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.

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Payback Time for Fat Cats

Mishmish went into the basket happily enough, probably anticipating a drive to her weekend retreat.

cat in the basket

She wasn’t purring when half a mile later we parked outside the vet’s.

The waiting-room was full of red setter. Yep, just one of him, but he was bouncing around as if he’d eaten springs for breakfast.  

red setter

We installed ourselves in the corner next to a pooch with a rhinestone collar. An elderly dachshund waddled in, rolling from side to side like a cross-channel ferry. His owner had turned-out feet and a similar gait. She heaved herself onto the bench.

I know. I look like my cat too. For a start, I’m covered in orange fur. Unlike Mishmish, however, I had a streaming cold. People recoiled visibly from me and my tissues, or would have done had there been any room.

Last time we were here, it had been for a check-up with the vet nurse, an enormously fat woman who pronounced my cat to be overweight. She calculated her BMI and promptly recommended dietary modification.  I wanted to lock the nurse into a room and give her nothing but a lettuce leaf alternate days. Preferably an expensive lettuce leaf.

lettuce leaf

Today it was for annual jabs. The vet had a Littmann stethoscope. This is the king of stethoscopes, but it didn’t impress Mishmish. We had the obligatory chat about female ginger cats being unusual, seeing as they need two x chromosomes with the relevant gene to be ginger. It’s just like haemophilia, only more desirable.

The vet looked Mishmish over and said she was a big girl.

I blew my nose and pointed out that she was big-boned.

“Are you OK?” asked the vet, his syringe poised. I didn’t tell him about my raging sore throat for fear of getting penicillin, gentamicin and a £200 bill.

Mishmish duly immunised, I paid at the desk, but the visit wasn’t over yet. I still had to pick up the prescription cat food I’d ordered.

We waited by the reception desk behind a huge slab of a man, stubbled and tattooed, with an award-winning builder’s cleavage. He’d come to collect his dog after surgery, so I heard.

“What’s the animal’s name?” asked the receptionist.

“Twinkle.”

Twinkle, it turned out, was a bichon frisé with a bandaged paw.   If you’re not familiar with the breed, it makes toy poodles look impossibly butch.

Twinkle and Macho Man left, the receptionist took a few calls, and there we still were. “I’m waiting for my prescription cat food,” I told her again, not quite as patiently as the first time. My baby could starve!

empty cat bowl

She went to look but it hadn’t been delivered, apparently. “What kind is it?”

“It’s the metabolic diet,” I said.  

The waiting room nodded collectively. Pet owners know what metabolic diet means. It screams “SLAG! YOU LET YOUR PET GET FAT.”

The woman with the dachshund fixed me with a rheumy eye. 

I felt like blaming my husband. He gives her high calorie treats, I wanted to say. But then I’d have been castigated for not controlling him as well. There’s really no excuse now that there are special diets for flabby felines and activity centre toys to exercise lazy cats, not to mention various harnesses and contraptions to stop spouses dishing out treats.

leads, harnesses and restraints

They still couldn’t find the metabolic diet. Only ordinary cat food. We’d been here about 45 minutes by then. In her basket Mishmish was getting stressed, and I had distributed viruses evenly across the waiting room.

“We’re going away for a few days and I need the food. I did order it in plenty of time, you know.” But it was no good. The other owners had already judged me. I was the kind of idiot who feeds her kid burgers through the school fence.

Didn’t they know that junk food is much cheaper than the healthy stuff? I felt a twinge of sympathy for parents of tubby children.

The receptionist gave up and a vet nurse was summoned. She couldn’t find our order either.

Eventually the fat nurse from last time was called in and she quickly found what we needed, our 4kg bag of Advanced Weight Solution.  

Hill's Prescription Diet Feline Metabolic Diet advanced weight solution

I’m far better disposed towards her now. She can even have a lettuce leaf every day.

***

If you have space for a cat or dog in your life, please consider getting one from a charity like the Mayhew Animal Home in NW London.

Germs and Geriatrics

She is asleep with her mouth open, so Geoff sits down quietly and watches for a bit. At 92 she still has some of her own teeth but the interior of her mouth has that glazed look that comes with age, and with candida.

Geoff is a GP from the pages of One Night at the Jacaranda. He can’t help making these observations.

Grandma stirs, and soon she’s sitting up yelling for the nurse.  “I’m in agony” she’s saying as she jabs the bell repeatedly.  “I’m in agony” she repeats to the rest of the ward.   The three other old ladies appear to have heard this before. 

Today Geoff had to put on a mask and gown before entering the ward.  Some nasty germs have been isolated on the unit, but high bed occupancy means it can’t be emptied and deep cleaned.  He’d asked a nurse which germs, and got a shrug by way of reply.

agar plates

The lunch tray arrives.  It looks vile, all that sloppy food designed to slip down elderly gullets.  “Feed me” demands Granny.

She watches Geoff with beady eyes as he spoons some of the beige slurry into her mouth.  That’s probably where the germs are, he thinks.   After a couple of mouthfuls Granny has had enough.  She’s staring at his head now.  “I like your hair” she says and reaches out to touch it.

She reminds him of Davey.  She might like to see her great-grandson again, but hospitals aren’t good places for 5-year olds, unless maybe they’ve got Henoch-Schonlein purpura.

There’s a miniature Christmas tree on the bedside locker. “It’s nearly February” Geoff points out.  “And you’re Jewish.” 

“I’m 95 now” Granny replies with impeccable logic. 

A nurse comes in, switches off the call button and offers Granny tablets for pain. Which Granny refuses, saying she’s fine.  

The nurse then rearranges things at one of the beds.  Geoff notices that she hasn’t bothered with a mask, gown or gloves.  She senses his stare and says “I’m not touching the patients.”  The nurse probably wouldn’t believe it if Geoff told her that viruses and bacteria can live on call buttons, beds and bedding. 

“The priest came to see me” Granny tells Geoff.

“Why, Grandma?”

“Because I’m getting married, of course. To Marvin.”

This is news to Geoff.  “Do I know Marvin?”

Granny swats at him with a bony hand.  “Of course you know him.  He sits next to me in class.”

She’s gone downhill faster than he thought.   Only last week Geoff was thinking of testing her with the SAGE questionnaire for cognitive problems.  He hasn’t used it on patients yet but it looks a useful test, with low false positives, and no copyright issues, unlike the MMSE.  But not much point trying it on Granny any more.   Although her mental state fluctuates from day to day, she seems proper demented now.  An MRI of her brain would probably look like cheese.

Swiss cheeseNow she says “Make me comfortable.” 

The nurse has gone, so Geoff tries adjusting the hospital bed.  It has lots of buttons.  Granny develops a liking for the buttons that controls the foot end.   

No harm in that, thinks Geoff.  After she raises and lowers the foot of the bed about a dozen times, he remarks that it’s just like a see-saw.

She gives him one of her stares.  “You’re really very stupid.”

Before Geoff leaves, he asks if Marvin’s going to visit.

“Who’s Marvin?” replies Granny.

elderly hands

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