That’s Life!

August 30, 2007

I heard an item on the radio this morning concerning an article written by the journalist Kevin Myers, in today’s Irish Independent. In this piece he refers to the perfect contours of the late Princess Diana’s nose which, when combined with her appealing eyes, made her into a real photogenic beauty. It started me thinking about the contours of my own nose and forehead which have been altered by recent surgery. My medical history is complex – I’ve had a lot of surgery, in various specialities and have the surgical scars to show for it – but none of these compare to living with a slight facial disfigurement.

I was admitted to an NHS hospital in northern England earlier this year to undergo a complex operation at a specialist Head & Neck surgical unit. This surgery is unavailable in Ireland unfortunately. I have a long history of serious sinus infection which has necessitated regular surgical intervention and intensive antibiotic treatment over the years. As a result of this, I now also (surprise, surprise) have a history of recurrent MRSA infection. The MRSA presented itself as orbital cellulitis following my last episode of frontal sinus surgery and this infection manifested into chronic osteomyelitis in the frontal bone of my skull. All surgical efforts to establish drainage from the frontal sinus had failed and despite intensive antibiotic treatment, I continued to develop abscesses in the bone close to the base of my brain. As this had an associated risk of developing into a brain abscess/septic meningitis, I was referred to the UK for assessment. Here I was advised that the most effective way to stamp out chronic osteomyelitis would be to have all the infected/dead bone removed, and an operation called the ‘Riedel procedure’ was recommended. I was fully informed that there would be a cosmetic disfigurement post-operatively and having considered my predicament very carefully, I finally agreed to proceed.

My little friend, the superbug, is thankfully still responsive to a tetracycline antibiotic, Vibramycin (Doxycycline), and this enabled me to obtain the requisite ‘all-clear’ from MRSA screening prior to the surgery. The operation itself went very well and was completed in just under four hours. My head was opened from ear to ear (zig-zag coronal incision), my ‘face’ was peeled back to the bridge of my nose and the anterior and inferior walls (bone) of both frontal sinuses were removed completely leaving a large hollow in my forehead. The margins of the frontal sinus along with the supraorbital rims were then ‘chamfered’ (planed) to make a gentle curve rather than a sharp step out of this hollow. This allows the soft tissue of the face to fall in and line the vacated frontal sinus area and improves the cosmetic defect which results from the procedure. My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in situ to minimise haematoma formation. I had no post-operative complications other than vomiting copious amounts of blood when in the recovery room – this had drained into my stomach during the surgery. Ten days later when I had the staples (59 of them) removed from my scalp, the incision was healing beautifully and I was well on the way to making a good recovery.

That all happened five months ago and I remain free of infection. The post-operative numbness of my scalp has almost resolved though it has left behind an unpleasant neuralgia which requires medication. The surgery has left a definite legacy – a facial cosmetic defect. The bridge of my nose ends abruptly where the large hollow begins in my forehead. I’ve got used to seeing my new ‘look’ in the mirror although photographs still tend to take me aback. I’ve also had to get used to having conversations with people, usually strangers whose eyes are firmly fixed on my forehead while they try to work out what’s happened to the contours of my face. I’ve had a few tactless comments but nothing that humour can’t handle. You have to keep things in perspective – I’ve been given a second chance at life – not everyone gets that chance. My surgeon has offered re-constructive surgery (a split calvarial bone graft/titanium plate) in the future but for the moment anyhow I’ve no wish to go there and certainly no wish to invite further trouble. And anyway, I’m proud of my war wound – my husband refers to it as the ‘bomb crater’- it was a hard fought battle and I’ve come through it still smiling 😀

I’ve just gotta face it – I’ll never be a Princess Di. But then, that’s life!

Up Yours!

August 27, 2007

It’s come to that. There’s only so long people can wait for help when their lives are on the line.

It’s been well-documented over recent years that Co Donegal has a raw deal when it comes to cancer services. There are unacceptably long delays for cancer screening in the region and patients who have had surgery, have to travel long distances to access chemotherapy and radiotherapy services. As you can imagine, this places a huge strain physically, emotionally and financially on the patients, and their families. It’s wrong and it shouldn’t be happening. The HSE is well aware of the deficiencies in the system but has failed to take action.

Well, Donegal has got fed-up waiting. A not-for-profit organization, the North West Wellness Committee (a voluntary group), has set about correcting the problem themselves. Through voluntary fund-raising, they plan to buy a breast-screening machine and hope “to have breast screening available to women in Co Donegal as early as next spring. It then aims to build a community cancer clinic within three years and has already had an 11 acre site donated for the purpose. All funds will be raised voluntarily and any profits made will be re-invested back into the cancer services”.

Now that’s what I call efficiency. This group could teach the HSE a thing or two about not-for-profit health care. The HSE should hang their heads in shame and they deserve to have their faces rubbed in it.

Only, please remember to wash your hands afterwards!

Back to school

August 24, 2007

I’m still in disbelief about the HSE’s scheme for “rewarding success”. I’m not talking sweets here. No, instead, extra consultants are to be appointed and distributed around those hospitals which have the highest-performing A&E departments. Only those who are best behaved will get the additional consultants. A spokesman for the HSE said “the new ‘100 plus’ plan was not about penalising any hospital, but rather was about rewarding those that met targets”. Yesterday Brendan Drumm, CEO HSE, was wheeled out again to reject the criticism of this crazy HSE decision. Do you know, I’m actually beginning to feel sorry for the man. He reluctantly took on the job in the first place and how he must long to return to doing a day’s work where he’s appreciated. I’m sure if this point was put to him, he’d reply “Je regrets rien”, in keeping with the level of denial presently emanating from the HSE.

Anyway, now we have a situation where those hospitals which are working well are to be rewarded and those that are not, are to continue to struggle to keep their heads above water. The difference being that some hospitals have step-down facilities available for their long-stay patients and some do not. The ones that do, are able to fast-track patients through the system right from A&E through to discharge. The ones that don’t, have patients with nowhere to go which causes a log-jam that backs-up through the hospital to A&E resulting in the overcrowded and chaotic scenes we hear about so frequently. What the HSE has done is akin to saying “goodbye and good luck” to a child who is performing poorly in school instead of looking at the causes of the problem and trying to remedy it. It’s also akin to giving those with advantage, the reward. The scheme is a bit like a useless school report which says “must try harder” and “could do better” but offers no explanation or support. The shortage of step-down beds in the community is an issue that needs to be addressed as a priority. The hospitals which face the greatest difficulties and have the longest waiting lists, are otherwise condemned to fall further behind. The HSE obviously hasn’t done it’s homework properly.

No more excuses Mary – put out your hand!

Que sera, sera

August 22, 2007

I won! I won! I made the right choice and the battle is won. The diverticulitis has gone into retreat.

It was a close call though. Last night I was seriously thinking I’d have to go looking for help and own up to my self-medicating ways but today instead, I’m celebrating ‘beating the system’. On this occasion luck was on my side – the antibiotic kicked in overnight and I’m feeling better by the hour today. I’m not out of the woods yet but I’ve definitely turned a corner in the right direction. Now I don’t advocate self-diagnosis/self-medication as a rule but sometimes it does work in your favour. I’m pretty certain that otherwise I would have been hospitalised with the symptoms I had and, because of my previous medical history – so I know I got off lightly this time. And just look at all the money I saved our ailing health service by choosing to stay in my own bed! Antibiotics are causing a lot of problems in the world these days but when you really need them, they are a life saver. While I’m aware that overuse of antibiotics generally in the health service is to blame for my history of MRSA infection, the reality is I wouldn’t be here without them!

Life has looked up again, the sun is out and things are looking good. I will own up to the Docs in due course but it won’t be an apology!

Relish the Day

August 21, 2007

We all like to think we’re in control of our own lives but in reality, none of us really knows what’s around the next corner. Life is not always plain sailing. As the owner of a complex medical history, I’ve had to learn to accept this fact the hard way. My life has been constantly disrupted by medical problems and yet silly as it sounds, I never fail to be surprised when I do fall ill. I’m a born optimist but I’m also a realist. Life is precious and I find it helps enormously to live life with a ‘carpe diem’ philosophy. But even the best plans gets disrupted at times…

Two days ago, I awoke on a Sunday morning with acute abdominal pain, diarrhoea, nausea, fever and chills and I knew instantly that these were all the symptoms of acute diverticulits – I’ve been hospitalised in the past for treatment of this unpleasant condition. Diverticulosis is generally a harmless condition where small, bulging pouches (diverticula) occur in the digestive tract. It most often occurs in people who eat a low fibre diet, particularly those in the middle and old age brackets. Diverticulitis occurs when the diverticula in the wall of the intestine become infected or inflamed and it can lead to serious illness. Now, while I might not be exactly in the flush of youth, I do eat lots of fresh fruit and vegetables, brown rice/pasta and brown bread. However, I also have an inherited connective tissue disorder, Ehlers-Danlos syndrome, which leaves me susceptible to developing diverticular disease. Rest and a liquid diet are sometimes enough to allow the intestine to heal following an acute flare-up but antibiotics may be required. The more serious cases of diverticulitis require hospitalisation/surgery. I had a clear choice last Sunday. Present myself at the nearest casualty department for assessment and treatment (in the war zone environment of A&E) – definitely not a day to relish – or stay in my own comfortable bed on a concoction of pills previously prescribed for the same complaint. I think you’ve guessed what I chose to do. Yesterday evening I thought I was seeing signs of improvement so having had nothing to eat for 36 hours, I decided to cook myself a boiled egg with a slice of toast. A couple of mouthfuls later and I’d developed overwhelming nausea and quite literally passed out, slipping off my chair onto the floor. I’m not usually prone to fainting so I think I gave my husband a bit of a fright but luckily no harm was done and I crawled back to bed resolving to stick to a liquid diet. It’s now early morning and I think I’ve improved a little overnight though only time will tell. I may be an eternal optimist but I’m not a foolish one. I accept that I may have to revise my decision re choice of care but at least I now have a further option – being a weekday, I can consult my own GP practice where my history is well-documented, rather than face yet another long haul being processed in casualty. An A&E department is no place to be with an acute medical illness and what with the state of the health service in Ireland, the chances of getting into a proper hospital bed are very slim indeed.

For the moment anyhow, I’m staying put in my own bed – que sera, sera!

Malnutrition in Hospitals

August 16, 2007

I spotted an article recently in the Health Supplement of the Irish Times about some research carried out into the causes of malnutrition in hospitalised elderly patients.

Malnutrition is known to be common among elderly patients hospitalised with acute illness, because they often have little appetite and don’t eat much. Such patients could benefit from higher caloric intake“.

I don’t quite understand why it takes research to point out these most obvious of facts? Surely it’s common sense that sick people, both young and old, need good nutrition to help to maximise their powers of recovery. I’ve touched on this subject before here about the elderly being unable to fend for themselves in hospital.

I would like to add the following observations about the food served up in Irish hospitals, based on my own experience:-

1. A hospital diet looks totally unappetising and is very boring. There is no variation in the presentation of the food. A hospital salad is a good example – it rarely strays from cold meat, half a boiled egg, tomato wedges with some coleslaw, all sitting on some soggy lettuce and served with sliced bread. This is okay the first time it comes round but when you get exactly the same thing day after day – even the location of the food on the plate never changes – it becomes a total turn-off. The hot food menu is just as repetitive and has little to recommend it. Sick people should at least be tempted to eat.

2. Hospital food should be high in nutritional value. You could hardly call the daily offerings of white sliced bread, cornflakes, over-cooked veg, and jelly and ice-cream nutritional! How about some freshly baked brown bread/rolls, some tasty cheese or some fresh fruit with every meal? What about the 5 servings of fruit and veg recommended daily?

3. There is little supervision of the elderly at meal times due to the problem of understaffed wards. I have often witnessed food being served up to frail, elderly people who don’t have the energy or inclination to eat. By the time a member of staff has noticed the untouched plateful, the food has gone cold and is inedible. High calorie drinks are offered in addition but they do not replace the enjoyment or benefit of proper food. Only the sickest get offered the expertise of a hospital dietician but even they are limited by what they can offer.

4. The food served in the hospital canteen for hospital staff (and healthy people) is definitely better than that dished up to the in-patients. It seems that patients are expected to either (a) do without (b) resort to asking relatives to bring in some decent food or (c) if they are well enough, make a trip to buy food in the snack bars which decorate the front halls of most hospitals.

5. Huge amounts of hospital food are left uneaten and wasted. Surely there is a loud message in this? I-N-E-D-I-B-L-E!

Our health service lacks direction, it’s like a ship with no rudder. There is little or no common sense employed in our large hospitals. Instead, it seems, it’s all about cost cutting measures to meet the targets imposed by an under-resourced health service.

Is it any wonder then that research shows that those most vulnerable in our hospitals, suffer malnutrition? And all our Minister for Health has to offer in return is promises of better care for the á la carte brigade in the co-located hospitals. Grrr…

I am not a radio advert

August 14, 2007

I am a patient

I am an MRSA statistic

I am disgusted by the level of hygiene in Irish hospitals

I am sick of watching the bureaucratic HSE waste our money

I am tired of listening to apologies from Mary Harney

I am sad to hear of patients suffering unnecessarily

I am in awe of hospital staff who work hard despite their conditions

I am not in favour of a 2-tier health service

I am all for equity in health care provision

I am only one voice but I’m not alone

Discovering Magic

August 11, 2007

People have often said to me “I don’t know how you cope so well with all that’s happened to you”. I know how – it’s not about ‘coping’. It’s about making the most of the options left available. I’ve found that it helps enormously to try to concentrate on the positives rather than negatives. Having a good sense of humour has it’s benefits too. When used appropriately, humour is a great way to dissolve anxiety. There is always something left to celebrate in life no matter how much sh*t is thrown at you! My own experience of recurrent illness has made me more resilient and I hope, more insightful as well. I’ve learnt how to appreciate many of the simpler pleasures in life – like savouring a mouthful of delicious food or simply being in the company of family and friends. I find I want to grab life with both hands and enjoy. You sometimes hear amazing stories about people who are terminally ill, who insist that they’ve never been happier. I think I’ve discovered their secret!

When someone is hospitalised as an emergency, they have little control over what’s happening to them. Privacy is lost as well as a comfortable bed, nice food, and the company of loved ones. Life is simplified down to basic needs and you are relieved of all the normal demands on your time. Horizons narrow. Your whole world gets narrowed down to what’s happening to you, and around you. Despite the hustle and bustle of the daily routine, life in hospital can prove to be a very lonely experience. Solitude tends to magnify everything – it can be difficult to manage, but it can be liberating too. It’s been my own privilege to discover that this solitude brings with it a sense of tremendous vision. Whenever I’ve been at a low physical ebb, I’ve often found that I can see the world through different eyes. Life becomes ‘black and white’, the grey areas dissappear and I find I have the ability to clearly visualise solutions to problems. It’s magical! As I recover my physical well-being, this clarity of thought gradually fades and I happily let it go in celebration of my return to good health. Sadly, not everyone has this choice or good fortune.

I explained this phenomena to an acquaintance recently and he kindly sent me the words below, which I now treasure.

“When you experience the power of your wisdom and the power of things as they are, together, as one, then you have access to tremendous vision and power in the world. You find that you are inherently connected to your own being. That is discovering magic” (Chögyam Trungpa).

The secret to better health

August 2, 2007

Spread the message – not the germs.

We’ve all heard our Minister for Health harping on about handwashing as the ‘way forward’ in the war against the superbugs. Handwashing is important to our health but it is only one of the many health care guidelines produced by SARI (an offspring of the HSE) for the control of MRSA in Ireland. For the moment, it would appear that the HSE has made it a ‘national priority’ to use handwashing as the weapon of choice. What they’ve failed to communicate properly however, is that handwashing is only effective if it’s carried out frequently and in the right way.

If people don’t wash their hands frequently (especially when they’re sick), they can spread germs directly to other people or onto surfaces that others touch. The correct procedure is for people to wash their hands with soap and water for at least 15 seconds. They should rub in between the fingers, the top and palm of their hands and under the fingernails, the friction being the reason which zaps off the germs. Then rinsing for an additional 5-10 seconds completes the process before patting one’s hands dry with a disposable paper towel.

How does one comfortably measure the 20-25 seconds it takes to have clean, germ free hands without watching a clock? The secret to getting the timing right can be solved by humming the “Happy Birthday” tune twice over in one’s head.

Simple, eh! But if you catch someone singing Happy Birthday out loud while they wash their hands, kindly remind them the washing still works if the birthday song is silent. In fact, tell them it works better if it’s silent!

Junior Docs risk Burn-Out

August 1, 2007

The final (repeat) episode of ‘Junior Doctors’ lived up to expectation last night. Catherine, Paddy, Paul, and Sinead ‘survived’ their year as interns which they completed at the end of June last year. All were in agreement that they’d been on a huge learning curve but at a huge cost. Talk about mental and physical torture – it’s really inhuman what’s expected of our Junior Docs! And I’m not the only one to think this. Burn-out is a real issue. The problem is that the good ones get burned out as well as the ‘not-so-good’ and potentially fine doctors are lost to another profession. You couldn’t help but notice that the patients too are pawns in this crazy training scheme. As Sinead confirmed, it’s unfair on the patient to have one of these exhausted Docs attempt to insert a cannula when they’re ‘drunk’ with tiredness. I’ve been there, and while I have great sympathy with the junior doctors, I can tell you it’s not much fun being on the receiving end of this sort of treatment.

The series ended last year with an update on each of the four interns. It’s seems that each of these bright young things had their dreams come true. Catherine wants to be a surgeon (a Consultant, no less) and had commenced her training (a very long haul) as an Surgical SHO in St. James’s Hospital Dublin. Paddy who also had his heart set on surgery but had some doubts creep in, did the sensible thing and took a complete break from medicine while he completed 10 weeks in flight school to get a pilot’s licence before commencing work in Emergency Medicine in Sydney. Paul left Dublin for Waterford to begin his training in Orthopaedic Surgery, while Sinead got her wish to return to country life to train as a General Practitioner.

This series was an excellent ‘warts and all’ insight into the life of an intern. Intending medical students need to know the real story before they embark on this arduous career path. Let’s hope that Mint Productions keep up the good work and bring us another update on the progress of these four Doctors-in-the-making. I’d place bets that we’ll see Paddy as a HEMS (Helicopter Emergency Medical Service) doctor before too long!