THERE are many reasons for the NHS’s difficulties, and one of them is the absence of ‘joined-up thinking’. There is no one responsible for the progress of the patient through the system, who can iron out problems and generally keep a watchful eye on the individual.
After a painfully bad stay in hospital, the distinguished former Daily Mail journalist Sir Patrick Sergeant, 97, said: ‘What the ward needed was a good editor. No one appeared to be in charge. I kept asking for matron.’
I’d like to second that, with an account of what happened to my close friend Rob (not his real name).
Rob lived in Birmingham. One day as he was driving a fool shot out of a side road, making him swerve (he had great reflexes for a man in his mid-seventies), in turn forcing him to bang through a series of potholes, and that did his back in. That’s when the fun started with the NHS: they didn’t want to fix him. Maybe it was age-related operative risks, even though Rob was a non-smoker, physically active and a keen archer; maybe it was the QALY calculation that makes the monetary value of patients’ lives tend towards zero as they get older.
Rob was highly intelligent, hugely well-read (a history teacher by profession) and determined. His GP was inclined to offer nothing more than palliative care, but Rob went online and found a surgeon who was prepared to operate.
Examining the X-ray of his spine, the radiographer missed the tell-tale shadow on Rob’s liver, otherwise I don’t think I would be writing this in the past tense. Still, unlike the old joke, the back op was a success and the patient survived.
This was pre-Covid, so hospital visitors were allowed. When I went to see Rob, I greeted him and shook his hand; he held mine for a long time as he smiled at me. I was slightly embarrassed. It was then that it occurred to me how the sick often feel abandoned: for all her fame and friends, when Margaret Rutherford was crippled and on two sticks her husband wrote, ‘We are very lonely. Where are all the people?’
A patient is an inferior category of person. Unlike the rest of us, it seems, they do not need much social intercourse – the cheering TLC that the less academic nurses of yesteryear could provide – or mental stimulation (except via pay-per-view TV). Food is put down, sometimes out of reach, and removed later untouched if the subject has been asleep (box ticked!) I got Rob a paper and a couple of sausage rolls from the hospital shop, so that was a start.
He had arrived in this ward from another hospital, where the op had been performed, and had come on a specialised orthopaedic bed. This was quickly swapped for a standard one – things disappear in hospitals, where a constant cadging goes on. The replacement was shorter and Rob’s feet tended to touch the end board, something to be avoided while his back was healing.
He also had problems with sleeping (so vital to recovery) because he had long suffered from apnoea. He owned and had brought in a tabletop CPAP machine (one that gently assists breathing during sleep), and asked staff not to disturb it as if accidentally jolted, the water inside would spill into the tube and cause a blockage; which is what happened, repeatedly. I notified the nurses at the admin point round which they tended to cluster, and they in turn called for someone else to sort it, a nice chap who used a hairdryer on the hose and got it working again; till next time.
There is no point in mending someone’s back unless you help them to use it. One of the surgeon’s aftercare instructions was for Rob to be moved from his bed daily to sit in a chair for a couple of hours. To shift him safely, a hoist was brought in; on the couple of occasions when it was used, his toes got banged painfully on the bed’s end; generally it didn’t happen at all, so he lay day after day in bed, getting thinner and weaker.
He wanted to keep up his strength, not least for archery, so I took him a spongeball to squeeze. A week or two later, it vanished from the windowsill beside him, together with the newspapers and magazines I had left him to keep his mind active: must keep the place tidy. A modern theme is the drive to tidy away the old, isn’t it? Get them out of their messy houses and the inconvenience of carer visits, uproot them from their memories and autonomy and put them into care homes, for their own good.
It won’t surprise you to learn that Rob didn’t feel safe where he was, and wanted to go home. Oh, the difficulties this would cause! Surely his wife wouldn’t be able to manage his needs; a room would have to be made ready, and an adjustable bed supplied. Well, Rob had a brother, a formidable man, and these impossibilities were overcome.
Another complication was the need for a hoist, to do the chair bit that the hospital hadn’t been doing. One was sent, but shortly afterwards his family were told not to use it since they hadn’t been trained. There it stood in the corner, useless.
Meantime, the cancer was slowly spreading and a drugs regime had to be supervised. Another communication blip: one powerful painkiller required another pill to counter the consequent constipation, and when the type of analgesic was changed its partner laxative wasn’t cancelled at the same time. Rob’s dear stepson was an angel to him.
In the last week or two, Rob was moved to a hospice where I am sure he was cared for appropriately. The second time I visited, political weekly in hand, he was unconscious and breathing in the laboured way that suggests the end is near. I had to go after a while, but his family were notified and he didn’t die alone.
I wish I had held his hand.