Disclaimer : none of this blog should be taken as criticism of the doctors and nurses that treated me. They were struggling to provide a professional service in under resourced conditions.
THURSDAY 9th MARCH 2023
13:00. I had called in to my GP surgery to ask if a doctor could ring me about the malaena I was experiencing. (I’ll let you look that up to save me having to type out the gory details). When I returned home the surgery rang to say the doctor would like to see me that afternoon.
16:30 I explained the problem and that I hadn’t eaten anything since eight o’clock the previous night. The doctor checked my vital signs. All OK. We discussed whether I should go to our local A&E or see if it resolved itself, my preferred option. He went to speak to a colleague for a second opinion. They both agreed – A&E.
I returned home and told my wife the news. We packed my overnight bag as I knew it would be a long wait in A&E, (The last time I suffered malaena I ended up spending 2 weeks in hospital – not all that time in A&E obviously!)
My sister came to collect me and took me to East Surrey Hospital. Knowing that I was in for a difficult time I needed a strategy to cope with the inevitable delays that I would face. It would be a chance to experience the health service in crisis. To pass the time/record my experience I decided to Tweet my progress. (Apologies for typing errors, I did have a cannula in one arm). Here goes…
18:20 Walked into East Surrey Hospital A&E. Handed the GP’s letter into reception and confirmed my details. I asked reception how busy they were that night. Not too bad! Fingers crossed. There only appeared to be 8 potential patients in the waiting area. I did not know how many had already been admitted to the inner sanctum.
After a few minutes I was called in by the triage nurse who took further details about my general health and medications.
19:20 Taken through to the A&E inner area and sat on a trolley in a cubicle.
19:42 A nurse inserted a cannula into my arm and took blood samples then hurried away to get them tested. A doctor would come and see me when the results were known.
20:45 A doctor, in very fetching all red scrubs, came over and told me that my Hb was 115. He had expected worse. My platelets were 120 which came as a surprise as they have been around 55 for the last few years (drug induced thrombocytopenia). The doctor said that he needed to do a rectal examination. I asked him to check my prostrate whilst he was there! No problem! He reported that it was small & smooth (which I think is a good sign). He directed me to a chair in another curtained area.
21:29 I was connected to saline drips together with cyclizine (anti-sickness) and then omeprazole (anti-heartburn) to protect my oesophagus.
21:57 Taken, in the chair, to have chest X-ray.
22:04 X-ray completed and returned to booth in A&E.
22:49 Just over 4 hours from checking in I was sitting in chair in limbo in the middle of A&E.
23:33 Another 2 hours of drips to complete before seeing another doctor. The chair was becoming uncomfortable and no sign of a bed. Midnight approached.
FRIDAY 10TH MARCH 2023
00:33 6 hours from arrival I was moved to a bed in a “Sub Unit”. This may sound very grand but in practice it was a bed, in one of the A&E corridors, signified by piece of paper stuck to wall saying “Sub Unit Bed 3”. Unfortunately it was next to the entrance for ambulance arrivals and the doors to the public waiting area. It was very cold as each time a trolley was brought in the sub zero temperature outside was evident.
03:46 Still on the bed SU3 in the busy corridor wondering what was happening. Communication is always the problem.
04:06 A nurse took my vital signs again and told me I was awaiting the doctor before deciding wha the next step was. Asked if I could have something to eat. Nurse returned with some sandwiches and ice cream. Managed a quarter of the worst sandwich I’ve ever tasted but the ice cream was delicious, albeit very small.
04:42 I went to the nurses’ station and asked what was happening. They were waiting for the medical team to come and see me. They were a bit “snowed under” but should be with me shortly.
04:45 Seen by doctor from medical team. Gave him a copy of my “jigsaw” diagram outlining my medical history which I had had the presence of mind to print off before heading for A&E. He seemed impressed. He was just filling in some details in my notes but I would have another couple of hours before I saw the gastro team.
07:19 I must have been tired enough to drift off for a while. The hospital was now waking up.
07:40 Have been told that the consultants started their rounds at 9:00 so have at least another 90 minutes before I get seen. Just heard nurse say “I’ve got one more bed space in the corridor then that’s it!”
08:08 A nurse came and put up a sign saying “nil by mouth” as “the gastro team might want to scope you. They could appear anytime this morning”. More frustration. She put up another saline drip. I asked if it could be put on a moveable stand so that it was easier to make my way to the toilet rather than have to disconnect it each time.
09:56 Must have dozed off again and during that time the saline drip had been transferred to a stand fixed to the bed and the moveable one had disappeared! Best laid plans….
12:09 It was getting so cold I put on my hat, scarf and coat in an attempt to keep warm. No outside windows so losing a sense of time. It’s midday already!
The gastro consultant and another doctor appeared to discuss my condition. I suggested that a busy, freezing corridor was not an appropriate location for this discussion and that we should find somewhere else. Luckily here was an empty office not far away so we decamped into there.
13:48 I had mentioned to the doctor that my shoulder had been hurting for the last few weeks. I should have mentioned it earlier and it was exacerbated by lying in the draught for hours. A porter arrived to wheel me, on the bed, for another x-ray. I was hoping that when I returned the position by the doors would have been occupied but no, it was still empty and I was back there again. At least it soaked up a few more mind numbingly boring minutes.
14:40 Another porter arrived with a chair to take me to the Endoscopy Unit.
15:00 It was now 20 hours since I had entered A&E and 14 hours on the bed in the corridor. I hoped nobody considered that I was whinging by tweeting my progress. I copied in our local Tory MP for East Surrey so that she was aware of the conditions in A&E. I did not expect a response and did not get one.
15:15 The consultant appeared and asked if I knew what an OGD (upper GI endoscopy) involved and the implications of banding. I replied that this would be my 16th time for having this procedure and that I had had one just 3 weeks ago! (Google oesophageal varices/band ligation for further information). I signed the consent form and preparations got underway. The nurses introduced themselves and I was wheeled into the theatre. Everyone was very friendly and caring. Bring on the burnt bananas (if you know, you know!)
15:37 I asked the endoscopy nurses if it was OK to take a picture of the equipment so that I had a record of when the procedure was about to start. (During my previous procedure at St.Thomas’ I had somehow managed, whilst under sedation, to take my camera from my pocket, carefully frame a picture and took a photo of the unit. I had no recollection of doing it so this time, to be sure, I handed my camera over!
17:30 I opted for full sedation. I always do. Even under sedation I do remember coming to slightly, retching and the nurse putting his hand on my shoulder telling me I was doing “very well”. When I fully came round in recovery I was told that 4 oesophageal varices had been banded.
18:41 I was wheeled to Charlwood Ward. I had spent a couple of weeks in this same ward after the last incident of malaena in June 2012, shortly after it was opened. A fifth bed had now been introduced into the 4 bed wards. Now, over 24 hours from setting foot in A&E, I had a bed on a ward. Fourteen of those hours were spent on a bed in a draughty corridor.
20:02 I must have dozed off yet again but that was understandable from the cocktail of fentanyl and midazolam that I had been given. I did need to see endoscopy report to confirm what I could eat but it was a little academic as no food was available.
21:48 I asked for a copy of the endoscopy report but was told that the consultant needed to explain it to me. It was important to know exactly what had been done during the procedure as it would dictate what I was allowed to eat. The nurse offered me a couple of Fortisips. Clearly I would be in hospital overnight so it was time to change into my pyjamas and try and get comfortable.
SATURDAY 11TH MARCH 2023
I managed to get some more, rather fitful, sleep as my shoulder was causing significant discomfort and the patient in the next bed was crying out in considerable pain. I must have still been under the influence of the sedation.
09:24 I messaged my wife to tell her that I would give her an update when I knew what was happening. Waiting for the doctors to do their round.
10:00 I was concerned that I might miss the ward round but decided to risk having a shower. The world seemed a better place afterwards!
10:13 The consultant and a doctor arrived. She explained again that she had banded 4 varices and that she wanted to keep me in hospital for at least another day. I countered that by saying that the hospital environment was “doing my head in” and that I was fully aware of the implications of having been banded and that, in my opinion, I would recover much quicker in my home environment. I also explained that I didn’t like the burden that being in hospital put upon my wife at home on her own. She hesitated but realised that I might discharge myself (I wouldn’t have done!). She agreed that I could leave that afternoon.
I asked THE question “what could stop me from being discharged”. As long as I had my medication from the pharmacy and the discharge letter then I would be good to go.
11:56 The period between the ward round and lunch is the quietest time on a ward and the best time to get some sleep. it was remarkably quiet. The patient in terrible pain had been taken off to theatre for his surgery and the other three patients were dozing.
12:25 The lunch trolley arrived. I was given a Level 6 soft bitesize meal and was just about to tuck in when it was whisked away from me! I needed a pureed Level 4 meal!
12:30 I was given a puree level 4 meal instead. Whilst it didn’t look very appetising it wasn’t bad and I enjoyed my first proper food for over 60 hours.
13:40 The ward sister appeared with my discharge letter and the tablets from pharmacy. I was free to go. I rang up my brother-in-law and he collected me.
15:01 Home again. Time to reflect upon what had caused my varices to burst so soon after having been given a clean bill of health only 3 weeks previously and to think about what I can do to prevent it happening again. will contact my consultants at my usual hospital to ask their advice.
There will be a second post comparing my previous experiences of A&E and how I tried to make the experience more bearable.