A & E Meltdown
I’m waiting to be wheeled into the operating theatre as I write this. Under normal circumstances the idea of going under the knife would terrify me, but that was before spending almost 20 hours on a trolley in Accident and Emergency.
It was such a brutalising process that, frankly, anything has to be an improvement. It will be a relief finally to go somewhere I am guaranteed a bed. Even one in an operating theatre. Accident and Emergency is like a nuclear fall-out shelter after the bomb has dropped. There is such mayhem swirling around, such an acute shortage of staff and beds, such a sense of over-stretched medics coping by no more than the skin of their teeth, that you feel nobody will ever get around to examining and diagnosing you.
The first time I left my trolley to give a urine sample, I returned to find my pillow gone. ‘Shortage of pillows,’ shrugged the nurse. I was found one 10 hours later. The second time I left my trolley to go to the bathroom, I returned to find someone else in my trolley. ‘Shortage of beds,’ shrugged the porter. ‘Emergency case.’
I had just been told by a surgeon that I would be operated on as a matter of urgency once arrangements could be made. That didn’t count as an emergency? Not in the topsy-turvy world of A and E.
Last week Mary Harney admitted there was a national emergency in A and E departments throughout the country. Tanaiste, emergency doesn’t begin to describe it. Try meltdown.
And I was one of the lucky ones, the medics told me repeatedly, because a surgeon examined me at 10pm at night – nearly 18 hours after I had first presented myself at 4.30am, doubled up with stomach spasms, at St Vincent’s University Hospital in Dublin. I couldn’t believe my eyes at the scene when I arrived, it was like one of Hieronymus Bosch teeming, tortured painting: patients in various stages of distress and undress lay in a tangle of limbs and contorted faces on trolleys strewn everywhere. Not a strip of corridor was left unclaimed - there was even a man parked right outside the women’s toilet, so close I almost tripped and landed in his lap. Relatives sat alongside patients holding their hands and looking angry, frightened, bewildered, panicked. And most of all helpless in the face of this maelstrom. There was scarcely a doctor in sight – I encountered more security guards than doctors. But there seemed to be any number of nurses, uniformly harassed, shimmying their way through the human debris.
One went off to find me some medication and was intercepted by another saying ‘we need blood bags urgently’ - and off she raced to do that instead. She never did remember me, I appealed to another nurse finally. Later I saw a woman who had been involved in a car crash and was clearly in shock lying moaning on a trolley. Nearby a man swept the floor, occasionally jolting against her due to lack of space, and inadvertently adding to her distress. There was absolutely no privacy, let alone the peace and quiet everyone needs when ill.
I was squeezed into a corner between the service lift and the nurses’ station, in a space too small for my trolley, so that every time, without fail, when someone passed they banged into me. Often it was a clatter from another trolley that went clanging into my side.
And still we all waited for someone to treat us: to move us through the A and E system and into the wards or back on the street. People were rocking and groaning alongside me, and by and large nobody took a blind bit of notice. I had the sense the A and E staff have lost that layer of empathy which characterises people in the medical profession, perhaps an inevitable coping mechanism under such onslaught. They are the final bulwark before utter collapse. And it has anaethetised them. Medics hurtled around trying to deal with the neediest cases - not always clear-cut when people were waiting hours to be diagnosed - and often, as is the way with human nature, responding to those people who complained loudest.
I was given a little pain relief at once and left lying as other, more important cases were attended to. But as hour drained into hour and still no real diagnosis, the pain intensified. I had stomach cramps which might have been due to kidney stones, or could have been bowel-related. They couldn’t tell until X-rays were taken, but when I was wheeled off for X-ray after four hours I only reached the doors of the department before being sent back to A and E. ‘An emergency case has come in, we’ll get back to you in half an hour.’
Three hours later and still no sign of an X-ray. By now unable to tolerate the spasms of pain, moaning audibly, I begged a nurse for another shot of analgesic. As before, there was no free cubicle to administer the injection to my rear, so it happened more or less in full public view. The nurse tried to hold a scrap of blanket in front of me as I slid down my trousers, but there wasn’t much left to the imagination. Privacy is one of the first casualties in A and E.
Afterwards, feeling a bit better, I lifted my bag off the floor to search for something - and found it was filthy. So much for hygiene. Eventually some 12 hours after arrival, I was wheeled into a curtained cubicle where there was a little respite from the pandemonium outside. I can’t tell you how blissful it felt. The doctor on duty – could there really only be one? - came to see me and debated sending me home because the X-rays which had been taken finally had proved clear for kidney stones.
He was on the verge of discharging me but I pointed out that I was still in pain, which meant there could be something they’d missed. He mused aloud that it might be an appendix problem and said he’d get a surgeon to check me out. So now I was waiting for a surgeon. Not too bad, that only took a couple of hours, but it was now 10pm, nearly 18 hours since I had first arrived at A and E. The surgeon, capped and gowned, was the first medic who, I felt, really believed me when I explained I was in considerable pain and worried there was something seriously wrong with me. Appendix was the most likely culprit and would require an operation as soon as possible, he said, but he’d like a second opinion. Then he looked me in the eye and I was struck by his expression because it was riddled with an emotion I hadn’t expected to see - shame. ‘The problem is we have no free beds,’ he said. ‘So shall I go home and return in the morning?’ I asked. ‘You’re not well enough to be discharged, I couldn’t take that risk.’ He shook his head.
Good grief … he couldn’t be suggesting … not a second night on a trolley in A and E? He was. ‘You’re at the top of the list for a bed upstairs in a ward, as an emergency, but I can’t guarantee one will come free,’ he said, that combination of shame and embarrassment shining again in his eyes.
‘Do you often have to tell people this?’ I asked him. ‘All the time, it’s frustrating,’ he admitted.
So I resigned myself to another night of what felt like Armageddon whirling around me. At least, I thought, I’m curtained off now, I have some shreds of privacy and, while it’s noisy, nobody can cannon into the side of my trolley. The surgeon returned with a colleague to discuss the possibility of appendicitis. They thought gynaecological problems were also possible, and there was a suggestion of operating that night. The second surgeon noticed I couldn’t stop trembling, something I’d been unaware of until that moment. ‘Are you cold?’ ‘No.’ ‘Are you frightened?’ ‘No.’ ‘What’s wrong?’ ‘It’s just that I’ve been here since the middle of last night,’ I explained. ‘It gets to you, this place.’
When they left I staggered up to use the bathroom, shuffling along holding my fluid bag in one hand and the wall with the other. I returned to find my bed occupied and my bag missing. This was after an absence of minutes, 10 at most. Panicked, I looked around at what seemed to me to be a sea of indifferent faces, trying to discover what was happening. ‘Someone’s in my bed,’ I said. ‘Emergency case, it had to take priority,’ said a porter who, I now realised, had opened my bag and was going through the contents.
For some reason this upset me enormously – a combination of feeling the last vestiges of my privacy had been violated, and the casual implication that I wasn’t much of a priority. ‘Why have you taken everything out of my bag without asking me?’ I wanted to know. Before he could answer, a nurse spoke up. ‘You were gone a long time at the bathroom,’ she said. ‘There was no toilet paper, no soap, no paper towels,’ I wailed. ‘I rang the bell, I couldn’t leave the bathroom until someone brought me something to wash with.’ Around us, people suspended their conversations to watch the scene. By now I couldn’t help myself: humiliation, pain and misery welled up and I started to cry, and everybody stared which made me sob all the harder. I just felt totally dehumanised. I had an overwhelming sense of not mattering a jot to anyone in this black hole version of the health system.
Finally someone realised I thought I’d be spending the night in A and E sitting on a chair. ‘We’ve found you a bed, we’re moving you upstairs to a ward,’ said a nurse. ‘That’s why your bag is being checked, so we can make a note of your possessions.’
The next day, waiting to be wheeled off for my operation (gynaecological, not appendix), I still feel traumatised by the experience. I’m certain that such a profoundly shocking prelude to admission must prolong recovery periods for patients. In fact I escaped relatively lightly, all my doctors agreed. ‘Some people can spend four or five days on trolleys waiting to be diagnosed. And days again waiting to be operated on,’ said my surgeon. ‘St Vincent’s isn’t the worst by a long shot – it’s much worse in Tallaght or Beaumont,’ said my consultant. ‘But the politicians say they have it under control.’ And he allowed himself a wry smile.
