Thirty-something years ago, in a small room
off the cancer ward in a big Liverpool hospital, my grandmother – who had been
unconscious for some days – was breathing her last, surrounded by her grieving
family. There was a knock at the door, and a large Irish auxiliary nurse stuck
her head in, wondering if Mrs Moore would care for some rice pudding.
My family has treasured this story for
years, and somehow it captures something of my feelings about hospitals – they
are filled with caring, earnest people – lovely, vocationally motivated people
who strive to help the sick and the infirm – but somehow the sum of their
efforts is hamstrung by lack of cohesion – they are defeated by the holes in
the system.
This week my mother has been admitted to
hospital in Edinburgh. I share this story not because I seek sympathy, nor to
lay before you a personal tragedy; I have a sense of inevitable disaster – like
a canoe at the top of a waterfall – however much frantic paddling we do, I fear
we are going over. Mostly I am bewildered, rather than angry.
A little background – just sufficient for
the journey. My mum is 90. When she was a small child she had polio. She
recovered well, and she has enjoyed very robust health ever since. However, there
can be a long-term issue with polio – the repairs which the body makes to the
nervous system are astonishing, but they do not have the same warranty length
as the original kit. Eight years ago she started to suffer progressive
paralysis of her left leg and her hands. She lives on her own, and she now
moves about her home with a Zimmer walker and she has a stair lift. She manages
well – she enjoys her books and her memories and her Mozart CDs and (especially)
her independence, and she has a daily 2-hour visit from a carer, plus whatever
support the family can provide. It works, but it only just works – it would
require only a small further deterioration in her mobility to render her
situation untenable – a fact which is always at the front of my mind.
Last Sunday she had the second of two minor
falls within a space of 10 days, but this time she hurt her knee – some kind of
muscle sprain – and could not get up. She phoned me, and I went round there to
find her sitting on the floor, in some pain but completely sensible and
rational. I could not lift her without causing more pain and possibly further
damage, so we rang the NHS 24 service. After an hour on the phone, explaining
the situation to a series of listeners – starting from the beginning each time
– we were sent an ambulance. The ambulance crew were wonderful – I can’t praise
them highly enough.
The next step was a no-brainer – they could
attempt to sit my mum back in her armchair, where she would be trapped and
helpless until further notice, or they could take her to a hospital in Edinburgh,
where her injuries could be checked out.
Some times on this: she fell at 11:30am,
the ambulance showed up at about 15:30, she arrived in the Accident &
Emergency department at around 16:30; she was examined and sent for an X-Ray,
and was eventually admitted to an Orthopaedic Trauma ward at around 23:00. That’s
a long day when you’re 90. This is not a complicated case – in emergency terms,
she was not a high priority, but it is very obvious that the process consists
mostly of hand-offs – by the end of the day I had described the incident and
her medical situation to about 7 sets of people – each of whom appeared to be
starting again from the beginning. Everyone is waiting – waiting for a porter,
waiting for an X-Ray to come back, waiting for a doctor to be available.
The A&E doctor explained that the
intention would be to check the extent of my mum’s injuries, get her leg rested
and better, and set about fitting her with some kind of leg brace, which would
be a big help in avoiding further falls at home.
All good. By the next morning, upstairs in
Orthopaedics, her temperature was up a bit, and she appeared to be confused.
The charge nurse spoke of a suspected urinary infection, which they would treat
with antibiotics, and she checked with me for any known allergies.
On each of the next two days (which brings
us to yesterday) Mum was even more confused and more agitated – yesterday she
was having actual hallucinations. I have yet to see the same member of staff
twice – each day I was told that a urine test had been sent away, and it would
take two days for the results to come back. Apparently this is another urine
test each day – so we are in full Groundhog Day mode. No antibiotics have been
prescribed – the latest suggestion was that they might start them last night,
but they’ve been saying that for a couple of days.
We are back to Mrs Moore’s rice pudding.
The ward is full of friendly nurses who are kind and enthusiastic, who look
after the physical needs of the patients and offer them cups of tea (even the
unconscious ones), and measure vitals signs and scribble things on charts.
Nobody knows anything.
More worryingly, the very junior doctors I
have been able to speak to don’t know anything either. They cannot answer any
question which is not covered by the particular page of notes they have open in
front of them, they are evasive and – in one instance – incorrectly informed.
They are waiting for some other department or some remote authority to do
something, to make a decision. They don’t make decisions themselves – decisions
might involve blame.
So my mother, who hurt herself, painfully
but not too seriously, 4 days ago, is now becoming very ill with something
which was not a problem when she was admitted. She will certainly not be
getting home any time soon, and I have a very bad feeling that she has just
become another faceless dementia victim, who will be expected to die and free
up a hospital bed. That, I believe, is the correct procedure. It will be nobody’s
fault, and no-one will know how it could have happened, and the latest urine
test results will arrive back on the charge nurse’s desk two days later.
If no antibiotics have started by this
evening I am seriously going to rattle someone’s teeth. Who is in charge of
killing off the elderly patients in these places? – that might be the person to
speak to.