Friday, 30 April 2010
Veterinary hospital or National Health Service?
We are very fortunate in having first-class vets close to hand (a two-minute drive away) to call on in an emergency. Almost immediately we are informed of the condition and treatment regimen required, though blood tests and x-rays take a little longer. While the animal is an inpatient a vet calls two or three times a day to update us on its condition. At every stage we are involved in the process and we are most grateful for it.
Contrast this with the National Health Service. The day after our young Ocicat Monty died after four days in intensive care, Barry's elderly mother, Dorothy, fell in her garden in Dorset and used her Alert button to summon help. Dorothy lives alone in her own home and, apart from help with housework and gardening and shopping, is quite independent. The paramedics were quickly on the scene and gave her morphine to ease her pain. In the meantime Barry's brother and sister-in-law arrived. (They live 20 minutes from her – we are 1½ hours away.) An ambulance arrived and transported her to a hospital 45 minutes away. During the journey she chattered non-stop in gibberish – undoubtedly as a result of shock mixed with morphine. Thus far service had been exemplary.
When she was seen in Accident and Emergency, x-rays revealed a break in a small pelvic bone (a ramus fracture). Dorothy was in great pain and yet the doctor on duty was doing her best to convince Trevor and Margaret that she would be able to return home that day despite the fact that she couldn't stand on her own and needed the assistance of two nurses to lift her to her feet. Dorothy is 93 – she was in shock, her blood pressure dropped alarmingly low and eventually the doctor reluctantly agreed that she would need to remain in hospital. The ambulance men needed their stretcher in order to continue their day's work so Dorothy was transferred to a trolley.
A ramus fracture heals without surgical intervention but the patient needs analgesics to control the pain. T and M were told that it would heal in a week. Dorothy was given a bed in a quiet ward where she spent the night under observation. The next day she was removed to a much noisier ward where one patient was yelling at anyone who passed by. During the night she was moved to a third, quieter, ward. By this stage she was gibbering, hallucinating and delusional. The pain was still troubling her and she stopped eating and drinking.
Every time Barry or his brother and sister-in-law or our eldest daughter Gillian, who also lives in Dorset, visited her they tried to find out why Dorothy was rambling. They were told she had a urinary infection which was being treated and would clear up in 48hours. It didn't! Frequently urinary infections in the elderly present problems of confusion and delirium. Each time the nurses asked if she was 'always like this' and each time they were told that she definitely wasn't. Dorothy was deteriorating daily, seeing fish with dogs' heads, black and white snakes, statues and puppies running round the ward. She became paranoid, convinced there were spies out to 'get her' and she was planning her escape, even though she was still incapable of getting out of her chair without help. She also could not manage the walking frame. Inevitably, incontinence became a problem.
After ten worrying and frustrating days, notes appeared in the ward which indicated that Dorothy was allergic to codeine, one of the analgesics she had been given. This drug was discontinued and an analgesic patch was applied. Almost immediately Dorothy began to respond. The hallucinations became less severe and the gibberish started to be interlaced with coherent speech. She began to eat but still will not drink much for fear of wetting her bed. A different antibiotic seems to be clearing the UTI. She is far from recovered, still unable to rise from her bed or chair or walk without assistance and still incontinent.
Dorothy fell two weeks ago today and so far neither Trevor nor Barry has been able to speak to her consultant. After a great deal of effort Barry was able to find out from another doctor what her treatment had been. He also arranged that he and his brother would meet the consultant – the earliest this part-time doctor* can manage is next Wednesday – nearly three weeks after the event! Yesterday he phoned her secretary yet again and asked to speak to her and was told that he could have the telephone call OR the meeting – it was not possible to have both. Barry has asked the hospital to relay to him its practices concerning informing relatives of elderly infirm patients – thus far he has had no response. Incidentally, this hospital is described as 'good' – heaven knows what the 'bad' or 'inadequate' hospitals are like. Well, there is the Stafford Hospital, of course, where between 400 and 1200 more patients than would have been expected died between 2005 and 2008. That is more than have been killed as a result of 9/11 and military operations in Afghanistan and Iraq put together.
*Increasingly doctors in the NHS are working fewer hours – the suspicion is that their salaries are so high that they can afford a pleasant lifestyle and time off. Another thought is that they are taking on private consultancy work. Fortunately, we don't often have to visit our doctor but on the last three occasions over a period of months we have seen three different locums.
So the net outcome is this: Barry's admittedly frail but otherwise healthy nonagenarian mother entered hospital with a minor break. While in there she developed an UTI, was administered drugs to which she was allergic, became delusional and paranoid and also incontinent. The hospital administrators must be thanking their lucky stars she didn't have an anaphylactic reaction and die or they might be facing a charge of manslaughter. Had she been admitted as an emergency with limbs hanging off her treatment would have been much more careful and caring.
We have also had experience of the Royal Veterinary College Hospital where standards of hygiene and professional care are second to none. For me the answer is clear – if you have to go into hospital for anything less than life-threatening, choose a veterinary establishment where you will be treated appropriately and observed carefully for adverse reactions and where those who are nearest and dearest to you will be kept informed at every stage of treatment.