Four Hours in the Eye Surgery Day Unit

On looking back, the signs had been there for years. First, Nadia had trouble at night from the glare. Then reading got harder, especially the day she picked up an Egyptian newspaper in Paddington. Arabic, with its tiny script and its proliferation of vital dots above and below the letters, is the least appropriate language for someone with poor vision.

She wonders why she’d got cataracts by the age of 55. Probably to do with a stupid game they used to play at the beach in Alexandria.  She, Zeinab, Chou-Chou, and of course her sister Simone all dared one another to look straight into the sun for as long as they could. Nadia still has the memory of the after-burn. How was she to know, until Simone told her, that her school friends all cheated by shutting their eyes when she wasn’t looking at them?

“The Nile has cataracts too,” says Chou-Chou. She is still stupid despite being middle-aged now.

“They’re not the same thing,” Nadia replies loftily, even though she is unsure of the difference.

Nobody gets a bed on this day surgery unit. They get an armchair, but only if there’s one free at the appointed time. There isn’t. Along with three other patients, Nadia sits in the corridor. Waiting in corridors is normal in the NHS. It was never like this in Egypt, if you could afford bakshish.

An Iranian nurse and two Irish nurses seem to run the place. Each of them asks Nadia if she is diabetic.

“I’m not diabetic.”

In a nearby office, a doctor sits with the door open. Nadia can hear her complain about the computer system. Doctors always do this.

Once Nadia is installed in her allocated chair, an Irish nurse comes in to put drops into her left eye. “Are you diabetic?”

“No.”

After two lots of eye drops, her vision is so blurred that she can no longer decipher the stream of bile about immigrants, shameless young people, and disgraced celebrities in the newspaper someone discarded.

A young doctor comes to explain the op, reeling off a long list of potential complications. “There’s a one in 1,000 chance of losing all the sight in that eye.”

Nadia recalls a handsome man at Montazah who wore tiny briefs and an eyepatch. He liked to say he’d lost an eye in a duel, though, as her sister told her later, it was really a cataract operation gone wrong. She signs the consent form, sure that things have moved on and that it won’t happen to her.

The surgery is under local while her surgeon hums snatches of an aria and asks about her family.

“There’s nobody left.” Still, Nadia cradles the hope that improved vision will help her find her lost sister.

Everything is bright with a watery blue light. A machine buzzes, and the lens fragments are washed out before a new lens is put into place. She feels nothing.

Soon he says, “All done,” and peels the plastic drape off.

“You can sit up now,” says someone else.

So many voices she doesn’t know, and her head swims when she sits up.

Once back on the ward, a nurse offers her tea and asks again if she is diabetic.

Nadia checks in the mirror that she always keeps in her handbag. There she is, a plastic shield over one eye, with two long strips of tape holding it down.

The nurse returns with tea and instructions: eye drops for the next four weeks, eye shield on at night for a week, sunglasses for a few days, and no hair-washing for five days.

Of course Nadia will wear sunglasses! If her hair is going to be filthy, she doesn’t want anyone recognizing her.

The next day, she removes the eye shield for the first time. Everything is so bright. She can see every leaf on the trees, every speck of dust on the windowsill, every wrinkle on her face. They don’t make mirrors like they used to, that’s for sure.

***

Nadia is a character from my next novel, which is set in Alexandria and London.

If you’d like to know more about cataracts, try this link from Moorfields Eye Hospital.

You may also enjoy Six Lessons from the Eye Clinic.

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What Your Doctor is Really Saying

Confused when you see the doctor? It’s no great surprise. Medics are famed for their jargon. But, even when they remember to use simple English instead of medicalese, they come out with euphemisms and other phrases that conceal what they really have in mind.

FreeImages.com/Carlos Paes

I know, because I do it too. Now, with the benefit of years of experience, I can help you decode what your doctor really means.

What the doctor says

What the doctor really means

I see you’ve brought a list. Splendid! Now we’ll be here all day.
Any thoughts yourself as to what it might be? OK, what did you find on Google?
As it happens, my colleague has a special interest in your problem. I’m all out of ideas.
It’s a classic example of Tsutsugamushi Fever. Never seen a case of it, but doesn’t it sound grand?
You’ve got a case of pendulum plumbi. You’re swinging the lead.
I think I should examine those feet of yours. Hope you’ve had a bath recently.
Or perhaps I’ll get Nurse to send toenail clippings to the lab. Actually, I’m bloody sure you haven’t.
I’m not in the slightest bit worried, but I think you should go to A&E just to get it checked out. I’m shitting myself.
This won’t hurt a bit. It’ll hurt a lot.
Now just a little prick with a needle. Now just a little prick with a needle.

 

So, with the benefit of this little chart, you can make the most of your next appointment. If you can get one, that is.

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A Day on a Hospital Trolley

Even though he’s a fictional character, GP Geoff is not so very different from most other medics. If he needs to see a doctor, all he does is look in the mirror.

hospital entrance

But the swelling and dragging sensation in his left groin have become hard to ignore, and today he’s going into the Day Surgery Unit of his local hospital. Hernia repair used to mean a sizeable incision and several days in hospital, but, with keyhole surgery, Geoff will be home the same day.

About 90% of operations are now done as day case surgery. Beds are as rare as unicorns, thinks Geoff as he meets Cecil, the day care nurse who’s looking after him today.

Today Geoff doesn’t get a bed, just a trolley on a six-bedded ward. If a patient turns out not to be fit to go home the same day after all, then he gets to stay overnight. On that same trolley.

Geoff has been qualified just 15 years and already things have changed beyond measure. Or have they always been like this for patients?

surgical dressings

A junior surgeon pops round with a consent form, then the anaesthetist visits. Geoff is distracted by her dazzling smile, her shock of red curls, but mostly by her multiple nasal piercings. What happens when she has a cold?

“With modern anaesthetic drugs,” she tells him, “you wake up so clear-headed that you can do The Times crossword.”

Which is wonderful because Geoff’s never been able to do The Times crossword.

He won’t get a pre-med, which is a shame. It used to be the best thing about having surgery, but there’s no scope for such things on the day surgery conveyor belt. Besides, Geoff needs to be in charge of his feet, because, when he’s changed into a flimsy gown and paper underpants, a nurse takes him for a long trek to the operating theatre. He hopes he doesn’t run into any of his patients.

Geoff meets the consultant surgeon for the first time in the anaesthetic room. He’s more Doogie Howser than Dr Finlay. Geoff resists asking if his mother knows where he is.

scalpel

When it’s all over, he can hardly feel he’s had anything done, but he’s lying in a large well-lit room where a nurse is telling him to drink. He had not realised he was clutching a small Styrofoam cup.

Back on the Day Surgery Unit, Nurse Cecil checks his pulse, blood pressure, and oxygen saturations every half hour, and reminds him to eat and drink. There’s an obligatory six hours before he can go home. There’s also the requirement to consume the tea and roast beef sandwich placed next to him.

The man on the neighbouring trolley is smiling at a film on his iPhone. Geoff can’t see the man opposite, as his girlfriend is busy delivering a prolonged post-op snog.

Geoff decides against powering up his phone. The pre-op instructions were clear: do not do anything important in the next 24 hours. The last thing he needs is a spirited twitter exchange with one of those anti-vaccine types.

Geoff doesn’t have a newspaper so he can’t test the anaesthetist’s promise. He brought the latest British Medical Journal, but he doesn’t much feel like it now. Or the sandwich. 

British Medical Journal

The patient by the window has already regained his appetite, judging by the takeaway his family brought in. The red and white packaging is already open, filling the ward with the heady aroma of grease, along with 17 different herbs and spices.

Eventually Geoff does what’s required of him: drink, eat, and pass urine. Post-op pain is breaking through by the time he gets to the tiny WC, where someone has already hosed down the floor.

In the corridor, one of the female patients is asking Cecil where she can find a nurse, oblivious of the fact that she is speaking to a nurse. “I’m a nurse,” says the nurse. The patient’s face is blank.

Finally Geoff goes home with a paper bag. It has spare dressings, a packet of painkillers, and instruction leaflets on not picking your scabs.

There’s supposed to be a responsible adult with him for the first 24 hours at home. Geoff, who’s single, fibbed about that bit. Luckily nobody checks, and he absconds in an Uber.

Nothing will go wrong, Geoff tells himself. Aside from the little lie he told the hospital, he plans to be a good patient and take careful note of all the instructions. At first, he is a little confused by the stated telephone times.

Then he realises it’s exactly like Sainsbury’s, trolleys and all.

 

Geoff lives in North London where he looks after patients, longs for a meaningful relationship, and rants about the NHS. You can find out more about him and his life in the pages of Hampstead Fever.

You may also like these posts:

How Are You Today, Grandma?

Germs and Geriatrics

 

How to Alienate Your Doctor in 10 Easy Steps

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

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But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

kitchen-clock

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.

Feedback Frenzy

My pocket chirrups as I descend the steps from my bank. The text message asks me to rate my recent customer experience. This happens to be one of a hundred or more perfectly routine transactions I’ve made at that bank.   

FreeImages.com/Simon Stratford

Irritated, I delete the text.

At school, there was a girl who was forever checking what people thought of her. Sadly, the answer was ‘not much’, but this didn’t stop her beaming at everyone and trying to decipher their expressions.  When she couldn’t read the emotional temperature, she would ask what we thought. I wince to report that we thought our classmate stupid. Looking back, however, she was well ahead of her time.

These days, Waitrose sends me emails asking how my groceries were. Would I rate and review them?

waitrose-redcurrant-jellyI get similar requests after almost every commercial interaction of the day. If not during it. A text thanks me for travelling with Addison Lee, and invites me to rate the driver. I get this message before I’ve even reached the destination.

Ditto Moonpig, who want to know how everything went with the card I ordered. It’s not even scheduled to be delivered till next week. Stop asking me!

Now an email thanks me for collecting my parcel from the Spar in Chesterton Road, and asks me how I would ‘rate the service in store’.

The bottom line? It was fine. I got my parcel. Had the guy behind the counter not found it, or handed me a damaged parcel or something entirely different like a Mars Bar or a lottery ticket, you can be sure I’d have let someone know, loud and clear.  FreeImages.com/Tony CloughFeedback can certainly be useful. Book reviews, for instance, help guide the author as well as people looking for their next read – though it’s worth noting that the most useful reviews have actual words in them, not just a star rating.

Evaluations from the students I teach can also be valuable, if they help improve the outcome for the next lot.

For feedback to be most useful to others, it pays to ask the right questions. One pension provider invites me to rate my recent dealings with them. A more pertinent point might be whether I was happy with the return on my investment.

Nowadays, detailed feedback from patients is an integral part of a doctor’s appraisal process. It’s a two-page form that demands a certain level of literacy and attention. That makes it difficult for many patients, especially those who’ve just had bad news or been sent to hospital.

Feedback from colleagues is even harder to come by. In smaller practices, family doctors may resort to asking people they haven’t worked with for years, just to make up the numbers.

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Feedback shouldn’t be just about collecting all the data we can, because we can. To have any value, it needs to be more selective, and to ask the right questions at the right time.

***

If you’ve read a book you enjoyed lately, please think of leaving a review on Amazon or your favourite reading site. It doesn’t have to be long, just your overall impression and anything you’d like the author and prospective readers to know.

Here’s more detailed guidance, should you feel like it: How to write critical book reviews – and why I think you should, by Debbie Young.

bookshelf crop

Just How Fictional is Fiction?

There’s a socking great disclaimer at the front of my novels.

“This is a work of fiction. All characters and events in this work, other than those clearly in the public domain, are entirely fictitious. Any resemblance to any persons, living or dead, is purely coincidental.”

The real bits should be obvious. All you have to do is check out Marylebone, or amble down Hampstead High Street.

Hampstead Butcher & Providore

I’ve made up almost all the rest. Not that readers believe authors’ protestations.

Friends and family are apt to dissect published novels with an eye on ‘real life’. Even Ian Fleming, I’m told, suffered from this problem. People don’t just ask “Am I in it?” They go straight for “Which character am I?” I have half a dozen friends who believe they’re the single mother from One Night at the Jacaranda, and one who still thinks she’s the femme fatale.

Waitrose Marylebone

“I’m Geoff,” insists my husband Jeremy. He has no discernible similarities with the doctor in my novels, though someone did once call him Geoffrey by mistake at a party.

Of course authors draw on reality when inventing their stories. Jane Davis says her favourite description of fiction is ‘made-up truth’. Her next book My Counterfeit Self was inspired by the plight of UK atomic war veterans. She even mentions many of them by name, but her book is still made up, and all the better for it, in my opinion.

Finnish author Helena Halme also uses the truth as a springboard for fiction. Her romantic series The Englishman is based on her own life story of meeting her Navy husband and moving to the UK. The prequel The Finnish Girl is now out, but, like the others in the series, reality has been fictionalized to provide the right pace and tension for a novel.

The Finnish Girl by Helena Halme

Fiction certainly benefits from an injection of fact. That’s what makes it relatable. I lost all faith in a story where the NHS doctor ‘worked shifts’. In those days, hospital doctors often worked a one-in-two rota. Going to work on Friday morning and not leaving till Monday evening was called many things, but a ‘shift’ it was not.

(I can’t help thinking a lot of non-fiction could do with a few facts too. Books on curing cancer with carrots really should move to the fantasy shelves, but that’s another story.)

A novelist invents stuff, but it needs to be right. While I can’t define ‘right’, I had to make that call with the image on the front of my forthcoming novel Hampstead Fever.  Cover designer Jessica Bell suggested adding a little red boat to the pond. The flash of red on the water seemed a delightful counterpoint to the red hat and red lipstick. But the pond in question is Hampstead Heath’s Number One Pond. Luckily one my sons, a local councillor, knows all about Hampstead’s ponds. As he explained, only the Model Boating Pond is a model boating pond. Cute as it was, my little boat had to be hauled out of the water.

Hampstead Fever

Being right is more about authenticity than fact. Being authentic, or so the Oxford dictionary puts it, includes

“Made or done in the traditional or original way, or in a way that faithfully resembles an original.”

Ain’t that the truth?

How to Save a Life Using Just Your Hands

At 8am on Tuesday morning, junior hospital doctors were due to take industrial action. Just for one day, they’d only treat emergencies. 

FreeImages.com/Carlos Paes

That’s now off, pending further talks. But does the average Joe know what an emergency is? I can’t help speculating. My experience of working in A & E suggests otherwise. Yes, there are heart attacks, car crashes, and fractured femurs galore.

Alas, there’s also no shortage of folks who pitch up for a second opinion on a runny nose, or who demand to know, at 4am, why they’ve had hiccups for two years.

Tragically, the reverse is also true: “I thought she was just sleeping.”

FreeImages.com/Johan Graterol POSED BY MODEL

If it’s that hard for the man in the street to recognize an emergency for what it is, it’s even more challenging to deal with it.

Forgive me for going all serious today, but research for St John Ambulance shows that almost four fifths of parents (79%) wouldn’t know what to do if their baby was choking to death. That’s despite it being a major fear for 58% of parents. In fact no less than 40% have witnessed choking. 

So kudos to those who’ve learned what to do, like the two people who saved a tot’s life in Hampstead a few weeks ago.

As you can imagine, the toddler’s mother is incredibly grateful to the passers-by who leapt in and did CPR. They’re unusual, because most people, as the research showed, wouldn’t have a clue.

We hear a lot about defibrillators in public places. Of course they’re a great idea. But while defibrillators help save adult lives, they’re not that useful for a baby or child. That’s because most little ones have breathing emergencies, not cardiac ones.

The good news is that their lives can be saved with nothing more than your hands, once you know how.

FreeImages.com/Helmut Gevert

So I wonder why basic life support isn’t taught more in schools.  And why parents and carers don’t often bother to learn how to save their own child’s life.

About five years ago, I was involved in Tesco’s BabySafe campaign. There were free sessions around the country designed to teach parents, carers, and others the basics of dealing with common but serious emergencies like choking and burns. People left with basic skills and the confidence to use them.

You can learn to save a baby or child’s life from the British Red Cross or St John Ambulance

These organizations have online information too, but it’s so much better to do a hands-on course if you can.

FreeImages.com/Denise Docherty