A&E cover: Don’t get ill over the weekend!
It’s funny, really, if you phone or look, NHS England tells you, “Not to come into hospital if you are ill”.
Huh?
Instead they tell you to, “Look on our online app“,
“See your GP” (they are actually trolling people with that! I can’t remember the last time I got past receptionist to see a real GP, can you!?),
or y’know, just google it, or something.
Just don’t bother us if you are feeling unwell.
I know what they really mean, but their wording is a tad less precise and openly embraces ambiguity.
True story:
Long, long time ago, I was on a ward and another patient had TB. They sent the lot of us for tests. I saw one of my GPs – a surly Scot – who greeted me with, “So, what’s up with you?”
Me: “Seems I may have come into contact with TB, in Whiston, and they want you to check me out”.
GP: “Get out.”
Me: “Sorry, what?”
GP: “That’s nasty! If you’ve got it, I don’t want it, get out. They [Whiston] don’t want it either! Go get checked out in Runcorn hospital. Bye”
Anyway, passing a tonne of blood a few weeks just after a renal op is a red flag.
The walk-in center won’t touch me (too complex), nor the GP. Tried, they didn’t answer. No surprise.
Tried the ward (my usual go to), no answer. Consultant, no answer. (It had got past 5pm by then).
Left it to see if it got any worse, which it did. Called 111, who went, “Oh”, and called a Dr, who went, “Ye, no, can’t help, go you A&E.”
So, off I went, on a late Sunday afternoon. To A&E. Joy!
Well, that was fun. AGAIN…
As any patient will tell you, pretty much anywhere in the world, waiting to be seen in A&E is rarely a fun experience. When you have a weak immune system, it’s so much worse as you risk the petri dish of the greater unwashed…
That’s meant literally, not disparagingly; if you’ve been labouring for 10 hours on some gritty site in the baking heat and… OUCH! 🤕, you crack your head, or have an accident with a power tool, or a pitchfork and, well, going home for a shave, shower and change of clothes is pretty low on the “to do” list.
Doing it on a weekend, so much less ‘fun’.
This time around it was just over a 15-hour wait in A&E to be seen. Not just me, pretty much everyone (short of those needing minor triage from a nurse).
But why? Why such a long wait?
Well, because it was a weekend and this 400 bed A&E hospital (with a catchment area of over 350,000) apparently only had 4 doctors to cover it – AGAIN – because that’s all the trust could afford*. (I encountered similar issues when they opened the newly rebuilt hospital a few years back. They spent so much on the rebuild (and PFI repayments) that they couldn’t afford to staff the hospital – according to one doctor I spoke to at the time).
Not 4 doctors for A&E, 4 doctors for the entire hospital.
Oh, and it was bloody freezing!
A number of patients – myself included – tried to find a nurse to ask for a blanket to keep warm.
Or used others’ discarded blankets (Ewww, Hells no, people! 😱 Germs! Bodily fluids! 🦠 ☣).
The place was probably a furnace earlier in the week as the thermometers raced toward 40°C, but the minute the heatwave receded, they threw open every door and let the arctic air in. OK, fine, it was around 7°C, but if you came in in just a t-shirt and are dealing with pain, shock, and blood-loss, it’s cold.
(It actually felt noticeably warmer outside than inside the hospital!)
So you arrive, hopeful and you look, “Christ, a six-hour wait?”
6 hours later you look again: “What the holy ****? It’s now ‘twelve-hours-plus’?”
I went in around 7pm, so I was looking at 1am, if I was lucky.
By 8am, when nobody had been seen, and they couldn’t give anyone a time other than, “You are next” (but you’ve been ‘next’ for the last 9 hours…) people were giving up and going home, because they have life and family and work.
Or, to quote one gnarled patient who’d took a golf ball to the back of the head, “**** this for a game of soldiers!”.
A young girl who’d been hacking up blood for the previous 12 hours joined the exodus. (I was under strict instructions from my wife to “not even think about leaving before I’ve been seen”).
The feature image (generated by Chatgpt) was actually a good approximation. Except there were even more ‘bodies’ in beds lining the corridors – too many to count – and the corridor was nothing like that wide, so all the great unwashed, the drunks, the drug-addled and the rest of the walking wounded were shuffling (and possibly dribbling) past the sleeping patients lining the walls – spreading their germs, hawking, and hacking up blood and as they stumbled to the toilets.
If you try to get an update you are met with a polite response – and a bored, indifferent shrug – from admin staff (who are behind safety glass – partly for protection from ‘cultural enrichment’, partly to protect themselves from the great unwashed coughing blood and germs on them, I guess).
I was there for 20 hours. In the first 15 hours, I only saw one doctor wandering around (or an illegal migrant from the many HMOs in the area that had robbed a doctor’s scrubs). There were, however, plenty of police and security patrolling, just in case anything kicked off.
You’d think, if the backlog was that bad, they’d have offered people food and drinks (they have in the past), but this is the new NHS. They have lucratively and ludicrously overpriced vending machines for their captive audience, why on earth would they engage in patient care and GIVE them anything when they can squeeze them for money?
TV’s used to be the same. You had a common rooms and a TV and games in wards. Now you have a decade old computer terminal (that was out of date before it even went in!) that they want you to pay through the nose to access. No!
Anyway, yes, I get it, it’s not a case of, ‘you get seen in order’, they have to prioritise. As a post-op renal patient I would normally move up the queue ‘cos more at risk, but if someone with life-threatening issues arrives, the deck gets shuffled. Which is how it should be.
And that was the case last night. Ambulances rushed in a resuscitation patient and it was a case of “Doctors, we need to save this man, stat”. All hands on board,
So regular A&E admissions are less of a priority. They can wait. And wait. And wait.
I’ve been in a ‘crash’ situation a time or two myself, I do understand. I once had something 2 consultants, 4 other doctors and 8 nurses run into the ward to save me.
I’ve also also seen them hit the alarm and run – and the guy was dead before he hit the ground. It happens. (Potassium level and renal patients. If you know, you know.)
I can also recall being left screaming in aneurysmal pain for hours and decorating the ward in projectile vomit (and nearly dying, again) because it was a weekend and doctors don’t do weekends.
(Malignant BP of 185/145, eGFR 3%, aneuric, hyperkalemic, etc., if that means anything to you).
The nurses reminded me of that meme of the toddler turning around and running off. Nope!.
(That was the Royal. I’d spent a month in Whiston, in a cardiac ward, as a forgotten renal patient(!) and when a bored nurse looked at my results all sorts of alarms when off and they moved me, presumably so if I died in the next hour I was on someone else’s tally sheet! (I eventually got a 4-page apology from Ann Marr, the trust CEO. I do regret not suing!)
‘Fun’ fact:
Researchers found that each year in England 11,000 more people die each within 30 days of admission to hospital on weekend compared to the other days of the week.
(But the study was very careful not to say this was caused by low staffing, or indeed anything else).
So, they can afford high-salary ‘EDI and ‘Lived Experience’ staff and mandarins, can afford to translate everything into any number of languages, can afford to re-write the manuals etc to be more ‘politically correct’ – like changing ‘women’ to ‘birthing people’ in case any pregnant men were “offended”.
My mum was a nurse/midwifery sister at the hospital for over 40 years and in all that time she delivery exactly ZERO babies from men. I mean, I am rounding it up here, but I think if I’d missed one she’d have mentioned it.
“We had our first male docker push out a healthy 9-pounder today.”
“Happens all the time” – said no midwife EVER.
But they cannot afford a few extra doctors to cover an A&E that is expected to cover a catchment area of 350,000 (to up to 6m) people!
(Whiston Hospital covers from Liverpool to Makerfield to Widnes – an area of about 10-12km radius (6-7miles~ish), or 120 square miles (- or greater!)
Officially, it covers Knowsley, Halton and St. Helens – and surrounding areas, but if you including its specialist burns unit, that extends to 6 million people).
And apparently they only had 2 doctors to cover it, ‘cos people don’t get ill or hurt at the weekend. I guess that only happens on weekdays, eh.
ANYWAY
Shift change, so the Monday morning crew trotted in to face whatever the weekend skeleton crew had left them.
So, another four hours passed before I was finally see by a surprisingly knowledgable final year doctoral student, and then a couple of more doctors – repeating symptoms and medical history to each of them, ‘cos they don’t seem to share notes on a system. Or look at the system, it feels. Y’know:
“YOU are supposed to be the person the other doctors got because YOU are the expert, and you are asking me why I’m there?”
Dr: “Have you given a urine sample”.
Me: “You mean, in the 15 hours I didn’t see a single doctor, or anyone to ask for it, that sample?”
Not all of them appreciate my sarcasm.
There again, sometimes I’ll grin, and others, well, my tolerance for stupid people is limited on a good day and too many doctors really are not as smart as they think.
One of my consultants said, “Please stop shouting at my doctors.”
To which I replied, “Then get more intelligent doctors. And tell them not to lie to me again.”
The young pre med doctor, I liked her. She understood and said, “You’re the expert here.” (In my condition and what’s normal for me).
I had a short, mildly heated conversations with another of my consultants. After bellowing at a doctor when she refused to give me my blood results (which she held in her hand) because, “I wouldn’t understand them (‘cos you are not a Dr, like me, *preen*)”
The short, polite version was, “My dear, how do you know what I would and would not understand? Are you psychic?”
The consultant that came to ‘rescue’ her said, “You don’t need to know the result. We [waving at his entourage] take the long term view to those results”.
To which I replied, “I’ve been in 3 days this time, your ‘long term view’ is 3 days. Mine is 20 years, would you like me to average them, sorted by year?”
He laughed, turned to sister and said, “Get him the result if he asks.”. The ward Sister, being used to me, just grinned.
That’s the thing – and too many doctors cannot get this into their thick skulls, cannot get past the hubris of “I have the letters after my name, I did my 7 years. I am the expert here.”
If you have serious, lifelong conditions, your life may well depend on you knowing yourself, your medications, what feels ‘right’ and when something is off.
“You spent maybe 3 months on a [insert condition] ward, ‘Dr’, I spend 20 years living it – but you are the expert. Okayyy…”
Little joke:
(PhD soft sciences): “It’s Dr Smith-Jones! DOCTOR!”
(PhD CS/engineering): “Bob’s fine!”
FINALLY, they sent me for a CT scan.
Then told me, well, yes, you’ve been pissing dark red blood for over 2 days, oh and your kidney functions have fallen to 19% (down from a steady ~26%, but up from lows of 3% and 8%), but the scan looks fine, so off you go. Just drink lots of water to keep flushing your system.
To be fair, one or two of them did suggest I have a catheter put in – just in case of blood clots – but I gave that kind offer a hard pass on account of OUCH! 10 to the Hells, NO!
SSDD then.
So, apart from it being bloody freezing, and the longer wait than usual (a casualty of inviting 12.5m third-worlder’s in the country and not building infrastructure around the mass intake), can’t say I expected anything different, or even disagreed with the outcome.
(My medical condition is as complex as it is rare. It is what it is).
The problem though is not the medical staff, doing their best, it’s a grossly bloated and mismanaged admin system in the NHS, overseen by ever more bloated and incompetent governments. The country is on its knees and the MPs are like, “While you’re down there…”