I stumbled one day while carrying him and again badly tore the shoulder ligaments. As my arms were full, I could not reach out to save my fall and landed on my right elbow sending the full force of the blow through my shoulder joint. I was seen by an orthopaedic surgeon who recommended an operation to stabilise the joint. I underwent open surgery (it’s done by micro-surgery these days) to have the ligaments of the shoulder joint re-structured to form a support network and they were also shortened to limit movement in the joint. A large metal screw was used to hold the re-attached ligaments in their new position. When I awoke from the anaesthetic, my whole right arm was tightly strapped across my chest and it was a struggle even to breathe. I was to spend the next six weeks in this tight strapping with only one arm usable. It was a difficult time as I had a small toddler to look after but we soon devised ways and means to get around most problems. I became a dab left-hander at doing most tasks though it took a while to get used to getting dressed one-handed and trips to the toilet took rather longer than usual. You try pulling up and down your clothes with one hand and you’ll realise what I’m talking about!
Once the ligaments had healed, all the strapping was removed and I started on a long programme of physiotherapy to recover movement in the joint. This was a very painful process and as time went on, the pain got worse instead of better so I was sent back to the surgeon for review. He was puzzled by the pain and recommended further rest for the arm, in a sling. A few weeks later I noticed a protruding lump at the top of my right arm which was very painful to touch. The metal screw used to fixate the ligaments had wriggled it’s way loose and x-rays showed that at least one inch of it was protruding from the bone. Back I went into hospital for more surgery to remove the piece of offending metal which I still have to this day, as a souvenir. Yet more weeks ensued with my arm in a sling before I was allowed to start physiotherapy again. You have no idea what pleasure it was to finally eat a meal using a knife to cut my food.
One of the aims of the surgery was to restrict movement of my arm in certain directions, to reduce the likelihood of further dislocation. No matter how hard I try, I cannot rotate my arm outwards and have learnt instead to rotate my body to reach objects on my right-hand side. I used to love playing tennis but my restricted shoulder movements made this impossible. Not to be defeated, I went back to tennis lessons starting at beginner level and learnt to play the game left-handed. Anything is possible when you’re determined to succeed. This all came to abrupt end however with another stumble which resulted in torn ankle ligaments but that’s another story. These days my right shoulder joint makes lots of strange creaking noises but it remains pain-free. I only wish the rest of my joints were as good.
If you enjoy fly-on-the-wall medical documentaries, then hold on to your seat as another series of Surgeons is about to begin. Following on from the success of the series produced by Mint Productions last year, this three-part observational documentary series returns to capture the real lives of both the practitioners and the patients in our hospitals. Prepare to be amazed.
The first programme looks at organ transplant surgery and the work of Oscar Traynor in St. Vincent’s Hospital and Freddie Wood in the Mater Hospital, in Dublin. The series also looks at some of the issues facing the health service today: waiting lists, public versus private practice, centres of excellence and hospital politics.
This is no docudrama. It’s the real thing and it provides an excellent insight into what goes on in our hospitals. The series uncovers some powerful human stories at the cutting edge of Irish medicine. If you’re squeamish, this may not be for you. Otherwise, I highly recommend it.
Thursday 22 May on RTÉ 1 @ 10.15pm. Don’t miss it!
After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?
I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”.I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.
A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.
As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.
Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.
And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.
New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.
There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?
So the saga continues with an infected lesion on the back of my hand. The infection has responded well to a heavy dose of antibiotics over the past week and the lesion has reduced to a fraction of it’s original size. However the centre of it remains incredibly painful to touch, as I discovered to my cost when I caught my hand briefly on the edge of a cardboard box. Ouch!
Yesterday I attended a day centre at the hospital to have the lesion biopsied. I was somewhat surprised to have a repeat swab taken from the lesion and another one from my nose before a punch biopsy was performed on my hand. Local anaesthetic was first injected around the lesion to numb the area and then under sterile conditions, a 5mm diameter chunk of tissue was removed for analysis. I felt no pain whatsoever though the wound spurted copious amounts of blood and the surgeon had his work cut out trying to stem the flow. Two stitches were inserted to close the wound and then a pressure bandage was applied to ensure that no further bleeding occurred. With my history of having the connective tissue disorder, Ehlers-Danlos syndrome (EDS), extra caution is needed following surgery due to skin fragility and poor wound healing. Unfortunately, my hands do indeed suffer from delayed healing and so special care is required to prevent infection. I was sent home with antiseptic cream, spare dressings and instructions to return in a week’s time to have the stitches removed, and to receive the biopsy report. I was also given a prescription for a further week’s supply of the oral antibiotic (Flucloxacillin) plus an antibiotic ointment (Bactroban) to be applied to the inside of my nose. My legacy of previous MRSA infection seems to follow me everywhere though I suppose I should be grateful that every precaution is taken to ensure there is no return of this unwelcome superbug.
As procedures go, yesterday was plain sailing. I had a somewhat disturbed night due to discomfort in my hand but it’s no big deal. The best bit of all yesterday was that I received strict instructions to avoid doing washing-up. My only regret is that I didn’t succeed in getting this in writing
I had occasion earlier this year to use a wheelchair while travelling home by air. I was en route back to Ireland following a stay in a UK hospital for complex surgery on my skull. I had been discharged from the hospital earlier in the day and felt totally elated to be on my way home at last. However, the journey proved to be more of a challenge than anticipated and I ended up needing a wheelchair. The experience was a real eye-opener.
I’d walked happily out of the hospital to the car with my husband but by the time we reached the airport, I had lost all enthusiasm for the journey home. I knew I was in trouble. On getting out of the car I was overwhelmed by nausea and dizziness and could feel the blood draining from my extremities. I felt so ill on entering the airport terminal building that I had to lie down on the nearest row of seats while my distraught husband contemplated the next step. We had two options. He could call an ambulance to take me back to the hospital or we could soldier on and try to endure the flight home. We had been told at the hospital that the flight would not represent a risk following the surgery. I knew what I wanted to do and when I’d recovered enough to be able to speak again, I proposed the idea that I could manage the flight if only I had a wheelchair. I was sure that if I did my utmost to appear well enough, I would be allowed to board the flight. It felt like an insurmountable challenge at the time but I was determined to get home that night. My husband soon found a rickety airport wheelchair (with zero suspension) and we proceeded to the check-in desk. Now it’s a well-known fact that you need to be in the full of your health to fly with Ryanair but this was taking things to the opposite extreme! I could barely even hold my head up at the time. However on reaching the top of the Ryanair queue, I smiled sweetly at the member of ground staff while my husband made light of our circumstances and to our surprise and delight, we were checked onto the flight no problem. No extra charges were requested – wonders will never cease – not only that, Ryanair also provided a decent wheelchair and promised that I would be boarded first, ahead of all the other passengers. Life was looking up again!
However we still had nearly two hours to fill in the passenger departure lounge before take-off and that time seemed to go on for ever. I can remember noticing that everyone seemed to be snacking on some fast food or other and it all seemed really busy and noisy compared to the quiet of a hospital environment. I was still feeling very nauseated and also very cold. My head was heavily bandaged and while I wore a large headscarf to cover-up, I was unable to disguise my swollen face. The thing that amazed me the most was that people were so rude in the way that they stared. While we battled our way through airport crowds I could really sense the unwanted attention. I had no idea that the experience of being pushed in a wheelchair could feel so demoralising – all independence is lost – and a wheelchair seems to represent a passport to others to stare. It really opened my eyes to the conditions that wheelchair users endure and of course, not everyone is as lucky as me to have been only temporarily using one.
When the time came for departure I was dutifully wheeled to the steps of the aeroplane by my husband, accompanied by a Ryanair escort and was helped to board the plane while all the other passengers waited in the terminal building. It was a great help to get this little bit of VIP treatment though it wasn’t long before everyone else followed and of course many of them had another ‘gawk’ on boarding the plane. The flight itself was fine and on landing, Ryanair again came up trumps by providing a wheelchair for transport through the airport. Again, I had to endure endless stares and by the time we got to the arrivals hall, I burst into tears on being met by a dear friend. It was such a huge relief to be whisked home, away from the public glare.
Yesterday I repeated the same journey as I had to make a return trip to the UK for a check-up with the surgeon. This time I did the journey alone and in the full of my health. The news was good – the surgery has been very successful and I felt like dancing in the streets afterwards. On the way home through the airport last night, the memories of that wheelchair journey came flooding back. I thanked my lucky stars to be able to walk to that plane. I also resolved to never, ever stare again at anyone in a wheelchair.
Posted by Steph 
“On the day before the operation the nurse should ask the surgeon how he wishes the patient to be prepared. If no specific instructions are given the patient should if possible be kept quiet the previous day: he should take only light food, have a warm bath and an aperient in the evening. On the day of the operation he may, if the operation is not to be performed too early, and with the surgeon’s permission, have a light breakfast of tea, with toast and butter, and, three hours before the operation, a cup of tea or bovril.
Posted by Steph 
Posted by Steph 
