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Hospital confidential

After suffering an horrific leg injury veteran Northern Irish journalist Chris Ryder spent seven months as a patient on our under pressure wards. In a searingly honest despatch, he reveals his encounters with medical staff, good and bad, as well as some moments of utter poignancy.

Once I felt the searing double-crack in my lower left limb I knew I was in deep trouble. Only seconds earlier, my wife, Genny, and I had left the Petit Ormeau restaurant (sober I must emphasise), and as I climbed into the front passenger seat of the car to go home, my leg suddenly gave way.

Those who came to my assistance could see it was a serious injury. The owner of a neighbouring Chinese takeaway produced a thick rug which kept the evening cold at bay while I lay half on the kerb and half on the pavement.

It took a seemingly eternal 45 minutes for an ambulance and other first responders to arrive and the last thing I was to be fully conscious of for several weeks was the prick of an injection in my lower back and a warm glow spreading all over my body which quickly put me into a very deep sleep.

The next few weeks, as later related by my selfless wife, Genny, can only be described as a surreal nightmare for both of us. Twenty-four hours after a very skilled surgeon had bolted my broken limb bones together with a metal plate and encased my injury in a Meccano-like framework with three anchor rods sunk into my leg to keep it steady, he gave instructions not to put pressure on it for 13 weeks. The doctors later told me I was very lucky not to have lost my foot. Instead I was to be confined to a hospital bed for at least that duration. Hours after the surgery my overall health suddenly worsened. I developed kidney failure and my oxygen levels dropped perilously low. My condition was so grave that my wife was telephoned at 3am and told she should come to the hospital. She got there in time to meet me being conveyed to the Intensive Care Unit with a medic running behind the bed carrying what’s called the ‘crash pack’ feeding lifesaving oxygen to me. I hovered on the brink of death for eight days as the incredibly skilled doctors and nurses literally saved my life.

In the event, I spent 15 weeks in the RVH, before being transferred to the Meadowlands Rehab Centre at Musgrave Park where I had virtually to learn to walk again. Thirteen weeks later, when I got home, I was back on my feet but still far from independently mobile.

My rehabilitation continues slowly and steadily. I’ve lost some six stone in the process, my sleep apnoea has ceased and I feel fitter than I’ve done in years if only I could walk properly to enjoy it.

The recollections below are thus based on impressions and events I witnessed in both hospitals. My initial arrival at the RVH created some challenges for the medical and nursing staff. Classified as ‘Bariatric’, the omnipresent health and safety practitioners put together a plan. I was to be housed in a larger bed and, as I couldn’t walk I was to be lifted in and out of it with a hoist. Later, I discovered that initially six nurses were tasked to attend to me when I needed to be rolled in the bed or moved.

Problem was none of the items was available and none of the staff were trained. So I was initially squeezed into a bed that staff admitted was entirely unsuitable. It was too short, most uncomfortable and the essential Meccano frame on my leg proved to be a troubled partner, although my fractured leg was surprisingly pain free. My discomfort was thoroughly aggravated on the first night in the medical ward though when I asked one of the nurses to help me connect the air pressure device that improves sleep quality for those who endure sleep apnoea.

“Nobody here is trained to use it so you’ll just have to do it yourself,” she said harshly. Asked for linctus to ease a dry cough, she was equally unhelpful saying it would have to be prescribed for me the next day.

I believe the same untypical nurses were responsible for more drastic treatment. Not surprisingly, because of what my body had been through, my blood sugars were haywire and being carefully monitored. Not eating much food didn’t help. However, alerted to very serious drops in my sugar levels the nurses woke and roughly forced me to ingest thick yoghurt-type drinks which were supposed to help control the condition. All they did was make me retch and vomit.

My first full day in the ward was May 9, my 70th birthday. Lying delirious in a hospital bed was not how I had planned to mark it. Instead the day was spent in a twilight state experiencing surreal dreams as a result of my medication.

Throughout May, as I became desperately upset about being confined day and night in what I felt were claustrophobic conditions, I was constantly assured that a suitable bed was on its way. Virtually every afternoon the same senior medical director on his daily round voiced this sentiment but one day after talking to him with some anger, he conceded my bed was unsatisfactory and said he would complain if he was in my position. Little good it did me. All I got were sympathetic nods but the better bed arrived eventually complete with an inflatable mattress.

By this time, I was consumed with such claustrophobia, confusion and frustration, I asked one of the doctors if he would call a taxi so that I could discharge myself. You’ve only one good limb to walk on, he pointed out as he calmed me down. Another night, my delirium exploded again. This time I dialled 999 and asked for the fire service to bring me home. A nurse quickly smothered that unwise call. Never having been hospitalised, I soon learned that being confined to bed for any length of time instantly strips you of dignity and any sense of modesty or privacy you might cherish. Nurses give you all-over bed baths and help you on and off with pyjamas. They also wipe your bottom and inspect it regularly for bed sores. And doctors, invariably with their stethoscopes hung around their necks as tradition dictates, frequently inspect patients in the most intimate places.

Almost daily blood samples are sucked from your arm for analysis. Every couple of hours a mobile unit is wheeled to your bedside to check your blood pressure and blood oxygen levels. Another contraption is poked in your ear and after two beeps it records your body temperature. Your urine is constantly tested for infection, as is your poo - whoever knew that it is classified into one of six categories depending on content and shape? A number 4, 'like a sausage or snake, smooth and soft', is considered to be ideal.

Ward nurses record all this diagnostic information on a wad of forms gathered on an A5 clipboard and hung at the bottom of every bed. Every time one had a meal, it was recorded in meticulous detail as was every bodily function. This accumulated data was then analysed by a team of doctors.

From one of them I learned that my overall health was pretty good but most significantly that my kidney function was the most efficient it had been for four years. Lack of wine, I thought nostalgically.

I encountered many Filipino nurses as well as African, Indian, Polish and English, but it was locals who were my principal carers, with various grades of state-registered status.

They each had an incredible workload requiring both demanding physical and precision skills - making and changing beds, mixing and prescribing medication and calibrating sensitive digital monitors.

But one routine task was anathema to a male nurse who confessed to a squeamish dread of giving injections. These wonderful professionals also need massive diplomatic skills to deal with fearful, demanding, frequently unreasonable and many hard-of-hearing patients, the majority of them frail and etched with age.

Twice a day at the morning and evening handovers, the nurses would cluster around the ward station, disbursing patient information but also participating in raucous conversations about their private lives and holiday plans.

The majority of the patients were tranquil but many were very distressed and frequently resorted to tantrums and even minor violence. Nurses have been goosed (occasionally by doctors) while others showed me bruised arms and dishevelled clothes where a patient has grabbed at their breast or arms. Some have tight grips and are hard to dislodge. It was common to hear yells of pain from behind the privacy curtains. A typical exchange would have the patient yelling, "You're hurting me" while the nurse would reply "I'm only cleaning you".

Others, known as 'climbers', had to be watched constantly because of a tendency to struggle to get past safety rails and out of bed. Others known as 'bolters' defied their frailties and made efforts to stand up and walk without their Zimmer frames. Most are fitted with movement alarms to alert a nurse that they are at risk but in a couple of extreme cases it proved necessary for a nurse to remain overnight by their bedside for safety.

Many patients shout or scream by day and night and call constantly for a nurse, sometimes before abusing them. One troublesome old boy made constant demands of a sexual nature. It is, of course, heartbreaking and humbling to watch once mighty men and women laid low by age and associated infirmity struggle in the twilight of their lives. It is testing for families too. One group arrived laden with cake and candles to mark the birthday of their patriarch only to be told to "bugger off".

Watching elderly frail patients being nursed has left me with indelibly poignant memories of touching humanity and lasting love. One night, as I was dozing off to sleep, the last image I saw across the ward was the hand of a black nurse, tenderly stroking the blotched hand of an elderly white man encouraging him to keep his oxygen mask on. A daughter spent considerable time reassuring her elderly mother that she should remove her false teeth at night because they would be as safe on her bedside locker as they would be at home. Another time I watched an elderly woman struggle up from her wheelchair to kiss her barely-conscious husband on the lips. By the morning he had died and I woke to the words of a priest praying for him.

The majority of patients were, however, calm, content and compliant but there were also a number who were 'away with the fairies', as it's often put. Without being cruel about their handicaps or mocking them it was impossible not to laugh. One was a nighttime shouter, who called at intervals: "Have you got them cows in yet?" Another was undoubtedly the star of the bunch. With the slightest encouragement he would burst into song and entertain everyone. His favourite was 'I'm forever blowing bubbles' and it could be heard up and down the wards several times a day. An elderly woman insisted she get butter on her morning porridge: "if it's good enough for the Queen, it's good enough for me". Another old-timer mumbled loudly most nights but brief snatches of clear speech revealed he was praying to Jesus, Mary and Joseph.

A 90-year-old male patient proved to be a 'geg', as they say in Belfast. He was introduced to the ward late at night after surgery and there was immediate confusion about the whereabouts of his hearing aid. Every square inch of the sheets and blankets were checked and checked again before they were going to call for an x-ray in case he'd swallowed it. But the panic ended when a nurse found it concealed in a pillowcase.

The next morning when he was wakened they asked the standard orientation question. Where are you, chimed the nurse. "How do you expect me to know, you brought me here?" Later that morning another nurse, unaware he was an amputee, asked where his leg was. Under the bed, she was told. So out came a false leg with flash socks and smart shoes.

Among the many threads that run through their workloads, none has a higher priority than preventing infection and cross-infection. As they transfer attention from one patient to another they put on fresh blue gloves and white aprons every time.

A costly laundry bill is the most evident sign of attention to cleanliness but so, too, is the constant mopping, brushing, wiping of all surfaces. And every bed is thoroughly washed down after every patient vacates it by a team of meticulously active cleaners. When I departed Meadowlands there was an MRSA scare, with some patients isolated and visitors obliged to wear gloves and aprons.

For the most part the nurses work non-stop 12-hour shifts with a totally impressive code of coming to the assistance of a colleague. But there were frequent instances when nurses appeared casual or slow about responding to patients. I counted an 11-minute wait for a bedpan. When the nurse arrived with it, the rueful patient merely said: "Too late".

On another occasion, a very restless elderly patient evacuated his bowels in the bed and in a vain attempt to clean it up made an almighty mess of both himself and his bed clothes. As with every time such circumstances occurred, the nurses set to work to make the patient clean and comfortable without any censure or complaint.

In general, patients were treated to exemplary standards but I did witness one instance of what can only be described as reckless behaviour. An elderly diabetic man developed a serious hypo and he was being fed sugary drinks to stabilise his blood sugars. After a time, he seemed to improve and fell asleep. Just on 5pm a female nurse appeared with a plate of food for him. She started to shake and hector him in a loud, insensitive manner to wake up and eat the food.

She then tugged him up, hectoring him to get up and sit in his bedside chair. After she had pulled his legs to dangle at the side of the bed, I told her he was always transferred on a device known as a 'steady'. Without ensuring he was secure and the bedrails raised to ensure his safety, she went to get the equipment. In her absence he fortuitously rolled himself back to the safe side of the bed. If he'd gone the other way he would certainly have fallen on the floor, with serious consequences.

After six weeks, about the midpoint of my initial recuperation, the fracture surgeon removed the metal frame from around my healing limb. As I lay on the bed watching him making his preparations, he slipped a spanner out of his case.

"Ah, the traditional surgeons' spanner," I remarked.

"Afraid not. B&Q's finest," he said, spinning the gauge to the right width. "These bolts are about 500 quid a time so we clean then up and re-use them. Keeps the Treasury happy."

A few weeks later, I was told a bed had come free in Meadowlands, where, the RVH staff promised me, I would receive gold standard therapy to get me back on my feet again.

After the generally comfortable environment at the RVH, the unit in Musgrave Park came as a shock. The atmosphere was more like an enlightened open prison. The staff were evidently hard-pressed dealing with elderly patients and, horror of personal horrors, they used flannelette bed sheets. The senior doctors, geriatric specialists, expressed their treatment emphasis as "blood, bottoms, bladders and bowels".

Anybody who thinks a long stay in hospital is a recipe for getting under the blankets with good books is soon disabused. Within as little as a day after an operation, a rehabilitation team, clad in blue gloves and white smocks, pull the blue bedside curtains round and get patients out of bed. There are frequent squeals of pain but within days, most patients with fractured hips, broken legs, even kneecapping victims, are well on the road to recovery.

The hospital food, it must be said, was pretty atrocious. Every day the centrepiece of the menu was a variety of stews, hot-pots or casseroles comprising inedible cheap cuts of undercooked meat and salt-laden sauces.

A chef confided that he and his colleagues wouldn't eat their own dishes. One of the doctors expressed his surprise that healthy eating guidelines were completely ignored. The breakfast club at Meadowlands every Thursday was the hottest ticket in town, for a 'proper' bacon, egg and sausage meal was served to ten or so patients.

The major flaws in the NHS, as I observed them, are the top-heavy administration echelons whose main function seems to be to dream up jargon-ridden policies such as 'referral pathway' and 'intermediate care plan'.

Perhaps the most egregious factor in the modern NHS is the way common sense has been overthrown by a mandatory health and safety regime whose edicts must be strictly observed.

I am, of course, grateful beyond all measure to the various doctors, nurses, physios, therapists, ambulance personnel and domestic staff who cared for me.

Whatever the flaws in the NHS, and I noted many within the two hospitals in which I was treated, there can be no doubt that these men and women truly give their all regardless of the constraints they face daily.

Continued from page 21

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