Hospital Car Parking – A Proposed Triage System

car park

People are angry about NHS funding, but in general they are more angry about hospital car parking. There are not enough spaces, there are too many queues and it costs too much.

At my local hospital, drivers seem to enjoy the drama of a long queue for the car park. They can drop the patient off for the asthma check-up or to have a plaster cast removed at the hospital front door and then join the car park queue. It makes a really good anecdote for later if the hospital appointment is completed before the driver is actually in the car park.

As it’s a city hospital, there are other car parks nearby – some of them fairly empty and most have similar prices. Or you can park in the supermarket car park, pop in for a chocolate bar and then walk back to the car via the hospital. But most people seem fixated on the hospital car park as their right as a patient or visitor.

In Accident and Emergency, there is a way of allocating medical help to those whose need is most urgent, called the triage system. My proposal is for a parking triage system for hospital visitors so that those who need the spaces can beat the queues.

1 Immediate parking allocation
Anyone visiting a patient whose life is in danger or with hours left to live.
2 Very urgent.
Anyone with mobility problems who has a timed out-patient appointment.
3 Urgent.
Other outpatients with timed appointments.
4 Standard.
Anyone visiting a child or vulnerable adult in hospital.
5 Non-urgent.
General hospital visitors who don’t know any other car parks and can’t come by bus; bringing a spare nightie in for mum, returning a pair of crutches, visiting father-in-law, collecting a letter or those who just like to have a cuppa in the WRVS tea shop.

The WRVS Cafe in the Grounds of St James's Hospital, which is being closed down by the NHS trust, against the wishes of the volunteers and its many customers. Pictured serving volunteer Jean Batty.

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Radiotherapy – Like being in Star Trek

IntrepidClassSickbay

The idea of radiotherapy to treat cancer goes back to 1934. I’m halfway through my treatment and there’s no particular problems; I just think it’s weird.

For three weeks I have to turn up daily for a 10-minute experience that is pure 1970s Star Trek. I’ve been told that the breast surgery, the chemotherapy and the other lot of surgery have already cleared my body of cancer and so this radiotherapy is just to be totally sure.

The principle seems to be to get my body in exactly the same position every day and then send x-ray type beams to attack the cells near the original site of the tumours. I am now very good at lying completely still and zoning out while a person each side pushes my naked fat overspill around and chants numbers and measurements. With my eyes closed, I appreciate the tone, accent and sound poetry that accompany this science. The best day was when I had a Welshman speaking on my right and an Irishman on my left. Once you are positioned correctly, they leave the room while you get zapped by the machine, which looks like an upside-down round glass and metal Habitat table.

My radiotherapists have been lovely; I was surprised that most so far have been men. The male professionalism that treats a half-naked female body in a detached, matter of fact way whilst at the same time talking warmly to you as a person is great and makes me feel happy. Like a crazy patient in love with her psychotherapist, I have wanted to take a cute radiotherapist home with me on more than one occasion.

Today, though was a really weird radiotherapy session. A different radiographer had put on a CD which played throughout the session. I’m all for using music to relax patients; a bit of Chinese music or Indonesian gamelan does the job, Mozart or Bach maybe or, at a pinch, some light jazz-funk instrumentals.

But the CD in question was ‘Love Ballads’. I lay there with my naked top half exposed, lights off and the machine buzzing and clicking whilst a couple of sexy anthems played. I think it might have been ‘Nights in White Satin’ and I was certainly glad when it reached an end. Afterwards, I got dressed to ‘You’ve Lost That Loving Feeling’ by the Righteous Brothers. Too right, I have lost that feeling; I’ve got one breast, a sad excuse for hair and virtually no energy, so, however lovely the radiotherapy men are, nights in white satin are out of the question.

Satinsheets

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Side Effects of FEC Chemotherapy – Sickness

sick bowl

It’s great to believe in mind over matter. A nurse had told me that a positive mental attitude was the key to getting through chemotherapy. And I think it’s true – up to a point.

After my first dose of FEC, I started to have lurid alcopop red urine but otherwise felt fine for many many hours. I walked round the park and started to feel smug and strong because my positive attitude was helping me with any side effects. Still in the habit of a primary teacher, I designed and printed a colour-coded spreadsheet for all the medicines I had to take and had stocked the freezer with foods that teenagers can cook and eat. I was sorted.

But then I started to be sick; I won’t describe it because writing about it is too disgusting. But I was sick from 3pm until 1.30am when I had to go into hospital to have much stronger intravenous anti-sickness drugs. Instantly the sickness stopped but I had a difficult night in hospital struggling with a urine infection. I wonder how much those elephant-foot NHS cardboard pots cost because I used a lot of them one way or another.

Over the next 9 weeks I had two more infusions of FEC, but didn’t have any more actual sickness. This was because I had proved to the NHS that I needed the extra-strong sickness tablets that come in a gatefold sleeve like a fancy CD.

In fact one of the pictures below is ‘Small Craft on a Milk Sea’ – a gatefold set from Brian Eno (price £70), the other is Emend anti-sickness – a gatefold set from American drugs company Merck (price £52). Don’t confuse them now.

emend  brian_eno_7_0

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First FEC-T chemotherapy for breast cancer

drugs

A lot of people have family members to take them for chemotherapy. You see the relatives fuss and get stuff out of efficiency bags packed with magazines, foil-wrapped nibbles and i-pods. They look anxious and they obviously feel terribly powerless to help the person going through it, because that person is locked in. It’s like getting onto a new roller coaster-type ride at a theme park and there’s no escape once the safety bar is in place; you just have to sit it out however scary or sick-wrenching it is. The people on the ground can’t do a thing to help you with your fears; their thumbs up and jolly waving gets ignored as you have to set your brain to survival mode.

With no family to drive me; a friend dropped me off. I had wondered what to wear. Should I dress up posh and hope for superior treatment (like an NHS free upgrade?), or go for comfortable, with layers to take off or put on if the temperature went crazy. In the end I went for comfortable-posh but with easy shoes.

My appointment was early in the day. The room with about 12 treatment chairs was empty as I was directed to sit down by an extremely jolly nurse. She sorted out the blue tray with the drugs, hand-maggot and needle-stuff whilst listening to my worries and assured me I would be fine.  My big worry was an allergic reaction in the first 10 minutes. If that happens, a crash team fly in and sort you out, but apparently it was not going to happen to me…

After taking steroid tablets and a ‘sharp scratch’ on the back of my hand for the cannula maggot, it all started. The FEC part of the treatment is 3 separate drugs given one after the other, and there are lots of medical websites that explain this if you want to know. Instead of having a drip to pump and gravity- feed these drugs into me, I had a method I labelled nursie-squeezie. She sat there for an hour or so, slowly pushing the syringe-plunger and chatting all the while. It was a really good way to get to know someone. I heard her life story and she mine; we founds points of connection and had a pretty good laugh. There was no allergic reaction, and I was not sure whether the slight weirdness I felt was due to the chemo, or my overactive imagination.

When I asked the nurse about side effects later, she just said, “You’ll be fine,” and that gave me confidence. I rang my friend to arrange to be picked up, and carried my packets of pills, syringes for tummy injections and the yellow sharps bin out to a sports ground car park nearby. When my friend went to pay the man in the hut for her parking time, he looked at my pathetic expression, packets of drugs and bucket and said,

“Oh no, love… that’s all right…. you don’t have to pay.”

Gosh. The cancer perks have started.

NHS chit chat

Computer - generic

At work, people like to have a chat. As a patient sitting in a waiting room, it’s not great to listen to people chatting when they should be working.I had thought the NHS was getting a bit more professional at this, but you still find the exceptions.

I work in a primary school; it’s generally thought inappropriate to have ongoing chat between the adults once school has started. In the classroom, the most I’ll admit to doing is catching a colleague’s eye with a significant look when a child says something like:

“My mummy and daddy like to lie down together on our furry rug,”

And that sort of comment happens more than you would think.

But, based on just a few months of sitting in different waiting rooms, there doesn’t seem to be anything holding back the staff in the open plan reception areas from discussing all sorts. I wouldn’t mind if there was a bit of political debate or interesting facts to overhear. But no; it’s invariably mind-numbing dross.

Here’s the top ten conversation topics for receptionists and other staff in NHS waiting areas. 

  1. “Did you go out last night?”
  2. “You’ll never guess what John’s done now,”
  3. “I’m not sure what to have for tea,”
  4. “She’s done it again… what a bitch,”
  5. “That’s a lovely scarf,”
  6. “When’s your break?”
  7. “I’m fed up with that school,”
  8. “Did you see The Voice?”
  9. “I’ve booked my holiday at last,”
  10. “Had to take the dog to the vets,”

Sorry NHS – I don’t want to hear it, and I wouldn’t hear it if you said it in the staff room on your work break.

Waitingroom

Sleep – A Basic Human Right

pillow

I’ve not been blogging this week. It’s because I have not slept for at least 5 days. I have been lying down a lot; I could even say I have snoozed a little, but I have not slept. And because I didn’t sleep, I couldn’t function. I know that the NHS has to prioritise, and there’s the pull towards innovation and expensive medical break-throughs, but sleep is a priority; it’s a Basic Human Right. After these few days, I’m a deranged hallucinating fuzz-brain, so what must it be like to have chronic sleep problems?

I’ve always loved sleeping; when I was in my teens, my dad was always urging me to stay up to see this great TV programme called ‘Monty Python’s Flying Circus’ but I never managed it, because bed was always better than any TV programme. As the child of Scots parents, I was always a big disappointment at Hogmanay, and I would have been ironically hopeless at sleepovers.

So in just over 50 years of mainly good sleeping, here are the things that have led to bad sleeping for me:

1. Tea or coffee after 5pm. Sometimes, I’d accidentally have a cup and would spend the night staring at the ceiling whilst my brain jerked around for a few hours.

2. Doing intense talking late at night; this includes performing plays and concerts, parents evenings at school or even just having a bit of a ‘debate’ with someone. I would re-run the whole thing in my head, thinking about what I said, how I sang, what I should have done, what went wrong. Eventually I realised that it’s better to stay up for another hour doing something quiet before going to bed with a head full of words.

3. Acidity regulator; I’m not sure of the exact one, but I have found that if I eat certain foods in the evening, it has the same effect as coffee or tea. It’s a kind of acidity regulator found in cherry pies, blackcurrant yogurts and cheesecakes, so I tend to avoid any of those preserved red and purple fruit products. Often I’ll lie awake, realise I’ve not had tea or coffee and then consider what I’ve eaten, only to go down to the kitchen, examine food packaging and…. ‘Aha!’

4. Emotional Troubles. Well yeah. I would advise anyone not to have anything go wrong with their lives if they want to sleep well. Conflict at work, relationships, money worries, responsibilities cumulatively add up to nights without sleep. At those times, all I have been able to do is lie there, try to relax, and put the radio on to try and drown out the constant worrying.

5. Chemotherapy treatment. I never subscribed to those ideas about cancer being a ‘battle’. I thought it implied a metaphorical thing; about being strong and brave. But now I understand it as a cell-on-cell punch-up that’s happening inside my body day and night. My brain isn’t alert; that’s why I can drowse for 10-15 minutes, but I really can feel the miniature battles going on inside me when I lie still.

However, I am lucky that sleeplessness has not affected me as much as other people. One third of UK residents have experienced sleeping problems with over 15 million sleeping pill prescriptions being issued by the NHS in 2011 at a cost of nearly £50 million. Whilst a huge amount of time and money is put into designing sleight-of-hand ways to build fancy new NHS hospitals that ultimately belong to private companies, what time and money is being put into solving the sleep problem?

There’s an elephant in the room and it’s sleeping.

baby-elephant-sleeping-lamphun



http://www.theguardian.com/society/2012/may/11/nhs-spending-sleeping-pills-50m

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NHS Do -It-Yourself

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Many years ago, if you needed a skirting board painting you would call a time-served professional painter/decorator. Nowadays, most people would nip down to B&Q and then slosh the paint on without bothering with the sugar soap and sanding.

DIY seems to be good enough for the 21st Century in the NHS too.

There’s a continuum, isn’t there, of medical procedures that you’re happy to do yourself, and those that really need an expert. In extreme circumstances women deliver their own babies, and exotic explorers amputate their own legs; people with diabetes and anaphylaxis routinely inject themselves, and I even cut my own toenails. We may all Google to diagnose ourselves, but there seems to be an increasing NHS expectation that patients should administer their own yucky procedures.

For example, having had a mastectomy, I was returned from theatre with a ‘drain’. Half a metre of see-through pipe poked out of my wound and ended in a measuring bottle of the type I use to teach 7-year olds about litres and millilitres. As I’ve mentioned before, I like my skin closed up with no piercings and so the sight of this was bad enough, let alone watching liquid slowly build up in the tank. Of course, the nurses were all matter-of-fact about it as they explained how I was to go home and look after myself. All I had to do was measure how much rusty water came out of me each day and phone in the results before 10am. I did have a little lesson on how to read the scale and how to subtract the old total from the new measurement; the maths lesson was great, but lacking in sympathy for the squeamish.

I am suspicious about this universal tendency towards DIY. A few days after the drain was removed, I stood in a short checkout queue at M&S foods. An employee harangued me for the whole wait time about using the self-pay checkouts.

“Look there are two free there; you’d be finished much quicker!”

“But I like to go to checkouts with a real person”

“I’ll show you how to use one, if you’re not sure,”

She didn’t want to hear my argument about workers rights and how all shops would end up as a row of self-pay machines and one security guard if we, the customers stopped using the proper checkouts. I ended up accusing an actual employee of Marks and Spencer of harassing me. And if M&S are doing it, there’s no hope.

I can imagine  a ‘super-streamlined’ self-service NHS with Do-It-Yourself ultrasound or MRI booths; where you consult a website and they send you a kit to operate on your own varicose veins.

No, give me an expert anyday. I’ll teach your children, and you can add up my shopping or stick an injection in me. That way, we’re all happy and in employment.