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’.