But what about the people?

We hear much about the National Health Service, both good and bad. Here is the reality as I found it.

In our family’s experience we had superb treatment in one case three years ago, and a most disturbing one very recently during the 5 days when I spent 5-6 hours each day in the Critical Care Unit with the patient (my son).

What surprised me at first was the noise in the unit, which contained 12 beds. It was busy, bustling. There was loud, cheerful chatter and music playing. Some patients were unmoving, others alert. Maybe that is preferable for those patients who are conscious, rather than a still, ominous silence.

Initially my son was being nursed on a 1:1 basis. His body was a mass of tubes and wires, going in and out, attached to drips, two electronic monitors, and an oxygen mask.  He was barely conscious. His arms were swollen and purple from needles. Beside his bed was a metre-wide chart on a chart table. The duty nurse kept coming, checking all the readings from the monitors and meticulously entering them in the chart. Replacing empty drip bags, administering drugs, taking temperature. His bed linen was immaculate. He seemed very peaceful. The nurses were friendly and gentle.

After two days he was moved to another part of the unit, where instead of having one nurse to himself, he would share with the next door patient, a woman who was conscious, mobile, and able to sit up in a chair and feed herself, unlike my son who remained immobile, still being fed through a tube.

I took this as an encouraging sign – he needed less care, therefore he must be getting better. He began to flutter his eyes open for a few seconds, and started mumbling, trying to talk. He was regaining consciousness to some degree. The consultant, a jovial man, said that they had had a meaningful conversation that morning. He seemed pleased.

Then I began to have misgivings. My son began trying to move, groaning as he tried to turn over and move his legs. A nurse came, went straight to the chart table, and began noting all the readings from the monitor. Now my son’s head came off the pillow and he lay uncomfortably, groaning. I waited for the nurse to move him, but instead, with a final glance at the chart, she went away without looking at her patient.

When she returned an hour later, it was the same procedure. I said to her: “Please could you move him and make him more comfortable.”

For the first time in two hours, she looked at him and immediately called for another nurse to help her move him. They asked me to wait in the relatives’ room while they made him comfortable.

There is a small room, with a television and tea and coffee making facilities for the use of relatives. There were six people already in there, the wife of an elderly patient, their children and their partners. The wife was crying, the younger women were distraught and angry. Since the man had been admitted – I don’t know with what – they had taken it in turns to sit with him in pairs, around the clock – relatives of patients in Critical Care can visit at any time and stay as long as they wish. In the early hours of the previous morning he had suffered a heart attack, with loud alarms coming from the monitor. There had been no reaction from the nursing staff until one of the relatives had rushed to find somebody. Now the man’s condition was worse than when he was admitted. He was going to have to be transferred to a different hospital.

What, they were asking, would have happened if they hadn’t been there? There were always staff on the ward, two central areas with glass screens where the nurses sat when not attending to the patients, apparently doing paperwork; presumably they could hear alarms when they went off. Why hadn’t they responded?

The following day my son was moving more, and clearly in discomfort. He managed to whisper. Could he have a drink of water, please?

Unlike the previous young nurses, his current nurse, an older woman was unsmiling, clinical. “Yes, I’ll get you some,” she said. She walked to a tap, filled a plastic cup with water, added a straw, put the cup on the side, and went away. After waiting ten minutes for her to return, I went and called a younger nurse and asked her to give the water to my son – involving removing the oxygen mask, raising his head, feeding the straw into his mouth and ensuring he swallowed it. In all it took perhaps two minutes.

This happened twice more, with a request for yoghurt and another for orange juice. Each time the older nurse went away, returned, put it on the side, and disappeared. Each time I had to collar one of the younger nurses.

As he became a little more conscious, he became increasingly uncomfortable. I asked him if he was in pain, and he nodded. When the nurse came, going immediately to the charts, I asked for him to have pain relief. Yes, she said, she would get some paracetamol. Instead she went to the next door patient, who was sitting in a chair, reading, and began examining the patient’s chart, discussing it at length with three younger nurses. I waited for 15 minutes, and then went and stood nearby. My sons groans were loud; they could be clearly heard. She glanced briefly at me, and then turned back to the charts.

I said, “He’s in a lot of pain.” “I’ll get him some paracetamol shortly,” she replied.

I walked out of the ward shaking with anger. The receptionist, who like all the other staff was outstandingly sympathetic, asked if I was alright. I would be, I responded, if the nurse could spare three minutes of her talking time to give my son the pain relief he needed. She asked me to wait in the relatives’ room while she spoke to somebody.

Half an hour later I went back to the ward, expecting to find my son comfortable, but he was still groaning. A young nurse came to fill in the charts. I pointed out to her that he had been in pain for more than an hour, and that the older nurse had not returned with the paracetamol. The young nurse said she’d go and see what was happening.

She returned a couple of minutes later. The older nurse was busy, but she had the paracetamol in her hand and she’d get here in a little while. I kept calm and pointed out that it wasn’t doing any good in her hand, my son needed it now. She went away again and returned with the paracetamol and administered it through a syringe.

I haven’t mentioned that several times while I was sitting there during those 5 days, alarms went off on the monitor. There was a sustained loud beeping, orange lights blinking, a line flat-lining, and the oxygen mask tube was continually disconnecting. Each time I had to find somebody, because there was no response to any of the alarm signals. I wondered what happened when there was no relative there.

The consultant came on his evening round, as jovial and friendly as ever. He said that while there had been a slight improvement overall, after a lung X-ray that morning there was grave concern, particularly given the length of time my son had been in Critical Care. He then turned to the consultant to whom he was handing over for his day off, and said loudly: “He has a living will, so ………..” I didn’t hear the rest. That was when I realised there was going to be no recovery.

For another day treatment continued, with physiotherapists massaging my son’s chest to try to help his lungs.

As far as treatment went, I am certain that they did everything possible medically. But all attention was concentrated on data and charts, while the needs of the patient went unnoticed. It seemed the patient was purely a medical case study, and not a person.

After five days I had to leave. My daughter-in-law kept me updated. We had discussed the situation privately and agreed that even should my son survive, his quality of life would be intolerable, and not what he would want, as he had specified in his living will. He should be allowed to go peacefully, with dignity and in comfort.

As I was leaving, my daughter-in-law phoned to say he had been removed to a small room and treatment had been stopped, apart from oxygen and pain relief.

She went the following morning at 10.30, and found him in great distress, which I don’t want to go into.

“I wouldn’t have wanted you to see it,” she said.

When a young nurse came in, she asked how long he had been in that state. “Since I came on duty this morning,” she replied.

He died shortly afterwards.

I have tried to write this dispassionately, understanding that NHS resources are stretched and that the staff are doing their best. But it seems fundamentally wrong that their efforts are concentrated on data while inadequate attention is given to patients, or what we would call ‘people’.

Advertisements

19 thoughts on “But what about the people?

  1. So sad to read this. I think you can at least derive comfort that there was no treatment he could have had that would have saved his life, It just seems awful that with so many pain killing drugs available they can’t just administer them when needed.

    • Yes, Cathy. I did not expect a miracle, but I presumed that pain relief was administered freely and effectively. It was truly shocking, and frightening to see the dispassionate attitude of one of the nurses.

  2. I was horrified to be admitted into hospital last year for the broken ankle, but the morbid curiosity in me was fascinated to see what life was like on the other side after working for the NHS for ten years and concentrating significantly on patients’ rights.

    You are right about data and charts. I found that annoying. Along with being given paracetamol at every verse end for pain I didn’t have. The reverse extreme to your son? We weren’t critical care of course, but staff did come through the night to check everyone was all right. I woke up during one of those visits, and was reassured ‘we’re just visiting the rooms’. We had personal alarms. I fell in the toilet once, one of my roommates buzzed and staff came in no time.

    Oddly though when the other roommate buzzed, (usually to go to toilet) they took their time. She started asking me to use my buzzer as they responded faster which I found embarrassing.

    I found staff pretty good for the most part, certainly the nursing staff, the auxiliaries were less helpful. It was easier to ask ‘my’ nurse for a glass of water than to ask an auxiliary. Sometimes the left the lid on the food tray, as well as a broken ankle, I’d pulled a wrist and couldn’t lift the heavy lid.

    But, in terms of nursing care, I suspect I fared better than in a UK hospital. Certainly some of the British nurses seemed to think they had more time for people. Clinically? Who knows.

    However, I’ll save my last comment for jovial consultant. His insensitive and thoughtless comment with total disregard for you was appalling. But, I’ve met consultants like that …

    • I do remember your awful accident and the terrible damage to your leg. It sounds strange that you received better attention than your room mate. I did wonder if some of the dispassionate treatment of my son by the consultant and older nurse was because they thought it was his own fault.

  3. As a former nurse, it is painful to read this, Susie. Where was the compassion and the caring? the very core of nursing the sick and supporting the relatives. Judgemental attitudes have no place when caring for the sick and vulnerable. They should be ashamed of themselves on that ward. Sooner or later, as these so called professionals, grow older and will have tragedies of their own, they might just realise their own arrogance. I am so sorry you had to endure this along with the loss of your son. No words can give you comfort but just know your friends are thinking constantly about you. Love, Jenn xxxx

    • Thank you, Jenn.

      I did not mean to imply that all the nurses were uncaring or unfeeling. They were all very sweet, apart from the older woman who appeared disapproving rather than caring. It just seemed as if there was something lacking in their training, and that they focused on the data and seemed not to notice the discomfort of the patient until it was pointed out to them. When it was, they leapt into action. I couldn’t criticise them, just the system and the frightening lack of pain relief when it was needed.

  4. Oh, this is just awful. Awful at a personal level and feeling so upset at what you and your son had to endure. But also awful overall. The obsession with data and the removal of the human aspect. My god, we could be talking about education here! I don’t want to say it, but really, what is the world coming to??

    • You’ve put your finger right on it, Alison. There was something almost robotic about the way the nurses (who were very sweet in themselves) went about their duties. A lack of connection between one human and another. Indeed, I don’t like to look too hard into the future.

  5. It seems as if what motivated those nurses was first and foremost the paperwork…the charts. For errors there they would have to answer, whereas for the physical care, for the compassionate care, they answered to nobody.

    I saw examples of it in France: the routine was important, the needs of the patient less so.
    It used to make me wonder what went on when I wasn’t there….and from what my husband told me I was right to wonder.

    How can a nurse just put down a cup without ensuring that the patient can drink from it?

    What is going on in nurse training schools?

    Horrifying to have to watch your son in pain while staff who were there to care for him did not.

  6. I think it must be how they were trained. Surely it would make sense if they just spent a minute asking the patient if they were OK or needed anything, before dealing with the data? The readouts could have been indicating anything, but only the patient could say if they were thirsty or uncomfortable.

    The older nurse, the one who put everything out of reach, didn’t just put them on a side table – there was none. She put them on a unit about 5 ft. away, where the medicines were kept. Every time. I felt she knew exactly what she was doing. She really wasn’t very nice. Almost hostile.

  7. I’m not an automatic fan of nurses but that older woman is clearly in the wrong job. Have you made a report to the hospital?

    I think you are right about the training, but how has this come about?
    Of course they need to make the reports on the charts, but how can you not notice a patient’s discomfort?

    Something seems to have gone desperately wrong in the NHS….

    • I have been thinking whether or not to write to the hospital, and haven’t yet made up my mind. The older woman showed absolutely no interest in attending to the needs of her patient.

  8. I’m sorry about your son. That his stay in hospital was not all that it should have been must have been very distressing for you.

    That older nurse sounds a callous woman who should not be caring for seriously ill patients, or indeed anyone. I think a letter to the hospital would not be unjustified.

  9. What a terrible ordeal for you and your son and daughter in law, the older nurses behaviour was more than callous, I would describe it as cruel.I am so sorry and sad that you had to go through this, and that your sons last days were so painful. Take heart that he had the emotonal comfort of knowing you were there with him. I hope that writing this had helped you. Thinking of you, and sending much love.

  10. Like many respondents here, I too am saddened to read of the loss of your son but also of the attitude of the nursing staff. I have long held the view that the governing body of nursing in the UK has done the profession a huge disservice by insisting on a degree as the minimum entry requirement. Since time immemorial nursing has been a vocational calling, not an academic one. There must be countless numbers of truly caring individuals – the real minimum entry requirement – who have been sidelined because they don’t have an academic streak. Consequently I cannot help wondering how your son may have fared with traditional nursing care, even if the final outcome could not be altered, I daresay the time prior to his passing would have been far less distressing for him.

  11. I didn’t know that, Sam. So individuals who are not academically gifted are automatically denied the opportunity to enter the nursing profession. And it is indeed a profession, now, no longer a vocation it seems. I would have thought that a genuine desire to care for sick people would outweigh a degree, but obviously not. With all the huge salaries being paid to ‘managers’, I think back to the days when it was Matron who ruled and had nurses and patients alike shaking in their shoes/beds, but things were done properly and patients’ interests came first.

  12. Pingback: Past, present, future | Susie Kelly - Writer

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s