Someone to watch over me.

A story about a vulnerable patient.

In hospital: 24-25 April Hospital A (District hospital in home county)

26 April – 20 May Hospital B (Second hospital in home county)

On the next (Sunday) morning the patient’s wife and son arrived in Hospital A.

This is a transcript of what they found:

“I have cause for complaint” he told us, “I am so thirsty – I have been asking for water, but no one has heard me”. We tried to give him some, but he could not swallow properly. The red neck blocks were loose, and he had clearly been moving his head a lot. A drip feeding him saline liquid wasn’t working; by 6pm the bag had not decreased in volume, and he was in much distress, with cracked lips. A nurse then arrived and said that she had turned if off that morning in order to give him liquid painkillers, and had forgotten to re-start it.

In the patient’s words

Hospital A

I recall a feeling that my soft palate was swelling up, and that it was almost impossible to swallow anything. This made it all the more unpleasant when later that day a nurse got me to take a painkiller in tablet form, which got stuck in my throat.

That afternoon, a nurse came to tell my wife and me that I was being transferred to the regional centre; but later the same afternoon another nurse told us that it was the Hospital B I was being transferred to. I said that this was a great disappointment, and that there must be some mistake, as we had been distinctly told that I was to go. At this point my wife and son asked to see the doctor in charge in order to find out what exactly all this confusion of information about hospital destinations means.

Wife’s recollection

“We said that we wanted my husband transferred to the Regional centre, but it was obvious that Dr F did not wish this. We could not quite understand why; but remembered that earlier in the day our daughter Sarah had been told by a nurse that it would be preferable to transfer her father to the Hospital B, which was within the same NHS trust and would therefore be cheaper. So I asked if the decision was being made on financial grounds. Dr F did not deny it”.

“ Dr F said that he had spoken to a Mr V, consultant orthopaedic surgeon in the Hospital B, who was willing to take my husband. We asked if there was a spinal unit there; and though Dr F did not actually say yes, he did not deny it. He was clearly not prepared to listen to our request.

The patient

He said that the spinal injury could be dealt with at Hospital B, that I would be assessed on Monday and that a halo would be fitted on Tuesday. If, he said, we opted to wait until later in the week for a halo to be fitted at the Regional Centre, on Thursday at the earliest, the delay could be life-threatening. We felt that we were being fobbed off, and suspected that Dr F knew it too; but there was now nothing for it, we concluded, but to agree reluctantly to a transfer to Hospital B”.

Later on Sunday afternoon, an ambulance did turn up with instructions to transfer me to the Hospital B; however, there were no paramedics on board, and the staff nurse on duty would not let me be moved. So we waited for another, but none came; and eventually it was adjudged to be too late to move me anyway, as if one arrived at Hospital B after 9.30pm “there would be too few nurses on duty to log-roll me”.

On arrival at the Hospital B Hospital, we found the Ward in chaos, with reorganisation of beds in progress. The bed found for me was a broken one; I was put with my head actually below the horizontal, with no one available, it would seem, to rectify the situation. All that was restraining my head now was a pair of fluid drip bags and some micro pore strip, which kept breaking.

This further aggravated the breathing difficulties which by now had become a major feature of my case. The staff in the ward appeared to show no understanding of this. The sister said that the snoring sound, both on inhaling and exhaling, was the result of a build-up of mucus in the back of my throat, and told us that I was to have no dairy products. This made it all the more surprising when, shortly after, another nurse brought a jacket potato with four portions of butter, to be beaten up with the potato to make it liquid; accompanied by yoghurt and an ice cream. It was this nurse who informed my wife that I had got lazy, and would soon learn to eat lying down.

After a while we began to wonder where Mr K could be. A doctor told us that a halo could not be fitted until Thursday. My wife asked if the operation could be done straightaway, since I was deteriorating visibly, and she said that we would pay privately if necessary. She was told that this was not an option, since Mr L was on holiday for a week. The unit was trying to contact a Mr L, to see if he would take over the case. It now seemed very odd that Mr K should have accepted me as a patient in absentia, knowing that he would be unable to see me at all until his return. It was during this day that I was fitted with a Miami collar.

At 5.15am the following morning my family was summoned, as my condition had worsened seriously, and I had succeeded in removing the Miami Collar unobserved during the night, while hallucinating. They were told that a doctor had thought that I had reacted badly to a drug that had been administered to relieve the breathing difficulties, and to an adrenalin injection to counter what was erroneously interpreted as anaphylactic shock. Breathing had stopped, and blood oxygen levels had dropped to 31%. To keep me alive, I was later told, a breathing tube had been rapidly inserted, but with great difficulty, and at great risk to the fracture itself. The doctor who had administered the adrenalin later apologies to my wife for the mistake.

The situation was now so serious that I had to be transferred to the Intensive Care Unit.

1000lives analysis exercise/jp/abhb 2012