Richard North, 10/10/2020  

My apologies for going absent without leave. I have been detained at the pleasure of the "world beating" NHS in a nightmarish episode that should have been a one-day procedure that ended up taking five.

As I rule, I'm not that keen on getting too personal on this blog but, since we are so routinely assailed with tales of this wondrous "service", I thought it would be a good idea to offer a quick note on one user's experiences.

The current episode of this story starts last week when I got a phone call from Bradford Royal Infirmary telling me there had been a cancellation on the list for a long awaited operation, delayed because of the Covid pandemic. That was the good news and still is good news.

On the day – that was Monday – I turned up for a procedure scheduled to last one day – back home by teatime. Anyhow, with ten others, I was processed. My turn came about midday when I was given a general anaesthetic and knocked out for surgery, ostensibly to remove my gall bladder.

Two hours later, after what should have been a one-hour op, I was brought back to consciousness with such roaring, intense pain that I bit through my lip in reaction. Yet all the nurses wanted to know whether I knew where I was. In between addressing a higher deity, I think I told them, wondering why they didn't know already.

Because of the delay in diagnosing my condition (about ten years), and the operation – over a year – my condition had deteriorated so much that my gall bladder had eaten through my intestine and created a fissure. That needed fixing, which is why the op took so long.

The second bit of good news is that it's fixed – we think. I won't know until the final test results are in and I don't take the test until Monday. But it was the last Monday that the fun started. Because of the fissure (not that I'd been told anything by then), there was no chance of me going home.

Sent back to the ward, there I learned that the surgeons had ordered "nil by mouth", not even meds. The trouble is, no one had told the anaesthetist who had prescribed – you guessed it – meds by mouth. By that time, the pharmacy was closed, so there were no intravenous drugs for me. I spent the night without pain killers.

After a virtually sleepless night, I still had expectations of going home – nobody by then had told me anything. Only on Tuesday, do I get told what went on by the surgeons. A quick review on the internet suggests I'd had a lucky escape. Left untreated, my condition can be fatal. But there was no home for me – another night under observation.

The day went alright. The day staff were brilliant and I had brought just enough work to keep me busy. No meals, no fluids by mouth but intravenous pain-killers at least, so I got some work done.

Then, come the night … bedded down for a much needed sleep, I managed until about midnight. Then it happened again - the high-pitched "bee-boo, bee-boo, bee-boo…". On and on it went until I was awake. With no staff in sight, I had to trek down the corridor to find someone and tell them.

Ten minutes go by: "bee-boo, bee-boo, bee-boo…". Eventually a nurse turns up, and ignores the alarm: "bee-boo, bee-boo, bee-boo…". It's an intravenous pump for another patient. The nurse changes the drip. At last, silence – sort of. But I'm now wide awake, and sleep eludes me. I've lost the tiredness.

By morning, with other interruptions, I got about four hours of fitful sleep. There's no food or drink for me, and the docs want me in for another day, to check whether the repair is holding.

So, another night … Wednesday. Exhausted, I get to sleep. Come midnight, it happens again: the high-pitched "bee-boo, bee-boo, bee-boo…". On and on it went until I was awake. With no staff in sight, I had to trek down the corridor to find someone and tell them.

It still takes about ten minutes to shut off the alarm. I accuse the night nurse of inuring the alarm – it was clearly audible down the corridor. She denies it: she came when I told her … eventually. Wide awake, I end up again with about four hours sleep. By now it's Thursday. My CRP level (immediately dubbed by me as "crap level") isn't dropping – a potential indicator of problems. So it's another night in the ward … Thursday.

By now, the Covid figures have soared and the position is far worse in Bradford than the papers are saying. The hospital is shutting down again and there are no new admission other than Covid cases. Our wing was staffed for 20 patients. It has six, me included – no-one could say that the staff were over-worked.

Come the night, seriously exhausted, I get to sleep – but before I bed down, I tell the night nurse about my woes. But come midnight, it happens again … the high-pitched "bee-boo, bee-boo, bee-boo…". On and on it went until I was awake. With no staff in sight, I had to trek down the corridor to find someone and tell them.

This time, I am somewhat less emollient, suggesting that the next destination of the machine is through the window, while I run amok with an axe, slaughtering the staff. The nurse turns off the alarm and promises me I won't be disturbed again. Too late, I yell. I'm already awake! As before, with the other interruptions through the night, I get about four hours sleep.

Interestingly, there are papers written on the non-response to alarms. This paper notes that the variety of alarms from all types of medical devices has increased from 6 to 40 in the last three decades, with today's most critically ill patients experiencing as many as 45 alarms per hour.

Thus, "alarm fatigue" has been identified as a critical safety issue for clinical staff that can lead to potentially dangerous delays or nonresponse to actionable alarms, resulting in serious patient injury and death. What they don't realise is that there is the threat of injury and death to staff to deal with.

However, the paper does concede that these devices share similar alarm volume characteristics that range between 58 and 85 decibels, which compete for clinician attention in patient settings with background noise ranging between 56 and 76 decibels. Alarms, it says, "may interfere with a patient's sleep, cause unnecessary anxiety, and potentially negatively impact healing".

But, now, from Friday the staff are safe, for the moment. My Crap levels were down slightly but not low enough but I've bartered an escape option with the docs, on the basis that another "bee boo" night and I can't be held responsible for my actions. They want rid of non-Covid sufferers anyway, so the escape committee agrees. I'm out of it.

Back home and after a few hours undisturbed sleep, I am able to reflect on the experience. Of course it wasn't all bad - I've got my operation and was lucky to get the slot. As long as the repair holds, I have a chance of a pain-free future in which I will no longer need industrial quantities of pain-killers just to keep functioning.

Oddly enough, that's the only reason I ended up at BRI last week. Under pressure from the NHS, some months ago my GP had unilaterally cut down my opioid pain-killers. When I protested, only then did he set up yet another round of diagnostics which at last found the problem which had been troubling me for so long.

For what I've got, I should be and am grateful. But that doesn't mean we shouldn't complain when things don't work as well as they should. If we don't, things will never get better.

It seems to me that the system has lost any grasp of what it is trying to do. Patients are just cogs in the machine – we are "processing units" necessary to keep the system going. In this machine, sleep is not regarded as having any value so, for patients, it is no longer offered as an option.

There is no need for night-time wards to be hell-holes of disturbance. Yes, there are certain essential procedures which must be carried out through the night, but a combination of better management (and some technology) could easily silence the machines.

Until this happens - and for many other reasons - hospitals will not be good places for sick people. If you are not sick when you go in, you certainly will be by the time you come out.

Also published on Turbulent Times.

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