Sat 10 April, 2004
By now I was feeling much better, both physically and mentally. Unfortunately, I was still attached to the bed by my catheter and the PCA as well as other lines and tubes. I was starting to want to get up and about, but frustrated by the encumbrances attached to my body.
My brother made a special visit down from Manchester to see me in hospital, so had a good chat with him and his family. Also, Peter, a doctor friend of mine popped in to have a chat. I asked if he wanted to hear all the gory details, but his response was that he probably knew more than me. He was only half joking, as my wife and I had reported most of the medical information to Peter and his wife Annie—also a doctor. We did not understand the jargon, but they did, and they were also able to make a prognosis. I later discovered that my blood (haemoglobin) count had fallen to 6.5. Apparently, this meant there was not really enough red blood cells to carry oxygen around my body. This was consistent with major blood loss, and Annie had urged my wife very strongly to call my parents and get them to my bedside.
Later in the night I felt sick, and attributed it either directly to morphine (nausea is a known side effect), or to withdrawal symptoms after stopping the opiate. I made a firm decision not to use the PCA any more, no matter what the medical staff said.
For readers in the United States, and other places that do not have a State-funded healthcare system, the National Health Service, universally known in the UK as the 'NHS' is something of a mystery. Let me try to cast some light on this.
On the positive side, I am in a top London teaching hospital. It has some of the best medical staff in the world, along with some of the best medical equipment money can buy. The medical care is, I honestly believe, second to none. In addition, they provide me with a bed, with good, wholesome food; with drinks, entertainment, linen, towels and most of the other small necessities of life. They supply all my drugs. I do not pay a penny for any of this, except my normal taxation burden.
This service is available to everyone here in the UK, provided they are a European citizen, and irrespective of the amount of tax or any other contributions paid over the last few years.
On the downside, the wards are crowded, the rooms and corridors a bit old and run down; the bed itself is a bit of a lottery—some are dreadfully uncomfortable; others are magnificent. The doctors have relatively little time to explain what is going on to the patients, so there can be a lot of waiting around and there is relatively poor flow of information to the patients about what is being done to them, what drugs they are being given. Of course a lively mind and a positive, questioning attitude go a long way to help fill the information gap.
Sometimes there are acrid-smelling pools on the bathroom floor, and sometimes there are mysterious stains on bathroom implements, and there is black mould growing everywhere in the bathroom and shower. Occasionally things of value go missing. Although in my experience, this is less to do with theft, and more to do with carelessness.
We in the UK often deride the health service, but this recent experience has left me with nothing but praise for the system and the people who work within it.
After the initial traumatic accident and subsequent surgery, the doctors have recommended (and the nurses arranged) treatments including Ultrasound scan, multiple X-rays, a gastric endoscope and others, at very short notice. All at no charge.
In one small example, I have been having stomach pains for some months. I should have gone to my doctor, but never did. These pains are completely unrelated to the accident, but in any case, I was sent at about 8 hours’ notice, down to the endoscopy department to have a camera pushed down my throat into my stomach to look for ulcers. They found that the lining on the lower few inches of my oesophagus has been stripped away by excess acid coming up from my stomach, but there is no ulcer.
The condition is called Barrett's oesophagus. It involves cells in the oesophagus which, after repeated exposure to stomach acids, start to change into stomach cells. It is a pre-cancerous condition. However, if the cells turn cancerous, and the change is detected early, then a simple operation usually provides a permanent solution.
I do not know how long it would have taken to arrange that type of endoscopy and diagnosis had I gone through my primary health provider, but I imagine it would be many months. However, once in hospital, it happened in the space of hours. This gives the lie to the myth of a creaking health service, at least under certain specific circumstances.
In another example, the physio service was also wonderful. On Easter Sunday, I mentioned to a nurse that I would need some physio. Within hours the head of physiotherapy service came to prod and poke and offer advice. I was given a walking frame, a stick and, eventually, crutches; shown how to use them and instructed in the various muscles and bones that had been damaged, together with suggestions for appropriate exercises.
I am no apologist for the NHS. I suffered a little toward the end of my stay. Although I am under the care of one of Britain’s top doctors, Mr Mudan, he is not a bone specialist. By day 9, for example, Mr Mudan had said, so far as his team was concerned, I could go home. However, there was an issue with some cracks in my pelvis, and these needed to be examined by another consultant, an orthopaedic (bones) specialist. Administrative problems meant there was a delay in studying the relevant X-rays. That meant I was left waiting to leave the hospital for about four days, while the orthopaedic team found the time to look at my notes and make a decision on my future. Silly and counter-productive, as they could have used the bed for another patient. But that is the NHS. Good at emergency medical care; not so good at simple administration.
The first-line healthcare provider for most UK residents is the GP, or General Practitioner. These are arranged in teams and serve relatively small geographic areas. There is a desperate shortage of GPs in the country, because the work is tough, the hours are long and the income is not especially generous. Perhaps $100 000 per year sounds good, but for the hours they work and the stress they endure, I can assure readers that it is not always an attractive option. GPs are leaving the profession in droves, preferring early retirement, alcoholism, or even suicide to the stress and heavy workload of general practice.
There is private healthcare in the UK. Many employers provide private healthcare as a perk for their employees on the grounds that medical procedures can be arranged at times to suit the patient--or the employer. Private healthcare is expensive, but it provides great service for non-emergency treatment. It also provides pretty furnishings, private TV, gourmet food, and more generally patient-oriented treatment and communication. If there was some reason to have a spleen out which could be planned, such as a diseased spleen or some such, then a private patient with sufficient resources—or insurance—could request the surgery be carried out by Mr Mudan at a private clinic. The patient—or his insurance company—would be charged thousands of pounds to buy his skill and expertise, and to hire an operating theatre and the associated medical team. And then a further £300 to £400 per day for the private hospital to go with the surgery. I got all that for free under the NHS.
Most of us survive with the NHS. When it works-—as with me-—it is wonderful, but all too often, and especially where minor or chronic complaints, or care for the elderly is involved, it does not work, and the patient is left feeling let down and frequently in pain. That is where the private healthcare providers, and especially the insurance companies who fund them, are making their money.