Surviving A&E

It may be stating the obvious that anyone can end up in A&E but for those of us with chronic conditions, or advancing years, the odds escalate. It’s clearly a stressful time regardless of whether you are the patient or simply accompanying them. News reports of long delays for emergency ambulances and extended waits to gain access to A&E itself make the prospects of a visit even more uncertain. For at least three years I’ve been dreading that I would need a trip to A&E, knowing it would probably be a very extended experience.

In the last 11 years I have been an A&E patient four times and have accompanied elderly parents on several other occasions. Over that period I’ve had a chance to see how things have changed and adapt my coping strategy accordingly. (I hope that you don’t think I’m over thinking it by having a “coping strategy”. I’ll let you be the judge if you make it to the end of this blog. Maybe you could give me some feedback via Twitter on your thoughts.)

My first two trips were after calling 999 and on both occasions the ambulance arrived within 8 minutes. Yes 8 minutes! Coincidentally it was the same crew each time. The first call (2011) was due to my stoma bag filling, quite rapidly, with blood. The second time (2012) still involved the red stuff but this time I was vomiting it and that time I had the added excitement of the siren and blue lights. I’ve written about the incidents in my book.

My wife came with me in the ambulance each time. The main lesson we learnt was that, once you’ve been processed through triage, communication is the biggest issue. With a large number of patients being treated it is simply not possible for each one to be given an update every 5 minutes. If a real emergency is brought in then the doctors and nurses are diverted to treat them. You have to wait until someone approaches you to move to the next stage of your treatment.

I found that having my wife made me more stressed! Whilst it was great to have her company I know how much she dislikes hospitals. I ended up worrying about how she was coping with the situation as well as what was happening to me. Double the stress, and as we went further into the night it became a question of what point should she call it a day (night0 and make her way home.

In 2010/11 I had spent several weeks in a major London hospital so had become relaxed about being in a hospital environment, having cannulas inserted and all the other checks and indignities that one undergoes. Being in London had made visiting difficult because of the distance from home so I became used to spending extended periods on my own. It has subsequently made it easier to cope but I can understand why it is difficult for those new to the experience.

On my third visit (2017) I had turned yellow (jaundice) and my GP sent me off to A&E. No need for an ambulance this time so I arranged a lift once I had packed an overnight bag and walked into hospital unaccompanied.

Having booked in at reception I was taken to see the triage nurse and then returned to the waiting area. At this point previous experience taught me it was into the unknown and the indeterminate waiting would start. Rather than looking at my watch every two minutes or trying to catch a nurse’s eye, each time they passed by, I decided to set a time, in this case one hour, at which, if I had not moved on to the next stage of treatment, I would go to the nurses’ station and ask what was happening. This structured approach seemed to really help.

To pass the time I read a book although it was not always easy to concentrate with all the hustle and bustle going on around me. I managed to keep relatively relaxed. In the end I was moved to a bed in the Medical Assessment Unit, a small ward attached to A&E and I stayed there until I had been seen by a consultant and discharged the next morning. I felt I had managed my stress well for the most part.

My last trip to A&E was two weeks ago (March 2023) after experiencing malaena. In the 6 years since 2017 I knew that the service level had been considerably degraded due to the lack of resources, staff and onward bed blocking. I was convinced that my previous “set time limits” strategy would not work this time. I packed my bag, said goodbye to my wife and then set off for A&E with some trepidation.

Ever since starting to write a patient’s blog in 2010 I have found that the creative process has been very cathartic. The “reporting” aspect has allowed me to be almost at arm’s length and to view my treatment as if I am a third party, detached. I wondered if treating this latest experience as an “opportunity to witness and report the situation at first hand” would help pass the time and keep stress levels down

I decided to regularly Tweet my progress through the system and illustrate with photographs where possible. A distinct advantage of using SoMe to post updates is that you get feedback from others and it helps to feel that you’re not alone through the ordeal. Even in the wee small hours there is usually someone awake that responds. There is also the discipline of getting your message across in the limited number of characters.

I decided to copy some of the Tweets to our local MP, Claire Coutinho (East Surrey), so that she was aware of what was happening under her government’s 13 year watch. I didn’t get any response, of course.

I have since compiled the Tweets and photos into a blog which can be found here –…….. I’ll let you be the judge of how well I coped, or not!

The experience was considerably worse than before and I ended up on a bed in one of the A&E corridors for 14 hours before being sent for an endoscopy and then moved to a ward. I wasn’t the only patient waiting in the corridors.

Again I found that by having a “strategy” I could cope with the mind numbingly boring periods when nothing seemed to be happening. It helped that I was fairly sure what the consultant would find when she scoped me and what the treatment would be. Having been through the same issue before I also knew what the aftercare should be and was able to use this to argue for my discharge from hospital sooner rather than later. As I said to the consultant on her ward round – “being in hospital is doing my head in. My recovery will be a lot quicker at home”.

I came away with nothing but sympathy for the NHS doctors and nurses trying to deliver a first class service without the resources they need. I cannot see the situation improving until the care sector is sorted out and patients can be discharged when they are medically ready rather than when they can be found a space in a care home.