A story about the National Health Service in the UK and a bit of pain

Arthur Smith on Royal Mile tour with prone punter (not me)

Well, I have four as-yet un-transcribed blog-chats to post, but someone has persuaded me to blog about myself today, so you can blame him.

I went to the physiotherapist this morning. A second visit. The muscles inside my left shoulder are still occasionally painful from when I tripped over and fell on the night-time cobbles of Edinburgh during the Fringe in August. I mentioned it in a blog last month.

I blame comic Arthur Smith.

It was during his night-time tour of the Royal Mile and it was at about one o’clock in the morning. I tripped over a kerb amid a crowd of people and fell flat forwards without putting my hands out. I guess I fell on my shoulder.

The problem goes back to when I was hit by a large truck while standing on a pavement in Borehamwood in 1991. The corner/edge of the large container behind the cab of the truck went into my left shoulder, pulverising (apparently that’s medical speak for turning-to-powder) my collar bone in two places. I was thrown backwards, twisting, and the back of my head hit the sharp edge of a little brick wall maybe six or eight inches high. The base of my spine twisted slightly, but I did not know that until a few years later.

I was kept in hospital for about a week.

Because of my head injury, I was in theory under the supervision of the ‘head injuries’ department (they kept me in to see if I had any brain damage) but, because of my broken shoulder, I was kept in the broken bones ward.

Each morning, the Consultant in the broken bones ward would do his ‘rounds’ with his students and chat to the patient in each bed – except me. One day, I heard him explain to his students that “Mr Fleming” was under the care of the ‘head injures’ department (not his words) so I was not his patient.

X-ray of broken shoulder at the time – pulverised, they said

No-one came to see me from the ‘head injuries’ department because I was in the bones ward. The bones ward had very attentive nurses but I was not seen by any doctors there. Until, after a week, late one afternoon, a very exhausted-looking younger doctor came and saw me. He was from the ‘head’ department, asked me how I was and told the ‘bones’ ward they could discharge me.

Apparently, I later learned, I should have had physiotherapy for a few weeks or months after my release but (possibly because I fell between the responsibilities of two departments and was a ‘head’ not a ‘bone’ injury case), I never did. I never heard from the hospital again.

At home, in bed at night, to stop myself rolling over onto my broken shoulder, I would lie with my left arm out at right-angles to my torso and, eventually, the broken bones re-merged themselves. Someone told me this had been the wrong thing for me to do because, instead of mending naturally, the left shoulder – stuck out at right angles to the body for eight hours of sleep – foreshortened the mend slightly and the two parts of the broken bone merged one-on-top-of-the-other instead of in a straight line. And messed-up the muscles in the shoulder.

But who knows if that is true?

It was just ‘someone’.

I did seem to have the results of concussion for about nine months: I kept thinking I was better and was not. I would come home and stare at the wall, unable to construct thoughts in my brain nor to read. It was as if my brain de-focussed after about two lines of a newspaper column. I still cannot read books (though, oddly, I can write them).

After (I think it was) about a year, my shoulder still gave me pain for about two-thirds of my waking hours. It was as if someone were sticking the point of a knife into me all he time. My GP doctor said it would be like that for the rest of my life and discussed what drugs I could take.

I don’t know what it is, but it worked in 1991

Instead, I went to a Chinese doctor – knowing that Chinese medicine is very slow because it tries to cure the cause not the symptoms. The Chinese doctor gave me Wan Hua oil to rub on and, within two weeks, the pain was gone.

The effect of the oil could not have been psychological, because it never entered my head there would be a fast result with Chinese medicine.

That was thirteen years ago.

If I put any prolonged weight on my left shoulder, it will still give me a bit of pain, so I avoid that. Most of the time there is absolutely no problem. But, since I fell on the cobbles of Edinburgh in August, there is some pain when I put on or take off a jacket or a pullover: presumably it is just a muscular pain as I put my arm through an unusually odd angle.

The physiotherapist this morning told me that there was nothing really wrong with the shoulder broken in 1991: the bones would have mended. Logically, he is right. But I know there is a problem in my shoulder. And I know there is pain.

I have been given exercises to do.

Doctors know best, eh?

I have much worse pain in the heel and on the sole of my right foot, but the NHS physiotherapist is only allowed to look at one problem at a time, not two.

This blog’s valued reader Sandra Smith has suggested the heel problem may be Plantar Fasciitis. I think, from the symptoms, she is probably right. It may take a year to mend.

I have started rubbing on the Chinese oil again: on my shoulder and on my foot.

It seems to be difficult to get Wan Hua Oil in the UK, so I have asked comedian Chris Dangerfield for a decent Chinese pharmacy, preferably in Soho.

This may be a mistake on my part.

But he knows about such things.

The British NHS – pain is still pain & death is death despite good intentions

My personal experience of the blind bureaucracy of Britain’s National Health Service – which I blogged about yesterday – continued after yesterday’s blog.

I blogged about how I encountered well-meaning bumbling when I had to have my eyes checked at the Ophthalmology department of my local NHS hospital in Hertfordshire.

My friend’s painful horizontal wisdom tooth is seen on the left

Later yesterday, though, a friend of mine encountered continuing blind bumbling at the Dental department of Guy’s Hospital in London.

She has had painful problems with a wisdom tooth for, I guess a couple of years. A couple of weeks ago, she was told by a very amiable doctor at Guy’s that the tooth could be taken out but, as it was close to a nerve, they would first have to take a cone beam mandible CT scan to see exactly what any potential problems might be.

Good.

It might take six weeks to arrange the scan.

Well, OK.

So it was a surprise when my friend got home yesterday night to find a letter from Guy’s Hospital telling her the appointment to have the scan was arranged for yesterday morning.

She had been away from home for a couple of days.

The letter from Guy’s Hospital – bad timing

The letter for a scan at 10.00am on Friday 15th February, dated Thursday 7th February, had been sent second class on Monday 11th February. In theory, this should have arrived on Wednesday 13th February. If you trust the Post Office.

My friend was at home on the Tuesday, away Wednesday/Thursday and returned at 2300 on Friday night. She missed the scan appointment at 1000 that day. The letter, we think, may actually have arrived on Thursday, one day before the appointment.

In the minds of the no doubt amiable and well-meaning people creating the letter on 7th February for an appointment on 15th February, that was enough notice. But then the letter was not posted until 11th February. It was sent second class so – even if the postal system worked effectively – it would not arrive until 13th February and there was no thought of someone being away from home on two consecutive days.

So well-meaning people bumbled into incompetence.

At the bottom of the letter, it says: “If you are unable to attend your appointment please contact the Department giving 48 hours notice… If you do not attend an agreed booked appointment your form will be returned to the referring Doctor and you will need to contact your Doctor for a new referral.”

So, even if my friend had received the letter on Wednesday 13th (with the mail being delivered late-morning) she could not have re-arranged the appointment with 48 hours notice.

And now, because she did not know about the appointment, she will have to go back to her GP, get another referral, get another appointment to see a doctor at Guy’s, get that doctor to make another appointment for another scan, wait for the system to arrange another scan and then hope she receives a letter in time to know she actually has a scan appointment.

Stafford Hospital – where 400 – 1,200 patients were  killed

In some parts of the NHS, of course, patients die because of lack of care.

A couple of days ago Lord MacDonald, a former Director of Public Prosecutions, was calling for police to investigate the “needless deaths” of between 400 and 1,200 patients at Mid Staffordshire Hospital between 2005 and 2009.

Five days ago, NHS Medical Director Sir Bruce Keogh announced that nine English hospital trusts were to be investigated because of abnormally-high death rates:

– North Cumbria University Hospitals NHS Trust

– United Lincolnshire Hospitals NHS Trust

– George Eliot Hospital NHS Trust

– Buckinghamshire Healthcare NHS Trust

– Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

– The Dudley Group NHS FT

– Sherwood Forest Hospitals NHS FT

– Medway NHS FT

– Burton Hospitals NHS FT

My experience in Hertfordshire and my friend’s experience in London are of course – in comparison – wildly trivial. But they are a sign that, even when well-meaning people try their best, the NHS (perhaps like all large bureaucracies) is a mess.

In the case of the NHS, though, it is not just inconvenience which is caused but, in my friend’s case, continuing pain and, in many other people’s cases, death.

From tiny, slightly deformed acorns do vastly warped oak trees grow.

My friend phoned the number on the letter this morning and got no answer.

“It rings and rings for ages, then cuts off,” she told me.

So she then phoned the main telephone number at Guy’s Hospital.

“You get a voice recognition computer which asks for the department you want,” she told me, “If you ignore it, it gives you operator. The operator told me the Appointments Department is only open weekdays.”

Britain’s National Health Service: Sod’s Law. What happened to me yesterday.

Mostly amiable but badly organised

I have said it here before. What’s the point of having a blog if you can’t have a moan?

My mother had the eye disease glaucoma. So did my father’s mother. And so, I think, did my mother’s cousin. It is hereditary.

If you get it and the doctors catch it early, you can be cured. If they catch it late, there is no cure. You will go blind.

So I have regular eye tests.

After the last eye test, my local optician said the pressure on my right eye (always my weakest eye) was slightly – but only slightly – abnormal. So she sent me for more tests at the Ophthalmology department of my local NHS hospital. I went yesterday afternoon.

I am not going to name the hospital because the people who dealt with me were well-meaning people and trying to do their best. But, as in most of the rest of life, meaning well gets tsunamied by Sod’s Law and everything goes arse-over-tit.

When I eventually got an appointment, it was not in a letter. I got a phone call last Friday (the 8th) from a computer with an automated voice. It told me I had an eye appointment at my local hospital on Thursday the 14th at twndthee.

What?

Twndthee.

I phoned the number a couple more times and, as far as I could tell, the automated voice was saying “twenty to three” but I was only, perhaps, 65% certain. It might have been twenty past three or something else to do with three. Or possibly two. If it was, indeed, saying “twenty to three” they had, presumably, programmed the computer to say that phrase as it is friendlier than saying “two forty”.

A good intention. But the result was less clear.

I decided to wait for the inevitable letter.

This arrived on Monday confirming that, indeed, my appointment was at 2.40pm.

On Wednesday, I got a phone call from a genuine and very polite human being asking if I could come a little earlier – 1.30 instead of 2.40.

No problem. All agreed. Earlier appointment at 1.30 was confirmed.

Yesterday morning, my eternally un-named friend asked me: “Are you going to drive there?”

“Ah!” I said. “I had forgotten about that. I think they put eye-drops in and warn you not to drive.”

I looked at the letter.

“There’s nothing in the letter about it,” I said.

So I phoned up the telephone number on the letter.

“What is your reference number?” I was asked by the very amiable man on the other end of the line.

I read the reference number on the letter.

“Not that number,” said the very amiable man. “I need the reference number.”

“That is the only number I have,” I said.

“What is your NHS number?” he asked.

I read it off the letter. There was a pause.

“…and what is your password?” the very amiable man asked.

“Erm…  I don’t know,” I said. “I didn’t know I had one.”

“It is on one of your reference sheets with the reference number,” said the very amiable man.

“I only have one sheet,” I replied.

“I cannot process your request without a password,” said the very amiable man. “The reference number and password are on the referral letter sent by your GP to the Hospital.”

“I don’t have any copy of that,” I said. “I only have the appointment letter sent to me by the hospital.”

“I need a password to process your request,” said the very amiable man.

“I am having eye tests at the hospital in a couple of hours for glaucoma,” I said “and just wanted to know if I was allowed to drive. I wondered if they might be putting eye drops in which would mean I shouldn’t drive.”

“I cannot speculate on the answer,” said the very amiable man, “but sometimes they put eyedrops in. I cannot speculate on what they may do without access to your medical records, which I cannot access without your password.”

So, yesterday, I got a bus to my local hospital for the 1.30pm appointment. I arrived early and had a cup of tea. Then:

1.20pm – I turn up, present my letter to the receptionist and point out I have been asked to come for the earlier 1.30 appointment. No problem. I am logged in.

2.25pm – I think it best to check. I politely asked the receptionist if he can double-check what time my appointment is. Much fiddling on computer. “Two forty,” he says slightly aggressively. “Ah,” I say.

2.35pm – I am called in to the very amiable nurse, who makes the first tests on my eyes, photographs the back of my eyes and tells me she doesn’t think there’s any real problem, but I will be having two more sets of tests by other people and then seeing the Consultant.

“Wait in here…” I was told by my first very amiable nurse

2.50pm – She takes me to another examination room and says, “Wait in here. You may have to wait a bit of time for the other tests.” I sit down. She leaves.

2.59pm – Another very amiable nurse comes into the room to get something and is surprised I am sitting there. I tell her why and I describe the nurse who left me. This second very amiable nurse takes my name and goes off saying “I will check.” I tell her: “The other nurse told me I might have to wait a bit.” The second nurse tells me with a smile: “Don’t worry unless it starts to get dark.”

3.06pm – The second very amiable nurse comes back into the room again to get something, looks surprised again and asks, “Any luck yet?” I say , “No.”

3.11pm – The original very amiable nurse comes into the room to get something, looks surprised to find me there, and says: “Oh, you’re not supposed to be in here: you’re supposed to sit outside” (in the corridor). I go and sit on a row of seats in the corridor.

3.17pm – I hear my name being called about 15 feet to my left, in the original waiting room. It is a very amiable Consultant. He examines my eyes.

The end result is he says I have no signs of glaucoma. “Your nerves are way too healthy,” he tells me. “When I look at them, they’re lovely and pink, lots of nerve tissue there. You’ve got thick corneas so, when they test your pressure, particularly with the air puff machine, they’re going to get false, high readings. The most important question is Is this pressure damaging your nerve? and the answer is No. Your nerves look 100% healthy. They’re lovely.”

“So I can put my nerves into the 2016 Olympics?” I ask.

“Yes,” says the Consultant.

Everyone was very amiable.

The organisation was a mess.

No one person was to blame.

That is life.

Sod’s Law.

I guess death in the NHS is much the same.

So it goes.