Sunday, 7 August 2016

Stories from the Frontline of Worcester Hospital

It's been quite a year for injuries. So many folk have gone down with broken bones, torn ligaments, concussions, and not just from riding. Thursday it was Steve's turn. Even the bionic man it seems, is not immune to the curse of 2016.

But beautiful summer trails are why we ride, and the reason we continue to do so, even with the injury risk.

It had been a stunning evening until that point. The most magical light  lit up the hills and everyone having a laugh and banter. We cruised the side trails and whizzed down descents.

I've seen Steve survive the biggest of crashes with little more than a bruise, but on an innocuous piece of trail, he went down hard. That was it, 6 ft of muscle mass all concentrated on a tiny ankle joint. I know it's cliché to say 'horror show'. It really was. Twisted, with ankle bone showing through skin and obviously pretty serious.

Instantly, teamwork began between the Thursday riders and with natural fluidity the situation was quickly managed. Neil phoned 999. Three of us supported Steve and tried to get him to stop moving. Others ran around sorting bikes, the van, kit, providing their coats to keep the patient warm, phoning Steve's family and generally helping out as necessary. Those who weren't needed sensibly headed on to the pub, to get the youngsters back to their families and prevent a 'too many cooks' situation.  

The NHS 'first responder' was fabulous; light-hearted and funny, whilst maintaining total control over the situation and undertaking his critical frontline treatment and monitoring duties. We all managed to keep Steve in good humour whilst he waited for the ambulance to arrive.

Warning - video has pretty graphic content.

Steve was taken in by ambulance and I headed home, dropping off our large van and picking up the normal things you lack in A&E. Food, phones, charger, clothing, reading material, toothbrush, the basic luxuries of life.

I could write a detailed essay about the care he received at Worcester. It has range from five star nursing from the absolutely snowed under A&E staff to draconian management and, worse of all, negligent behavior that could have ended in disaster. It was very different to the great care I experienced in Gloucester A&E earlier in the year.

A doctor had already undertaken the reduction by the time I arrived and Steve was round from his sedation and back in x-ray to assess the damage. The sheets were bloodied from the manipulation work, but he was in good spirits and dosed up on meds.

Sure enough, it wasn't just a dislocation, the leg was unsurprisingly broken too. The long wait began. A few more hours were spent in resuss with the fantastic Nurse Zoe, on yet another long night shift. The poor lass seemed majorly unhappy with the system, and yet, at all times, she behaved impeccably with Steve, ensuring he was looked after and monitored correctly. Of all the staff we dealt with, Zoe was one of the best. With the system being under such strain, it's staff like Zoe who are needed to keep it propped up. But it's those conscientious nurses that feel the pressure of not being able to do their job as well as they wish, that are probably most likely to leave. Zoe wanted Steve to stay under observation in resuss due to his earlier sedation, but higher management determined the bed was needed for someone else and soon enough we were out in the corridor with around twenty others, under the watch of two overstretched nurses, bedless and waiting. Steve slept and I sat, night became morning and the almost-calm of the early hours turned on a penny when the shift change hit.

7:30 am the chaos started up. Important looking people in shirts wandered about. Surgeons came and went. I sat and watched, Steve drifted in and out of medication-fueled sleep. Still, no consultant until finally, mid-morning an orthopedic nurse arrived. She reassured us that the consultant had looked at the x ray and there was no issue. The bone was in a good position and Steve could go home. No operation necessary. "Well that's just great", said Steve, "but what about the open wound under this plaster?"

Oh. Suddenly the nurse wasn't so sure. Suddenly it became apparent the orthopedic team had no idea it was an open fracture. Suddenly our confidence dropped in their judgement, as she went scurrying back to relay the news.

Sure enough, an op was needed as a minimum to fully flush the wound with saline. Intravenous antibiotics would follow. Let's make this quite clear. If Steve hadn't spoken up, he would have been sent home with a festering dirty wound, hidden away in a cast.

The system is under such pressure, patients who don't question every stage are at significant risk. Risk of neglect, infection and mistreatment. Of course there was fault banded about (it was the new doctor, apparently),  but even with reassurance that it would be followed up, I think we all know it will happen again, to someone else, and probably soon.

At least he was scheduled for a bed, and afternoon surgery, so, barring any major incidents, he would be in theatre or recovery for a good part of the day. I headed home to grab a little sleep before returning in the late afternoon with a big bag full of decent food. Nil-by-mouth had meant Steve hadn't eaten for over 24 hours. He'd be starving once the recovery had kicked in.

Some random guy let me in the ward without question. I wandered about until I found an unattended screen with patient details on and noted Steve's room number. I got to his room, there was no bed. The kind-hearted male healthcare assistance let me know he was probably still in theatre, or recovery, but that I was welcome to wait.

Time was spent watching the elderly man in the adjacent bed deal with another day in hospital. He'd been in since the 18th of July. There was little positivism from him regarding his treatment, and I found myself trying to translate his needs to a nurse who couldn't understand his concerns, and, to be honest, didn't really make much attempt to try. I guess she was at the end of her tether and yet another explanation about treatment was just too much to bother with. I must say though, the healthcare assistant who had let me in was brilliant with the older gent. Patient, kind, treating him with respect and getting the best of out him. Sometimes just a few more seconds of focus, a little listening, is all that is needed to turn healthcare around. Maybe the assistant just had a little more time and a little less responsibility pressure, maybe he was just a better carer, but either way, listening to patients must surely be on the 'important list' of any nurses training program?

The clock kept ticking and Steve didn't arrive. I figured he was probably having a hard time in the recovery room but it did start to seem like a very long wait for what was, apparently, just a wound flush. Hours passed and then, finally, he was brought in, obviously still in agony.

They had operated fully, plated and screwed the bone, cutting the ankle on the other side to the wound. The wound itself was also, apparently, fully flushed, cleaned and he was dosed up on massive amounts of painkillers and antibiotics. Steve was in a lot of pain. Enough pain relief to knock out three horses, apparently, yet a mix of morphine, ketamine and goodness knows what else was barely touching the edges of his agony.

So now we had gone from Steve being close to discharge at 9:30 am, with nothing but a 'there there, come back in a week' to major surgery and intravenous antibiotics the same day, only because he had spoken up and questioned the 'expert' judgement. Negligent? I'm not a lawyer, but I would say so.

I comforted him as best I could, although there was little I could do as he drifted in and out of consciousness. Then the nurse came. Visiting hours were over. Blanket policy. 3 pm until 7:30 pm.

What is this? 1940? Seriously, what kind of management allows an emergency patient in agony to have their partner's support and love overridden by such a draconian rule? To say I was fuming would be an understatement, however, I tried not to let Steve see it, for he was already worrying about the repercussions from injury. It wasn't the nurse's fault either, she was just operating in the framework given to her from the tiers above.

I was allowed a little more time to say goodbye, and then that was it, I had to go, or a, shock horror, an inspector might see me. Older patients apparently, become weak, feeble and reliant on their relatives if they are allowed in too often. I suspect it may be as much to do with relatives asking questions, and actually ensuring their loved ones receive the care they need. I certainly didn't want to leave Steve, in a barely conscious state, unattended in an overstretched hospital that nearly sent him home with a dirty unplated wound, and into the hands of the sepsis gods.

But I had to leave, there was no choice.

We must all be grateful for the NHS. Free at point of need is healthcare that is a privilege that our first world lives are blessed with. But we must all take responsibility for it, pay our taxes, not waste resources, and support the system where we can. It's not the government's fault, the doctors, the nurses, top heavy incompetent management. It is all of them, and us. We are all cogs in the system in one way or another.

I just implore any one who ends up in Worcester Royal Hospital they ask questions and monitor their treatment closely, and speak up as soon as they feel there is an issue. Never assume the 'experts' are right, everyone as the potential to make a mistake, and ground staff can barely keep on top of their work load. The situation is desperate.