Friday, 9 March 2012
Loss of Innocence (On the Ward)
As soon as I thought it late enough for the ward to awake I rang, and rang, but no-one answered. Then after many attempts it was finally answered and I was told J' was already on her way to theatre, and I should have rung earlier! Stifling the expletives, I asked when they would know if she was OK and was told to ring back at midday. I tried to calm my stress and rationalise the risks as I always told others to do, but it didn't work, so I busied myself sorting out her glasses, her 'phone and fresh underwear. I wanted to be the first face she would see on awakening, but I was beset with a dread that that would not even happen.
The walls were closing in and after calling in to be taken off standby I drove down the hill once more to get as close to her as I could. I had 'phoned an old surgeon friend earlier to get advice and he had helped a bit but I sensed some tension in his voice, and was to learn later that he had become an arch enemy of the Trust after his wife had died there due to misdiagnosis some months before. He had given me some sage advice and I guessed he didn't want to depress me too much by relating his woe's, at the time. I rang at midday and surprisingly the 'phone was answered quickly and I was told J' was out of theatre and would be on the ward by visiting at 2pm. Emotion washed over me like a tide; she was alive! I used my 'borrowed' staff pass and parked in the empty car park at geriatrics. I walked then to the entrance and sat down to wait out the time, clutching my plastic carrier of donations to her future comfort. She was alive at least; I had that to be grateful for and surely nothing else could go wrong, could it?
I entered the ward just as they unlocked the doors; her bed was curtained off. I entered and there propped up on pillows was my love. She looked terrible, so small, oxygen mask on, IV drip, four other lines and oximeter and BP monitor permanently connected. I kissed her and she opened her eyes and smiled wanly at me.She was very dopey and kept drifting off as I talked to her. I was quite concerned about her health; something was not quite right. I checked the BP monitor and pulse and pressure were very low (hypo tension). Oxygen saturation was also pretty poor, hence the oxygen mask. She seemed somewhat more ill than I had anticipated or that my friend had suggested to be likely. I put it down to an adverse reaction to anaesthesia but I was later (much later) to find it was due to inadequate preoperative assessment and lack of care.
About two hours after my arrival a nursing assistant entered the curtains and ran a check on the machinery and entered it on a chart I realised was at the bottom of the bed. As soon as she was gone I looked at it. Fifteen minute 'obs' (observations) was listed; that obviously wasn't happening! J' was violently sick shortly after and she told me that had been happening since she arrived back on the ward. I told her it was quite normal especially after morphine administration. As she became less sleepy I tried to find out what had transpired prior to the operation and after. She knew very little except she had seen a Consultant for a few minutes and an Anaesthetists very early that morning, but was unaware of what had been done, or the type of implant. She was somewhat tearful and I realised that it had been very traumatic for her, unsurprisingly and I pressed her no more. All too soon the bell rang for the end of visiting and I had to leave her again, in that awful place.
It was a dump. Hot, humid with no cold drinking water. Down at heel, with floor tiles missing, curtains hanging off rails, immensely noisy and food that had a remarkable similarity to, well,' pig swill'. I began to wonder what all that extra money we had given the NHS had been spent on. It certainly wasn't the infrastructure or patient comfort, and staffing levels were appallingly low. I spoke with the 'ward manager' on my way out but pretty much got 'brushed off' with platitudes and little else; she had no knowledge of what J's prosthesis was and suggested I speak with a Doctor, but one wasn't available. This pretty much remained the theme of most of J's stay.
I emerged into the late evening sunshine and drove back up the hill. Not wanting to go back to the empty flat I went to see Rob and Sandra, my friends who ran a local pub. Sandra insisted on feeding me and as I sat with them I related my tale of woe. They were kind and sympathetic, expressing genuine concern for J' and slightly heartened I decided to go home and do something. I 'phoned the Hospital communications provider (which went bust a few weeks later) and set up an account so that J' had television and a 'phone. I couldn't believe the expense; there was a daily charge of £5 plus call charges of 50p a minute, even then incoming calls were also charged, so you paid twice! I was past caring then so I put a £100 credit on my card and tried to rest.
I wasn't very successful and kept waking up in a cold sweat, fearing for both our futures, especially what outcome J' would have and when I could retrieve her from that awful place. I got up at dawn and tried to fill my day until visiting. I got her a newspaper and some cold bottled water and put it into a 'cool bag'. I bought some snack foods to pad out her diet little realising that that which I chose was likely to add to her illness, but that was something for the future. I made my way back to the ward and there she was still on the oxygen! The drip had gone but all the IVs were still in place, all five; two in the anticubital fossa, which is uncomfortable, even painful. She was at least brighter and more animated, but I was still concerned that pulse-ox was permanently in place and the BP cuff. She said no-one had been near her all day to talk to her or get her out of bed and the wound had bled profusely in the night, needing her to be changed twice. Her old knee injury was hurting a lot due to the leg being flat and I showed her how to adjust the contour of the mattress to impart a little bending of the knee and it eased her pain. I set up the television and 'phone and made a note of the number so I could call her before 'lights out' that night. At least now we could keep in touch. At 8pm I again had to leave. Sunday was drawing to close and I had to cope with work tomorrow and I didn't know if I could.
Once home I tried to watch TV without success. I talked on the phone to Doris, her friend from the office and gave her a progress report. She said she would try to get in to see J' on Monday. I tried to read a book, something I have done daily for most of my life, to ease stress but I couldn't. At last the time to 'phone J' arrived and I did. It took forever because the system takes you through an interminable menu and sales nonsense all at some ludicrous cost (to you) despite the fact that you have paid already! She answered me, and I talked with her for a few minutes mindful that the credit was reducing at alarming speed. She said she did feel a bit better but she still had the oxygen. I told her I loved her and wished her goodnight and signed off. I tried sleep again and went off quickly only to awake shortly after with the 'terrors' again.
Monday dawned and I got into the office early. I asked my daughter to take on some of my workload and sensed a lot of resentment, but she reluctantly agreed although I still had to keep my 'phone on in case of emergencies. She was going to like it even less when I took to leaving at 2pm every day but that was for the future. I was off like a greyhound out of the trap at two, and raced to the hospital. Parking was a nightmare as it a weekday and everywhere was full. So I found a spot half a mile away, and now late, I hurried to the ward.
She was still in bed, she still had oxygen! I was getting really worried now, but saw that at least the flow rate had been lowered. J' said she had been up and was allowed to use a 'zimmer' to get to the toilet, which made her feel better. She was concerned about her hygiene as she'd had no real wash beyond a wipe with a flannel since arriving and her legs needed shaving! Doris arrived and brought her some biscuits and we whiled away the time until the end of visiting; me not wanting to press J' about her treatment anymore. She kept telling me that they know what they are doing and I shouldn't be so critical. Doris let me have a few moments alone with J' before I had to leave, so kissed her goodbye and went out the door. Doris was waiting for me, so we could exit together. As I related what had happened in more detail, I started to cry. I couldn't stop myself and I was sobbing by the time we reached the outside air. That big, lovely woman encircled me in her arms and we both stood there weeping, for what seemed an age. Although we had never met before (although we had talked on the 'phone) she had driven miles to get here, after work, when she hates driving, can't park for toffee and can't afford the fuel. The kindness of strangers, it floors me sometimes.
The days and hours crawled by, with me spending six hours a day with J'. What I saw on that ward was appalling. Many 'inmates', as we started to label them, had been there months. Most were quite elderly, some very astute but a lot in early and late stage dementia with broken bones and many comorbidities. Some had been there for months and the lack of sympathetic care, even any care astounded me. Many were left sobbing, even screaming for hours. Some of the relations were plugging the deficit of care by providing it themselves, including feeding, washing, and quite high levels of nursing that the NHS at this trust seemed unwilling or unable to provide. An old friend of J's who actually worked, there castigated me for mounting a 'vigil' at J's bedside and I'm afraid I took that badly, and avoided her for the next year as a result. And yet I had saved that woman's leg a year before, when she broke it in a home fall, lay groaning on the floor for twelve hours until I heard her calls for help and then told her it was broken, when she thought it was just sprained (it's not rocket science). It took a lot of persuading to get her to go to hospital where she found it was almost beyond saving. She had DVT and spent the next three weeks there and has been on Warfarin ever since.
After that Monday J' progressed rapidly, soon learning to walk with crutches. They didn't want to let her go and I had many arguments with the physio's about that as I knew she had to get out of there before she succumbed to some infection, or actually starved. She also hadn't defecated for six days, due to the opiate's. Her BP was still low and I at last realised why; they were pumping ultra low molecular weight heparin into her stomach wall every day, despite her moving about most of the day. And, she still had all the IV's in place at day six! On that day a male nurse, an actual 'real nurse' was on the ward, and I drew his attention to this. He went ballistic! Those lines were out straightaway together with his apology for the tardiness of his colleagues. I went to see the phsio' then and told them I was collecting J' the following day, whatever they said. I don't think they took me seriously but I told the 'ward manager' as well and told them to get the discharge documents sorted otherwise we would go without them. The physio's all seemed to be frankly bloody useless. Beyond teaching J' to walk with crutches and how to cope with stairs, they did stuff all. They didn't even give her any warnings about dislocation avoidance protocols or any after care routines, but I had that in hand. The ward didn't even have a wheelchair available so she was expected to walk half a mile to the entrance, on crutches!
On the discharge day, the Friday, a week after the accident, armed with a wheelchair from the Red Cross, bless 'em, I arrived at the main entrance and parked in a visitor bay with my little red van with the Red Cross sticker displayed. The security guard soon shut up when I told him a I was collecting a disabled patient in a wheelchair, so trundling the chair before me I set off to free my love from the tyranny of the Trust. What a palaver it was as well. Nothing was completed, papers had to be signed, drugs provided for analgesia, a litany of checklists and forms that do nothing to advance the patients care but fulfil the 'tick box' mentality of the empire building management, that was now in charge of this huge teaching hospital. After more than an an hour we set off with me remarking to the cleaner, on our way out that we were making a 'break for the wire', I pushed J' through the corridors to the real world and out into into the sunshine; escape! I got her carefully into the passenger seat of the van, stowed and folded the chair, we were to need for the next three months and drove off. At that moment I was happier than I had been for years. We had escaped the clutches of the NHS, at least for the moment. The aftermath was yet to come and it would be a long time before my love would even approach her previous mobility, but a first step had been taken on a long road that was to test our courage, our relationship, even our sanity.
This is the second instalment of the saga (sorry about the length), that was to unfold over the next months even years. I will post the next instalment shortly, I've called it Aftermath.