How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Thursday, 23 February 2012

Loss of Innocence ( 7 days in June).

(Part One)

For one of quite some age such as I, it was strange to lose my innocence. The events were so profoundly life changing that I was caught up in a whirlwind of doubt, dysfunction and misery. My career, what was left of it, my control of events and even my very life became threatened by a calamitous and traumatic sequence of events that came to pass, at the hands of the NHS.

I had until that time had some respect for that bastion of Healthcare, probably because I had used it infrequently and when I had, my expectations were quite low because that which was wrong with me had little in the way of a cure. Osteoarthritis, glaucoma and cataracts can be ameliorated but completely cured, no. I never expected it and Healthcare did not let me down, especially when it came to the cataract, that was made worse by lens implant. Posterior Vitreous Detachment it was called, made all the worse by that short window before it's occurrence when I saw real colour's for the first time in years. Such a revelation; the world was so bright and vivid, well for 48 hours anyway. Then it hit, and from that day and henceforth, life was to be viewed through a mist; a fine net curtain, obscuring detail and it's recognition.

I was already quite depressed at that time, with my life already falling apart at the domestic level, as it had been for years, but I had ignored it by immersing myself in an arduous routine of work and more work, not wishing to address the pain because that way it wouldn't hurt. I did decide that any further eye surgery would likely be counterproductive so I settled down to live with what was left, and then tried to address my life before the remainder slipped through my fingers.

And I did; I found a sort of happiness, that gradually replaced the pointlessness I had felt that slowly swelled and for the first time in more years than I remembered, plans started to form. The NHS; well they had made a mistake, but it wasn't life threatening and we all make mistakes after all. I didn't bother complaining very much and accepted the explanation that PVD was always possible when ultrasound is used to remove the old lens. Pity no-one had informed me it was possible, but hey-ho them's the breaks.Then,one summer day in June I learnt that the NHS's hubris (and mine) had consequences that can reverberate throughout your life, and that colossal mendacity is practised daily, along with cognitive errors that can only be judged as incompetence (or stupidity).

She, with whom I will end my days, was off in front, pushing on up the hill, pedals whizzing round, whilst I paused, foot on the ground, gasping for the air that effort had stolen from my lungs. Then, with graceful ease, almost in slow motion, she fell from the bike and landed heavily on her side. With increasing fear, I dropped my cycle and staggered over to her, my breathlessness no longer from effort but panic. She was white with pain and emitting low screams. I tried to help her up but the pain was too great. I made her as comfortable as possible with my jacket under her head. Her pulse was racing, breath coming in short pants; she was definitely in shock. Fumbling with the damn (not so) 'smart phone' I cursed it's stupid step logic, but finally got through to the Ambulance Service and told the story almost screaming for help. It seemed a lifetime in arriving and all I could do was to keep her warm and still and feel inadequate.

I suppose I knew already what was wrong. Foot turned out, unable to move her left leg and in great pain, it had be a femur fracture and worst; probably at the top, the dreaded hip fracture. It took three of us to get her into the ambulance using a crude device of a blanket to help immobilise the joint and with blue's and two's slowly drove down the hill (yes that hill) to A&;E. All throughout the journey I found myself praying to a God I didn't even believe in, for her to be alright, that it could be a dislocation, that she would be home tonight or tomorrow at worst. I was of course wrong, and no God was listening to my prayers, as always.

At last ensconced in a cubicle, her ordeal began. It took nearly three hours for an X-ray, just after she got some Paracetamol (Acetaminophen; as if that was going to be of much use). More than four hours to even see a 'doctor' (some FY1 child), who didn't really say much, partly because her English was somewhat poor, and partly because she was out of her depth. The notes got lost, then they were the wrong ones, as I pointed out that J' was not a teenage male with a broken arm. This caused some consternation and after that I never saw any notes in evidence. Some four hours in, she was given IV morphine but not until (apparently) she had an ECG; this came to light only after perusal of the notes some six months later, but as neither I nor her witnessed any such event I very much doubt it. Also she had a 'ghost' chest X-ray, of which she has no recall as no machine was placed over her chest only her pelvis, but again that only came to light much later.

After some six hours from admission, some nurse or other (we had seen a few) informed us both that J' had a broken hip which by this time the cleaner could have diagnosed. What type she did not say. She did say that an operation would be needed to 'fix' it, but again did not say what type. So ill informed and bemused we were shown up to a ward. Through what seemed miles of corridors and one lift journey we arrived and I was placed on a chair at an unlit corner of the nurses station to ponder and stress about what was to come. My brain was racing through the likely short and long term outcomes and I was searching my memory for long forgotten learning of the human anatomy and biology from nearly fourty years before. I filled in the admission form for J', ensuring I noted her problems (she had a 'stiff' arthritic left knee from a riding accident from twenty years before) and intake of any med's, which was only a high Omega 3 supplement. An hour later, which seemed forever, I was summoned to her bedside through the darkened ward bay and into the curtained area that surrounded her.

She was in tears. Without me there to support and question anything; J' is primarily an Accountant, with no knowledge of anything remotely related to Medicine or Health, she was confused and distraught. And yet I had been excluded whilst some Surgical 'on call' FY2 had explained some of what was needed for her operation and had asked for a signature of consent. Being presbiopic and without her reading glasses she had then requested my presence, which is likely the only reason I had been called at all. She asked for my help and passed the form to me to peruse. I clearly recall it as being one sheet of paper simply requesting consent for anaesthesia and little else, this was to turn out to be critical but by that time 2 am, with no food and little water, up since 6.30 am the previous day, we were both somewhat 'punch drunk'. The very young (and very beautiful) black woman who faced me explained in halting English, what was to occur in the morning. It was garbled, almost incoherent but the word 'hemi' kept coming out. I didn't have a clue. After some patient questioning by me it transpired she meant that J' needed a half hip replacement which was some sort of repair. Thinking, in my orthopaedic ignorance, that half was better than whole I suggested that we had little choice than to concur and J' signed.

I then spent half an hour with her, before they decided to kick me out, clinging to her, not wanting to say goodbye, with a sense of doom coming over me. I left my contact details with the nurse on duty and took the number to contact the ward stating that they must let me see her before the 'op'. I know how capricious a general anaesthetics effect can be, but despite my advice J' had said she did not want to be 'awake' when they sliced her thigh open. I explained she would not be awake as such as she would be liberally plied with tranquilisers as well as the regional anaesthesia but she would have none of it. That, I had to admit made me a little resentful (sic), but it's her body and I knew she was quite squeamish, so I pressed her no more.

I wandered through the long corridors and found an exit eventually. I found the car I had illegally parked in the empty disabled car park, with my Police ID prominently displayed on the dash. The parking Gestapo had consequently ignored it and I made my escape; well I tried to. I was so wound up, so preoccupied (and knackered) that I went round the perimeter road twice before I found an exit to the real world; where people could walk, laugh and get drunk, which is what I wanted to do, right then, more than anything.

I entered the empty flat and went straight for the Rum. I hardly diluted it at all, just tipped a small slug of Cola into the half full glass. I sat in the window, with it wide open, staring into the night, or what little was left of it. An impending sense of doom was all I could feel. Thus far my experience of the Hospital was one of confusion and incompetence; like a ship steering through a storm with no-one at the helm. I was frightened that my sight of J', in that bed might actually be my last. And I now had little confidence that the outcome would be good, whatever happened. I felt like the last man on the Planet, and I was scared, no terrified, that I could be losing her after years of letting her down. Had I let her down again? In the next few days I was to find that was the least of her problems. Because the NHS was much more adept in that than was I. And what was that the paramedic had said, "how do you control your diabete's?", what the hell was that about?

Note to reader; this is too hard for one instalment, even after three years. It would also be too long. You will find some of it so unbelievable that I could not make it up. 'On the Ward' will be posted soon.

Tuesday, 7 February 2012

HPV Vaccination; There's More.....

Moving on from my last post, I have looked at outcomes and costs of this protocol, and it seems to me that it is more of a ploy to give GP's 'something to do' (for which they will want paying-as always) and to make 'Pharma' richer, rather than anything of real worth.

The objective at the moment is to vaccinate young girls to 'prevent' in later life the incidence of cervical cancer and now throat cancer (and possibly genital warts). Well the cost is looking pretty staggering. If the NHS is to achieve it's goal of all teenage girls receiving Cervarix (GSK's version of the vaccine), it would cost, at £450 a 'pop', some £2.155 billion. If we add in the boys as well this goes up to £3.375 billion. And that's without factoring in the cost of administering 3 doses over six months which will be at least £5 and probably nearer £7.50 a 'go'. If some sort of 'target' payment is introduced to encourage take up, (likely-because GP's don't do anything for nothing) we're already looking at least an extra £22 million and more likely £40 million. That's an awful lot of taxpayers money, for a problem that isn't really, er... a problem. So what is?

Well, HPV Vaccines are not proven as being preventative, because the timescales involved can be as long as 40 years and generally at least 20 years, before Cervical Cancer develops. So, it will be along time before we know the real outcome of the vaccine protocol. In the majority of cases found, the lesions do not progress to cancer and those who end up with actual cancer have a quite low mortality. The incidence rate in the UK is in fact 8.5 per 100,000 (0.0085%) but the mortality rate is only 2.4 per 100,000, leading one to believe that treatments are very successful or (more likely) a lot of women are being counted who did not really have full stage 3 cancer. Both mortality and incidence have been falling (off a cliff) since the 1950's with the largest decreases in the quintile one would have expected to be most 'at risk', those sexually active in the 1960's (or 70's if not in London), the 55-64 year olds. This cohort have in fact had the most spectacular drop of all, in mortality of 79% (up to 2000). Mortality and obviously incidence increases with age unsurprisingly, but even in those over 65 the mortality is 11.8 per 100,000 or 0.0118%. These sort of percentages if seen in a clinical trial would be viewed as too small to count as significant.

There is now a view (a desperate one) that we should utilise HPV Vaccines for genital warts, (Gardasil is licensed for warts, but not Cervarix), and yes incidence has risen since the 1970's but is now slightly on the decrease. However at 148.7 per 100,000 could hardly be viewed as an 'epidemic' (1.49%). yet some clinicians advocate this for boys/girls and young men/women as a precaution against warts, which the last time I checked could hardly be viewed as 'terminal' and is eminently treatable. I feel all of this 'hype' of vaccination is counterproductive and dangerous. Good sex education and the discouragement of 'early' sexual encounters would be somewhat more in keeping with the needs of society. And, as I said in my last post the actual incidence of harm for vaccination is higher than the risk of cervical cancer.

Do we need to spend vast sums on vaccines of dubious benefit for 'so-called' cancers of extremely low incidence, such as throat, cervical and some sexually transmitted diseases generally without fatalities? Life itself is dangerous and to the best of my knowledge, no one has yet escaped alive. Whilst I would advocate cervical smear tests for women over 30 years (pap tests), I feel we are in danger of more 'disease mongering' if we continue down this road of trying to remove all risks from simply, well 'being' (alive that is). The sort of sums involved are colossal for rewards that are dubious, unsupported by any real scientific evidence, and that can cause harm, even death. The NHS has promoted mammography, DXA-scans, exclusively hospital births, hormone replacement therapy, even thalidomide in it's history (in the main for women) and some of these have turned out to be a tragedy of enormous proportion. In many ways it should take note of the old adage that 'if it ain't broke, don't fix it'.