A&E Trolley Dolly

I’ve done it again – another visit to A&E.

If you’ve read my last posting you’ll remember that I had surgery in the UK in March and I’m back in Ireland now recupperating under the care of a surgical team in a large Dublin teaching hospital. I can’t praise this team enough for their expertise and efficiency combined with real care and compassion. It was they who referred me to the UK for my operation as it’s not available here unfortunately, and now it feels good to be back in the care of people who know me well.

I knew before I’d opened my eyes yesterday that something had changed, this was a different sort of pain and I instinctly knew that I needed to seek help. Several phone calls later and I was instructed to report to A&E for assessment. I checked in, was assessed by a triage nurse and then joined the long queues in the waiting room area. I’m no stranger to this A&E department having been through it’s doors for emergency admission or treatment at least 6-7 times since surgery in the same hospital in July 2005. This was as a result of complications following that operation (more anon). I’ve definitely been here, done my time and got the teeshirt! Yesterday though I hit lucky. I was whisked through those double doors and onto a trolley in double quick time and as always, the staff were fantastic – at all levels of the ranks. It definitely helps to be a ‘regular’ though I wouldn’t recommend it! The place was heaving with patients everywhere, all cubicles were full and my trolley was lined up next to the nurses station. Having had my history taken (and most of my blood as well) I was examined and told that my fate depended on the lab results and so there was nothing for it but to make myself at home on my trolley and prepare for a long wait. One side of my trolley was up against a window of an examination room (which thankfully had a blind in place) but I counted five discarded drinking bottles of various types lined up on the windowsill at my elbow, obviously from the previous occupiers of my trolley. I loaded up as many as I could carry and staggered off to find a bin to get rid of this disgusting rubbish. That achieved, I took up residence and watched the world go by for about two hours. Nothing much has changed since my last visit here. Patients of all ages wandered around in various states of undress and mental incapacity, most of them in hospital gowns that were gaping open at the back. My heart goes out to the elderly in these circumstances – they seem so lost and vulnerable and confused in this busy environment. And what is it about A&E staff that they can so successfully avoid eye contact with patients? I’ve observed this trend over the years and they have it down to a fine art. It’s quite a skill you know to be able avert your eyes when patients all around you are looking for attention. It appears that there’s no eye contact with patients unless and until you’re next on the list for their attention. But the wait can be unacceptably long for some especially when in pain and discomfort. My luck was in yesterday. When my initial blood reports came back there was nothing indicating that I had to have I/V treatment and so I was released on oral antibiotics and instructed to report back at any time if things deteriorate further. There’s been a lot of bad press recently about A&E but sometimes it does work well and I have to say, the treatment I received yesterday was second to none during the three hours that I was in the hospital. The staff were very friendly and considerate but I was more than happy to wave them all goodbye, and that trolley, and return to my own bed, with my own drinking bottle!

The Nurses Dispute

So the HSE has finally started talks with the Nurses though not without some hiccups along the way. What the outcome will be is anyone’s guess at this stage but one thing’s for sure – if Ireland is to continue to have the high standard of nursing it has presently then it’s in everyone’s interest to get this unrest in the nursing profession sorted, and quickly. The working conditions for Irish nurses leave a lot to be desired. Would you continue to work in a job in which you felt demoralised? Is it any wonder that nurses are leaving the profession in droves to work elsewhere?

My worry is that our health service is becoming just like the NHS – target driven. Anyone who saw that recent BBC television series presented by Gerry Robinson, about the NHS in Rotherham, will know what I’m talking about. However, I also speak from personal experience having returned from the UK last month following major surgery in an NHS hospital. As an in-patient, I was shocked and saddened to witness firsthand the level to which nursing care has been depleted in the NHS. My surroundings were spotless – in complete contrast to our filthy Irish hospitals – but compassion seemed to have been struck off the list. Not one nurse asked throughout my stay “How are you today?” and there was no banter to be had unless I initiated it. Pills were simply dispensed throughout the day according to the instructions on your chart. I’m not saying that the nurses were unfriendly but they certainly didn’t go out of their way to make conversation. I got the distinct impression that NHS nursing was all about ‘ticking the boxes’ and meeting’ targets’. And you can definitely forget about getting clean sheets each day – you’ll be lucky to get your bed made at all!

You see this is where I think we’re spoilt in Ireland. Our nurses, granted with some exceptions, are friendly and for the most part it seems to be part of their job spec to interact with their patients. I’d really hate to see nursing in Ireland become like that in the NHS.

Take note Mary Harney – we should treasure what we have!

Surgeons – RTE 1 Monday

What a brilliant new television series! The same team (Mint Productions) that made “Junior Doctors”, last year’s successful fly-on-the-wall documentary series is now turning it’s attention to the surgeons. The first programme last night featured two neurosurgeons, Ciaran Bolger based at a Dublin hospital and Charlie Marks, in Cork. Both surgeons came across as hard working, highly skilled but still wonderfully human human beings. It was interesting to witness how much their work impacted on their overall lives. Both commented on how hard it was not to bring work worries home with them. You may be pleased to learn that neurosurgeons refrain from alcohol (just like pilots) in order to perform with precision the following day.

I found this programme facinating on several scores. It showed up these two surgeons for what they really are – highly skilled people – but thankfully ones that are still capable of sharing humour and compassion with their patients. If anything, for me the programme was most interesting from a patient perspective. It gave a hugely graffic insight into the impact that hospitalisation and surgery can have on the patients themselves. These were no minor procedures being performed and we were able to witness first hand the dilemmas that faced each of the patient’s involved.

If I had one criticism of last nights programme it would be this. Why did Ciaran Bolger have to wait until the night before a major operation to ask his patient to decide whether or not they wanted him to remove all of the tumour (with serious risk of loss of speech) or to take a slightly less aggressive approach (with the risk of leaving some tumour behind). I don’t know what you think, but to me this seems like a pretty major decision and one that could have huge consequences for the patient. Surely, this was a decision that should have been made at a pre-operative consultation at a time that was less emotionally charged, for everyone?

Next week’s programme focuses on the cardiac surgeons. I await with anticipation of another stunning insight into real life in hospital.

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