My NHS experience: Not quite as ‘hip’ as the Sixties
If you think about it, everything happens in hospital. Most of us are born there, die there, have children there and go there when we are seriously ill. When I left the Edinburgh Royal Infirmary after a second NHS hip replacement operation (I had the first one last year) due to a childhood disability which had meant many years spent in a wheelchair and on crutches, the experience got me thinking…
William Beveridge: Is this what you had in mind?
After the Second World War, in 1948, the Beveridge Report heralded the arrival of the NHS. It was a big step forward, the democratisation of medicine. You no longer had to be rich to see a doctor. We all put money into the same pot and the subsequent amount serviced the nation’s medical needs.
But if William Beveridge were alive today, after repeatedly turning in his grave, I reckon he would, quite rightly, be appalled at what has happened to his brilliant concept.
At one end of the spectrum we have amazing neonatal care for premature and seriously ill babies; at the other, the equally laudable service delivered by intensive and coronary care units. In between, however, if my recent experience is anything to go by, is a black hole, pockmarked with the odd bit of good luck and a postcode lottery win.
And, I am not referring to the doctors and nurses here.
The good, the bad and the ugly
With all the NHS cuts, it takes a very special person to care for the sick, to carry containers of urine and worse, to wash sweaty bodies and dress wounds despite the ever-present risk of infection. I don’t wish to paint a Florence Nightingalesque picture of caring women in veils tip-toeing about with candles. These are people who also make life and death decisions as part of their everyday work. The ERI has some first-rate staff.
The tragedy of the 21st century is that so many young nurses suffer from burn-out. They have too much to do and too few resources with which to do it.
The NHS is a wonderful idea: care for everyone whenever they need it and nothing to pay at the point of delivery. But, since my childhood in the Sixties, hospital procedures have changed dramatically. Back then, I had bones repeatedly re-set, pinned into position so my legs turned outwards instead of in. I was in traction for months on end. If I wasn’t in a wheelchair, I was on crutches or walking with sticks. I limped. I couldn’t walk or run or play games at school. I became a disabled person, inhabiting that strange world in which you imagine – and society reinforces your belief – you are not as good as other people. I was a second-class citizen, a cripple.
This was the Sixties, well before Political Correctness and disabled people knew their place, which was, effectively, at the back of every queue going. But, on the upside, then, a visit to hospital for an operation was a calm, leisurely affair, and you were admitted the night before surgery.
These days that is probably considered too costly, and, by the way, they need the beds. Now, on the day of the op, you have to report to the Edinburgh Royal Infirmary by at least 7.15am.
At least checking in was quick and painless. But then I was escorted to a room to wait and my husband, Alastair, was immediately sent away. What they don’t tell you is that everyone scheduled for morning surgery is called at the same time, you have no idea where you are on the list and you are given nothing to eat or drink.
It’s a bit like waiting at a foreign airport for a delayed EasyJet flight.
Fortunately, this time I only waited an hour before I was taken away and someone drew, with a black felt pen, a large black arrow on the area for surgery.
No longer do the medics give you anything to calm you down before going to theatre, and, despite having had a lot of operations in childhood, I was shaking like the proverbial leaf when they wheeled me towards the men with knives. Nor do they like giving general anaesthetics anymore. At a seminar beforehand, you are told, in no uncertain terms, that a general anaesthetic is a far from favoured option.
The hospital prefers to use an epidural with the option of sedation. They call this ‘enhanced recovery’, meaning you are not out of your face for days after surgery so you are allowed home more quickly. There is a room next to theatre where I was given a numbing injection and asked to lie on my side while the anaesthetist explained what he was doing.
When I woke up I felt fine – no anaesthetic hangover and no ghastly catheter. Instead I now had a pair of tight white stockings, a pillow between my legs to stop them crossing over, as well as an oxygen mask. The only real sign I had undergone major surgery was the self-administering morphine drip, which is a real boon. You squeeze the pump when you need the drug and it saves the overworked, underpaid nurses having to come back and forth with pain relief.
My operation took time as the brilliant surgeon, Mr Paul Gaston, tried to remove a number of metal pins from childhood. One or two complied but the others stayed firmly embedded in my bones. The hip, like the previous one, was a great success.
It really was only when I awoke on the ward that I began to notice failures in the care system. Last year, the pain had miraculously vanished when I woke up. There was some wound pain but nothing like this. How can I best describe pain? Stabbing, burning, a gnawing ache? This was the worst I had ever experienced. I presumed it was because the search for old bits of metal had taken a while and I was feeling the consequences. But what really happened was, on the first night, the cannula (a form of drug delivery) containing the painkiller had not been correctly inserted into my vein. I had gone eight hours without pain relief. By then, the pain was unbearable.
Then, there was the time it took to replace the morphine-equivalent pouch. In the middle of the night, a wonderful female anaesthetist, called Kirsty, had re-inserted the cannula and the pain vanished, almost miraculously. But by lunchtime the following day, the cannula was out of the vein again. Was it my fault for being so restless? Maybe, but, given what had happened the previous night, why didn’t anyone check?
The more I complained, the more I felt like a nuisance. The hospital felt more like a torture chamber than a place of expert care. I was frightened for the first time ever. I felt sorry for the nurses who tried to help me; who were rushed off their feet; who looked as if they needed a month to recuperate on a desert island.
Then I was told I needed to vacate my hospital bed on the Saturday, just four days after the surgery and the one day my husband has to work all day for a Sunday paper. I thought they would keep me one more night. Instead, I was bundled out into the chilly night air, at 9pm. The journey home was painful and unpleasant.
A researcher visited me on the ward to question me about ‘enhanced recovery’. I told her I thought it was nothing but jargon for clearing beds. She said most young people disagreed with me. They couldn’t wait to get home.
Hmmmm! In 40 years, the NHS has undergone dramatic changes – not all for the good.
Article focus: NHS care
Photo: creative commons