Pancake Thursday

Last year I reached that magical age when I could officially join the ‘club’. BreastCheck is part of the National Cancer Screening Service in Ireland and invites women aged 50-64 for a free breast x-ray every two years. Breast cancer occurs most commonly in this age bracket and with early detection being the key to successful treatment, regular screening is recommended.

My birthday came and went and when six months later I still hadn’t heard from Breastcheck, I decided to take the matter into my own hands. On researching BreastCheck online I was able to check if my name was registered using a self-search facility. My name wasn’t known. I next phoned BreastCheck to enquire what action should be taken and to my surprise, the helpline was answered by a decidedly grumpy male voice. To be fair, my call was made during the time of the outcry about breast cancer misdiagnosis when women all across the country were up in arms and I would imagine that all breastcare services were probably bombarded with enquiries. I still felt it wasn’t right to have a man dealing with enquiries in what is essentially though not entirely, a woman’s area of health. I persisted however and he took my details assuring me that I’d hear from BreastCheck early in the New Year.

Yeah right, I thought! But actually I did get an appointment in the post and today I attended a mobile unit of BreastCheck to undergo my first mammogram. The unit staff were courteous and welcoming. I arrived early for my appointment and as there was no one else waiting, I was seen straight away. While sleet and rain battered against the window outside, I stripped to the waist and a nurse carefully helped me into position to be x-rayed from two separate angles. Each breast was compressed like a pancake in a vice-like structure causing significant discomfort but it only lasted a few moments while the x-rays were taken. My biggest problem was having to contort my body with an arm raised over my head to get the angle required. I have one shoulder which has been surgically restricted to stop recurrent dislocation and this did not make things any easier. However, it wasn’t long before the procedure was finished and I was invited to look at the images on screen. I was informed that one breast is larger than the other though apparently this is quite common and is nothing to be concerned about.

Having dressed and returned to the reception area, I decided to use the opportunity to ask more about the system used to automatically register women. I was confused as to why I seemed to have slipped the net. I was told that BreastCheck compiles their list from information supplied by the Department of Social and Family Affairs, General Medical Services and private health insurance providers. I then learnt that the process can take up to two years before someone will be called for screening. I was appalled to hear of this as I have several friends who developed breast cancer at my age and with this disease, it’s well-known that time is of the essence. My prompt appointment had come about simply because I’d pre-empted the system by making an enquiry. I would urge all women in this age bracket to ensure that they are in the system and that they attend for mammograms when called. We owe it to ourselves to take whatever steps are necessary to stay safe. Please make time for your breast health.

I have no particular reason to fear breast cancer but because I’m aware that a mammogram can show up some tumours two years before a lump can be felt, I’d rather be safe than sorry. I was pleased to hear that today’s results will be posted out to me personally and to my GP, within three weeks. With that reassurance, I took myself and my lop-sided breasts home to wait.

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.

Life or Death

There’s been a lot of hype recently in Ireland about the appallingly inadequate hospital services for adult patients with cystic fibrosis (CF), and rightly so. Put simply, our Government’s failure to provide a dedicated CF unit in this country, is costing lives.

The critical issue here is the limited availability of suitable isolation facilities. 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.

When I was first diagnosed with an MRSA infection following surgery, I was hurriedly moved out of a general ward into an en-suite isolation room to be barrier nursed while receiving intensive IV treatment. I felt like vermin and in reality, I represented a high risk to those patients whose immune systems are compromised by disease or treatment. I was eventually discharged home on oral antibiotics but the infection recurred and I was re-admitted through A&E for further IV treatment in a single isolation room. I was again allowed home on oral antibiotics but the infection worsened and I soon had to come back into the hospital. On this occasion I was transferred from A&E to the MRSA isolation unit where all patients with MRSA are nursed together. This unit was full of elderly patients, it was poorly ventilated and I felt distinctly uncomfortable with the high risk of cross-infection there. During my stay, I would spend the evenings sitting outside the door to the unit to get fresh air and to escape the blaring televisions. None of the staff ever objected to this practice. As my health improved, I soon ventured further afield to use the hospital coffee bar as a venue for meeting visitors. Nobody advised me otherwise and indeed, I often met doctors I knew while on my travels and they’d stop for a friendly chat. The point here is that as a carrier of MRSA, my outings put other patients at significant risk of cross-infection. This stark reality was brought home to me when listening to the recent public debate on CF issues. At the time, my only concern was self-preservation but now I realise that I should never have been allowed to wander the hospital corridors. If anyone is to blame, it is the hospital authorities for their slack policy of infection control.

Ireland has the highest incidence of CF in the world and yet we have the highest mortality rate and lowest life expectancy. CF patients have been waiting for more than a decade for a dedicated CF unit to be built and they are quite literally, sick waiting. Our Government has failed miserably in it’s duty of care to these young citizens. Lives are being shortened and young people are dying as a consequence of our inadequate hospital services. This really is a matter of life or death.

Holding on for dear life

Last week, I was busily preparing a new post for this blog when some unexpected news came through, leaving me unable to concentrate on anything much since. Life has taken on a new light and we as a family are quite literally ‘on-hold’.

Ten days ago we moved my 88 year-old mother-in-law into a local nursing home as it had gradually become too difficult to manage her care around the clock despite daily help from a small team of carers. Last Wednesday, a blood test unexpectedly revealed that she is in acute, end-stage renal failure from which there is no return. Her days are acutely numbered. This news came like a bolt out of the blue and initially left the whole family reeling in shock. We were given the option to transfer her immediately by ambulance to hospital for treatment which might at best, prolong her life by a few weeks or alternatively, to allow her to die naturally within days with palliative care provided at the nursing home. The whole family were all in agreement that she should be allowed to end her days peacefully without the interference of emergency medicine and we have opted to maintain a bedside vigil for her in the nursing home. My in-laws are spread far and wide but over the past few days they’ve arrived in a constant stream to take their turn in helping to smooth the final journey of a much-loved mother, and granny.

My mum-in-law was a legend in her own right. She lived a privileged life and together with her late husband, raised four fine sons. She was an outstanding cook, seamstress and gardener in her day. She loyally moved location every three years throughout her husband’s career and everywhere they went, she set-to with gusto to furnish each new house using her old-faithful sewing machine. No task was ever too great and she was never idle. She always found time to spend in her beloved garden where she designed and created gardens that were the envy of all who knew her. When her four children were very young, she made all of their clothes and continued this tradition for her grandchildren making beautifully embroidered smock dresses for the girls, individually crafted hand knits, clever fancy dress outfits and gorgeous soft toys for everyone. She also produced many fine tapestries in her time. She was the stalwart of the whole family and her home was always a place of warm welcome with lovely home cooked food in abundance. She was well-renowned for taking under her wing children less fortunate than her own and she would lovingly provide them with the stability needed to thrive. When I first met my future mother-in-law, she welcomed me into the family with open arms and I shall always be grateful to her for all her love and encouragement over the years.

She’s had a very good innings but now her time is rapidly running out. She’s being kept very comfortable in the nursing home and has rallied somewhat due to a change in medication. In the past few days she’s been more alert than in many months and her family have been able to enjoy some special time with her. It’s like her final swan song before she departs. Her funeral will be a huge celebration of a life well-spent but until then, this is my tribute to the mother of all mothers.

What’s your view?

Last week I learnt that my blog had been short-listed as a finalist in the Medical Blog Awards 2008. I was initially chuffed to have been nominated for this award and was then even happier to find that my blog had been short-listed by the judges, but that’s where my delight ended. I simply do not agree with public voting as a means of selecting a winner and therefore I’ve chosen to boycott the voting system and to accept the consequences.

Polls opened for public voting last Wednesday and are due to close on Sunday 20 January 2008. Thanks to anyone who’s already given me a vote – it’s good to know that you like my blog. However, the results tally so far appears to prove my point and I now suspect that I’m not the only finalist to hold this viewpoint. ‘The Biospy Report’ currently has the lowest number of votes in it’s category. I’ve no doubt that this is because of my decision not to canvass anyone for their vote though I accept that this will not be the only reason 😦

I believe that if awards are to have any real meaning, then they should be based on merit, not on popularity. What value can you put on an award when the system of voting is so open to abuse?

The Irish Blog Awards this year seem to think likewise.

“There are two judging rounds this year, so every nominated blog will be judged. No public vote means it is about quality, not the number of people who like you”.

I’d like to thank Medgadget for hosting this award, but um … no thanks if this really is their method of judging?

Life’s not all plain sailing

I grew up near to the coast and as a result I’ve always loved the sea. I learnt to sail when very young and this helped me to develop a healthy respect for the sea. It has lots of fun to offer but sometimes, it holds surprises too.

I took to sailing like a duck to water. During my school days I used to spend every summer messing about in small boats that looked a bit like bath tubs. It was well-supervised fun and we learnt all the rudimentary skills required to race bigger boats. As a teenager, I won a prize of a week’s sail-training course on the ‘Asgard’, the original gun-running boat that earned itself a place in Ireland’s history. This boat leaked like a sieve but it didn’t spoil the adventure of sailing from Dublin port to Dartmouth in the south of England, calling in at various ports along the way. As time went on, I graduated to racing on bigger boats and often crossed the Irish Sea as part of a crew of keen sailors. I actually met my future partner-in-life on a boat as we shared a common love of sailing. We soon bought a small boat together and enjoyed many years of highly competitive sailing – think racing cars at speed, but on the water and you’ve got the right idea.

One summer evening we were out racing in a fleet of about 20 boats when we got the shock of our lives. As I’ve always had problems with my joints due to having Ehlers-Danlos syndrome (EDS), I used to helm the boat while my other half did all the hard work of keeping the boat well-balanced and doing all the frantic sail changes. It is also part of the crew’s job to keep a watch-out for other boats so that collisions are avoided. That evening my crew suddenly yelled at me to take avoiding action as he’d spotted an obstacle in the water. As we passed what we thought was a submerged log, we both fell silent. There was a white shoe clearly visible in the water. We looked at each other in horror as reality hit home and then quickly turned the boat around for another inspection. When we passed the shape in the water for a second time, we could clearly see a hairy leg attached to the shoe. Without hesitation we abandoned the race to stay with the body until further help could be summonsed. This left us with a bit of a dilemma as by this stage, the rest of the fleet had passed us by and the body was rapidly drifting out to sea on an ebbing tide. We had no choice but to tie a rope around the shoe with a marker buoy attached so that we could sail away towards a bigger boat to access a ship-to-shore radio – this all happened in the days before mobile phones. Once the lifeboat had been notified, we sailed back to our marker buoy and stayed in the vicinity to help the emergency services to locate the body. When we finally returned to shore we were met by a full turn-out of the emergency services as the body was brought ashore. We were asked to give detailed statements to the police before going home. Neither of us were able to sleep a wink that night due to the trauma of the experience. Today I can still clearly see in my mind, the sport logo on that white shoe.

We heard no more about this incident until one day, a letter popped through our letterbox at home. It was from the mother of the lad whose body we’d found at sea. Sadly, he’d taken his own life and his body had been missing for three weeks when found. His mother had managed to access our address from the emergency services as she wanted to thank us for the part we’d played in helping to bring closure to her family’s grieving. It was a very touching letter and a fitting end to a difficult experience.

The Minister’s off her trolley

Today we hear that the number of patients waiting on trolleys for admission to hospital around the country has reached similar levels to last year when the Minister for Health announced a national crisis in A&E. And the HSE is still trotting out excuses.

Has anyone else noticed that there’s been an ominous silence from Mary Harney since Christmas. What ever happened to the consultant’s contract which she insisted would be signed and sealed by Christmas? Where are the 2,000 extra beds promised for the public hospitals to alleviate the problems in A&E. Have you heard anything recently about the plans to develop a system of co-located hospitals to move private patients out of public beds? The HSE wheeled out a spokesman this evening to defend the inaction of the organisation. He was full of excuses as to why the problems are ongoing – even the winter vomiting bug was blamed. “It’s been difficult to find agency nurses to work in A&E”. “Home-care packages are coming on stream to enable old people to manage better in their own homes”. “Step-down beds will be available in a ‘few weeks’ for patients categorised as ‘delayed discharges’. This will release beds for acute patients”. All measures to relieve the crisis are always in the future. What about now?

Well, frankly Mr. HSE I’m not one bit impressed as we’ve heard it all before. A whole 365 days has gone past, very little has changed and today 365 patients are lying on trolleys awaiting beds. The backlog in A&E is a symptom of the failure in the whole hospital system. More beds are urgently needed and the HSE has no immediate plan in place to alleviate the shortage. Working conditions in A&E are so horrendous due to the overcrowding that only the most dedicated, or the most desperate, will work there. Is it any wonder that agency nurses are difficult to find? Why are we still waiting for the funding for home-care packages to happen? The recent Department of Health cutbacks in spending have curtailed any efforts to get this system up and running. There are long-stay beds available in nursing homes around the country but the HSE hasn’t put out to tender to secure these as step-down beds for the ‘bed blockers’ in our acute hospitals. Thousands of bed days are being lost in acute hospitals because of the failure to free-up beds. Improved primary care such as GP services, would greatly relieve the burden on our hospitals but again this invaluable resource is being ignored by the HSE.

It’s becoming patently obviously that the Minister for Health has lost the plot. Even the dogs in the street know that the HSE is failing to steer the health service in the right direction. It’s like a ship without a rudder… if only it would sink.

A Long Time Waiting

I listened to a radio interview today where it was stated that nothing has changed in A&E despite the Department of Health’s insistence that patients no longer have to wait long hours on a trolley for admission to hospital. My blood is still boiling.

Dr James Binchy of the Irish Association for Emergency Medicine, which represents A&E consultants, stated that Irish patients are dying unnecessarily due to delays and overcrowding in A&E. Many A&E departments continue to be unfit for purpose despite a damming report last year. Dr Binchy talked about feeling despondent when he arrives into work each day to face a backlog of patients still waiting for admission from the day before. He described how he endeavours to avoid eye contact with these patients, such is his despair at the conditions they must endure while they await a hospital bed. I’ve personally observed this avoidance tactic in A&E and I know exactly what it feels like from the patient’s perspective.

A year ago, my elderly father was rushed to hospital by cardiac ambulance from the nursing home where he resides in full-time care. He suffers from acute short-term memory loss and needs constance reassurance as to his whereabouts. Thankfully, his collapse was not as serious as first suspected but in order to ascertain this, he had to spend three days and nights on a hospital trolley in the busy A&E department of a large general hospital. He was thoroughly investigated and monitored but his surroundings caused him great anxiety and he became hugely confused during his stay. He was eventually discharged back to the nursing home, not because he was well but because they could no longer care for him in such an acute hospital setting. Luckily, my father is physically none the worse for this experience but to this day, he remains traumatised from having felt so lost in that A&E environment. He still phones me regularly to report “I’m in hospital for the night in case anyone is looking for me”. It’s sad and it sickens me to think of all the elderly people who are suffering this sort of abuse because of our third world hospital system.

Little or nothing has changed despite the urgent recommendations of the task force set up in 2006 after our Minister for Health, Mary Harney declared A&E overcrowding a “national emergency”. Dr Binchy makes the point that the delays in A&E are due to the backlog caused by a shortage of beds in the public system. He quantified this with figures which show that no patient in the hospital where he practices, had to wait overnight on a trolley for admission during the Christmas period. This is simply because elective admissions had been cancelled over Christmas thereby temporarily alleviating the bed shortage crisis.

And the moral of this story is? If you’re going to get sick and need emergency care, make sure you do it during a festive period unless you’re willing and able to rough it out in A&E.

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?