Stranded

Dying to get home. It’s no fun getting stranded especially when you’re on your own. Just imagine it…

You’ve spent an exhausting day anxiously waiting for news. It seems no-one can tell you how long the wait will be. You try to pass the time by reading but the constant level of activity around you, makes it impossible to concentrate. Each time you visit the toilet, you risk losing the cramped space you’ve made your own.

Night time comes but there’s no prospect of getting any rest. Sleep is impossible in the noisy, brightly lit environment. You lie there exhausted hoping that tomorrow will be a better day.

Yes, I did feel sorry for all those people stranded in airports last week but not half as sorry as I feel for the many patients stranded every day in our overcrowded emergency departments while awaiting a hospital bed.

Four years have passed since our Health Minister, Mary Harney declared A&E overcrowding a national emergency yet still the number of patients on hospital trolleys continues to reach record highs.

Do Not Enter

I had a great bit of fun last week on my last night in the A&E department. If there’s one thing I’ve learnt over the years of being admitted to hospital, it’s to use humour to get through difficult situations. This time, it really helped me through a potential emotional meltdown. I won out in the end too!

Those of you who’ve read this blog before, will know that I have a past history of MRSA infection and although I am clear of this horribly resistant bacteria, I’m still regularly stigmatised by it when in hospital. On this occasion, on admission to A&E, I was carefully questioned about my MRSA status and swabs were taken for analysis. A very kind ward manager found me a bed rather than a trolley and it was pushed into a little side room to ‘protect’ the other patients in case the swabs came back MRSA positive.

The side room had four walls, a bed, one chair and a door. No television, nothing. No en suite either which means that potentially infective patients use the same facilities as everyone else. As I was only a ‘suspected’ carrier of MRSA, no restrictions were placed on my movements around a very busy A&E department. On the third night, I came out of the side room to find a new sign on the door… “Do not enter, please contact staff desk first”. My immediate reaction to this was “Help! My swabs must have come back positive”. I went back into the room and lay down on the bed in despair. That’s when the fury hit. “How dare they put up this sign without first informing me of a change in status!”. I was tired and in danger of losing my cool. Humour was called for. I sat up and carefully made a sign which proclaimed “Enter at own risk, I bite!” and using a sticking plaster from my handbag, I stuck it to outside of the door below the other sign. About 30 mins later, a night nurse stormed into the room and asked if I was responsible for the sign. I smiled back at her cheekily and replied,  “two can play at your game you know. Nobody consulted me about the restrictions placed so I didn’t consult you”.  I demanded to know if my MRSA status had changed. She replied that it hadn’t and admitted that they were playing safe. She then left the room clearly annoyed. I chuckled to myself in victory.

Shortly afterwards, she returned with a smile.  “You win”, she said.  We’ve taken both signs down now”.

The following morning, I left the room briefly and on my return, my bed and all my belongings had disappeared. Nobody could tell me what was going on but I was hopeful it might be a sign I was about to be transferred to a ward. Another patient was wheeled into the side room and my bed was eventually found in the middle of the department, lined up with trolleys all groaning with patients. Later that day, I was informed that I was to be moved to a ward and as you can imagine, this news came as a huge relief.

The swab reports came back negative on my fourth day in the hospital. Phew! If I’d tested positive, it would’ve compromised my treatment and also meant that I’d been infective to others in the hospital, for a full four days. Countries like Holland, which has brought MRSA contamination under control in the hospitals, must laugh so hard at the Irish interpretation of  infection control.

Weathering The Storm

Been a bit off form the last few days with blinding headaches accompanied by a major sense of humour failure.  I took to my bed on Friday evening, battening down the hatches until the worst was over.  While the storms raged outside yesterday, I had my own lightening bolts going through my head.  Today, the forecast is brighter bringing with it a welcome return of my sense of humour. You have been warned…

Two kids lined up for surgery are lying on trolleys outside the operating theatre.

The first kid leans over and asks, “What are you in here for?”

The second kid says, “I’m here to get my tonsils out and I’m very nervous.”

The first kid tries to reassure the other and says, “Oh! don’t worry. It’s very simple. I had that done when I was four. They put you to sleep, and when you wake up they give you lots of jelly and ice cream.”

The second kid, feeling a little better, then asks, “What are you here for?”

The first kid says, “A circumcision.”

The second kid says, “Whoa! I had that done when I was born. I couldn’t walk for a year!”

The Show Goes On

Do you remember the television series called M*A*S*H?  It was a medical drama/black comedy and the show followed a team of doctors and support staff stationed at the 4077th Mobile Army Surgical Hospital (MASH) in South Korea, during the Korean War. The series won countless awards and the final show was one of the most watched television shows ever.

Now Ireland has it’s very own version of the same show which can be viewed in most A&E departments around the country, any day of the week. The only difference between this show and the real M*A*S*H is that no-one’s laughing at the Irish version as it ain’t one bit funny.

British-based freelance journalist and author, Diane Taylor visited a friend at Tallaght Hospital’s A&E in Dublin last week. She was shocked by what she saw. Here is her account of that experience (with thanks to the Irish Times online).

“I was impressed by the modern, spacious, hospital buildings at the Adelaide and Meath hospital in Tallaght. Sensible health promotion posters covered the walls of the reception area and dispensers of disinfectant hand rub were clearly visible in triplicate throughout the public areas.

Only the huddles of visitors and dressing gown-clad patients at the entrances inhaling deeply on their cigarettes sullied the wholesome image of the place.

I had just flown in to Dublin from London to spend a few days working with Kathy O’Beirne on the sequel to her book ‘Don’t Ever Tell ‘, a story of childhood abuse in various institutions in Dublin.

But the work plans had to be abruptly halted when Kathy called me to say she had been rushed to hospital with complications to a chronic medical condition. I headed straight to Tallaght Hospital to see her.

The hospital has the largest emergency department in the Republic, with 80,000 patients streaming through its doors every year. The A&E waiting area was full, but not bulging the way I’d often seen A&E departments look at London hospitals.

Those waiting to be seen appeared remarkably resigned and those administering the triage system seemed to be working in a calm and ordered way.

I explained to the two security guards that I had come to see someone receiving treatment in the department and was nodded through the swing doors.

What I found on the other side of the doors shocked me. Lined up on trolleys stretching as far as the eye could see along the corridor were seriously ill patients waiting for beds.

Some lay on bloodied sheets, many were attached to one or more drips and quite a few were elderly.

It wasn’t clear who was unconscious and who was sleeping, but what was clear was that everyone on the trolleys – 35 people in all – were very unwell and needed to be in a proper bed in the relatively tranquil environment of a ward rather than in the frenetic setting of a corridor in A&E.

Kathy lay groaning with pain on one of the trolleys. There were some splattered drops of dried blood on the floor under her trolley. She had a tube up her nose running down her throat and into her stomach, a tube in her arm and a bag attached to a tube running from her abdomen draining out some foul liquid, which was causing her intense pain.

A cocktail of drugs had been administered to her and she was extremely distressed to be so exposed when she was feeling so ill. Sometimes she cried, at other times she appeared to be slipping in and out of consciousness. The other patients on the trolleys appeared similarly discomfited by their surroundings.

Now and again, ambulance staff hurried past the patients lying on the trolleys, dodging the drip stands and other bits of medical equipment as they delivered the emergency cases they had decanted from their vans to the waiting doctors and nurses.

It was distressing for both the patients being rushed in and the patients who were lying, prone, on the trolleys to catch glimpses of one another.

When doctors or nurses examined or administered treatment to those on trolleys, there was no privacy for the patients. Everything was carried out in full view of whoever happened to be walking past at the time.

The nurses kept on shaking their heads when patients and anxious relatives asked them when a bed was likely to become available.

“We just don’t know, we’ve got 35 people waiting. It’s terrible but there’s nothing we can do,” said one.

“I used to work in a hospital in London and people there complained about the state of the NHS – but they don’t know how lucky they are with conditions there, compared with the kinds of things going on here,” remarked another.

“The average waiting time on a trolley before getting a bed is 24-48 hours, sometimes longer,” explained a third nurse.

While all hospital emergency departments expect spikes in admissions at certain times – such as after a major accident or during a winter flu epidemic – neither scenario was in evidence when I was in the hospital.

On the contrary, it was a beautifully sunny October day – nothing out of the ordinary seemed to be happening. The staff said that this situation was not a blip – but, rather, the norm.

When the noxious substance had finished draining out of Kathy’s abdomen, the nurse said that she could remove the tube snaking its way from her nose into her stomach.

“You’re not going to pull the tube out of my stomach here in the corridor, are you?” asked Kathy, aghast.

“Well, where else am I going to take you?” replied the nurse. The tube was duly pulled out of Kathy’s stomach in full view of whoever happened to be walking past. Kathy was mortified.

I’m no health service expert, but during my various visits to A&E departments in London over the years I have never witnessed the kinds of scenes I saw at Tallaght.

After 24 hours on a trolley, with no prospect of a bed on the horizon and only the offer of another trolley in a day ward as a substitute, Kathy could take no more.

Her resistance to infection was low and, with various tubes stuck into different parts of her body, coupled with her extremely close proximity to other sick patients lying on trolleys and the new emergencies being rushed through the corridor, she feared leaving the hospital sicker than when she arrived.

So she opted to go home. She was warned that she was leaving against medical advice and was asked to sign a form accepting responsibility, should any medical complications arise.

She flicked through the “signing out” book and was amazed by the large number of other patients in recent weeks who had also decided to get out before their treatment was complete.

In the six hours that I spent in the corridor I saw nothing but dedicated professionalism and kindness from the doctors, nurses and auxiliary staff in the A&E unit, all working in intolerable conditions.

But it did not stop me from leaving the hospital with the impression that what I had witnessed in Tallaght Hospital’s emergency department was more reminiscent of a makeshift field hospital hurriedly established in the wake of civil war or some other disaster in a developing country, rather than the biggest A&E department in a thriving European country”.

I don’t suppose our Minister for Health will win any awards for this production but you can be sure that her finale will be one of the most watched shows ever.

Vive la France

Okay, so here’s how the Irish health service could/should operate if it was properly resourced and managed. The following article was published in the Irish Times and documents the experience of an Irish person who required emergency care in a hospital in France.  I’ll leave you to draw your own conclusions.

Vive la Différence

“No waiting room, no trolleys, no queues, no admission fee and free parking. It was very strange indeed”, writes Michael Foley

“It is 1.30 in the morning, the first night of the annual Feria, when Beziers, in the south of France, goes en fete for a week of partying. Getting to A&E through streets thronging with revellers is a feat in itself, but arriving at the hospital is an even more unusual experience.

I rushed to hospital, with what later turned out to be a blocked artery.

Where is the waiting room? And where are all the corridor trolleys gone? Well, there is no waiting room and no queue, no line of people drunk or groaning with pain, and facing a 12-hour wait, just a woman at a desk and a sliding door that lets you straight into your own single-occupancy examination room. Parking is free and there is no €60 admission fee either.

Very strange indeed. It is so strange that we waste valuable time assuming we are at the wrong place. Why no waiting area? Goodness me, said a French nurse, urgence, the French name for the A&E, means someone requires urgent treatment; you could hardly expect someone in need of immediate treatment to wait, now could you?

It has to be said that when I last attended a Dublin hospital, eight months previously, I did not have to wait either. As I pointed to my heart and handed over the €60 casualty charge, a wheelchair almost buckled my knees as it wheeled me into triage, but behind me were others who would be waiting and waiting and waiting – unlucky enough not to have chest pain.

Back in Beziers, and two-and-a-half hours later, I had blood taken, a brain scan, a chest X-ray, and all the test results returned, and was tucked up in bed. At no stage did I see anyone on a trolley in a corridor.

Trolleys were used to ferry people. Patients slept in beds. My room, in a public ward, was for two patients, with a toilet and shower en suite. The equipment was new and worked. The bed was high-tech and moved in almost every direction.

What followed were days of tests, done without delay, and all ordered by specialists, who personally delivered results, usually within the hour. I was given scans, X-rays, MRIs and investigations I thought I might have been given eight months previously in Dublin. “Should I have had this test before?”

The doctor was non-committal.

The first specialist was a neurologist. The Centre Hospitalier de Beziers has three (as opposed to a dozen for the whole of Ireland). The doctor was a quiet, respectful woman who was available throughout the day, and who delivered the test results she herself ordered.

There was no entourage, no one to fawn and laugh at her jokes. She even had office hours when family could call in for information or advice – no need for intervention, divine or otherwise here.

We kept checking as to her status with the nurses, because her availability was akin to that of a registrar or a junior doctor in an Irish hospital, but yes, she was everything one could possibly want in one’s neurologist – professional, available and attentive. Extraordinarily, if a test was required, it was done immediately, and she delivered and discussed the results in person.

The second specialist, a vascular surgeon, again was one of three. When surgery was decided, I was moved to another floor and opted for a private room. Cost €40 a night.

Surgery was successful and after a period of recovery, I was out. When discharged, I was given a slip that was officially stamped, this is France after all, and that was it; I paid not one cent.

Under the EU health insurance regulations, I received the same treatment as a French person – 80 per cent of the cost borne by the state – and like a French person, my insurance (in my case, the VHI) paid the rest, including the cost of the private room.

One of the most remarkable features of the hospital was the level of hygiene. And not a nun in sight. The corridors were completely clear. The cleaning trolleys, with their colour coded buckets for every individual surface, plied up and down the corridors.

Masks and sprays were used as appropriate, from one patient to another. Head-to-toe disinfection twice before surgery . . .

In the Dublin hospital I attended recently, there was one shower for some 50 patients. This was in a room with a bath fitted out for disabled use. There were cracked tiles around the shower. The bath/shower room was also used as a store. If you were able to walk, you washed and shaved at a row of washhand basins, like a 1960s boarding school.

The VHI was amazing, constantly phoning me and my wife to see if I was alright. Did I want a second opinion? Was I was satisfied with the doctor? Was everything explained adequately? It also had a French-speaking doctor contact the hospital doctors who came back to explain what was going to happen.

Isn’t it extraordinary that the VHI pays no such attention to the interests or concerns of their members in Irish hospitals?

Would I have returned home for treatment if it had been feasible? Not if the advice I was given was to be taken seriously. Proof of the serious lack of confidence there is in the health service in Ireland was evident in the number of calls I had, from friends, colleagues and family, telling me how lucky I was to be sick in France and not Ireland: “Stay where you are. It’s the best place to be.”

If I returned, they thought, I might not get a bed, and if I did, I would be at risk from MRSA. “MRSA is a given,” said one friend, whose mother recently contracted it.

For the next two weeks, a local nurse visited to clean the scar and eventually remove the staples holding the surgical opening together. Cost for a home visit, €5.50 a day. But it is not just money that is the main difference between the two systems as experienced by patients. I was treated as a critically ill patient, the same as if I were French, by nurses, doctors, specialists and home visits,

I even have a GP in France now, who gave me a free consultation, just to get to know me. I only hope we don’t get to know each other too well.”

With thanks to the Irish Times for their online publication.

Need I Say More?

Orla Tinsley suffers from cystic fibrosis. Earlier this year, Orla received a People of The Year award for her campaigning in the Irish Times on behalf of cystic fibrosis sufferers.

Ireland has the highest incidence of CF in the world and to it’s shame, it can also claim to have the highest mortality rate and the lowest life expectancy for CF sufferers. The critical issue here is the limited availability of suitable isolation facilities in Irish hospitals. 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.

I’ve written about Orla before to document the appalling hospital conditions which she and many other cystic fibrosis patients must endure.  CF patients have been waiting for more than a decade to have a dedicated CF unit built at St. Vincent’s Hospital in Dublin and they are quite literally sick waiting.

Here is her account of her recent visit to hospital as published in today’s Irish Times.

“Dear diary: It’s Tuesday and I’m back in hospital for another blast of treatment for my cystic fibrosis, writes Orla Tinsley

I … ENTER St Vincent’s hospital in Dublin as I need treatment for an exacerbation of my cystic fibrosis. I have two options. I can go to A&E and wait on a trolley for a bed, or I can go home and wait on a waiting list.

Although my home is safer, I choose the A&E. I can’t continue in college or do the things I want to do if I am unwell, so I wait on a trolley.

A special type of needle, called a gripper, is used by most CF patients who have frequent infections. I need one now, but no one in A&E is qualified to put it in. A nurse from the designated CF eight-bed ward is called and comes down to put it in for me.

I am on a trolley in A&E and this procedure requires a certain amount of exposure. The porters are nice, the nurses are nice – they are both busy.

We ask if there is somewhere private for me to get my needle put in. There is nowhere. The specialised nurse and I think of what to do, she decides to take me out of A&E to try and find a room in the main hospital.

The A&E nurse stops us.

For a procedure that requires the utmost cleanliness, she says we can use the bathroom. The toilet in a busy, infection-ridden A&E is open to us.

We leave the department for the main hospital. It is after hours, treatment rooms are closed and wards pose a cross-infection risk. We eventually find an open door in a room that we know is clean and use it.

I go back to my trolley in A&E wishing I could have slept in that room. In A&E a nurse comes to give me my nebuliser through an O2 cylinder. I tell her that there are nebulising sets on the CF ward; if she could just ring them up she could get one. I’m sorry I didn’t bring my own, but she doesn’t understand what I’m saying. I explain twice more, then a porter who had been listening steps in. He tells her to leave it and goes up to the ward to get it.

There is no plug near the trolley I am on and so I have to wait before I can have it. I get moved to another square of the wall so that I can take my nebuliser. I then get moved into a curtained area for the night, and I am relieved.

The next day I am moved out to another curtained area. The nurse minding me is nice but busy, and late giving me one of my drugs. I ask her three times over the next few hours. Being on this drug long-term can affect kidney function, so the morning time is the best time to have it.

I use my mobile to call my CF nurse, who calls the A&E department and asks them to give me the drug. I still do not get it. I try calling my CF nurse again, but then my battery dies.

I walk up to their office and they call again, frustrated for me. They should not have to sort this out. I go back to A&E and get it.

Late that night I get a bed on the semi-private ward. It’s Wednesday night. I am in a room with a young girl, a lady with cancer and two elderly patients.

I am aware from the time my aunt was dying with cancer that I am not allowed to be around immune-suppressed cancer patients. Over the next few days I find out that the lady is in fact immune suppressed.

I am a danger to her, and I don’t think it’s a good thing to tell her.

One night the breathing of the elderly lady in the bed beside me gets worse. The next day her family are by her bedside and they keep apologising to me that it’s happening in my room. They are so, so sorry.

I tell them please, it’s not your fault. And I feel guilty that they feel so bad about it as they watch their mother die.

Another woman comes in, a new patient replacing the young girl. She is coughing violently, but seems pretty happy. She makes a phone call to a friend to tell her that at least she doesn’t have double pneumonia, like her neighbour, she only has pneumonia.

I feel the room shrinking.

She tells her friend on the end of the line: “Don’t get the sliced melon from Marks and Spencer . . . It’s right inside the door, I want the diced one,” she giggles down the line.

At that same moment a relative behind the curtain of the lady beside me says: “Is she gone? Yeah? Oh God.”

The other woman continues to talk on her phone. After the lady passes away her body stays in the room for three hours.

That night, another lady with cancer moves into the bed beside me. Her temperature has gone up so she had to come in. Both ladies with cancer are so much fun to be in a room with.

The lady who had just moved in is only starting to lose her hair, the other lady had already lost hers. She wants a “Posh Becks” hairstyle, like Victoria and David Beckham when her hair grows back. We giggle at the thought.

At every opportunity I leave the room to talk to the nurse about trying to get moved. Bed management are aware of the situation, but there is nowhere to move any of us.

I talk to the ladies about it and tell them I might write about it. They are meant to be in isolation, but they are not. I am a risk to them, and then there is the lady with pneumonia in the corner, who poses a risk to us all.

I try to sleep with a mask to protect myself and the people in the room, but it is sweaty and a bit restricting for breathing.

On Monday I am given the option of moving to a two-bedded room on the same ward. I accept and find myself in a room with one the kindest, most vivacious elderly ladies I have ever met. She is chatty, but knows when to leave me alone. She is a pleasure to share with, but even our camaraderie can’t disguise our different needs.

As she is unable to leave her bed, she needs the commode two or three times during the night. She is the nicest woman in the universe, but my cough is already making it difficult for me to sleep.

The rattle of the commode at 12.30am, 4.00am and 6.30am rips into my ability to rest. There is a smell too. It is not her fault, but I cannot sleep properly.

One day she is complaining of discomfort and extra swelling in her legs. I only become aware of it because this woman is not a typical patient.

She never complains, even though she has a chest drain in, which makes it impossible for her to walk around. That morning she complains a lot about her feet.

It is three hours at least since someone has been at her chest drain and I notice that it is clamped. I tell the nurse, he comes in straight away and deals with it. I ask a medical person about it later – chest drains should never be clamped unless they are about to be removed.

She feels better, we’re getting on well, but I’m still not sleeping well. We keep in good spirits chatting, and she tells me about how her handbag was taken while she was in hospital. Luckily her daughter was with her to cancel her cards and keep her afloat.

It wasn’t her bank card so much, but being without her reading glasses really upset her. She was told a member of security would come back to investigate the situation, but they didn’t.

There are 28 cystic fibrosis patients in as I write this, and there are eight single en-suite beds. The beds are allocated on the advice of the microbiologist. There is a long list to get into them. The eight single en-suite beds are on a new ward, but there are also general beds on that ward too for patients who do not have cystic fibrosis.

In February this year former junior minister for health Pat Gallagher said 14 single en-suite rooms would be available by the end of the summer for CF patients. I remember being told early this year that there would be six more, in another area in the hospital.

I ask a person in officialdom what is going to happen with the six other beds we desperately need until our unit comes at the end of 2010. This person tells me that there are no plans for six beds, that they have heard nothing about it. They have no funding; they have other things to sort out first. They want to see how the eight single rooms work.

Meanwhile, the winter months are coming, the number of cystic fibrosis patients needing inpatient treatment will rise. Some will refuse to go into hospital and risk damaging themselves, some will come to A&E, and risk damaging themselves.

Others can be treated at home, but if that doesn’t work they will have to come in anyway. Those who are not in the eight beds will continue enduring cross-infection, exhaustion and fear every time they are in hospital.

We will all think of the recession and what that means for us. We will comment to one another that 2010 seems like a lifetime away, and feel sick to our stomach that some of the 1,100 people in Ireland with cystic fibrosis will not see it.”

This article is published courtesy of the Irish Times online.

Swallow This

I had the dubious pleasure of donning a theatre gown again yesterday but thankfully, only briefly on this occasion.  Some weeks ago, I attended my GP with intermittent discomfort in the centre of my chest. The pain had gradually worsened over a period of days and as there is a strong history of hiatus hernia in the family and I was otherwise feeling well, I felt sure that a hernia must be to blame. Following examination, my doctor agreed that a hernia was a possible explanation for the symptoms but refused to prescribe treatment until first ruling out other potential causes. Despite my protests about not wanting any more medical intervention, he put me on the waiting list to have a gastroscopy performed at our local public hospital.

These days, GP surgeries are able to bypass the consultant system to fast-track patients for endoscopic investigation. In the past, a patient had to be referred to a consultant before a decision could be made to proceed with further investigation. Nowadays, family doctors have set guidelines to follow and if the patient fits the particular criteria, they are referred via a direct access scheme for endoscopic examination. This speeds up the investigation process and eliminates unnecessary specialist consultations. The endoscopy unit is consultant-led, it’s highly staffed so that it runs efficiently and the waiting list is the same for everyone regardless of health insurance or medical card status.

I only had to wait three weeks for the gastroscopy appointment and attended the hospital yesterday having fasted overnight as instructed. I’ve undergone this procedure before so I knew exactly what to expect.  There was no delay, I was assessed immediately by a nurse and asked to change into a theatre gown.  Following a short wait, I was escorted to the examination room to meet with the doctor and his assistant. I was given the option to have light sedation for the procedure and I didn’t hesitate in accepting. I’ve seen enough of hospital procedures to know I’d rather not see any more. I lay up on an examination trolley and following the insertion of a cannula into the back of my hand to administer the sedative, I was asked to lie over onto one side. A plastic mouth guard was placed between my teeth to protect them and stop me biting the endoscope. The next thing I knew was when I awoke in the recovery room feeling relaxed and sleepy following the sedation. An hour later, I was ready for home having received the diagnosis. I was informed that I have a significant peptic (gastric) ulcer in my stomach and shown the pretty pictures taken during the procedure. This news came as a surprise as I was expecting to hear I had a hernia but No, there was no evidence of a hernia seen.

The leading cause of a gastric ulcer is currently believed to be infection of the stomach by a bacteria called “Helicobacter pyloridus” (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs). I had two biopsies taken yesterday which will show if H. pylori is the cause of the problem and in the meantime, I’ve started on a six-week course of tablets to reduce acid production and aid healing of the ulcer – yet more pills to add to the daily pile!  If H. pylori infection is found, I will be commenced on two different antibiotics to eliminate the bacteria.  It’s quite possible that NSAIDs are to blame in my case as I’ve been on various types for years (though always in conjunction with a gastro-resistant medication), to control the joint pain I experience from my connective tissue disorder (EDS). Whatever the cause, I have to return in two months time to have a repeat gastroscopy performed to assess the situation.

I’m really in favour of this direct access scheme for out-patient care as it’s an equitable system which is efficiently run. I left the hospital yesterday feeling lucky to have received such good attention. The only difficult thing to swallow now is the fact that when I next return to see my GP, I have to admit that he was right and I was wrong.

Some Day…

Do you have health insurance or is this something you’ve put off until another day? If you’re young, fit and healthy, the chances are you’ve never really given your health much thought. Why would you worry when you haven’t had to face huge medical bills? With the rapid privatisation of our health service, health care in Ireland is becoming more like the 2-tier system in the States. Those with insurance will get top dollar care while those without, will suffer.

About five years ago, my GP sent me urgently to the A&E department of our local public hospital as I had developed acute abdominal pain. I was processed by the triage nurse and allocated a trolley in a cubicle so that the doctors could assess my condition. Once my blood tests had come back from the lab, the decision was made to admit me overnight in case I needed to go to theatre. I was put on a drip (nil by mouth) and lined up on a trolley in the centre of the department along with scores of others, in a queue for a bed. I hit lucky on that particular occasion and was transferred to a ward in the middle of the night. By the following day, my abdominal pain was severe (my intestine was blocked by an abscess) and it was decided that a CT scan should be performed to ascertain if surgery should be performed. I was started on intravenous antibiotics while I awaited the scan but kept fasting in case surgery was required. This was bearable until a harassed looking junior doctor appeared at my bedside to announce that the CT scanner had broken down and was awaiting repair. By the following morning (day 3), the scanner was still out of action and my situation was beginning to look very bleak. Around lunchtime, the same doctor rushed in and asked me to confirm that I had private health insurance. I did, thankfully, so the decision was made to transfer me to the private hospital, to avail of their scanner. The scan confirmed a diagnosis of acute diverticulitis with obstruction of the bowel but it was seen to be resolving so I could finally be taken off the emergency list. Had I not had health insurance, I hate to think that I may have ended up having investigative surgery as no scanner was available to make the diagnosis. Please don’t get me wrong here, I received excellent medical care during my 10-day stay in this public hospital and was very grateful for it. However, the system was clearly in overload and patients were suffering as a result. My insurance was worth every penny to get the care I needed when I needed it most.

Health insurance is a complicated business. It’s designed this way so that the insurers are protected against excessive charges by private doctors and also to restrict patient benefits. There are three main insurance groups in Ireland and they each purposely have slightly different health plans so that it’s almost impossible to compare like with like. I have spent vast amounts of time over the years, trying to work out which plan offers the best deal for my family. It was years before I realised that each member of the family can hold a different policy to meet their individual needs but don’t expect your insurance company to tell you stuff like this, ‘cos they won’t. I review our policies every year to see how we can reduce costs yet still retain adequate cover for both emergencies and day to day care. There are all sorts of clauses to catch you out, so be careful what you change. And remember, it’s too late to look for insurance when you’ve already become ill because penalties will abound. You have to put in the work yourself if you want to see improved benefits. I long ago gave up hoping that an apple a day would keep the doctor away.

So Dat’s Dat!

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?

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!