Until January 14th, 2025, in my 71 years I had
never spent even a single night in a hospital. That all changed with an
unfortunate accident, which happened on that day. As a result, I spent very
nearly three weeks in the Royal Surrey hospital in Guildford, only finally
leaving on Wednesday 5th February.
My purpose in writing this screed is two-fold. First, to
record after only a brief delay my impressions of the “health care” system
yclept the National Health Service, generally abbreviated to NHS. And second,
the Reform UK party, of which I am interim campaigns manager for my local
branch of Godalming and Ash, has chosen – in the absence of upcoming elections
to Surrey County Council, brazenly cancelled by a cowardly political
establishment that fear for their butts – to place the NHS at the top of its
list of targets for reform. Therefore, I wish to set on the record my thoughts
resulting from by far my most serious encounter with the beast so far.
The day in question, and its aftermath
On January 14th, I was nearing the end of a major
piece of writing, with only about two sections of 15 or so left to complete. I
decided to spend the day on a pleasant walk along the Wey towpath, finishing at
my local Wetherspoon, where I would do a full proof-read on a substantial
portion of the document (the final third, as it happened). A pub seems like a
strange place to do proof-reading, you may say. But I find that the standard of
my proof-reading is actually improved by a moderate amount of alcohol, up to
around two pints of beer. The mind sees different mistakes depending on its
state of libation, and as I want to remove all the mistakes, I need to try as
many different combinations as possible.
Having completed my business, and enjoyed a gammon steak
and a couple of glasses of wine, I packed the papers back into my rucksack, and
set off on the walk to the taxi rank at Godalming station to get a ride home. I
remember nothing more until waking up under the too-bright lights in Accident
and Emergency at the Royal Surrey hospital in Guildford.
They soon made the decision to keep me in A and E
overnight. I slept fitfully, two or three hours only, but otherwise normally.
In the morning, I was seen by a consultant, who told me that I had broken the humerus
bone near the top of my right arm. It was a clean break, and he told me he was
confident it would heal without needing surgery. But that meant that I would
need, first, to have an X-ray, then to have a special brace fitted to keep the
arm in place, then to have another X-ray to check the efficacy of the brace.
I was not fully aware of this at the time, but I had blacked
out and fallen over very hard indeed, apparently on the Godalming station
forecourt. I sported an enormous bruise above my right eye, and lesser bruises
below both eyes. It seems that the broken arm had been caused by putting out my
right arm straight in an effort to break my fall. As a right-handed person, I
was going to have to learn, rapidly, how to live without my dominant hand and
arm.
Acutes – 1
By now, it was Wednesday morning, and I was transferred to
the Acute Medical Unit or AMU, otherwise known as “Acutes.” The staff seemed
confused as to what was supposed to happen to me, in what order. I found myself
repeating, in detail, the instructions the consultant had given me. It’s a good
thing I have a decent memory! Anyway, it was soon all done. First, an initial
X-ray. Then the brace, expertly fitted by a member of the Physio (or is it
Orthopaedics?) (or is it Occupational Health?) team. I couldn’t tell the
difference; and this provided an example of what I will call Overlapping
Departments Syndrome.
It was an unusual type of brace, holding my arm very
tightly, much closer to the chest than a standard “sling,” and with the hand
parallel to my chest, rather than at right angles to it. Still, it certainly
did its business, and was surprisingly comfortable too.
In A and E, I had had a cannula fitted into a vein in
my left arm. This is a small tube that can be used to administer intravenous
fluids into the body, without having to find a new vein and make a separate jab
each time. It can also, at need, be used to take blood samples, though it looks
as if each individual cannula can be used only in one direction.
On the positive side, the cannula made for a far more
comfortable treatment experience than I had expected. On the negative side,
though, it encouraged them to fill me with every IV drip they could think of.
These drips contain surprisingly large amounts of water, which, of course,
passes straight through the system on its journey towards the bladder. As a
result, my need to visit the loo became ever more and more frequent and urgent.
I tried using the simple solution, the “bottle,” but this
was a messy failure, as with only one hand available I could not both hold my
penis inside the bottle and control the direction in which the bottle was
pointing. So, more direct methods were required. Since I could walk without
problems, but could not, at this stage, get out of bed unaided, I had to be
physically hauled out of bed by my left arm every time my need became dire.
By this point, the experience had become so surreal, that I
lost track of time. I thought that I had already been through the day on
Wednesday, and it was approaching evening. In fact, it was still daytime, and I
misconstrued the meagre ration of sleep I had been able to glean as having been
a night. When evening did finally come, I was taken back to the X-ray
department for the second set of X-rays. These proved to be far more
comprehensive than the first set, with no less than five different angles being
snapped.
Almost immediately on my return to the AMU, I was
transferred upstairs to Clandon ward on Level C in the East Wing. While
officially an ear, nose and throat ward, it was in practice being used for any
patients, including me, whose requirements didn’t fit into any of the standard
paradigms. I certainly got an impression that I was being treated specially. I
was even introduced personally to the care assistant, Giselle, who was tasked
with helping me through my night.
I didn’t know it until the next day, but this was the night
when they had determined to flush my system with so many IV drips, that the
result would be to expunge any remaining traces of alcohol from inside me. The
required loo visits increased in both frequency and urgency; but Giselle was
there, at the touch of a buzzer, to haul me out of bed every time. Sometimes, loo
visits were required as close together as 20 minutes. She handled it all with
the best of grace. It helped that by now I had become confident enough in my
balance to be able, once out of bed, to walk to and from the loo under my own
power.
And so, the following morning there came what was, to date,
the most surreal experience of all. With my night’s emergencies having been
completed, Giselle had about twenty minutes remaining before the end of her
shift. We occupied the time with a perfectly normal, rational conversation. And
a wide-ranging one, too. One thing about working as a care assistant in a
hospital – with all the different patients passing through, there is never a
dull moment!
Clandon Ward
It was now Thursday morning, January 16th. I
began to take in my surroundings in Clandon ward, Room 2, Bed 1. Most of the
rooms within the complex of four wards, of which Clandon ward forms a part,
have six beds. But this one had, for some reason, only five.
Opposite me was a gentleman called Kevin, a working man who
had come in for a tracheotomy operation, and had then suffered a series of
complications. It seemed that he was always
two or three days from being able to leave the hospital, yet something always
cropped up to prevent it. From absurdly low blood sugar levels, to a
long-forgotten tooth that had flared up to provide another source of infection,
there was always something new wrong. He was on a series of special diets, and
was unable to speak at all, though he did have a board on which he could write
messages for the nurses, visitors and other patients. And the day on which I
arrived was, so it seemed, the three-month “anniversary” of his first admission
to the Royal Surrey. A bond rapidly formed between us, as our respective
disabilities were perfectly matched, albeit in opposite directions. I could
speak without difficulty; but my efforts to write with the left hand were, to
be frank, as yet completely illegible.
On the other side of Kevin, in the diagonally opposite corner,
was a Frenchman called Philippe. By his own account, he had been in and out of
hospitals for the last three years or so. As the following day, Friday, is
traditionally chucking-out day in NHS hospitals, he was soon discharged for a
week-end at home, with instructions to attend Frimley Park hospital on the
Monday, to prepare for another operation to try to solve his medical woes. He
was replaced by a very quiet young man, who needed all manner of tests and
biopsies in order to work out what they should do to him next. He also had a
persistent cough, which I was unable to avoid catching off him as he passed
regularly by the end of my bed on his way to and from the loo. That cough was
to bug me for several weeks to come.
In the far corner on my side of the room was Alex, who
hailed from Falmouth or some such place, and whose main concern seemed to be to
get back at some man who, so he claimed, was taking his woman away from him. He
appeared young and fit, and seemed to have latitude to wander in and out of the
hospital. I assume this was because, as Kevin told me, the treatment he was in
for was long-term, fighting a particularly nasty cancer. He eventually decided
that, all things considered, the Royal Surrey wasn’t where he wanted to be. So,
after a monologue to us all (in which he confessed that he liked everybody in
the ward, except me), he discharged himself, and vanished into the night.
Paradoxically, the most difficult fellow patient to get to
know seems always to be the one in the next bed to yours. This is because, as
long as they keep the curtain on your side closed, you cannot see each other.
But this particular patient was soon on his way out of the door. He was
replaced by a retired anaesthetist, originally from Nepal, who had made his
career as a medical officer and instructor in first the Nepalese army, then the
British. He quickly made me realize just how many of the nurses in and around
the ward hailed from Nepal!
The hospital routine
I gradually began to adapt to life in an NHS hospital. There
was a lot of time when nothing at all was happening, and life was pretty boring
with nothing to do. There were regular moments, four times a day, when nurses
or care assistants took blood pressure and temperature readings. There was the
twice a day “drug run,” when they counted out your prescribed medications for
the day or evening, and gave them to you, sometimes as many as a dozen pills in
a single small, white pot, to be taken with liberal amounts of water. There was
also paracetamol, available four times a day, maximum two pills a time. I had
also had codeine or morphine prescribed for me if I needed them. But in my
whole stay, I needed only two doses of morphine, and didn’t touch the codeine
at all.
My pain came mainly from two sources. First, underneath the
operative part of the brace, I could always feel the fracture smouldering away
in the background. But the more obvious pain tended to come from my right elbow.
Whenever I inexpertly overdid some motion, even something as simple as getting
into bed, I was more likely than not to hear, and to feel, a small crack from
my right shoulder. At the risk of a pun, I could say that while the fracture
itself was in the humerus, the worst of my pain usually came from the
funny-bone. (Though later on, after I left hospital, the right hand also became
a major source of pain.)
There were regular visits from the turquoise-shirted
cleaners. The lady cleaner had to use an instrument, somewhere between a
miniature cricket bat and a hockey stick, in order to reach the top sides of
the railings which separated the beds. She had a good sense of humour, and
seemed to enjoy swishing her hockey stick around with great aplomb! A pity that
she was a left-hander; hockey is not an easy game for the cack-handed.
Even more welcome was the tea-lady. She worked out very
quickly that, in a hospital (or, indeed in an office) environment, I drink only
one hot beverage; black tea, no sugar. I was surprised to find that quite a few
of my fellow patients agreed with my choice.
Then, of course, there was the ritual of meals. As a full
English breakfast person when at home, I found the options for breakfast very
limited. I am not in to poncy stuff like yoghurts, nor am I in to cereals,
since I do not use milk. About my only option was brown bread with marmalade.
Provided I remembered in time to ask the server to remove the tops from the
packets of marmalade, I was able to complete the opening process with creative
use of the teeth. Then it was mainly a matter of the ambient temperature, and
how viscous the marmalade was on a particular day. I used my jug of water as a
counter-weight to allow myself to push a knife into the marmalade, using only
my left hand. The runnier the marmalade, the easier it was to transfer it to an
appropriate piece of bread for ingestion.
The other meals were easier. Indeed, the menu for those of
us on normal diets was quite comprehensive. And the food was both simple, and
surprisingly good. But only being able to choose food I both liked and could
eat with one hand, I evolved an all but fixed daily menu. For lunch (usually
about 1pm) I took all day breakfast followed by fruit cocktail. For dinner,
usually around 5:30pm, I took roast chicken followed by chocolate sponge
without custard. (Due to high demand, I sometimes had to substitute cottage pie,
or occasionally roast beef, for the roast chicken). Both meals were
supplemented by a cup of the drink I take more of than any other, whenever I am
ill; namely, orange juice.
Eating left-handed was not the only skill I had to learn as
a substitute for the right-handed skills I had been using all my life. I soon
learned how to control the direction of Number One without any use of the right
hand. Cleaning up after Number Two was a more complex and time-consuming
matter, but I got there without too many mishaps. Getting into bed under my own
steam was relatively easy, as my centre of gravity was always going downwards.
But getting out of bed, to a position where I could stand up, was far harder.
Particularly because I did not want to use any features of the hospital bed
which could not be replicated in my own bed at home. I tried increasingly
complex and energetic techniques. But the problem began to solve itself, when I
noticed that increasingly, I was feeling less and less pain in my right
shoulder and other parts of my body, each time I tried. Over time, then, I was
able to move back towards more “normal” techniques, whose only major difference
from what I had done before was that they didn’t require a right arm or hand.
As to writing left-handed, my breakthrough came when I
realized that writing very slowly, and in capital letters only, was the way
towards at least some semblance of legibility. But getting my computer back and
working was a far more significant step. Even if I did need to type left-handed,
and to avoid key sequences such as Ctrl+End, which are not physically
feasible with only one hand.
The staff and their customs
The IV drips continued. Giselle was not on duty this
evening, but her replacement, Gabriel, proved to be more than adequate to the
task of hauling me out of bed whenever necessary.
The care assistants, the cleaners and the tea ladies may be
seen, by some, as the lowest of the low. But from the perspective of this
patient, they are the most important people in the whole hospital. Their
unfailing courtesy and camaraderie, often supported by a good sense of
humour, makes them into the human face of the hospital. I will hear nothing bad
said against any of the people I met in these roles.
The nursing staff were more of a mixed bag. They worked,
usually, a twelve-hour shift (8 till 8), plus half an hour at the beginning to
receive a hand-over from the previous shift. Some were cheerier than others,
and some seemed more confident than others at doing things in their own
particular ways, including making their patients as comfortable as possible.
Some also regarded promises made to patients as more important than others.
The overall fulfilment-to-promise ratio seemed actually to
be quite low. I suspect this may have been due to every small impediment in the
way of fulfilling a promise causing a stop to the activity, which was only
rarely resumed later, because the individual had been distracted by new,
seemingly more pressing concerns. I also got a feeling that some of them may
have felt a little bit intimidated by working in a system that didn’t give them
much latitude, and would always be ready to jump on them if they did anything
even slightly wrong.
As you went up the formality scale, the uniforms changed.
From the grey of the care assistants to the light blue of junior nurses, to the
royal blue of the senior sisters, and up to the burgundy of the Matron for the
shift, overseeing the whole complex of four wards.
Among the doctors, however, maximum comfort seemed to be the
order of the day. Most wore light blue smocks, some of which looked as if they
had been worn every working day for decades. There were also green-smocked
doctors. I couldn’t work out just where the dividing line came between them and
the blue smocks.
On occasions, you could also see pristine white uniforms,
with piping of various colours. These were the people who worked in the various
specialist departments of the hospital. Such as Physio (white with blue
piping,) Occupational Health (white and green) or Orthopaedics, who for some
reason had no colours of their own. Again, I couldn’t tell the differences.
At the very top of the tree were the consultants and
Registrars, who simply seemed to wear whatever clothes took their fancy, as if the
hospital was just an informal office. In-patients normally saw such people only
on their morning rounds, when they came to ask a question or two, and just
occasionally to talk about what might happen next. They were usually
accompanied by one or two lieutenants, who were very occasionally allowed to
speak a few words to the patient. They also often had an entourage of
what looked like student doctors, carrying laptops, on which they never seemed
to make any notes. It really did have the feel of an outdated custom from the
last century but one, still being continued because that’s the way they’ve
always done it.
My situation
One difference between my situation and other patients’ was
that I didn’t seem to have anyone in particular to look after me, particularly
in those areas beyond the medical. I had an appointment scheduled for Thursday
23rd January with the consultant/registrar from “Trauma and
Orthopaedics.” But that was an out-patient appointment, as it seemed to be
assumed by all that I would be discharged home within just a few days. Indeed,
the doctor who visited me most frequently in my first spell in the hospital was
the one from A and E, who had admitted me in the first place. While his visits
were most welcome, there was little he could do to oil the processes that would
determine when, and to where, I would eventually be discharged. And those
processes were to prove, to say the least, creaky.
The lady who had so expertly installed my brace claimed that
she was my case manager. But this proved, on examination, to be so only within
her own department of Physio. I gave her all the information needed to assess
the risks of discharging me home, including that to reach my flat front door
from the road or the car park would require negotiating either 42 or 55 steep
steps, that the hand-rail on the stairs was on the right-hand side only when
going up, and that I was currently heating the flat only using electric
heaters. Despite all these, and despite my needs for carer visits having not
been agreed or indeed discussed in detail, I was to be discharged home on
Friday 24th January, the day after my consultant appointment.
My impressions of the NHS
As the days passed, I began to put into perspective some of
the characteristics and ways of working of the NHS. One thing was very obvious
right from the start. Even by its own admission, the NHS does not communicate
well to patients. I was virtually never told, clearly and straightforwardly,
what the plans were for me going forward. Instead, I found myself having to
glean information either by hearsay, or even by some process that felt like
little more than osmosis. As a result, I never felt at all sure what was likely
to come next.
Another thing which became obvious is that communication
down the hierarchy was quite strong, with political and, to an extent, clinical
correctness being ensured by directives imposed from the top, in some cases all
the way down from the National Institute for Clinical Excellence (NICE). But
communication between different departments, all of which were dealing with the
same patient, was very much a hit-and-miss affair. And different people even
within a department, rather than making themselves into a focus for the
patient, often preferred to “dip in and out,” appearing for one conversation,
then disappearing again.
This led to a strong feeling that, whatever the priorities
of the system as a whole might be, ensuring the best possible outcomes for the
individual patient was not particularly high on the priority list. There were
“environmental champions,” “safety champions” and the like, but there was no
role of Patient Champion to ensure that every patient was kept fully informed
and consulted.
Somewhat paradoxically for a government organization, with a
received culture of “safety at any cost,” safety was in some ways quite lax. For
example, it was not uncommon for nurses who had connected a patient to an IV
drip to fail to disconnect the drip once it had finished. This could easily
result in the patient, some hours later, trying to move off, unaware that they
were still connected by a small tube to the large, moveable frame which carried
the drips. This was not an amusing experience.
The top-down impositions on staff could result in some quite
awkward situations, too. Someone up high seemed to have decreed that the nurses
must “sell” to patients a blood thinner preparation, supposedly to avoid clots caused
by long periods of patient inaction in bed. This blood thinner was administered
via a jab to the tummy. The patient had the right to refuse it, but very few of
the nurses would tell you this. In my case, as a conscientious objector to any
jab of whose necessity and efficacy I am not fully convinced, I always refused.
And I usually followed up by demanding why my Clopidogrel, an anti-platelet
medicine prescribed by my doctor, which had been doing for me for seven years a
similar, but better, job to a blood thinner, was not being provided to me as it
should have been.
There were certainly moments of confusion, too. One morning,
I was visited by a bemused pharmacist from the hospital’s central pharmacy. He
wondered why he was unable to see in his computer system my whole patient
record, which ought to have told him which medicines, including Clopidogrel, he
ought to be issuing for me each day. Even though I am among much else a
professional software tester, I did not know enough about the hospital’s
computer system to be able to help him. Although it did seem to me that such an
individual ought to have full, unconditional access to the list of
prescriptions for every single patient in the hospital. I sensed a permissions
problem somewhere within the bowels of the hospital’s, relatively new, computer
system.
Another thing that surprised me was that the staff, even on
outpatient appointments, very often seemed to know the patients personally.
They had obviously gotten to know each other over time. It seemed as if the
hospital was, for the most part, attended by a client class of regular
patients, never so ill as to be unable to make their next appointment, yet
never quite well enough to be discharged permanently as fully cured. People
like the Frenchman Philippe, whom I had met early in my stay, were representatives
of this client class, which I had joined on a one-off basis through the Gate of
Misfortune, and heartily despised the idea of staying in for even one moment
longer than necessary.
Even more surprising was finding, among the visitors to
other patients in my ward, a surprisingly high proportion of people who were
themselves in the medical profession. Many of them, indeed, worked for the NHS
itself. The idea of the NHS client class as a kind of family formed in my mind.
Indeed, the whole system began to feel more and more like some select club,
into which I had inadvertently blundered.
The benefits for those at, or towards, the top of the club
appeared clear, too. They had highly prestigious, and presumably well paid,
jobs, in which they could use their clinical skills to make themselves feel
that they were making a big positive difference to many people’s lives. Yet,
with only a few exceptions (of which surgeons were the most notable), the
responsibilities of the jobs were sufficiently diffuse that it did not seem
common for anyone to be held fully accountable for what they did, as they would
have been in a well-run business. (I had seen a somewhat similar syndrome many
years before among NHS staff, when working on a dental computer system
project).
My peregrinations
Being unusually active for my age, I soon began to seek some
exercise. After all, there was nothing at all wrong with the lower half of my
body! So, I began to explore the complex of four wards, of which Clandon ward
formed a part. The others were Compton, Bramshott and Ewhurst. There was a grid
of corridors, many of which were dead ends. But four of the widest corridors
formed a rectangle, and following them would take you around all four of the
wards. After a bit of experimentation, I used my mathematical knowledge to work
out that a complete circuit of the four wards was 215 metres long. Kevin’s son,
visiting him on the Saturday afternoon, timed me at 3 minutes 23, about
two-thirds of my normal pace.
There was also a central corridor, which was used for the
heaviest traffic of all, and in particular for transporting patients in beds in
and out of the wards. On top of this, there was a “gym,” which was used to
teach people like me how to do things they wouldn’t normally contemplate, like
climbing steps backwards. One day, there suddenly appeared in the gym a white human
skeleton! It appeared to be smiling at me. Maybe it liked me?
Because the clothes I had arrived in were soiled, I was
performing my peregrinations wearing only a hospital gown and a pair of bright
red non-slip socks. On occasions, I needed “emergency repairs” to my dress from
members of staff. And most of all, when whoever had dressed me in the gown that
morning had neglected to tie up its back tightly enough! But everyone, except
one individual who seemed to have made himself a “policeman of propriety,” was
most friendly. Even some of the patients gave me thumbs-up as I passed their
wards! I felt that, just by walking around and making an exhibition of myself, I
was doing something to enrich people’s lives.
One potential problem was that NHS staff are accustomed to
walking fast. With my right side vulnerable to even the slightest
contact, I found myself at the start operating a manic system of priorité à droite, like a
French driver of the early 1970s. But as I gradually built up my speed towards normal,
I seemed to become accepted by all those who might inadvertently run in to me.
I felt almost like an honorary member of staff.
And on one occasion, I had to become just that. I had
completed a circuit, and was opposite my ward, contemplating whether to do
another. It was early evening, the time at which there are many large rubbish
carts in the passageways, awaiting collection. Just then, two beds, both manned
by purple-shirted porters, collided at the junction with the central corridor.
There seem to be no rules of priority for these situations, and the porter of
the incoming bed won. The outgoing porter had to retreat past my vantage point,
and the winner took his revenge. But this stranded the staff, whose duties
included moving rubbish carts out of the way, the wrong side of the triumphant
gladiator and the bed he was piloting. Next to me was a particularly large
rubbish cart, and it was right in the way of any bed, most of all one that was
about to turn into my ward, as this one proved to be. I had to press both
myself and the cart hard against the wall; and he made the turn by a few
millimetres.
When she came up, the lady whose responsibility it should
have been to move the cart asked me, “I suppose you’ll be trying to take away
my money?” To which, I replied in my best gravelly Mephistopheles voice: “Not this
time.”
There is one more tale I must relate, which shows the
strangeness of one of the customs to which the NHS sticks. In the early hours
of a morning, after Gabriel had hauled me out of bed for a loo visit, I was
sauntering back when I heard a two-tone alarm I had not heard before. Suddenly,
I was surrounded by running people. A patient in Compton ward, so it seems, had
triggered a medical alert. Which required everyone on duty to drop
everything else, and get there! Does it really make sense to require all nursing
staff, however inexperienced, to drop entirely their normal duties – for about
half an hour, so I estimated – and get to an emergency, in which most of them
would be very unlikely to be able to help? Has the NHS never heard of a
“targeted response” to an incident?
Neither In nor Out?
The next few days were relatively uneventful for me. Saturday
and Sunday were the main days of the week for visitor footfall, but after that
the pace subsided again.
It looked as if I was going to be discharged home in a few
days, regardless of how confident or otherwise I felt about it, and without certain
potentially interested parties, such as social services, having been involved
at all. I spent some time, with Kevin’s assistance, preparing a case to discuss
with the lady from Physio. We did discuss on the Wednesday, but there was
little communication.
Thursday was the day on which I had my appointment with the
consultant. A porter took me from Clandon ward to the consultant’s waiting room
in a hospital wheelchair. I found the wheelchair excruciatingly uncomfortable –
I could not easily move my feet, and I could not get out of the wheelchair and
stand up. Then, because he wanted me to have another X-ray, the consultant
asked two of his staff to wheel me to the X-ray department. There seemed to be
confusion about whether I was an inpatient or an outpatient. They took me to
the outpatient X-ray, where two important snaps were quickly taken. But no-one
came to wheel me back. I was stuck for two hours in a cold, draughty, public
corridor, wearing no more than a hospital gown, as the blanket I had had on had
already fallen down around my ankles. Eventually, the man who had done my X-ray
took pity on me, and put into the computer system a flag to tell the porters to
pick me up and return me to the consultant’s waiting room. But even this did
not work, as the porters were apparently looking for me in the inpatient X-ray
area, not the outpatient. Like the infamous Duke of York, I was neither in nor
out.
When a sheepish-looking porter finally arrived and took me
back to the consultant’s waiting room, he deposited my chair right outside a
loo. Blocking the exit, which certainly fazed the lady occupant! Then there was
the small matter of getting my appointment with the consultant re-activated,
since I was now two and a half hours late for it. This having been achieved
with help from his personal staff, I was finally admitted to The Presence. It
didn’t last long – he merely ordered a splint to be installed to support my
wrist, which one of his staff did. It was not very comfortable.
On my return to the ward, I found that Kevin had been moved
to the next room, and a new patient, John, had already replaced him. We got on
well. But it was to be my last night in Clandon ward.
Discharge – 1
I didn’t feel ready to be discharged home on the morning of
Friday January 24th. But it happened anyway. The ambulance crew who
were to take me home were overjoyed that I was ready – there were no last-minute
delays caused by pharmacists or others, as there so often are. But their
optimism was premature.
We got to my home, and they took me down to Farncombe to the
cash machine, so I had some resources with which to begin my new life at home.
That was surreal, too – using a public cash machine, dressed only in a hospital
gown, in freezing conditions, and stuck behind a woman who didn’t seem to know
how to use the machine. Having done the business and climbed the hill home
again, first check. “Where are your home keys?” “They should be in that green
bag” – containing everything I had had with me in the ward. But they weren’t.
It transpired that a department calling themselves HALOS –
Hospital/Ambulance Liaison Officers – had taken, not only my keys and other
valuables, but also the rucksack, in which I had stowed my papers after
proof-reading them. This meant that the ambulance crew had to take me back to
the hospital, retrieve my things which hadn’t been passed to the ward staff as
they should have been, and take me out again on their next run.
On that run, I was one of three passengers. One was a noisy
gent on a stretcher, bound for Milford hospital, who was always complaining
about everything, and who, when I came across him again later, I chose to dub
“Mr. Ranter.” The third, I don’t remember; but as I was the first out, it
didn’t really matter. But it was almost three hours from leaving the hospital
for the first time to finally arriving at home.
The next morning, as pre-arranged, a lady from Milford
hospital called. She helped me, as a one-off, by doing some food shopping for
me and cleaning away some of the worst of the mess that prevented me from
living independently in my condition as a “one-armed bandit.”
On the Sunday morning, a carer arrived. Who clearly thought
things weren’t going to work with me and my home in our current states. So, she
arranged for a “false discharge,” which would get me re-admitted to hospital.
The problem was, having been returned by ambulance, I then
had a wait of around nine hours in the emergency waiting room, before I was
X-rayed once more. And the news wasn’t good. If anything, the fracture was
starting to open up again. Moreover, I was in in a very uncomfortable
wheelchair, and I felt cold, going on very cold. And the wrist splint, which I
had worn for three days now, was causing me more and more pain.
I have never felt so ill in my entire life as I did outside
that X-ray room that Sunday evening, with people bustling past me, almost all
of whom simply ignored me. The next day, I was told that my blood pressure had
gone down overnight to 90 over 40. Scary territory for someone more accustomed
to readings like 150 over 80. And the pain from the splint was excruciating,
causing me to whimper.
But eventually, a passing blue-smocked doctor stopped,
looked, took pity, and acted. He took the splint off my wrist, and he must have
tapped some high-level priority codes into the computer system. For very soon,
a porter appeared to take me to my new bed, back in the AMU or Acutes ward. And
for the only occasion in all my time in the hospital, that night I slept all
night like a log.
Acutes – 2
My second stay in the AMU was less surreal than the first,
but more eventful. It didn’t take me long to work out who was who in the beds
around me; Roger, David, George, Raymond and next to me Geoff. Geoff was a
noisy patient, albeit of a different kind to Mr. Ranter. He would rattle the
sides of his bed loudly, until someone noticed and asked him what was wrong.
Then he would ignore the question, go quiet for a while, then start the
rattling again. He had a regular visitor, who did look a bit shame-faced about
the performance. And several patients complained about the noise. The nurses
usually pre-empted the matter, by giving Geoff something to put him to sleep.
The 28th was quite an eventful day for me. In the
morning, I was visited by two doctors, who seemed to know something about my
condition. But they told me nothing I didn’t already know. Then at 2pm, a lady
arrived, who was dressed like a Matron, but introduced herself as a doctor. We
had been talking for about two minutes, when her pager went off, and she said
she would “come back if it isn’t urgent.” I was so struck by this strange
departure from normal business practice, that I found myself most surprised
when, half an hour later, she came back with what appeared to be her boss. And
this gentleman, Dr Pramin Raut, both understood my situation, and seemed to
have enough clout to get something done about it. He arranged for an
ultra-sound scan to be done on my arm, later that afternoon. Progress!
That day, I also had a conversation with someone from social
services. She gave me lots of phone numbers, but our meeting made no progress
towards working out exactly what social services might do for me, and what
steps needed to be taken to make that happen. In the end, I formed the view
that the entire social services system is a total sham. That, like the NHS, it
exists for a beneficiary class and its client class. And that, if you are not
already a member of that client class, for example by renting a council house,
then you are not in fact eligible for any benefits at all, no matter how much
you need them. So much for the lie that the welfare state provides insurance
for the needy.
The ultra-sound scan, however, was a far better experience.
The porter who took me there and back did everything right; and he told me
about his recent shift, in which he had amassed 40,000 steps. That’s an amazing
figure: 32 kilometres, or 20 miles. The man who did the scan was a little bit
cagey about the results. But I couldn’t help but pick up a sense of quiet
elation; there was something good about these pictures. As was to become
obvious a few days later.
On the morning of the 29th, Roger was replaced by
a black gent called Richard, who had just returned from a business trip to Las
Vegas. He was the first fellow patient I had felt able to chat with since Kevin
and John in Clandon ward. But it didn’t last long. Suddenly, we were told that
Richard had tested positive for COVID, and been removed from the AMU. Just a
few moments later, I was told that George in the far corner had tested positive
for ‘flu, and had apparently passed it to me, too. So, I found myself on the
way to Eashing ward, a floor above Clandon ward. Where, because I had ‘flu,
they gave me a private room.
Eashing Ward
Eashing ward, officially an old folks’ ward, was less busy
than Clandon ward had been. Not that it mattered much, since I was in
isolation. The doctors, while never actually speaking directly with me, had
been very crafty, in a way of which I thoroughly approved. For they had used
the excuse of ‘flu to isolate me for long enough, that they could experiment
with the quantities of my blood pressure medications, in order to correct the
low blood pressure issues, which I had suffered on the Sunday evening. And they
thought (and I tended to agree) that it was these low blood pressure problems
that had caused my accident in the first place.
On the 30th, the doctor in charge of the room I
was in sent me for another X-ray. On the way, I told the porter about his mate,
who had amassed 40,000 steps in one shift. He gave me a huge smile, and said
“Oh, you must have been with Rob, then!” Rob the long-distance strider is,
apparently, something of an institution in that hospital.
That X-ray went well; the fracture was starting to heal
again. But things were not going so well for my case as a whole. I had started
to lose some of the mobility in my right hand and arm, which was concerning. I
was also feeling more pain and swelling around the brace.
On top of this, I had discovered that Mr. Ranter, whose stay
at Milford hospital had obviously been a short one, was now all but my
next-door neighbour in Eashing ward. I did not enjoy his tuneless renderings of
such ditties as “I’m suffocating” and “We’re all going to die.” Not to mention
“Turn it down” and “Turn it off.”
On the morning of the 31st, after a long night in
which I had been unable either to sit up or to lie down without pain, I made
the decision that my left-handed writing was now good enough to begin a diary. It
took me the best part of the next three days to go over in my mind the various
things which had happened to me, and to set them into some kind of order. Of
which you, dear reader, will by now be well more than aware.
Going forward, my words became terser. For February 1st,
I recorded only, “Unable to sleep” and then, “Bad night, good day.” On the 2nd,
the cough I had picked up two weeks before became serious. And I discovered
that getting cough medicine in a major hospital is harder than the proverbial
“organizing a piss-up in a brewery.” It took 10 hours to get a dose of cough
syrup, and another couple of days for it to start to have an effect.
In the early morning of Monday 3rd, I recorded
the eerie scenes in an all but empty ward, in which the main lighting had for
some reason been turned off, and staff were moving around carrying blue
torches. Then that afternoon, a lady called Caroline, wearing the bright white
uniform with green piping of Occupational Health, visited me. She seemed to
understand my case well enough, that I found myself wondering why she hadn’t
previously been sent to see me. Another doctor then came, mumbling about low
sodium levels in my blood, and inviting me to try a low-liquid diet. Which
proved to be precisely the opposite of what my body was telling me I should do.
Indeed, that night, though not sleeping particularly well, I
began to feel better and better. The movements in my right hand, fingers, wrist
and thumb had started coming back of their own accord – though the last was
painful. Even the cough was starting to feel better. I felt, if anything, a
little bit de-hydrated, and the idea of a low-liquid diet proved to be the
pipe-dream I had all along expected it to be.
When offered the blood thinner tummy-jab that morning for
about the 14th time, I finally lost my patience with the nurse, and
demanded why anyone in their right minds would accept a blood thinner, when it
would inevitably disrupt the process by which the doctors were already
adjusting my blood pressure medications towards their optimum. She tried to
evade the issue by trying to make out that the effects of the blood thinner
were only small… thereby digging herself an even larger hole. A situation which,
happily, ended up with both of us laughing!
Discharge – 2
My brace was changed and tightened again in the late
morning. That afternoon, Caroline came once more. As I was now, unlike the
first time, confident in my ability to live at home in my then rapidly improving
physical state, it was easy for us to agree that I would leave the hospital on
the following morning, Friday 5th, after my second meeting with the
consultant. And in the afternoon, now freed from ‘flu isolation, I did ten
circuits of Eashing, Elstead, Frensham and Hindhead wards in around 31 minutes.
At the appointment, when he saw how much of my right hand’s mobility
had come back since the last time he had seen me, the consultant seemed pleased
and almost astonished. He even said that I wouldn’t need a splint any more.
There’s still a long way to go, of course. Lots more
out-patient appointments. And plenty of pain, not to mention a monstrous list
of things that will need to be “sorted” just as soon as I can get my right hand
back functioning. But I feel now, on Sunday February 23rd, that I’m
on the way towards a good recovery.
The NHS has, of course, many and quite serious cultural
problems; several of which, I have brought out in the screed above. And it
looks to me as if it is only because of the hard work and indomitable spirit of
the people “on the ground” that an NHS hospital like the Royal Surrey can
function at all.
So, what I say to my Reform party policy friends is this. To
fix the NHS in general, and its hospitals in particular, you are going to need
to make root-and-branch changes. Many of which will not be well received by the
major beneficiaries of the current practices. But, however much dirty bathwater
you have to throw out, always be mindful that there is a baby in there, who must
not be harmed.
