The NHS is tens of thousands of stories like mine – every day
Up until the moment I left the Royal Opera House the “Night at the Opera” went wonderfully well. Marvellous meal in the Balconies Restaurant with a couple of nice glasses of wine - and then a stunning performance of Verdi’s Aida. After the show Ann and I were making our way back to Waterloo when I suddenly felt very dizzy and within moments this turned into the world spinning in my head and violent and uncontrollable vomiting. I collapsed on the pavement near Waterloo Station vomited some more and lost orientation completely. I knew that this wasn’t something, whatever it was, that was going to clear up quickly. Ann wondered whether any passer-by would volunteer help but there weren’t many around - it was 10:00pm on a Sunday evening, not a busy time and those who were probably took a look at me bent over and motionless in a pool of my own sick and moved on rapidly. Who can blame them - superficially I had the appearance of someone who has dined rather too well and was paying the price.
Ann dialled 999 on her mobile and was assured that help would be on its way and in less than five minutes a paramedic on a motorcycle was assisting me. He took immediate charge asked some quick questions which included my (or more likely Ann) telling him that I suffered from Atrial Fibrillation – a heart condition which can lead to a stroke if not treated. He checked my pulse and blood pressure and said he was fairly sure that I hadn’t had a stroke or a heart attack and surmised that I was probably suffering from acute Labyrinthitis – a viral infection of the inner ear which interferes with the body’s balance mechanism. Whilst the paramedic was treating me an ambulance car drew up to check on progress. As I was comatose and obviously incapable of moving I had to be admitted urgently to hospital and this required an ambulance in which I could be laid flat and given further examination and treatment. Between them the paramedic and the ambulance car officer arrange for this to happen. The ambulance took a little while to come – there were reports of a shooting somewhere in South London and staff and vehicles were being diverted to this incident. But I didn’t really have to wait long and soon I was being gently loaded into the back of an ambulance. Inside I received further checks including an ECG and blood pressure. My head was still spinning violently and I was still sick and unable to focus properly. We moved off slowly to St Thomas’s Hospital which is very close by and soon I was in the Accident and Emergency area where I waited tended by the ambulance paramedics until a cubicle for the doctor’s examination was available – about a quarter of an hour.
The nurses undressed me, connected me to a heart and blood pressure monitor, took my temperature which was a bit low and tended to me as I was still being sick (not very productively by now). They took a blood sample and connected a device to a vein in my arm to allow drugs to be administered quickly if necessary. They did another ECG which they then showed the doctor who now arrived - he examined my eyes and asked me to do some hand and eye coordination movements and checked my hearing. He authorised an injection to help my nausea and sickness. To check that I had not had any cranial bleeding or a tumour I was sent for a brain scan. Further blood samples were taken and I was advised that I would be admitted and a bed was found for me on Mark Ward – a trauma ward primarily for stroke patients. In the ward a young doctor examined me and conducted further eye movement tests; meanwhile Ann was being looked after and found a taxi at about 3:30am to get home. Overnight I was still unable to move much – any movement of my head increased the unbalanced feeling and increased the nausea. The night nurses made me as comfortable as they could, gave me water (I was very thirsty by now) and gave me a bottle to relieve myself.
The day starts early on a hospital ward and well before seven there was a buzz about. Patients were checked and preparations were made for breakfast. I declined any food but the rest had helped and I was certainly a bit less dizzy and had stopped being sick. The big event was the ward tour by the consultant and, as St Thomas’s is a teaching hospital, his entourage of assistants and students - around ten people in all. All the other patients on the ward had had strokes and I watched as each was looked at and as the doctors related to them individually. The key was the consultant’s personal dialogue with the patient, his assurances to them about their prognosis and his hands on testing of their condition. Essentially what he seemed to be looking for was evidence, positive or negative, of changes since his last visit 24 hours earlier. In the main the patients were progressing positively. “You couldn’t do that yesterday” was the comment as a patient wiggled a toe or raised an arm. The consultant exuded confidence and knowledge and his communications style was clear and unequivocal. The takes must all have been “This man knows what he is doing and cares.” It was very uplifting. As far as I was concerned I was something of a novelty for the team and they spent quite a while with me.
The diagnosis tentatively made by the motorcycle paramedic was confirmed by the consultant. I was suffering from vestibular neuronitis which the medical dictionaries describe as “sustained dysfunction of the peripheral vestibular (balance) system with secondary nausea, vomiting, and vertigo.” Key to the diagnosis was “nystagmus” – an involuntary eye movement. One of the students also tested me for this – presumably so that they could recognize the symptoms in others in the future. I was told that I should stay in hospital another night for precautionary neurological monitoring. Accompanying the doctors’ team were two young women who it turned out were to play a very important part in the next step of my treatment and recovery. Laura was a physiotherapist and Anna specialized in occupational health. Simply stated their task was to get me sufficiently mobile to be able to go home. This started immediately after the doctors’ visit. My first movements were tentative and brought back the dizziness a bit. But with tips on how to cope I gradually began to move a little more freely – and even take a shower under supervision. Anna asked me quite detailed questions about my home – the configuration of my house, locations of lavatories etc. Clearly if I was to be released then they had to be assured that I could manage. After a light lunch, which I managed quite well, Ann visited me and brought me some headphones so I could listen to music and some magazines to read. I felt fragile but was certain that progress would continue to be made.
I slept surprisingly well that night. A ward is not a quiet place what with the nurses’ visits and the high tech apparatus which bleeps a lot! But although I felt rough I could understand what was happening to me and the it seemed that if the outlook was positive I would be allowed home the next day. Obviously I had to move reasonably freely and not look too helpless. The following morning followed the same pattern as on Monday. The doctors again examined me, seemed pleased with progress and the consultant said that subject to a positive mobility assessment I could go home. Laura and Anna got on the case swiftly – they needed to be sure that I could manage not just on the flat but the stairs as well. So there was a test on the hospital staircase, and all was well. I was discharged and around midday I was on my way home by taxi.
We are all guilty sometimes of extrapolating from the particular to the general. One good (or bad) experience skews our views of an event and we may draw inaccurate conclusions. I will try not to do this but it is important to state up front, less there be any doubt, that I was entirely in the hands of the National Health Service (NHS) from the moment that Ann made that emergency phone call on Sunday evening until the moment I got in a taxi to go home around 1:00pm on Tuesday. Throughout I am absolutely certain that standards were being applied and procedures followed. True on the margin one is in the hands of an individual or individuals and we are all fallible – we all have good and bad days. That aside I had no sense that I was being treated any different from the norm – why would I be? The dominant characteristics of each of the players in the event were subtly different.
The paramedics were absolutely task focussed. Had I had a stroke or a heart attack? What was the most likely cause of my collapse? How should I best be taken to the hospital’s A&E? How could they make me confortable and be reassuring to Ann? What were the essential questions that had to be asked of me and Ann? The A&E staff had to stabilise me, assess the options and when the Doctors required it find room on a ward for me. The ward nurses had to make me comfortable, apply the necessary checks (temperature, heart, breathing, blood etc.) at intervals and “manage” me. The two young women were my friends – they were there to provide practical advice which would help me to recover – and to supervise the process. The doctors, and particularly the consultant, were in overall charge. Their writ ruled – as it had to. So whilst the consultant was at the top of the pile the rest of the staff was fairly unhierarchical. There was no real divide – it was a team effort.
I was exceptionally well treated throughout. Everyone seemed to do their jobs as they had been trained to do. Compared with a stroke patient I was perhaps easy – I had no impairment to my cognitive functions and once I was through the worst I was alert. That said, and although there were clearly repetitive processes underway, I never felt that I was just another patient. The nurses were the toughest of the various people around me – not so much with me but certainly as I observed with some of the other patients. A stroke is hugely debilitating and one or two of the victims were quite abusive, unintentionally I’m sure. The nurses handled this firmly but with consideration. One very cantankerous lady in the bed next to me was shouting and swearing a lot and she had to be firmly spoken to. She responded to this and quietened down! If the nurses were the hard-nosed cops sometimes the physio and occupational health young ladies were gentle and smiling at all times. They had to force one or two of the stroke patients to move – an essential part of early rehabilitation therapy I think. This was tough – but they did it with charm and skill. Horses for courses were everywhere.
So what did I come away with from this experience – apart for a deep gratitude to all of the medical staff who helped me so ably and caringly? Let’s take the paramedics of the London Ambulance Service (LAS) as an example of what I now feel. On the day that I was taken to hospital it was announced that in the next five years £53 million is to be taken out of the LAS budget of £262 million. In the next year alone this means 162 jobs will go, 130 of which are ‘front line’. Over the next five years 890 jobs will be lost, 560 of which will be from road crews, as front line as they come. So between now and 2015 the LAS will lose nearly one-in-five of its staff. If my attack had happened at the end of this process rather than before it begun what would the effect have been? Would a paramedic on a motorbike still have arrived within five minutes? Would my progress have been checked, as it was, by a supervisor in a car? Would an ambulance have been available to get me swiftly to hospital? Would I have been treated like a sick human being by caring staff who had time to look after me in the same way that I was? What do you think?
The NHS is an absolutely massive institution and I can readily imagine that when you look at the mountain that it is you can lose sight of the people who like me who, from time to time, are clinging on to it quite literally for dear life. And with the caveat already mentioned about not extrapolating from one event and drawing simplistic conclusions let me just say this. Every day there are tens of thousands of events across the length and the breath of Britain like mine. That is our NHS. Not a top down bureaucracy but a bottom up and patent focused jewel in our crown. It makes mistakes because it is comprised of humans and we are fallible. But it reduces these mistakes by having standards and procedures and good people to operate them. It was not a coincidence that I was well treated and I was not well treated by comparison with others. I was well treated because that is what the NHS is for. It must be patient driven and everything that happened to me in those two days has given me the feeling that it is – at present. So ask yourselves the question – will the London Ambulance Service be better for patients if it reduces in numbers by 20%? Are the cuts planned designed to improve the chances of patients like me surviving a traumatic collapse on the street? And apply the same logic across the board. The question is not can we afford the National Health Service providing the healthcare that it currently does. That has to be a given. The question is can we maintain patient care standards, or indeed improve them, whilst the same time being more efficient and cost effective? I don’t know the answer to this – but I know that it is the right and indeed the only question. And I know also that it is a subject about which we should all make our feelings clear and that we should march in the streets to defend our NHS if we have to. And when my balance is fully restored in a week or two’s time I’ll march with the rest!