The Great Escape & Cost of Care (Thank God for the NHS) Day 6 post op

Friday morning. Another restless night. It was difficult to find a position to sleep in and the wards were noisy. I made a decision last night that I would go home on Sunday as I had planned preoperatively. I now needed to persuade everyone else.

Yesterday going home over the weekend seemed an impossibility but I calculated what I would need to do to manage this. The critical task would be to do the stairs under the watchful gaze of the physiotherapist to ensure that I was safe to go home. Without this tick box, there was no way anyone would let me escape! The journey home would also be an hour and a half and I would need to ensure that I could sit in a car without motion sickness. Game on!

I managed to have breakfast and have a shower before lunch and then fell asleep. I was woken by the physiotherapist who suggested that as I was so tired that I should leave the stairs until Monday. I think I must have got myself out of bed and into the wheelchair in the quickest time possible. I managed to get myself up the stairs and down again and then back to bed. Mission accomplished! Not sure where the energy came from and my brother and sister were shocked that I had done this so quickly. 

My Consultant and the team visited and said they would review me over the weekend and if I was well, would agree to my discharge. Interestingly, throughout my stay, I saw more senior than junior doctors. This is worrying, as it is sharing the experience of senior decision-making that allows trainees to develop.  Trainees find that they are forced to work odd shifts that prevent them from learning from the continuity of experience that we enjoyed in the 90s. On two occasions, the most senior registrar had no team accompanying him, as there was no-one, and he was doing all the work that two or three people do by himself!

I did little on Friday and Saturday apart from eat, sleep and contemplate. Privacy on the wards is difficult and the staff were excellent in ensuring that dignity is preserved at all costs. Patients around me were travelling on their own difficult journeys but even when ill, it was noticeable that there is a recurrent strong human desire to connect with each other. Whether that is just a smile, a greeting or alerting staff when a fellow patient needs help. I had moved within the ward and therefore had to walk further to the bathroom. This was a challenge of course as Miss Independent was desperate to ensure she could do this and have the confidence of the nursing staff, so she could go home. The husband of the patient next door  was very sweet and although he did not say anything, he kept a careful eye on me walking whenever he was there. 

You cannot but overhear conversations on the ward and patients were concerned with paying £12 for the bedside television. Many years ago, each ward used to have a patient area with a  free television that encouraged patients to leave their beds and spend time and conversation with family and other patients.  Many tv lounges have been replaced as there is a greater need for bed space in our hospitals. Now we charge for the bedside tvs. I do often wonder if these tv companies reduced the price for each bedside session by half, whether more people would actually use them and they would increase their profits.

Overnight many patients were admitted and discharged. The turnover through the beds was immense as well as those needing longer term neurosurgical care. One young patient had been in or several days and was desperate to go home. The patient was keen to take their own discharge against medical advice and the staff worked hard to understand the concerns of patient and family to ensure a safe, timely discharge.

Another patient was very keen to go home. They had an accident whilst they had been away from home and their family had travelled to stay near them during their acute admission. Finance was obviously being stretched as the area around the John Radcliffe is not cheap to rent. They and their family were keen to get an early discharge as otherwise they would have to pay for another night in a hotel for three of them. 

This made me start thinking again about the NHS. We are privileged to live in a Nation where we do not have to think about the cost of care as we make decisions about interventions for out health.

Daddy was 90 when he died. The last few years required repeated hospital visits and care as his medical health changed and dementia set in. We were able to access this without a concern that we would not be able to afford it nor whether we should take him to hospital. 

I thought about my own care and listed all my treatment so far:

Medical outpatient x 2

Diabetologist x 3

Cardiologist x 2

Neurologist x 2

ENT Surgeon x2

Neurosurgeon x 5

Audiologist x 1

Nurse preassessment x1

Inpatient stay of 6 days

ITU stay 1 day

Procedures:

Craniotomy for an acoustic neuroma 10 hours

CT scan x 5

ECG x 2

Echo x 1

Dobutamine stress Echo x 1

CXR x 1

Bloods Full blood count, Urea and Electrolytes, Glucose x 4 Cross Match x 1

Medication: 7 days

Estimated Costs 

Private Costs in the UK: £20, 000

Private Costs in the USA: $50, 000 (I have been advised by many readers that this is a gross underestimate and that $500, 000 is  a more realistic figure)

Cost in NHS: 0

There must be many who feel very strongly with regard to the NHS and surely it is time to ask the public what they want and how to fund it. I am eternally grateful for my care as it will get me back to active life doing what I love and enjoying time with my family, colleagues and trainees.  

I was in awe of the night staff in my bay, who had a very difficult job managing a patient who had a bleed within their brain. This caused nausea, vomiting, confusion and a need for expert nursing and medical care. The dedication of the nursing staff was exemplary in the way they were able to manage the patients concerns and fears. Despite the nursing staff being so busy with this patient, I still felt I had the attention I needed to ensure that I had pain relief and all my observations were done. Despite the fact it was only day 7, I was already fed up of the needle prick to ensure my sugars were fine and developed real empathy for my patients with diabetes.  I needed to get out of hospital!

I knew that I would have a long journey on Sunday and was really worried about feeling sick whilst travelling. So we decided that I would visit the coffee shop in the wheelchair. I soon discovered that this was going to be an uncomfortable journey but my brother was a great driver! It was great to get out of the ward, even if just down to the main foyer. I was beginning to feel quite depressed and wondered how my patients managed being in for many weeks. When staffing levels on wards seemed better  many years ago, I remember Ward Sister (with whom you did not argue) asking junior nurses to take patients into the sunshine in wheelchairs, when they had no family or friends of their own to do so. Not sure we do this now at all?

The next day, my husband arrived bright and early. I was given my medications and take home letter. My dressing was changed and I managed to escape on Sunday morning. I had planned to change into outdoor clothes and flat shoes but did not have the energy to do so and left in my pyjamas, dressing gown and slippers. 

The journey back was long. Every bump in the road made my head hurt. I had taken painkillers before I left but these did not seem to make a difference. My body ached but it was such a relief to sit in the car knowing I would be home soon. I am not sure why but I started crying as soon as I sat in the car in the car park of John Radcliffe much to my family’s dismay. I discovered that travelling with my eyes shut seemed to be the best and my husband had to drive reasonably slowly otherwise I felt quite queasy.

Home was strange. Suddenly you feel very vulnerable. I was worried as to whether I would manage the pain but I had several strong painkillers sent home with me. My sister posted on Facebook for me and I felt that I started to reconnect with the real world. When she left later on, I opened up the computer and started to see what had been going on. I began to feel quite tired and made the difficult trek upstairs and tried to sleep having taken the strongest painkillers. 

My brain was obviously not used to thinking and concentrating and it rebelled. I had the most awful headache and just could not sleep. I spent a very restless night and was unable to get out of bed in the morning. I did not touch the computer for several days!

The next few days were spent in bed, in pyjamas doing nothing. I was so exhausted and just could not get myself going. I ate, drank and slept. It is interesting how we all return to our basic needs. My family was wonderful and made sure I had my pain killers on time. We rediscovered my father’s neck warmer which was a godsend. 

Then the flowers, cards and best wishes started pouring in. 

I was surrounded by the scent of flowers and humbled by the good wishes and prayers to help me get better. This is my kitchen table by the end of the first week! Thank you to all of you. When there are so many evil occurrences in the world, gestures like this make you realise how wonderful human kindness and caring can be.