All’s Well that Ends Well

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The NHS is broken – part 2. One thing that should change.

Lots of great reactions to my post yesterday about my experiences with the NHS.

I contacted a nurse who works at the BRI, but will remain anonymous, and got them to read it. They were just as nice as all the staff I’ve talked to before, and very sorry about my situation. It was interesting that the thing that really got them about my post was how a patient has to put their life on hold before going in, and the stress and frustration it causes when the operation is cancelled through no fault of their own. I guess when you see 10, 20, 50 people a day you just don’t have time to consider their lives outside of the immediate medical problem.

They did say one thing that was interesting – “we’re always open to ways to doing things differently”. That got me thinking about ways they could do things differently.

Ok, here’s one very simple thing:

How about you pre-warn the patient that their operation *might* be cancelled. Or, even that there’s a high probability that it *will* be cancelled?

That way we can plan better, and we won’t feel as crushed as we do when the rug is once again pulled from under our feet. I naively had no idea it was even a possibility when I rocked up for my first cancelled surgery.

Take a look at this photo – it’s all the info I’ve been sent about my operation.

 

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Here are the headings on the pamphlets: Requirements for admission, Moving to the discharge lounge, Hospital acquired thrombosis, Pressure ulcers – everyone’s business, Your visit to the Pre-operative Department (POD), Keeping patients warm, The management of pain after surgery, Keeping an eye on your alcohol use, You and your anaesthetic.

It’s all about what *you* need to do to make this happen.

Not once, in any of the literature is there a single mention that your operation might be cancelled.

Not once in my surgical consultations was it ever mentioned to me that the operation being cancelled was even a possibility.

Being given hope, only that have it taken away, is a kind of psychological torture, and it needs to be recognised more openly by the NHS.

 

The NHS is broken, and so am I

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Sexy surgical socks

Just before Christmas, I accidentally clashed heads with somebody while doing sports so hard that I broke the orbital bone underneath my right eye. This is called a “blowout fracture”. He effectively headbutted my eye. Yes, it hurt. A lot. And bled from my nose. I didn’t know anything was broken at the time, I just thought I’d had a bad knock. But more worrying was the instant double vision, which seemed to return back to normal(ish) very quickly. Even though it was getting better I still had it, so I phoned 111 the next day. Head injury with double vision? “Stay there, we’re sending a paramedic over”.
 
They took me to A&E since my symptoms were an indicator of bleeding on the brain, which is obviously a serious business. The doctor gave me an X-Ray, looked in my eyes and said I was fine. Go home. I had a bit of a black eye, but it didn’t look particularly bad. After Christmas I got a call from the hospital saying they were going over the X-Rays and found something they missed. Could I come in for a CT scan straight away? This sounded serious so I did. The CT scan indicated a fracture under the eye. I was referred to the Maxillo Fascial Unit at the Bristol Eye Hospital. After waiting a bit I went for my appointment with a surgeon who started talking about volumes of liquid in a glass and how mine was now a bigger glass, but the only words I was really taking in were “over time your eye will recede into your head”. So there’s nothing you can do?, I managed to blurt out at one point. “Oh yes, there’s surgery to correct it. We’ll put a metal plate in your head”.
 
Faced with that or my *eye receding into my head* I went with the latter option. I did the pre-op visit the same day and after a few days, I received an appointment at the BRI to have the operation done in a couple of weeks. That seemed a reasonable time to me as it was classed as a non-emergency but “needed doing”.
 
Here’s what happens when you are admitted. First, you have to rearrange your life around the fact that you have to stay in hospital overnight. So you’ve moved things around at work, cancelled things you were going to do, booked time off and generally written off the week for getting over the general anesthetic and pain. You can’t eat or drink anything 7 hours before the op, which is inconvenient. Then you need to get to hospital at 7.15am. The BRI is right in the centre of Bristol so you get dropped off by a helpful friend (thank you, Jonathan).
 
So you do all that. From 6.30am onwards you and your little group of today’s patents gather in the waiting room, with a sense of too early morning doom hanging over you all. You’re all going through your own different personal hells as you wait. Then you are called in.
 
A nurse calls you to a room, does some blood pressure checks and makes sure you haven’t got MRSA or any other major health problems. Once that’s done the anesthetist rolls in. They are full of optimism and joy. They talk you through the anesthetic procedure and how it’s all good to go from their end and there won’t be any problems. Now your spirits are lifted and you’re feeling positive everything is going ahead. Then the surgeon comes in and tells you there’s a 50% chance it won’t happen because there’s no bed for you currently. And since you were last here (yes, this is your *second* attempt at an operation after the first was cancelled because there wasn’t an anesthetist available), “50% of all patients have been sent home without their operation”, so your chances really aren’t good. But wait until the 11 o’clock bed meeting and hopefully one will free up, but it doesn’t usually because you are a lower priority to people having a genuine medical emergency, and your procedure “doesn’t need to be done today”.
 
But after waiting 2 hours there’s some good news! There’s a bed! After another wait, you see the surgeon again and he looks positively relieved “Good news!”, he says, but there are people due to be operated on before you so it won’t be until after 3.30. That’s ok, I’ve got a book and a comfy seat. I can wait.
 
To be fair, the constant state of anxiety about whether it will or won’t happen does take your mind off the fact that a surgeon is going to open up your face with a sharp knife and mess around with your eyeball before putting a metal plate underneath it and screwing it in.
 
You relax and settle down to read. 2 hours later a very nice woman you haven’t seen before turns up and tells you that she’s very sorry but your operation is canceled because they’ve “run out of time”. That’s it. Go home, wait for another appointment in the post. “But this is the second time this has happened!”, you say. “I know, sorry…”, she says. Apparently, the woman due to go before me has only just gone in and hers is a long operation, meaning they won’t be finished before 5.
 
At this point you say FML and look into private health care, wishing you’d done that a month ago. At least they wiped the arrow they’d drawn on my head off this time before they sent me home, unlike last time.
 
I’m lucky that my job comes with private health care (BUPA). I’ve never used it. My NHS surgeon was at great pains to say that if I went private then he couldn’t recommend one hospital over another, but I got some options out of him. I eventually wrestled a ‘consultation authorisation number’ out of BUPA’s corporate team (There’s a £100 excess I need to pay, or something) over the phone and contact a private hospital. They gave me a consultation date of the next day at 9.30am in the morning. “We have our own car park, which you can use”. (Words you will never hear in the NHS.)
 
I still don’t know if my insurance covers me for the op – I have to get a procedure code at the consultation, then phone up and find out if I’m covered for that procedure, or something. I still might not actually be covered. I’ve yet to find out.
 
I’ve used NHS local doctors and dentists all my life. I hadn’t felt the need to go through the hassle of enacting private health insurance because everything seemed to be going smoothly on the NHS. Until it wasn’t. Twice, now. And with no guarantee it will be any different the third time.
 
I love the idea of the NHS. I’ve been paying for it all my working life. I tried to use it, but it’s broken. All the doctors and nurses I met were lovely, but if the system is broken how does that help?
 
If there’s a motto then just don’t get any sort of non-emergency injury in Britain in 2018. Or be rich. I guess that’s the message.
 
Oh and if you live in Britain, then please vote anything other than Conservative at the next election. That would help, thanks.