Nurses

The NHS: Something good

~ beetleypete ~ 13 Comments

There are always stories in the media about the poor state of the Heath Service in this country. We have all heard the sorry sagas of unacceptable waiting times, botched operations, and postcode-lottery drug administration. You could be forgiven for believing that the NHS is on the verge of collapse; swamped by high demand, pressurised by an increased immigrant population, employing staff who have no interest in the job. This is not my experience though, and I feel that someone needs to put the opposite view, just for a change.

In any organisation as large as the British National Health Service, there will always be errors. It is impossible to provide a service envied the world over, without accepting the reality of mistakes being made occasionally, and the odd member of staff who is not up to the job. I do not wish to detract from individual cases of tragedy, or to comment on them. Instead, I would like to offer an overview of where it does work, instead of criticising every tiny aspect of where it does not. I must start by stating that I know of nowhere else where a system like this exists, and works. We pay a relatively small amount into our National Insurance Scheme, and receive huge benefits in return. Those not working, or unable to pay, receive exactly the same care, free of charge.

Of course, I would like to see an end to prescription charges, still paid in England. I would also like to see a return to completely free dental care. With the right party in government, this would all be achievable. Despite this, the care provided really is exceptional. Those of you who are healthy enough not to need to visit a doctor, hospital, or other medical service provider may wonder what all the fuss is about. One day, you will find out. It is naturally more difficult to provide a good service in areas of high population density. Or is it? When I lived in London, I could normally see a GP within a week. If that wasn’t satisfactory, I could sit in the surgery, and would be seen after the other appointments. Attending a clinic in one of London’s busiest hospitals, University College, I was seen in under an hour. I only waited one week for the appointment to arrive too. At the same hospital, I waited just fifteen minutes for a blood test, and the results were with my doctor in four days. By my standards, by any standards, that’s very good.

Here in Norfolk, despite constant publicity to the contrary, it is even better. My GP has contacted me at home in the evenings, something unheard of in London. The out-patient appointments at the Norwich and Norfolk hospital are efficient, and thorough too. The staff are friendly and committed, and patients are never left to feel that they are an intrusion. The consultants and junior doctors take time to explain your case, and their treatment, and interact with you as if you are an adult, who wants to know what is going on. It is true that the regional Ambulance Service has a poor record. Given the legacy of poor management, under-funding, and the sheer physical geography of this region, that is understandable, if not excusable. The whole county has only two main roads, few dual-carriageways, and no motorway. Remote villages, weather problems, and the logistics of running a service covering six counties, all adds up to a problem that needs to be solved.

There are few major hospitals in this county. The ones that do exist are constantly criticised, with little balanced reporting of their struggle against the problems that they have to deal with. But there is little mention of the many good things. Mobile clinics, that remove the difficulty for patients of having to travel into the towns and cities for treatment. Sensible use of smaller hospitals, to provide out of hours GP clinics, geriatric care, and other community-based services. Widespread use of mobile community nurses, offering visits and treatment in the patients’ own home. We have had occasion to attend Eye clinics and Diabetic clinics, and my step-daughter has received very good service from the Maternity Department and Midwife team. Nothing seems to be too much trouble. Telephone calls to any branch of the NHS here are dealt with quickly and professionally. E mails are answered promptly, letters are sent out when due, and text message reminders of appointments are also commonplace.

I didn’t need the NHS for most of my life; but as soon as I did, it came through.

There is no magic wand to wave to make this service faultless. Given the increasing and ageing population, financial restraints, and new advances in medicine, it is always going to appear to be catching up. But it is undeniably good. And when you need it most, you will realise just how good it is.

Ambulance stories (6)

~ beetleypete ~ 37 Comments

F.O.I.R.

The above abbreviation stands for Foreign Object In Rectum, and was something that I would use on paperwork, completed during and after Emergency calls, in my time in the London Ambulance Service. Abbreviations were commonly used, to save time, ensure privacy, and because the space on the form for diagnostics and treatment was very small! Other frequently used abbreviations were;  WTASOS (Walked to Ambulance and sat on side). PMCCAH (Patient made comfortable and put in chair at the Hospital), and a personal favourite, MAMH (Mad as a March hare). They are not used these days, as the new forms have various tick boxes and codes, leaving little space for ‘artistic expression’.

In the early 1980’s, the Earls Court area in West London, was a well-known gathering point for the homosexual and lesbian communities in London. There were gay clubs and bars, many of which had been around for decades, and a general tolerance in the district, that made it a lot safer than most areas for those communities to get out and about in, or to live there. The local hospital was called St Stephen’s, now re-built extensively, and re-named The Chelsea and Westminster Hospital. This hospital served the area well, and did pioneering work in the early days of HIV/AIDS, always showing great respect to Gay patients, whatever their reasons for attending. It also offered all the usual services to the area, including a busy Casualty Department.

One of its ‘accidental’ specialities, was the treatment of FOIR. These objects, were inserted into the rectums, of  (always) men, for various reasons, predominantly sexual gratification of some kind, and almost always by the men themselves, and not by a third party. The frequency of these arrivals at St Stephen’s was such that it often went without undue notice. Sex toys that had gone in slightly ‘too far’, household objects, and some fruits and vegetables, were commonplace. There were some more unusual efforts, I recall a shower head attachment on one occasion; however, one night duty, a nurse drew my attention to something that I still remember, 30 years later.

A man in his 40’s had arrived at the department after midnight. He complained of stomach pains, and after further investigation and questioning, claimed to have ‘fallen’ onto a large light bulb. The screw-in connector for this bulb could clearly be seen by staff, protruding from his somewhat distended anus.  An X-Ray revealed that this was an enormous Theatrical Spotlight bulb. It had some material inside that was visible to X-rays, similar to the chemicals in a fluorescent tube. The size of this bulb had moved the organs inside the man, pushing them all into a small cavity below his diaphragm, causing great pain, and the glass seemed to still be intact. When he was advised that emergency surgery would be necessary to remove it, and that this would be major abdominal surgery, carrying great risk, the man admitted that he had inserted the bulb himself. Apparently, he had practiced this insertion for some time, adding more and more lubrication, until he was able to get the entire object inside himself. It was something that he had obtained from work, as he worked in a theatre, in Covent Garden. We saw the X-ray, and heard the story, then had to carry on with our work for the night, and the man was taken off to the operating theatre.

When we were next in that area, a couple of nights later, I asked the nurses what had become of the man. I was told that he had died. This was not as a result of the surgery, or even as a consequence of the original insertion of the bulb. It seems that there had been a crack in the glass, and this had allowed some of the powdery material to escape into his bloodstream. This had caused numerous blood clots, which had resulted in his death.

I still have a vision of this man, alone in his home, tentatively trying to insert this huge bulb into himself. It has always haunted me, for some reason.

Ambulance stories (2)

~ beetleypete ~ 22 Comments

Jimi Hendrix pubes

For those of you who do not know, Jimi Hendrix was a once-famous rock guitarist, who reached his height of popularity in the 1960’s. More information, and pictures, can be found at; http://www.jimihendrix.com For the purposes of this post, his hair is the only thing of interest. It was quite wild, usually in an Afro style, with a headband habitually worn around it. The reasons for this explanation will become apparent later.

Not all the interesting things that happen to you in the Ambulance Service happen as a result of 999 calls. It is a popular misconception that ambulances operate from specific hospitals, and are run by those same hospitals. This is not the case. In London, the whole area is covered by the London Ambulance NHS Trust, and the vehicles and crews are based on Ambulance Stations, at various points around the Capital. This means that they can go to any and all hospitals, usually choosing the nearest one to the incident, for convenience. In recent years, this has changed a lot, with specialisation, but at the time I am writing about (early 1980’s) an ambulance could go to almost any hospital, and as a rule, chose the nearest one to their own base. Where I worked, in the area between Notting Hill and Paddington, we tried, as often as possible, to use the small Casualty Department just off Ladbroke Grove. Our frequent arrivals here meant that we knew the staff well, and we were conversant with the layout of all the wards and departments. It was more or less a second home to us, where we could get the occasional cup of tea, meet up with other ambulance crews from different areas, and generally feel like part of the furniture.

This accepted familiarity also meant that we would help out, when we could. At that time, there was no computerised admission procedure, so we would fill out the name and details of the arriving patient in a large ledger book, like something Uriah Heep would have used in Dickens’ ‘David Copperfield’. These details were transferred to a smaller card, for the nurses and doctors to add comments to. If the staff were all busy, and we were at the reception window, we would also enter the details of people walking in off the street, as well as those of the person we had brought in.

One particularly busy night duty, there had been a lot of serious incidents. Added to the usual parade of unconscious drug users, violent drunks, and patients awaiting admission to the ward, it had all made for a difficult night for the staff. By the time things had quietened down a bit, around 4am, we arrived with instructions to take home a frail old lady, who had been waiting almost all day to return home after treatment earlier. The staff were having a well-earned tea break, when we entered their rest room to let them know we had arrived. After a brief discussion about keys, whether or not she had eaten, and what clothes and possessions she had, we heard the bell ring at the desk in reception. I told the staff to finish their tea, and that I would go and see what it was. In the small waiting room at the front, I saw a tall man, about 30 years old. He was of mixed race, with frizzy hair, and wearing a raincoat. He spoke politely, though he was obviously agitated, and asked if he could see a doctor immediately. I advised him that I would take a note of his details, fill in his card, and pass it to the nurse for assessment, and I began to do so. When I reached the section requesting a diagnosis, I asked why he had come to casualty at this late hour, and why he needed to see a doctor so urgently. “It’s my pubes”, he said, “they won’t stop growing”. This was uttered without a trace of sarcasm, and with complete sincerity, his face remaining severe and grave throughout, his expression one of concern, with furrowed brow. I thought at first that he must be mentally ill. I asked why he had not done anything about this condition previously, or seen his GP, instead of bothering a busy Casualty Department in the early hours. He was close to tears, telling me that his family doctor was of no help, and he could not be taken seriously, as it was not painful, or life-threatening. However, he told me, it was affecting his life in many aspects, and making him distressed, as well as depressed. I went back and told the staff. They were too tired to argue, and asked me to book him in, then someone would get round to seeing him eventually, and probably refer him to a psychiatrist.

We left, to take our old lady home, and had a bit of a chuckle about the ‘man with the pubes’. A couple of hours later, we had another job nearby, and had to go back to that same hospital. As soon as I dropped off my patient, I was met by an excited nurse, who ushered me into the rest room, hardly able to contain her giggling and obvious delight in something. ” You have got to have a look at that guy’s pubes” she hissed. She continued by telling me that she had never seen anything like it, in all her years of nursing. As the story unfolded, it turned out that they had brought the chap into a cubicle, deciding to have a quick look, before writing him off as a nutter. When he got undressed, he revealed a thatch of pubes, the like of which had never been seen before, by any of the staff. It was so amazing, that they were ringing other wards, so that their colleagues could get a look at the phenomenon. This man had been examined by more staff than if he had been at a private clinic, he must have thought that he had finally gone to the right place to get his problem sorted. Little did he know, that he was the subject of morbid curiosity, in the same way as John Merrick would have been displayed in Victorian times.

I was not going to miss out, that was for sure! I was given a white coat to cover my uniform, and I borrowed a stethoscope from a nurse. I would have to trust to luck that he did not remember me from earlier, or just presumed that I was one of the staff. I entered the cubicle with a flourish, barking in a loud voice, “good morning, what seems to be the problem?” He lifted the sheet, and raised his gown, no other explanation necessary. Luckily he was wearing underpants, though they were of the Y-Front type, so could hardly contain the veritable forest of pubic hair that greeted my gaze. From above the belly-button, extending down both thighs, almost to his knees, covering his genitalia to the point of invisibility, stood a four inch tall mat of hair, as frizzy as that on his head, and where the underpants intervened, sprouting like dark cauliflower florets, under some pressure. ” I cut it, and it just grows back like this really quickly” he told me, and I heard tiredness and resignation in his voice. ” Can you do anything about it please?”  “I will have to see” , I replied. Of course, what I did do, was to stifle my near hysterical laughter, then pass on my coat to the next in line to have a look, with the added inspiration, ” his pubes are like Jimi Hendrix’s hair, his pants even make the headband effect, you’ve got to see this!”

Sometimes, you just have to look on the lighter side.

Ambulance stories (1)

~ beetleypete ~ 29 Comments

The un-snippable turd

Sometimes, ambulances are called by other agencies, and not by the person in need of help. Railway staff make frequent requests for ambulances, whether in underground stations, or on the main line system. When you consider how many people are travelling on both systems on any given day in Central London, it is understandable, to some degree.

So, when we received a call on the radio to go to Paddington Station, it was not particularly unusual. We had added information, that a female was in a collapsed state in the toilets, in great pain, and unable to move. On the way to the job, with siren blaring and blue lights flashing,  we were in the habit of considering what we might be going to encounter on arrival. Using the basic information and diagnostics supplied by the caller, we could presume a whole number of things. Young female, toilets, great pain, cannot move. This could be a back injury perhaps, or maybe a gynecological problem. The pain of appendicitis, or kidney stones, could be very severe, and might impair movement. We would have to establish if the female was pregnant, as that could open up a lot more possibilities. Fortunately, Paddington Station is only a few yards from St. Mary’s Hospital, one of the biggest and best in London, with a very good Emergency Department, (which I prefer to call ‘Casualty Department’) so we would not be travelling far from the scene of the crisis.

On entering the station, we were met by staff, who quickly showed us down to the female toilets. They had thoughtfully closed that particular facility, to allow us to work in peace, and to leave room for the equipment we carried down, in case we needed it. It was soon apparent we were in the right place. Loud screams could be heard coming from a cubicle, and a worried-looking female Railway staff member advised us to ‘hurry up’. It is not easy to work inside a toilet cubicle that is already occupied by a sitting female, as I am sure you can imagine. Squeezing through the small gap available, I made a full assessment of the scene facing me. A shouting, near-hysterical young woman, aged about 25, was sitting on the toilet, legs splayed, bracing on the sides of the adjacent stalls. She was not wearing anything below the waist, and was yelling in a strange mixture of French and English combined. I have enough French to get by, and I managed a rough translation of her dilemma. ‘Get it out, quick, I can’t get it out, you do it, it hurts.’ She confirmed the location of the problem by raising her left buttock, and signalling between her legs with an agitated hand motion. I wondered what it could be. Perhaps she was trying to deliver a baby, not uncommon in toilet areas. Could she have sat on something sharp, or even been attacked, and have a foreign object impaled in her person? I managed to calm her down, stopped her screaming, and finally got her to co-operate. I gently lifted her from the seat, her arms around my neck, and I peered behind her, which given the physical restrictions of the situation, was not an easy feat.

What I saw, was a dark, hard stool, protruding from her backside to a length of some four inches. Or was it? It could have been a Mars Bar, or a Picnic, a Double Decker, or similar turd-like confection. It occurred to me that she may have been inserting it into her anus for personal reasons (not as unusual as you might suppose) and it had stuck there, unable to go all the way in, or come back out. But no, it was just a turd. Further questioning established that she was at the end of a short break holiday to London, she had become constipated, and tried to relieve herself, before travelling back to France. The recalcitrant bum-muffin had a short look at the outside world, viewed its fate, and decided to stay where it was. No amount of flexing of her young French sphincter would budge the first effort; it was literally un-snippable.

I decided that manual evacuation would be the only option, and handed her a latex glove, with instructions given to her in French to grasp the offending object, and snap it free. She refused, stating that it was too painful to contemplate. There was nothing left but to don the glove myself, and attempt the tricky manoeuvre personally. With no assistance from the panicking Parisienne, I was forced to crouch on the toilet floor, place my chin on her thigh, and reach around the rear of the toilet seat. This placed my face dangerously close to her arched pelvis, as she struggled to gain height from the bowl. No sooner had I come into contact with her stool, with no more than a brush of my hand, as light as a butterfly’s wing, she resumed screaming, and crying out that the pain was unbearable. By now, my temper was fraying. Her worried friend was yelling at me to leave the girl alone, and the Railway staff were asking how long would it be before they could re-open the toilets. I had to concede victory to the turd, and take it, and the girl, to the hospital.

I was far from happy. Although I am sure that it must have caused some discomfort, to have called an emergency ambulance to this nonsense was unacceptable in my view, and I told the Railway staff exactly what I thought of their actions. We had to wrap the girl in a blanket, place her into our small carrying-chair, and get her upstairs to our vehicle. She yelled all the way, as if we were deliberately hurting her, gaining the sympathy of the dozens of people on the main station concourse. There was increased volume as we transferred her onto our trolley bed, for the one minute journey to the Casualty Department. I handed over to the head nurse, unable to hide my annoyance at what I considered a complete waste of all our time. Luckily for the patient, nurses are unusually sympathetic by nature, so she was cooed over, and put into a comfortable cubicle. As the nurse unwrapped the blanket, to examine the girl’s nether regions, we could see the outcome of being carried upstairs in our chair, then transferred to the trolley. What had once been a proud, firm digit of a stool, now resembled a quarter-pounder burger, squashed flat against the young woman’s bum cheek.

I later found out that she had been given a laxative, and had manged to pass the rest of her package. Makes you feel all warm inside, for a job well done…