So that’s summer gone then, I guess, judging by the plummet in temperature. It seems to have passed me by in a blur this year – dominated by my encounter with that great institution the NHS. I never did get round to telling you about that, did I? Well let me start at the very beginning…(no I’m not about to launch into another Julie Andrews moment):
It probably passed you by unnoticed. Perhaps a little extra flatulence after an impromptu barbeque, a hiccup or two after an ice-cold beer enjoyed in a rare ray of sunshine. But for the majority, ‘National Gut Week’ this summer passed uneventfully like a mild spell of indigestion under attack from Andrew’s Salts, with not so much as a ‘pass the Rennie, please’.
My gut, however, had an entirely different plan. Having spent fifteen years researching health and health care cerebrally, the rest of my body obviously decided National Gut Week provided an ideal opportunity to get in a spot of undercover investigation, to immerse the researcher in her subject fully. So this week of gastric celebration saw me doubled up in agonising abdominal pain, able to keep neither food nor fluid down any longer than it took to rush to the nearest loo. I was rushed to the local A&E department by my GP.
As a health researcher, I’ve always harboured a healthy suspicion of the medicalisation of society. From cradle to grave, all aspects of our lives have become subject to the medical gaze. Celebrity Doctors tell us how to live our lives healthily during our morning dose of television, and supermarkets coach us on calories, fat and sodium intake. But on this occasion, presented with a clear dis-ease of the body, I, like most people, was happy to lie back and leave it to the experts in white coats. Only I found those experts are more likely to wear pinstripe than white, and while my number one priority may have been to move through the system as quickly as possible, the biomedical paradigm and bloated bureaucracy conspired against me.
My GP, bless her, is one of those rare breeds of medics who has not lost sight of the person surrounding the symptoms. She knows I don’t like taking unnecessary medication or submitting to invasive procedures just to fill an empty slot in my diary. She knows I’ve given birth to two large babies with nothing more than a puff of gas and air. In short, she knows me as an intelligent, capable adult, who faced with most experiences of illness or pain can reel with the punch and get on with life. Put me in a busy hospital however, I am seen simply as a 35 year old woman (oh not one of those!) presenting with non-specific symptoms (i.e. they can’t see it on an x-ray), and they have me down as a hypochondriac with an extremely low pain threshold.
The first diagnosis was consumption of suspect barbeque fodder, despite my assurances that I was a vegetarian who hadn’t managed to eat anything, least of all raw chicken, for the best part of a week. However, this barbeque casualty lasted unexpectedly long, and for the duration of National Gut Week, and the following week, I was marooned in a hospital ward, not able to move further than the buzzer to call the nurse for a bedpan. But once the morphine took hold, and the pain subsided, I had ample time to reflect and marvel at the intricate workings of the beast that is the NHS in this new age of ‘efficiency’, reduced waiting times, MRSA and celebrity chef’s meal choices on the hospital menu.
I quickly discovered that to be admitted to a surgical ward - even if they have yet to identify anything that actually requires surgical intervention - gives staff carte blanche to dress the patient in surgical gown, squeeze her legs into thigh-high anti-DVT stockings, inject with anti-coagulant and hang a ‘Nil by mouth’ sign over the bed. All of which will be completed with the utmost efficiency, but sadly no explanation. My first few attempts at seeking clarification demonstrated my naivety and confirmed my status as hospital virgin:
‘Oh you’ll have to ask the doctors when they come round’, replied the nurse. I was happy with this, so ventured to ask when that might be. And I think this is the moment I received the most confusing, yet also the most unintentionally honest piece of information in my entire stay:
‘It may be before 2 o’clock’. Pause. ‘Or it may be after 2 o’clock’.
Numbed by the pain of trying to make head or tail of this latest example of the laboriously incomprehensible workings of a hospital, I lay back defeated, and awaited the next round of morphine.
I’m not saying the individual professions that comprise the hospital system are not good at what they do, they just don’t seem able to collaborate. The ward sisters and nursing staff are heavenly angels of mercy, divinely administering medication and commodes, and checking their charges are within acceptable limits for blood pressure, pulse, oxygen, temperature and fluid balance. All this with a constant smile, poor pay, low status and exceptionally long hours. Then along come the consultants, who seem to operate with the belief that they have no duty to explain themselves or their treatments to either patients or nurses. So the nursing and auxiliary staff flock around the ward like a giant holding bay, trying to calm and placate patients, with nobody knowing what the hell is going on.
As the government announces the scrapping of the hospital star rating in favour of yet another concoction of targets based on managerial and bureaucratic rather than clinical need, I ponder the question of whether implementing a more holistic approach to health care might be a better way forward. I ‘breeched’ by spending longer than four hours in casualty before admission. This may have cost my hospital a third star, but quite frankly, I would have been happy to spend four days in casualty, if only the system could operate effectively in terms of health care rather than management protocols. If only I had been treated like a capable human being, who can play a part in my own health management, rather than being forced to lie passively in my unattractive stockings, starved of nutrients and dignity - reduced to little more than a receptacle for needles and pills. Add to this the simmering hospital heat and pent up frustration, apprehension and sometimes sheer terror of patients, and the modern efficiency of the NHS looks more like a backstreet B&B than an establishment worthy of one star, let alone three.
Initial conclusions from my bed-bound research would suggest not all consultants are the same. But the majority are. The arrival of the consultant is heralded by a fanfare of footsteps approaching at breakneck speed. With a spectacular visual display of blurred pinstripe and stethoscopes, the charge halts abruptly at the foot of the bed. As the dust settles it becomes apparent that this wasn’t a herd of elephants being chased by a pack of well-dressed hunters, but merely a flustered Senior House Officer, a slightly distant and seemingly side-lined Registrar, and God himself…oops, sorry, the Consultant. He (usually is!) bustles in with all the importance of a foreign dignitary, addresses the ‘Nil by mouth’ sign above the patient’s head, delegates menial tasks to the SHO and then, with a click of the heels, is gone. There is the odd consultant who manages to blend biomedical expertise and clinical excellence with a more holistic understanding of the patient as a person, rather than a disembodied case of symptom presentation. But it would on average seem the higher up the chain of command, the less willing or able they seem to indulge in the very human pastime of talking to the patient. To such a degree that when I first attempted to ask my consultant a few questions, he immediately became defensive, claimed there had been ‘a breakdown in the doctor-patient relationship’, and promptly passed my case over to a colleague. Perhaps I just upset his natural stampede rhythm.
It wasn’t until day 10 of my ordeal that I was informed negative test results are not routinely reported back to patients. For the medical team, a negative result is merely the cue for putting in place the next test in a process of elimination. Never mind the poor patient, languishing in a hospital bed waiting to be told whether or not the scan showed up any unusual growths knocking about inside.
Thus the hospital experience for someone presenting with unusual symptomology, becomes a laboriou
sly slow and drawn out process, and the discovery of a fully functioning television in my third ward provided a welcome distraction. There on Channel 5’s ‘Doctor, Doctor’, I thought my prayers were finally being answered, not dressed in pinstripe but in the guise of the celebrity expert. Viewers with stomach problems were invited to ring in for a live on-air consultation. Dr Mark Porter beamed down at me, oozing bedside manner, charm and confidence, and I was momentarily star struck, convinced he held the key to unlock my suffering. Even the nurses were egging me on to make that call. There’s a celebrity, surely he could get me out of there? Pass the telephone trolley, nurse…
moment with Poppy and Lily! The usual war-zone was in active session in the kitchen at teatime, so I dug out from a dusty corner on the shelves a CD that I bought ages and ages ago from M&S.
