So it is true. Your life does pass before your eyes, or rather, race through your memory, when you look death in the face. Seven months ago my life came to an abrupt halt when, without warning, I collapsed with a heart attack. In those months which followed I walked hand in hand with death, never knowing when the final blow might be struck, ever hoping that I would be one of the lucky ones who pulled through to a better life. People rave about by-pass surgery, I suppose because most come out of it feeling 10 years younger. It appeals to the modern idea of a throw away society and is really no more complex than renewing the plumbing in your house. In reality, it is an expensive 4 hour operation and takes months in recovery.
I was impressed with the NHS through the treatment phase and did not really have long to wait because I was having warfarin, which thins the blood, as a treatment for a pulmonary embolism. Although, theoretically, I could have had heart surgery whilst this was happening, I was glad that we waited because I felt so much better afterwards. So, in my view, the best time for surgery is now, which means I have not had to wait at all.
'Come in next week for tests and a pre-admission visit', they said. Your operation will be the following week. Already my heart was pounding. Still, it was not too long to wait.
The visit went well. Very efficient and friendly. Outstandingly efficient x-ray department. Thorough questionaire, lots of blood samples and swabs. All systems go. 'Your admission is next Thursday', they said, 'for surgery on Friday. There are 3 operations each day and we cannot tell you which slot you will have.' I left feeling both apprehensive and re-assured that I was in good hands.
How long does it take to dissolve admiration? Ask the NHS (National Health Service, for the benefit of overseas readers). The journey home from the Royal Infirmary, Stoke on Trent, to Shrewsbury takes about an hour. Whilst I was away I had my phone diverted to a friend. I arrived home to find I had a message telling me that the admission had been brought forward a day. I was pleased. The next morning I had a phone call from the hospital asking me if I would go to Wolverhampton or Coventry instead. Bewildered, I explained that my admission had only just been confirmed and tests had been done ready for it. The woman said that she had been given a list and told to ring everyone on the list. That was all she knew. 'I think you'll find that I am on a short list, now', I said, hoping, rather than believing. She promised to investigate and phone me back. As tea time approached I realised that I had been forgotton. I rang her. She was surprised to hear from me and said someone else was supposed to have rung me. Anyway, it was good news. The admission was confirmed for Wednesday with surgery on Thursday.
The arrangements were made. Everyone knew the schedule. It had been a mad rush but I was ready. Strange to think that when I returned to my house I would be unable to reach the tea and sugar because of the soreness in my chest. I moved them down so I could get to them without stretching. As I waited that morning for time to catch up with events my mind drifted back to the debarcle of a week ago. I will ring just to confirm the day, I thought. I did. The woman remembered me and said she would check and phone me back. She did and quickly, too. 'Admission tomorrow for surgery on Thursday', she said. 'Tomorrow is Thursday', I said. 'Oh, surgery on Friday, then', she said. I quizzed her a bit to make sure she was correct and put the phone down. So, an unexpected extra day of freedom. I enjoyed it. Relaxed. Felt better for being able to chill out after the hectic preparations.
The peace was shattered with a phone call from my daughter. She told me that the hospital had phoned asking why I had not turned up. Not to panic, though. Just get yourself up there as soon as you can. My mood was changing now. It was not helped by the difficulty I had getting through to the hospital. I did not know who had phoned so rang the ward. No reply. Try again. No reply. Try switchboard. Eventually, I got through to the ward and put to them my proposal which was that I present myself for admission at 7 am. This was too much for the ward staff to deal with, a patient who makes proposals! They were, however, good humoured and promised to phone me back. It was nearly 2 hours before they did and the delay was caused by their attempts to track down the surgeon. He agreed. Brilliant. There then followed promises, nothing to eat, etc, no later than 7 am, and so on. Fast track thinks I. All sorted in a day.
The admission happened. I had the usual tests, tags on my wrists, Nil By Mouth sign over my bed, and so on. I felt as if I had sneeked in after a night on the town. The other patients were still asleep and I was ushered into my bedspace and installed before they were awake. It was exciting and again I felt my heart race a little faster.
I knew I had a long wait ahead. I was third on the list, which meant I would not be going into theatre before 3 pm and likely as late as 6 pm. I dozed awhile. Gradually, the others awoke. Strange, no one had had heart surgery. We began to talk. It turned out that the man opposite me lived a few streets away in Shrewsbury and passed my house when he collected his grand daughter from school. He had been admitted the previous day for surgery today. However, he explained, he had been waiting 5 months and had already been admitted once before only to be sent home again the next day. He expected the same thing to happen again. 'That's crazy', I said. 'Why should they send for me last night knowing that they are likely to discharge you today?' He didn't know and said he didn't mind really. They must know what they are doing. I began to wonder what was going on and particularly what my own position was going to be. No one had mentioned even a hint that my own surgery might not be proceeding. Nor did they. The man opposite left. The time passed. At 1 pm a staff nurse casually asked me, in passing, if anyone had checked to see if my surgery was going ahead. I replied, defensively, that this was the first mention to me that it might not. I had come here to have surgery. More time passed. At 3 pm the same staff nurse returned with the bad news that there was now confirmation that my surgery was not going ahead. I was to return home.
To say that I was displeased is an understatement. However, I have much experience of crisis and intense situations and my brain always manages to take over before my emotions make a fool of me. My eyes narrowed on the poor bearer of bad news. My voice became cold and logical as I gathered from her the facts. There are but 9 intensive care beds and although the surgery can be done it is the intensive care which causes the bottle neck. I quiz her on the man opposite. 'It's not the same', she fumbles. 'He has a different consultant to you.' 'Yes, but its the same intensive care department', says I. She admits defeat. Then my death blow. 'So, every day you admit patients, keep them until lunch time and if no one unexpectedly dies, you send them home again?' No reply. Then a defensive excuse to leave. Ten minutes later the staff nurse returned with a piece of paper. She had re-arranged my admission for the following week and ordered a free taxi to take me home today and to collect me next week. I would also be receiving a written apology from the hospital.
As statistics go the written apology, not to mention the taxis, are likely to be statistically significant. I cannot imagine that many patients receive the treatment I had. I seem to hear a hushing sound. No question, I am afraid. The facts in this affair are too important to be hushed up. I do not have exact figures but it is not difficult to extrapolate on known figures. The hospital does about 900 by-pass operations a year which equates to around 18 a week. The number admitted who are sent home again is likely to be all of that 900 who are not admitted directly from an emergency facility multiplied by the number of false admissions. So, if there are, for example, 450 admitted from a waiting list and each has 2 'false' admissions then there are 900 frustrated admissions.
There is a possible justification for this policy and that is that it guarantees that the expensive and scarce resource of intensive care is always full. Well, lets look at that. Most intensive care admissions are for a predictable period of time so it is possible to tell reasonably accurately when someone is likely to be moved to another facility because they no longer require intensive care. Mostly, but not always. Some develop complications and need to stay longer. Some die and create an unexpected vacancy. To some extent these 2 balance each other out. There is bound to be a surplus but I cannot say on which side it falls. Let us suppose that it is in favour of unexpected vacancies through death. Most patients are given around a 2% risk of death from surgery. So let us suppose that the surplus is around 1%. That means that an unexpected vacancy through death arises once every 6 weeks. That hardly justifies the huge number of 'false' admissions.
So why are so many patients being admitted and discharged on this dry cycling system? The answer is unclear but the Hospital Trust needs to give an explanation, as well as the figures. It is possible that the costs involved here are greater than the costs of the surgery actually performed. But I can tell you first hand that the human cost is definitely greater than the surgery itself.
Pierre
