A Long Time Waiting

January 6, 2008

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.

Skin Deep

September 12, 2007

I’m pretty choosy about the television programmes I’ll watch these days but when I see something produced by Mint Productions, I never fail to be disappointed. Last night saw the screening of another programme in the RTE series ‘True Lives‘. It was called ‘Skin Deep‘ and covered the topic of living with a severe facial deformity. The message conferred by the programme was clear-cut – it’s no fun being facially different. Lives are changed forever by a facial deformity. It can have a devastating effect on people who have to cope with being ‘different’ in a world that’s obsessed with image and appearance.

Mr. Michael Early, Consultant Plastic Surgeon, explained how the anatomy of our faces and our facial expressions affect communication. He talked about the ‘triangle of communication’ – the area of the face between the eyes, the nose and the upper mouth. The programme featured five people with a variety of severe facial deformities which had been caused by genetics, or by an accident or as a result of cancer. These remarkably courageous individuals all possessed huge insight into how they are perceived by ‘normal’ people. Some people give them a ‘funny’ look, others look ‘curious’, while some take a ‘serious’ look and then ‘look away’ ashamed to have been caught staring. People who have a facial deformity lose their anonymity and become ‘different’. Their faces look unfamiliar and don’t conform to what ‘normal’ people look like. Society can be very cruel at times.

This programme has certainly helped me to keep my situation in context. I was pleased to learn last night that I’ve already taken the first step towards acceptance of my new look following recent surgery – I’ve got used to seeing my new face reflected in a mirror and no longer search for the ‘old me’. I know that true beauty comes from within. People need to look past the face which is after all, only skin deep – it’s what’s in the heart that really matters.

That’s Life!

August 30, 2007

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

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

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

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

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

A&E Trolley Dolly

April 28, 2007

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

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

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