The Hospitality of the NHS

I spent the weekend hospitalised. Not fun at the best of times, but unfortunately, this isn’t exactly the best of times. Before you medivac, fearing a bout of introspective morbidity or existential angst, snap out of it! This post is about how fucking shit the NHS is becoming.

Look, I don’t understand the NHS, I don’t understand how the funding works, I don’t understand the government, the Trusts, the Foundations, the whatever-the-how-you-funds. All I understand is that more stuff has got worse over the years than better. Despite more money. Despite more nurses. Despite more doctors.
I know this because I have used the NHS a lot. I have been a life-long, hard-core customer. I am well placed to report on its strengths and weaknesses, certainly in London.

I also know that the NHS is merde compared to France’s system and Scheiße compared to the German system. The former, because of stories like these and the latter because my sister spent around 16 years of her adult life there and experienced both sides first hand. She now lives in England and is now beginning to miss a lot about Germany.

Friday night I started to feel ill. I knew I’d be sick. I try and fight it, breathe through it, but I just know I’ll chuck. I’m not like those alcoholics who think its fun to throw up, that it proves one’s manhood, or more and disgracefully more nowadays, one’s womanhood.

Retching reminds me of being a minute or two away from dying. One involuntary heave to projectile-expunge a quart of spirits from your gullet whilst under the mildly-anaesthetising influence is one thing, but vomiting hour after hour, day after day until eventually, you are in a coma induced by diabetic ketoacidosis, having lost most of your muscle and fat, having no muscles left to retch with and having been reduced to a skeleton is completely another.

That was my first experience of vomiting. Aged 7. December 1973.

When my local GP failed to recognise diabetes, despite several examinations and a month of disease progression to the eventual coma. (My mother never forgave him)

All I remember is the out of body experience, watching my prone body from my bedroom doorway on the bed, and my drunken father, equally prone, on temporary night-watch duty, asleep. My mum, having been awake for five nights, heard something in her dream, or a noise from within me like a banshee, she could never tell which – all she knew was DANGER – and she bolted upright, grabbed my limp body, rand down stairs and made the call to 999.

Dr. Lidell, an Australian doctor, at the (now closed, natch) Paddington Green Children’s Hospital, who I only remember because my mum repeated his name in prayers of thanks often enough to burn him into my memory, smelt ketones on my breath and diagnosed diabetes in about, oh, three paces across the room and one inhalation. I was put on a drip and after a day or three, I don’t remember, I regained consciousness, slowly, to a new world.

Ninety years without slumbering,
Tick, tock, tick, tock,
His life seconds numbering,
Tick, tock, tick, tock

It stopped short
Never to go again,
When the old man died.

After the diagnosis and the stay in hospital, I knew a few things: Hospitals were very, very clean places, most nurses were good, almost as many doctors were great and they all worked bloody hard. And most of them cared! They had smiles on their faces and cared. And this image persisted for many years and many admissions.

Oh, I also knew that I didn’t like vomiting, because it meant dying.

Fast forward almost exactly 33 years to the day, and I was vomiting endlessly. Over 30 times. Eventually, the vomiting was so frequent and debilitating, that I couldn’t breathe and was vomiting out of my nose and mouth and choking. Then, because I’m on stroke-busting medication, and my blood is thinner and there is little coagulation going on, a vessel or two in my throat burst and I was coughing up blood. I won’t talk about the other end of the alimentary canal. You’ve had enough detail.

In the old days, when a diabetic became this ill, because of the huge risk of DKA (Diabetic Ketoacidosis, remember?), a doctor would come over immediately, day or night, and if you were not getting enough fluids, you would be admitted to hospital. Now, there are no night doctors. Now, there is NHS direct. A wonderful, call-centre oriented call-back service where you get to speak to a doctor after two or more hours if you’re lucky, and a nurse probably an hour before that. A fucking helpline where like every other broken system in this broken country, you have to repeat your symptoms and details over a trillion times to every numpty and they all get their own versions of it.

It’s at times like this you think that the national database might not be such a bad idea, if it replaced humans who make such bad systems and those that implement them. More seriously, I wouldn’t mind my medical history being available to someone on demand, but from a chip I broadcast at will, encrypted, or something like that, over a cellphone perhaps. I only say this because my medical details now occupy more than a page of A4, make it A3 actually, and my hospital file makes War and Peace look like toilet reading. And I’m talking a piss. Yes, talking, not taking.

So after hours of this, we eventually called an ambulance as we had been instructed. It was I don’t know, about 5 or 6 in the morning by now.

OK, we didn’t call one. I was vomiting from my nose and asking my wife to call one. I don’t know what I sounded like, but it wouldn’t have been pleasant. That’s the downside of having an en-suite, it gives you the opportunity for fucking up twice as much tile space and hearing two types of reverberation on your porcelain-bus-driving masterpieces.

The ambulance arrived after an hour. Probably not the end of the world. Then from arriving at our flat to getting us to St. Mary’s took another hour. The NHS is about waiting. Lots of waiting. I would have hated to have been my wife.

I’m light on the detail here because I was so out of it and reliant on my wife’s time-line. Thankfully, she does memory very well indeed.

When we arrived, I was put in a cubicle at around 8:30a.m. and we were seen by the nurse by 9, but it was 10 before I was put on a drip and given anti-nausea drugs. The doctor finally arrived at 11:20 and took my blood to test for DKA at 11:30. They had checked my urine earlier and found a huge amount of ketones in, despite my blood sugar not being massively high. This is suggestive of enormous dehydration in a diabetic, and is of course, incredibly dangerous. I was given the saline way, way too late, but I was at least seen by a doctor within the four hour New Labour target. It didn’t take the doc to put me on saline though.

The doctor was nice enough, but he was absolutely bushed. He took the blood from my left arm and then promptly dropped the loaded hypo into my lower leg. You know how big the needles for IV blood withdrawal are. Well, thankfully, my peripheral neuropathy meant I felt very little pain indeed. The doctor was embarrassed, but I laughed it off. I remember that.

Another doctor saw me at mid-day. She asked me the same questions I’d been asked a million times – and thankfully – having learned our lesson – we came prepared – a neatly typed summary of my condition and recent complications on 4 pieces of A4 were handed over to her to photocopy. She then uttered the words no heterosexual man wants to hear in front of his wife. “I want to have a look in your bottom”. Sure. Go right ahead.

I was finally moved into the Clinical Decision Unit into a bed by 1p.m. (I’m having to get all of these times from my wife, I was out of it). There was no bed-table at any of the beds, no drip-stands and precious little nursing. My saline had run dry for over two hours during which time my wife repeatedly requested a replacement pack. This was finally administered only because my wife asked the nurse when the doctor was present. The nurses didn’t look overworked by anything other than computer work and gossip. The only people the ward seemed to be short of were doctors.

I had been advised to eat so that I could take some insulin. (No way). Nothing to eat arrived for hours.

Later that night, I finally found the energy to get up to take a pee. With an IV hanging out of my arm at my elbow, I grabbed the saline pack off the oxygen chamber onto which it had been jury-rigged, then was told that the toilets were filthy. I waited, and eventually managed the feat of pissing without soaking the back-revealing gown you get at hospitals.

I asked for a drip-stand and there were none. It’s not like these things are stolen, is it? So why can’t a hospital like St. Mary’s, one of the biggest in London and certainly the most famous, afford these bloody things? If you think this is funny, and it kind of is, I’d like you just to imagine, if you’re male, taking a piss, standing up (because if you sat, you wouldn’t have the strength to get up again), with a gown that falls over your flyhole, a saline pack held aloft with your left hand and a catheter going into the vein in your right. It’s a delicate coordination exercise, that’s for sure. A drip stand would have helped enormously.

Earlier, when my wife had gone to ask the nurses at the station for some water for me, after saying “excuse me” twice, she had to wait over 20 seconds before any of the five nursing staff would even acknowledge her. What were they doing? They were having a chat, moaning about patients. Elderly ones specifically – and about how they could “help themselves”. Well, if you pay peanuts, what calibre of nurse will you attract? And why would you blame them for going to the private sector? The good ones who stay are saints.

Back to the nurses-round-the-fire. One of the male nurses had his feet up against a wall, whilst reclined against his chair. This was no meeting. This was modern rudeness. It would never have been tolerated a couple of decades back.

Dinner was absolutely fucking shit. Worse than any I’ve ever had. Worse was to follow. You want to know what dinner was, right? Cottage pie. Mashed potato. Dead broccoli. Pale, watered-down simulacrums of them. With yellow gas-light murk smeared uniformly over the whole plate.

Breakfast was one weetabix and a cup of tea. That’s it. One fucking weetabix. Still, that day, that was all that I was going to manage. I was still ill, but I just had to get out. All the while I was thinking “what if someone who really needs this bed is waiting out there?”

More staff were rude than I ever remember (and I am always, always incredibly polite to NHS staff, no matter what they do). The Polish girl serving our breakfast was the worst. Four patients in our section, I’m the only brown guy. I have the best manners, and yet I’m the only one who gets talked at brusquely, got no “sir”, got no “you’re welcome” and got my breakfast practically chucked at me. Still, I’m a guest, so I don’t complain.

Then of course, there are no longer any blankets by default for the beds, they have to be requested. We had to wait over an hour and a half for one and this was then thrown on me by the nurse, half-folded. She went back to the phone and continued her chat with her friend.

And can you say “mixed wards”? I had to do my injection late on the Saturday night, and wanted just 30 seconds of privacy to do it. The curtains were drawn back on me by three different people on four occasions in less than a minute whilst I sat there with my cock out. Talk about a lack of dignity. Meanwhile, the poor lady to my side had her boil-infested arse on display as she walked around with her open-backed gown on. Mercifully, her son warned her after a while and this was corrected. I wanted to puke. Not for the first time, I should add, that day.

On the other hand, visiting hours are clearly shown to be between 3pm and 8pm and these were roundly ignored. And everybody was quite happily using a mobile phone, brazenly and default-Nokia-themed-ringtone-loudly. I felt like such a kid, keeping mine hidden at all times, on silent at all times and conly communicating by text when I started to feel more awake later that evening. And the nurses apparently had a good telephone manner and were patient. They didn’t do much, but I didn’t sense impatience, just indifference.

The night passed relatively well. None of the nurses had a clue about my medication, which was just as well, I would never have trusted them with it. Fuck, if they had had to administer my insulin, my next visit would have been downstairs. To the morgue. So I tested my own blood sugar, took my own medications and took my own insulin.

Credit? One of the night-time nurses, a Nigerian, was brilliant. Nigerian nurses are invariably brilliant. My all time favourite nurse was a Nigerian, I wish I could remember her name, but she made me feel better as a child with her beautiful attitude. Healing is mostly that. Attitude. Many nurses with their glamour-shot-smiles miss that, whilst missing your eyes with their blank gazes. And thus the point. And one of the day nurses on my second day, a small, squashed face English girl, a bit round, a bit shy, a bit giggly, was absolutely wonderful. She was the only nurse out of the 8 I encountered who asked her patients how they felt. And she meant it. Great nursing is about human-facing-work. Not public-facing. And certainly not inward-facing, as it has become today. I sensed one of the nurses in particular was hugely concerned about how she came across to the doctor – and to the database.

I can’t make a judgement of the NHS based on this most recent experience, but I do know this. It doesn’t make me feel safe. It doesn’t make me feel looked after and it certainly doesn’t make me feel as if it cares. I don’t know what fucked it up, and I couldn’t offer solutions unless I knew more about it. I do know that directors take the cash, not the blame.

Doctors work their nuts off, make mistakes when they’re tired, have to under-charge in order not to make it look like they’re overworking (new Labour) and they’re the ones who have to deal with patients and their families on the front-lines of battlefields created by directors and managers who know nothing about the cold reality of turning a brain-tumour patient away from scheduled surgery because their place has been given to some drunk-driver in A&E, freshly scraped off the windscreen of his uninsured car. I was taught an expression by a young man who reported to me many years ago. “Shit rolls downhill”. And yet – doctors were once revered. Now, we the public – and their managers and directors – shit on them. Doctors. The healers. The savers of lives. No wonder so many leave medicine before they’ve found their place in consultancy.

Is it society? Does too much TV and too much google make us more knowledgeable and thus more argumentative? Or do we just know enough to be dangerously misinformed? Or is it that our respect for so-called-authority has dwindled down to fuck-all? Well Britain, as ye soweth, so shall ye reap.

At best, this system, once a jewel of this wonderful country, is now just a Notional Health Service.