Tag Archives: A&E

Just Another Day in A&E

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A&E isn’t called that any more, it’s been re-branded as the Urgent Care Unit, though everyone, staff, patients, taxi drivers, police etc, still universally call it A&E.

The foyer has been barricaded by a detachable crowd barrier, with a home made laminated sign saying ‘Wait Till You Are Called’ in red lettering. A queue stands in the short entrance hall. There is no seating. There is no room for any. People coming out have to push through the queue. The shiny new reception desk is visible at some distance ahead.

Everyone coming into the hospital (other than for a pre-arranged appointment) has to be processed through this medical Checkpoint Charlie. The wide modern atrium (thank you PFI & a permanent financial deficit) is next door.

The A&E entrance, sorry, Urgent Care Unit, is tacked on at the side as a kind of brick hut afterthought.

We make it to the desk. The receptionist can’t hear or understand. Grandpa has a hoarse post surgery voice and can’t speak loudly. There is smeared perspex security screening and no microphone. I speak loudly and clearly. She asks me Grandpa’s religion. I say C of E for the sake of simplicity. She can’t find it. “Church of England?” “Christian?” “What choice is there?”

Hopelessly I explain that he was told to go to General Surgery who are expecting him, but I already know the answer. Everyone has to be processed through A&E, sorry, Urgent Care. We’ve been trapped in this Kafkaesque hell-hole of a system before.

We wait 2 hours to be seen by a nurse who takes bloods, puts in a cannula and tells us we will have to go back and wait to see a General Surgery person who will be called off the ward. We know what that means. Getting surgical staff off the ward is like prising barnacles off a ship’s bottom.

“It will be a bit of a wait,” nurse warns gloomily.

Thankfully Grandpa does not feel very ill. He just has a pain, which of course might be serious, but he doesn’t feel awful, unlike others amongst the trapped humanity sharing a space too small for the seating squashed into it. He isn’t actually bleeding or nursing a broken bone or collapsing against a carer or throwing up. (There is a stack of cardboard sick bowls considerately placed beside the reception screen.)

The soft drinks machine is out of order. Little children accompanying their ill siblings run around. Teenagers are sent off to the posh atrium shop next door to fetch supplies.

We wait for hours, as do most of the others. To be fair, the lady who is half carried in, actually unable to stand, is allowed through the security door quite quickly.

The television screen above reception plays a loop of information about how well the hospital is doing and how much it has improved, alternating with warnings about seeking treatment for TB.
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The collapsing lady’s elderly husband comes out & is directed by reception to a public telephone on the wall. It doesn’t work. The man waiting next to it gives him his mobile phone.

We are seen by a doctor at 4.15pm.  He does a thorough examination. He says the blood results seem normal, but he would like a scan to be absolutely sure. He tells his trainee junior doctor to set it up.

We are directed to a cramped seating bay in the Observation Area where a homeless man in a hospital gown is fast asleep in a chair. He coughs restlessly . He has not washed for a very long time. I think of the TB warnings on the screen in reception. We wait in the corridor.

At intervals I ask at the nurses’ station what is happening about the scan. I know that after 5pm the department shuts. It’s on emergency call only.

No, it operates 24/7 I am assured.

In the end I go in search of X-ray, sorry, Clinical Imaging. It is deserted, apart for a young man waiting for his discharge from a  disappeared doctor. I return to Grandpa’s nursing station. Nobody can enlighten me. A new nurse didn’t realise Grandpa was there. She enters something on the computer.

I go back to X-ray. The young man, showing initiative, has gone on a doctor hunt and lured one back to the department. I grab him. He kindly checks up for me. No scan has been requested. Grandpa has by now waited 3 hours in the Observation Area.

I go back. There has been change of shift. Nobody at desk. I check computer screen. Grandpa registered as entering at 6.35pm, 2 hours after he got there. Status – awaiting scan. The scan nobody has requested.

A junior doctor appears for another patient. I insist she deal with Grandpa. She apologizes. He can stay in overnight & have scan tomorrow. (Hang on – What happened to the bed shortage? What about the other really ill people waiting there for beds i? What about the homeless man nobody has been near for hours, still peacefully asleep in his chair out of the nurses’ station eyeline?)

“No!” we shout simultaneously. “We’ll go home and come back for the scan tomorrow! Take his cannula out and we’ll be off!”

Young doctor now terribly worried. We can’t do that. We’d have to self-discharge. She can’t authorize a scan for tomorrow. She can only keep Grandpa hanging around somewhere in the hospital till at some point, possibly tomorrow, they might find a gap for him in X-ray, sorry, Clinical Imaging.

If we self-discharge we will have to go through the same A&E route again tomorrow.

“We’ll risk it!” Grandpa says. He’s had enough nights in hospital, to know there’s no rest as you hang around in corridors, as drunks and emergencies are noisily admitted, till someone locates you a bed. “Take the canulla out and show me where I sign!”

As we make a run for the exit, he notices blood dripping down from his jacket sleeve. We rush back to the nurses’ station. Grandpa’s arm looks as though he’s been stabbed.

As the nurse mops him up, she cheerily inquires if he’s on aspirin.

“Yes” he replies.

“You should have told us!”  she says reproachfully.

I bite my tongue, but keep silent. It’s been a long day.

“Perhaps you should have asked?”

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All Human Life Is There

Life’s lessons 5  On patience being a much required virtue

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I had planned a nice relaxing week, but best laid plans and all that.

On Monday lunchtime,  when I came back from a nice TKMaxx dressing up session, I was greeted by Grandpa who had had minor day surgery a week ago. He thought it needed checking out. His neck looked a bit odd.

Off we set. We couldn’t go to our nearest local hospital, because their ENT had been moved to another hospital in the group. It was the furthest from us on the other side of a long traffic jam. (In London the moment the schools close for summer, a rash of major traffic works start.)

We went directly to the department where he was treated, but they said we had to go through A&E. This was at the other end of the large, confusing complex with no maps displayed to find your way. Various people helped.

When we got there it didn’t look too bad. Only one person was groaning in pain, while her friend patted her back with one hand and texted with the other. It was one of the hottest days of the year. There was a notice on the board apologising for the fact that the heating wasn’t working.

I couldn’t concentrate on reading to pass the time, but I didn’t need to. The girl next to me was on her phone. Her boyfriend was cheating on her. She had found out by going through his phone and had rung the number he had just been speaking to secretly in the kitchen. She said she had been very polite to the girl who answered, though I didn’t entirely believe her on this.

Her friend thought going through his phone was ethically questionable. I was with the friend on this. It was a bit sneaky. But she said the fact he was cheating exonerated her. I felt her reasoning was rather weak on this point. Anyway, he hadn’t been best pleased.  Perhaps that was why she’d ended up in A&E.

This saga got us through to the Triage nurse.

The next stage was waiting to see the doctor in another small seating area. The Chinese lady next to me was holding a sick bowl and a towel, but when her teenage son came in with some snacks and sandwiches, she cheered up and tucked in. There was a picnic atmosphere. He had to sit on the floor, next to the ten year old girl who was in with her mum and her mum’s friend. She had a tale to tell.

Her mum had a head wound. Every so often a passing member of staff would poke her and say “Don’t go to sleep darling!” It all had something to do with a fight. Ten year old was cheerfully recounting a blow by blow account of the altercation to Mum’s friend, covering what had led up to it and what the police had done. She also offered a detailed critique of the various social workers involved.

She appeared to have a confident familiarity with A&E. She helpfully showed me how to operate the water cooler. She could also negotiate the staff only route to the vending machine to which she made regular visits. 

Just when we had covered most aspects of the incident, further entertainment appeared in the form of two policemen and their handcuffed prisoner.  There was some discussion with hospital staff regarding his name, as the one given didn’t match their recent acquaintance with him. It was all very cordial. Everybody appeared to know each other.

Then a surprisingly cheery man with kidney stones turned up. The staff greeted him by name “Hello, Frank! You back again!” He told us all how he just popped in whenever he felt a new stone required attention. His local hospital couldn’t deal with that speciality any more, so he usually made a day of it.

Eventually at five minutes to eight we saw the ENT duty doctor. Grandpa was her last patient. Her shift finished at eight. It was five past nine before she managed to get away. She had to hunt down items of equipment she needed from distant departments and track down his notes. Everything was locked up and closed by this time.

I couldn’t help thinking how good natured everybody was considering the inconvenience of their workplace. The guy doing Grandpa’s blood test had to find him something to sit on and lay out his equipment on a plastic sheet on the floor.

And Grandpa? He’s still hanging around waiting for that scan 24 hours later. At least he’s healthy, apart from his odd looking op scar.

You need to tough to survive in hospital these days, as patient or staff!