All Tagged Out

I’ve been tagged by Mousie. Now Mousie’s not someone you mess about with as one day you may end up on a trolley in her A&E Dept and that’s when you’ll be glad you did as she asked! Having said that, I’ve never been good at obeying rules so I’m going to do my own thing with this meme. If you want to see how it should have been done, pop on over to Mousethinks and, be impressed.

I’ve been asked to share some facts about myself, some random, some weird. As the theme of this blog is medical/health-related, I’m going to stick with my medical misadventures. Here goes!

I am a twin. My mother spent the final month of her pregnancy in a small nursing home, on strict bed rest. My twin brother arrived into this world 20 minutes ahead of me but he arrived so quickly, my mother never made it to the delivery room. They tried to transfer my mother immediately afterwards but I decided to arrive while she was on the stairs. She was rushed back to her bed just in time for my delivery. In all the excitement, my brother got forgotten and was later rescued from under the bedclothes. That all happened 50 years ago last May.

I once smashed my big toe when my ‘hot jar’ landed on it. When I was a little girl, we didn’t have the luxury of rubber hot water bottles. I had a heavy ceramic jar filled with hot water, with a large ceramic screw lid on top and it was used to take the chill off the bed as our house had no central heating at that stage. Anyway I managed to drop this thing on my foot one day causing my toe to bleed profusely. I can recall having my foot immersed in a basin of hot water (with Dettol) and watching the water turn bright red. I also remember my Dad giving me a piggy back every day into school. A few week’s later I felt something peculiar in my sock and found a discarded toe nail.

During my college days, I was the proud owner of a gold Yamaha 50cc motorbike having worked for a whole summer in a German canning factory, to fund it. One dark wet winter’s evening on driving home, an oncoming car suddenly turned across my path without warning, at a road junction. In that split second, I had a clear choice. 1) to crash into the side of the car or 2) to take evasive action and swerve into the path of oncoming traffic. I chose to hit the car and I can still recall the ‘thump’ and the sensation of being catapulted through the air, over the roof of the car. I was lucky in that I survived and was carted off to hospital by ambulance but I lost my dear bike that night. It took many years before I rid myself of the nickname, Evel Knievel.

Those of you who have read this blog before will know that I have an inherited connective tissue disorder (EDS) which leaves me prone to joint laxity. I’m right-handed and so my right shoulder takes the brunt if/when I have a fall. After several dislocations it eventually got to the stage where I needed surgery to stabilise my right shoulder joint. The surgeon carried out a ‘Putti-Platt’ procedure to shorten the ligaments and prevent further dislocation. Now no matter how hard I try, I cannot rotate my right arm outwards (no external rotation) to reach things on my right side. Think about this, the next time you reach for your driver’s seat belt.

And that’s as far as I got last night before I became all tagged out and went to bed feeling rotten. I’ve not been feeling well since last Friday having woken with marked congestion in my nasopharynx (area behind nose and above soft palate) but with no sign of a cold or sore throat. The congestion continued over the weekend and I began to feel like I was fighting a viral infection. My husband had to abandon the bed by Sunday night as loud snoring prevented him from getting any decent sleep. Yesterday, the congestion moved on up into my forehead and overnight it turned into a fulminating infection with pus literally bubbling over in my head. With my past history, I cannot afford to take risks so I headed to the doctor first thing this morning to get nasal swabs taken before starting on an antibiotic. So my medical misadventures are ongoing. I’m going to call it a day now as my head feels like it’s been taken over by aliens. I’m not going to tag anyone with this meme for fear it may be infectious. Enjoy the lucky escape!

Superbug Fear

Now, I don’t know about you but I have a fear of hospitals. I have good reason to be afraid. I don’t mind needles and I’m not afraid of pain but I would be concerned about picking up another hospital acquired infection (HCAI). My fears are well-justified as it’s no secret that Irish hospitals are rife with superbugs. Mary Harney says she doesn’t accept that people are afraid of our hospitals. She would say that, wouldn’t she? She hasn’t had to fight for her life following a serious MRSA infection.

Today’s news (and I particularly recommend that you listen to the audio links at the bottom of RTE page) has done nothing to allay my fears. Over a 7-month period last year, a high incidence of deaths which were directly or indirectly attributable to superbugs, was recorded at one Dublin hospital. This hospital has no consultant microbiologist in place and is forced to ‘borrow’ these services from another hospital. It beggars belief after the outcry over the prevalence of HCAI’s in Ireland, that this relaxed attitude to infection control continues to exists in our health service.

Mary Harney says she is learning from best practice and that plans are in place to minimise the possibility of acquiring HCAI’s. You know what Mary? Two can play at your game. I don’t believe you!

Blog Land

Today is the first anniversary of this blog. Hip Hip, Hip Hip, HURRAY!

Okay, so I know some clever dick is going to tell me that the tool bar shows The Biopsy Report started in June, not April! You’re right, it did but this blog actually came into existence this day last year. If you don’t believe me, scroll down and have a look at ‘archives’. The blog was originally known as Que sera, sera and after a few months of dipping my toes into the blog pool, I decided to make a few changes and start all over again. That’s when The Biopsy Report was born.

How well I remember those first few tentative steps into ‘blog land’. I hadn’t a clue what the whole blogging concept was about but my son, Robin, kept telling me “You’ll love it, Mum!”. He was right, of course. I totally adore it and now I can’t imagine life without blogging. My friends think I’ve lost it but they don’t know what they’re missing! He! He! Hardly a day goes past without me announcing to someone “but one of my blog friends says this” or “one of my blog friends does that” and it raises some interesting looks. Okay! Maybe I have lost it but I tell you what, if this is losing it bring it on, I want more!

So, some 22,000 visitors, 2 blog award nominations and a whole lot of fun later, here I am celebrating a year of giving an insider’s view, from a patient’s perspective, on what life is like within the health service. To sow the seeds for this, I had to put my story out there first and this had the added bonus of bringing welcome support and understanding from all my blogging friends. I used to talk about my medical saga as being a lonely journey. How things have changed! This blog has really helped me to find the plot and I’m hugely grateful to everyone who’s given support. Now that I’ve got my own woes out of the way, I’ve started to focus on the bigger picture of our rapidly crumbling health service. I don’t pretend to be an expert. I just say it as I see it and hope that by exposing the various issues, it will get people to think more about what sort of health service they want, and need. They say your health is your wealth. Sadly, in Ireland it’s rapidly becoming more of a case of your wealth is your health. I’m determined to do all that I can to raise awareness of the flaws within the system, as I see them. Some day, you may be very glad that I did.

And now, where did I see that great lasagne recipe yesterday? I’m off to give it a whirl! Thanks! Grannymar.

A Balancing Act

I listened with interest to Prof John Crown on the Late Late show last night as he outlined the failings within our health service. John Crown is a leading consultant oncologist working in the front line of the Irish health service and he doesn’t mince his words. He believes that the consultant’s contract as currently presented by the HSE, is a fiasco. He described it as an apartheid contract for an apartheid system of healthcare. Today, I heard that the Irish Hospital Consultant’s Association (IHCA) has accepted the HSE’s proposals and will be recommending the contract to it’s members in a ballot later this month. Meanwhile, the Irish Medical Organisation (IMO) is still refusing to come on board and has today requested third party mediation to resolve the problems. On one side, we have a government that insists on perpetuating a 2-tier system of healthcare despite the consensus of opinion which believes that a single tier health service is the way forward. On the other side, we have doctors who don’t like being put under the thumb by administrators who will decide their working hours. This contract has already been four years under discussion and I have to agree with Prof Crown, it has the potential to be a fiasco.

We have a health service in Ireland that offers a high standard of care but the care is not optimal. According to John Crown, this is due to ‘mal’ funding rather than underfunding. When the allocation of money from the HSE runs out, services are cutback at the expense of patient care. Treating patients costs money but It costs the system nothing to have patients on waiting lists. We have a health service run by civil servants instead of having a medical leadership structure in place. The policy of co-located hospitals as proposed by the Progressive Democrat (PD) health policy, is set to cause an even wider divide between the public and private systems. Each system will be differently funded, further adding to the complications. The concept of co-location ultimately means that services are duplicated in the one location. This is neither efficient nor cost effective . The co-located private hospitals already in existence, tend to be small and have sub-optimal expertise in place. As a holder of private health insurance, I can personally testify to this having once faced the decision of having to choose between standard of accommodation and standard of medical care. I was very unwell in A&E at the time and required admission for investigation. As I was known to be infected with MRSA , I required isolation facilities in order to be admitted to the hospital. There were single rooms available in the co-located private hospital but the physician under whose care I was to be admitted, worked only in the public hospital where no isolation facilities were available at that time. This dilemma typifies all that is wrong with the plans for co-location and the divisive nature of the consultant’s contract. I had no problem choosing medical expertise over comfort but I should never have had to make that choice. Why does healthcare have to so divisive? If you’re sick and in need of hospitalization, the type of care you receive shouldn’t be dictated by your ability to pay.

John Crown is in no doubt that the way forward for our health service is a single-tier, not for profit system of healthcare based on a universal system of social insurance. He makes no apology for speaking out about the deficiencies within our health service. As long as there continues to be vested interests and a burgeoning bureaucracy in control of our health service, the system is doomed to fail. The future of the consultant’s contract remains in the balance.

A Long Wait

So that’s it! My grumble of last week has already become a reality. The HSE cutbacks are in full swing. One large ward at the public nursing home where my parents reside, has now officially been closed down. Once enough beds have been freed-up (which only occurs when another resident dies) to accommodate the residents from this ward, there will be 20 less long stay beds in the system. As well as this, all further placements for long term care at the nursing home, have been suspended until further notice.

It’s inevitable that this action will cause a negative knock-on effect on public health in the area served by this nursing home. People who are struggling to cope at home with a relative suffering from dementia (who needs round the clock care), are now going to have to wait even longer for help to arrive. The HSE has just cruelly lengthened the queue for long-term beds. If you have an elderly relative in hospital who’s ready to be discharged to a step-down bed in a local nursing home, then their wait in hospital has just got longer. These patients are often unfairly referred to as bed-blockers because of the log jam caused when acute hospital beds are used for long term care. This blockage of acute beds impacts on A&E services where waiting times on trolleys will inevitably increase thereby causing further chaos in emergency departments. Waiting lists for elective surgery will also get longer and operations will be cancelled because of the pressure put on bed allocation.

These delays are all a direct result of the HSE’s decision to restrict funding to one nursing home. Once again, we have no joined-up thinking coming from the HSE. If this action is replicated around the country which no doubt is the plan, then I fear the consequences. Morale in the health service has already been eroded by cutbacks across the service. This latest action from the HSE is enough to make anyone despair.

Help! I think I feel another health crisis coming on.

Going Incognito

Do you recognise these velour pyjamas?

Last seen at the Health Debate in Trinity College Dublin on 8th April, 2008.

If you see someone wearing this outfit who answers to the name of Mary, please contact the Irish Medical Times blog @ Viscera, where all will be revealed.

Well not quite all, thankfully! 😀

Wanna be a Superbug?

This week news broke of a serious outbreak of the superbug Clostridium difficile at Ennis General Hospital last year. A damning report published by the HSE, listed a litany of problems at the hospital. The hospital has since taken appropriate action to bring the situation under control but the response from the HSE is less than encouraging.

The extent of the problem in Ennis came to light when routine laboratory surveillance showed up higher levels of infection at the hospital than would be expected. The review, conducted by two assistant national directors with the HSE, found that in total 46 elderly female patients became infected with this superbug within the first 6 months of 2007 and of these 21 had died by the end of the year. Clostridium difficile was not listed in any of the cases as a primary cause of death though it was listed as a contributory factor in 13 of the deaths. The report published by the HSE yesterday concluded that the contributing factors included overcrowding, poor hygiene, high bed occupancy rate, faulty equipment and staff shortages. In all, it made 15 recommendations in relation to improvements which should be made at the hospital. It also recommended that a national reference laboratory be established to improve control of this superbug. Ennis General Hospital has already implemented changes and levels of this dangerous bug are now very low at the hospital.

The HSE’s response to this report was “The HSE will ensure that learning from this specific incident is applied nationally and on that basis will be holding a briefing session with hospital and other appropriate healthcare managers in coming weeks“.

Meanwhile, last Tuesday I read in this week’s edition of Healthplus, published by the Irish Times that “The Health Service Executive (HSE) West has sought to allay concerns about the impact of current financial cutbacks on laboratory testing for MRSA. Restrictions on testing for the MRSA superbug have been implemented as part of State-wide HSE stringencies since September last“.

So at the same time as alarming rates of the superbug, Clostridium difficile were coming to the fore in Ennis, the HSE implemented cutbacks which have directly affected laboratory staffing levels and caused “service restrictions“. This week’s report clearly recommended that laboratory services should be increased and improved and yet we hear that the HSE continues to restrict services in this area. The cutbacks introduced last September have also had a knock-on effect on the problems of overcrowding, poor hygiene, bed occupancy rate, supply of equipment and staff recruitment in our hospitals – all the factors listed in the Ennis report as contributing to cross infection.

You don’t have to be a rocket scientist to work out that we have an infection control crisis in the making. The cutbacks across the country are giving superbugs free rein to march. The failure of hospital management and senior health officials to appreciate this real and growing threat, is putting lives at risk. I rest my case.

I dunno

When I visited my parents in the nursing home this week, I was sad to learn that one of long-standing residents at the home had died a few day’s earlier. Her relatives had arrived to collect her possessions and I felt the pain of their loss. That was, until I heard the full story.

Norma, at 95 years old, had lived in the home for many years. I know that the staff and other residents, were very fond of her but I never actually saw her with a visitor. She was a gentle soul who rarely demanded attention so it was always a pleasure to stop for a chat. Norma would whisper her thanks and reward you with a smile.

I learnt the other day that Norma’s relatives had rarely, if ever visited her during her time in the home. She was so neglected by her nieces and nephews that the nursing home had to take her under their wing and provide all of her personal requirements. I used to always admire how well-turned out Norma looked and it now transpires that her clothes were provided by the home. When a resident dies, their relatives often choose to donate the best clothes of their loved one to the home. The staff keep a store of these clothes for use as spares when needed by some of the residents. Norma was beautifully kitted out from this source and the home supplied all her other needs, including her favourite chocolate treats.

I was horrified to hear that her relatives had arrived this week to collect the contents of Norma’s wardrobe and locker. Few, if any of her possessions were supplied by the family but they were determined to take them. It must have been sickening for the staff to watch this happening having lovingly cared for Norma for all those years. No guessing then what the relatives will want to get their hands on next!

Be Angry

When I first saw the list of speakers lined-up to participate in the Health Debate, I couldn’t believe my luck. This was a prime opportunity to hear our Minister for Health endeavour to defend her tactics to privatise healthcare in this country at the cost of the public health service. As it turned out, she left in a bit of a hurry but I did, at least succeed in getting to have my say.

I arrived early in the front square of Trinity College Dublin (TCD) just as the State car drew up at the entrance to the Exam Hall. Mary Harney stepped out of the car wearing what can only be described as, velour pyjamas and with her entourage in tow, she proceeded up the length of the exam hall with me in hot pursuit. Her pyjamas proved to be an excellent decoy as nobody took a blind bit of notice of her and she was quickly escorted to a side room to await the arrival of the real stars of the night. The debate was ably chaired by Conor Gannon of TCD VdeP Society, who did a fine job introducing each of the speakers and keeping order throughout the debate. The motion put forward was: “This House believes that the Irish Health System Fails the Disadvantaged”. I’m delighted to be able to report the motion received unanimous support from the audience and Mary Harney and her band of loyal followers suffered a resounding defeat. Unfortunately, she didn’t stick around for long enough to hear the disquiet that flowed from those on the panel in support of the motion, and from the audience. She made a hasty retreat shortly after delivering her own contribution to the debate. We were told that she had been “called away by Cabinet business”. Yeah, right!

The debate was opened by Prof. Orla Hardiman who gave an impassioned speech about the faults within the health service. She urged the audience to “be angry, be very angry”. She is firmly in favour of an equitable healthcare system for all and her address received rapturous support. Mary Harney then got to her feet and declared that it is her intention to provide a health service based on medical need (as opposed to ability to pay) and insisted that huge progress has been made. We got reams of statistics about how the health service is helping us to live longer but in reality, it was a lacklustre performance. She was constantly interrupted by a heckler in the audience who persisted in shouting her down despite repeated requests to desist. While this heckler was clearly out of order, his intervention proved to be the only challenge to Mary Harney last night as she departed before any one else got the opportunity. Fergus O’Ferrall, speaking in favour of the motion, informed us that 90% of the €16 billion spent annually on the health service comes directly from our taxes. The other 10% of funding comes from the private health insurance market. He accused the HSE of mismanagement through under-provision and rationing of services. The next speaker, Dr. Sean Barrett who opposed the motion, almost won approval when he declared that this health service not only fails the disadvantaged, “it fails everyone”. However, he then proceeded to place the blame on productivity being too low, the fact that private medicine is practised in public hospitals, the high ratio of staff to number of beds, and a greedy medical profession. He made no mention of the Dept of Health or the HSE. Mary Harney scuttled out of the room at this point while she still had someone on side. Throughout the evening, those in support of the motion gave credit to the late Susie Long for using her own plight to highlight the failures within the service. The opposition put forward two further speakers, an ex-TCD student and member of the young Progressive Democrat party (Mary Harney is a PD ) and also a manager from the HSE who were both, it has to be said, less than convincing. We also heard from two further speakers in support of the motion. Audrey Deane, representing the St.Vincent de Paul Society, told the room that HSE managers are turning to the SVdeP to access help for those failed by the system. How bizarre is that? The final speaker in support of the motion was Prof John Crown who denounced the waiting lists caused by underfunding in the health service. He joked that if we had such a thing as an abortion clinic in this country, he was sure the waiting list would be 10 months. “That’s if you go privately, going publicly would take longer!” EU figures for waiting times, show Ireland coming 2nd last on the list. He accused the HSE of employing too many spin doctors, referring to the place as ‘Burassic Park’. John Crown wants to see the Bismarck model of healthcare implemented (a one tier, not-for-profit health service) or else he warned “we’re heading for a ‘Paris Hilton’ style of health care”.

The debate was then opened to the floor and speaker after speaker outlined their experience of the deficiencies within the service. I waited until the end of the night before taking to the floor and then, I let rip. I surprised myself by the depth of passion which flowed as I spoke about the chaos in the public health service, the squalor of the conditions endured by sick people and the scourge of MRSA in our hospitals. I outlined the madness of the recent HSE cutbacks, the continuing problems in A&E despite claims to the contrary and warned of the consequences to follow if Mary Harney’s continues to privatise healthcare in this country. I also spoke out in defence of those who have private health insurance. We tend to be blamed for contributing to the a 2-tier health system when in fact we feel forced to seek insurance as we know we cannot rely on the health service in times of need. I concluded by commending the hard work of those healthcare workers who strive to provide excellent care in difficult conditions and reminded the audience that we need to protect the good aspects of our health service from further government interference.

Following the resignation of our Taoiseach, Bertie Ahern, last week Mary Harney announced that she had no intention of running away from her post as Minister for Health. In response, I’d like to say to Mary “be afraid, be very afraid. Time and patience is fast running out.

UPDATE: I forgot to thank Grannymar for her support in helping me to highlight this debate. The chairman of the debate was delighted to have a full house for this annual event and was impressed to hear that the blogging community had given support.

You wanted more

Here is another opportunity to join the Health Debate.

Motion: “This House Believes That The

Irish Health System Fails The Disadvantaged”

Tuesday 8th April 2008, Exam Hall, TCD @ 6pm

Speakers include:

Mary Harney (Minister for Health & Children)

Dr Sean Barrett (Lecturer in Economics, TCD)

Frank Mills (HSE)

Prof John Crown (Consultant Medical Oncologist, St Vincent’s Hospital)

Audrey Deane ( St Vincent de Paul Society)

Fergus O’Farrall (Adelaide Society)

Prof Orla Hardiman (Consultant Neurologist, Beaumont Hospital)

It’s a fantastic line-up of speakers. I intend to be there too!