This post has been a long time coming. As to why? Well, perhaps the fact that any names (including that of the hospital) are absent may offer a clue.
I am no stranger to hospitals. Since my spinal cord injury in 2005, I have clocked up weeks of ward time. After the initial three months rehab, there was the removal of my spinal metalwork, followed by more than five years on the outside.
This run came to an end when I developed septicaemia in 2012
, which resulted in a five week stint, interrupted when I was discharged and readmitted twice (I should point out that I was far from happy with my care during this time, but this was due to the delay in making me better rather than them making things worse). The treatment consisted of lots and lots of antibiotics, until a 'peri-urethral collection' was drained by a radiologist with a syringe, an ultrasound for aim and a talent for darts. With my feet behind my head, I watched in awe as she hit the target first time. Abscess aspirated, the infection went, and I got home just in time to carry the Paralympic torch in Hackney.
All fine and dandy until May of this year. What appeared at first to be a UTI that I couldn't shift became more complicated as blood tests revealed my liver wasn't happy, and the febrile episodes became more frequent. Rather than waiting for my temperature to hit 41c (as it had in 2012. Rigors
are best avoided, people), I checked into my local hospital.
Just to clarify, this is not a small country hospital with starched nurses and doctors in aeroplanes, but a 500 bed urban hospital.
On admission, I was put on I.V. antibiotics, and through a combination of CT and MRI scans a bacterial collection was identified in the same area as 2012 (my abscess, not the torch relay. If the collection had been found in Hackney, I would have been in better shape).
The urologist decided that the best course would be to drain the area surgically, thus making sure that the area was fully clear, in case some residue had been left behind in 2012.
When I came out of theatre, I was informed that I had a 'corrugated drain' in place to ensure the area is fully drained, after which the area would be dressed, and allowed to close over time, so that it closes from the inside out, ensuring no cavity is left behind.
The drain itself looked like a ribbon cable from an early computer, and was a couple of centimetres wide. My scrotum, on the other hand, was the size of a space hopper, and almost the same colour.
In order to speed up the reduction of the swelling, I was trussed up like a turkey in a double layer of some fetching synthetic stretchy underwear called 'Mollie Pants' to provide extra lift. For a week, I had my dressings changed twice a day, and everything seemed to be progressing well. The nurses did mention that they would need to keep an eye on the drain itself, to ensure it wasn't pressing into my skin.
At the end of the week, the registrar finished his ward round visit with a parting shot. After examining me, he mumbled that there was a small amount of ulceration that they would need to keep and eye on. Despite this being 7.15 am, alarm bells began to sound in my head.
To become a fully qualified paraplegic, I had to undergo a rigorous training programme that covered all the elements that would enable me to be considered self-caring. As a result of this training, even the mere mention of the words ulcer or pressure are enough to make me scurry for a mirror and embark on a spontaneous yoga session to allow me to, if not disappear up, at least scrutinise my own arse.
Having been in dressings all week, I had not had a previous opportunity to inspect the drain site or the area surrounding it. I pulled a mirror from my wash bag, and angled it between my legs to discover an area of very dark purple skin, with two angry red sores on one edge.
In having the drain pushed up against my skin, the combination of pressure and the exudate (the fluid draining from the wound site which can burn surrounding skin. See, I learned something) from the drain had caused a pressure sore 2cm x 3cm.
I was seriously annoyed. As far as I am concerned, this was an avoidable complication, and for it to happen to someone like me (I like to think I can fight my corner pretty well, and I've made it my business to learn as much as I can about SCI) was even more worrying. What if I had been incapable of self examination? What if English wasn't my first language?
The wound management CNC (a nurse consultant) was called, and she recommended an appropriate dressing, and a careful watch and wait strategy to find out just how deep the tissue damage was.
A few days passed, and by the time she returned, the area had become considerably larger. During her absence, the colo-rectal doctor had happened to examine me (they got in on the act to make sure the original infection hadn't come from their end, as it were). On looking at the pressure area, he suggested getting plastics to have a look at it.
I mentioned this to the Wound CNC, and plastics duly paid me a visit. The registrar described the area as being necrotic and the kind of thing they only usually see with a bad TB infection or someone who is immuno-compromised. He put me on the surgical list for the following day.
The surgery involved the removal of the affected area (thankfully the scrotum has plenty of skin to go around), and after three days, I was packing my bags to go home when the plastics team paid me a visit with some bad news.
The tissue they had removed had been sent for analysis, which revealed an MRSA infection. There was enough evidence from previous tests to indicate that I was not carrying MRSA prior to the sore developing, which means I had a 'hospital acquired infection'. Suffice to say, I have made a formal complaint; I await the official response with interest.
Fortunately, I was able to leave with two lots or oral antibiotics, so my return home wasn't delayed any further. Yesterday I finished the course. Now I have to wait and see whether the infection is cleared or whether it will reassert itself. A nervous time, especially when my confidence in the standard of care I can expect to receive has been undermined.
Would my experience had been different had I had private medical insurance? It's hard to know, but from what I saw, it would only have provided me with free TV, and possibly a side room (although I don't know if such rooms are available for private patients, as I am not one). Perhaps private cover would have made it easier for me to ask for a second opinion, but seeing as there isn't another urology team for many miles around, I'm not sure how practical it would be for me to be passed on to another hospital.
My experience of the NHS has been far from perfect, but the principal under which the organisation operates does make it feel like one big institution, where moving from one discipline to another is relatively easy (depending on how stubborn the consultant is). The UK population still cares deeply about the concept of the NHS, even as the Government attempts to dismantle it before their very eyes.
During my stay in an Australian hospital, I overheard another patient describing how one of their relatives had meningitis and had been advised to seek treatment in a hospital elsewhere in the country, but couldn't afford it. Their inability to pay would make a difference to their long term prognosis.
coffee counter in the hospital, there is a tin for people to make
donations. The money was to help a 2 year old child who was seriously injured
in a fatal car accident. The money is to go towards the cost of
treatment, a wheelchair and rehabilitation therapies.
In one of the
wealthiest countries on the planet, why is it necessary to rattle a tin
in order for this child to get the best care and rehabilitation?
In Australia, the Federal Government has just cut $50 billion over eight years from the health budget given to all of the states to provide healthcare services. The idea is to force each state to have to raise the money to cover the funding gap by increasing GST (Australia's equivalent of VAT) or by taking funding from other state services.
To hold the provision of healthcare for all Australians to ransom like this is one of the most appalling pieces of political cynicism I have ever seen. It does not bode well for the future standard of care for those who cannot afford to pay for their treatment.