The Night Mail

[jjb1970]

3 hours ago, Northmoor said:

Daily Show presenter Trevor Noah once told the story of being admitted to a US hospital with appendicitis, which only became more concerning and painful each time he was moved to another room and had to ask the same set of questions about his symptoms, how long it had gone on etc.  After he had been asked for about the fourth time, how he intended to pay, he replied, "With my life, apparently!".

 

I remember my appendicitis two years ago. I went to the drop in centre, waited several hours and then was sent to the adjacent A&E where they did a scan and confirmed appendicitis. Waiting in A&E a fight broke out and there was a police officer stationed in the unit to keep order. Not a very good advert for the country. the thing burst before the operation which wasn't a pleasant experience but at least it was removed. However, they didn't clean my stomach properly and there was a couple of pieces of faeces left (a junior doctor told me 'there was puss everywhere), after four days post op recovery they sent me home as the infection markers were going down but after two days at home my stomach bloated like a beachball and I was re-admitted for emergency surgery to address a stomach abscess and do a full clean and then put on a cocktail of drugs to control an infection which had apparently exploded and run riot. After a week with various tubes pumping me full of who knows what and being on IV feeding I was discharged again and recovered, but it was an awful experience. When I was admitted the second time they inserted a tube through my nose and down into the stomach and were using it to draw off fluid, that was pleasant..... The moral of the story is that if you suffer abdominal cramps see a doctor. I'd been suffering intermittent cramps for a week but just wrote it off as another of those aches that comes with age. If they'd removed it before it burst it would have been an overnight in/out routine job rather than a two week nightmare which could have turned very nasty.

[DenysW]

52 minutes ago, jjb1970 said:

I remember my appendicitis two years ago

I remember my appendicitis 15 years ago. I went to my GP as an emergency (same day, be prepared to wait ...), she diagnosed probable appendicitis in 5 minutes or so (not much else it can be), and booked me into the local non-A&E hospital for later the same day. They hung around for 18 hours because I didn't have enough of the right sort of symptoms. Eventually they cracked under the pressure of time-to-treatment targets, to find, during keyhole surgery, the appendix had already perforated. Generally a good experience of the NHS, once you realise they are a production line, you are a widget, and they'll do their reasonable best. Ministering angels only on a time-available basis.

[jjb1970]

My own experience was in two halves. The second half was much much more unpleasant and really rather horrible (I suspect few of us expect to be taken back into hospital in an ambulance and on arrival be told that you'll be operated on first thing in the morning) but I really couldn't fault the doctors and nurses who were very attentive and really very nice. The worst bit, weirdly enough, was all the needles. I don't like needles and in addition to drawing blood every day and various injections I had cannulas in each arm which were only lasting about one and a half days, by the end of it they were having to insert them into my feet as they ran out of veins. The first half was much less stressful/uncomfortable, the hospital people were lovely but hanging around the drop in centre, A&E wasn't pleasant.

That said, it is quite eye opening to see some of the people medical staff have to deal with. There was an old man on the ward for the first couple of days who really was a horrible individual. Many of the nurses were Ghanaian and Filipino and had to put up with him shouting stuff like 'you shouldn't be in this effing country', 'I'll cut your effing face' etc, the ward sister was an old school no-nonsense lady who would put him in his place and one of the doctors was quite good at handling him but nobody should have to put up with that.  

[simontaylor484]

My brother did some of his RAF medical training at Queen Alexandra Hospital in Portsmouth. They were quite pleased to have service personell in A&E to deal with various scrotes

[iL Dottore]

3 hours ago, jjb1970 said:

….The worst bit, weirdly enough, was all the needles. I don't like needles and in addition to drawing blood every day and various injections I had cannulas in each arm which were only lasting about one and a half days, by the end of it they were having to insert them into my feet as they ran out of veins.

I’m usually pretty much indifferent to needles – whether they are being used to administer something or draw blood out. Obviously, the more skilled and experience the phlebotomist, the less discomfort a patient will have

 

Back when I was drawing blood from patients, most of the times I could do it so efficiently with a butterfly needle that often patients told me to hurry up and get a move on – as I was labelling the Vacutainer tubes of blood. Only twice in drawing blood have I been defeated: the first was a five month old baby whose scalp and foot veins (a frequent choice of location in very young babies) were so fine that even with a very fine gauge butterfly I couldn’t draw any blood (finally the consultant paediatrician managed to get the blood samples); The second was a woman who was so obese that her upper arm was twice the size of my thigh (I used to play the occasional game of rugby, so I definitely don’t have Twiggy like legs) and in the end we had to send her into A&E for the on -duty surgical resident to do a cut down to find a vein.

 

Collapsing veins are quite common in the older patient and mine are (I think) deliberately perverse: when they put the tourniquet around my arm, my veins stand up to attention like well-trained soldiers; but as soon as the needle pricks the skin they collapse like a soufflé taken too soon out of the oven.

 

3 hours ago, jjb1970 said:

…the hospital people were lovely but hanging around the drop in centre, A&E wasn't pleasant.… 

My most recent trip to A&E was before the pandemic when, reaching across my workbench, I managed to catch my hand on an  upturned scalpel - slicing through skin and subcutaneous fat to just short of the fascia around the finger muscles (lucky escape). Knowing that the Steri-Strips wouldn’t do the job I put a compression bandage on the wound and took myself off to our local A&E.There were about two people in the waiting area – both relatives of patients being seen. After informing the receptionist that it was not critical but it did need a few stitches I was escorted into an examination room where I waited to be seen. 
 

After what seemed to be an age (but probably no more than 5 to 10 minutes) I was seen by a young doctor and (I have to say) a rather cute young medical student (whose command of English was pretty damn impressive).  After explaining why I was messing around with scalpels (No!, Herr Doktor, I wasn’t doing DIY surgery, but some railway modelling);  after what seemed another age the rather winsome and adorable young medical student turned up with her suture set and stitched me up (and did an excellent job as well). 
 

Door to door the whole experience lasted about 90 minutes to 2 hours and the reason it took so long was that I insisted that it was not an acute or critical matter  and it sounded like they had one or two really sick patients in A&E at the same time as me

3 hours ago, jjb1970 said:

…it is quite eye opening to see some of the people medical staff have to deal with. There was an old man on the ward for the first couple of days who really was a horrible individual. Many of the nurses were Ghanaian and Filipino and had to put up with him shouting stuff like 'you shouldn't be in this effing country', 'I'll cut your effing face' etc, the ward sister was an old school no-nonsense lady who would put him in his place and one of the doctors was quite good at handling him but nobody should have to put up with that.  

Pain, especially severe pain, does strange things to people - so a certain amount of atypical behaviour is not unexpected. However, there is absolutely no excuse for abuse. In the American hospital I worked in, if patients became abusive it wasn’t unusual for one of the attending medics to order a powerful sedative “stat”. And the prospect of facing a really pissed off nurse with a BIG needle flanked by two burly orderlies was usually sufficient to calm things down.
 

In the ER (UK: A&E), there were usually one or more police officers present either dropping off, collecting or guarding prisoner patients. Knowing how often the medical staff have ministered to, and sometimes saved the lives of, themselves or fellow officers, when ER staff needed assistance they didn’t hang about (I was once attacked by a psychiatric patient and it was only due to a very big police officer sitting on the patient whilst the nurse threatened to break every single finger of the patient’s  hand that had grabbed me – hard – by the hair, that I didn’t end up scalped). Once arrested and brought to trial, anyone assaulting or abusing medical staff would be guaranteed to be enjoying prison meals for quite a few months, if not years afterwards.

Edited September 24, 2022 by iL Dottore
Typo, text errors

[iL Dottore]

As a coda to the above, I have to say that having been on both sides of the stethoscope (so to speak) in the ER/A&E I can say without any fear of contradiction that time in such places behaves very, very strangely. If you are behind the stethoscope (so seeing patients) an hour consists of about 60 seconds; whereas if you are in front of the stethoscope (so you are a patient) each minute in the ER consists of at least 3600 seconds.

 

And did you know that the half life of a Krispy Kreme or Dunkin Donuts doughnut in the ER is measured in the femtoseconds?

[jjb1970]

When I worked at Sellafield we had self injection packs to be used in the event of a radiation leak, the needles were like something you'd use on a horse, huge things. I quickly determined that if it came to that I'd sit down and wait for the radiation to see me off as there was no way I would stab myself with one of those things. 

[jjb1970]

There is a definite skill in taking blood and inserting cannulas. When we arrived in Singapore we had to provide blood samples for a serology test to recognise our vaccine certificates (although they recognise foreign vaccine certificates for tourists, for long term residents and nationals they want either a local certificate or a serology test confirming your status. As hinted, my veins are dreadful for that sort of thing (even as a child it was a nightmare in hospital), the nurse tried several times and couldn't get it and so called in a doctor, he not only hit the target first time but I barely felt anything.

[TheQ]

We have a lot of these illegal signs around..

Why are they illegal..

1 it's not a national park.

2, the courts gave permission of "Broads National Park" to only be used for advertising by the broads Authority.

3, road side signs for advertising attractions have to be in brown...

 

Graduate types?

Well working for GEC on some installations I got lent a couple of graduate engineers.. when something went wrong they'd try to redesign the circuit instead of fixing it...

 

Baby RAF officers..quite a few thought they were god's gift and looked down on the men.. a few got caught out when an airman had a better degree than the officer...

 

Some times they'd try to tell you how to fix something and interfere with how you worked on equipment..  They may have a degree in engineering.. but we'd have a six month training course on that equipment and  could have 5 or more years experience of doing so..

 

 

[rockershovel]

I spent some time in hospital in tbe early 2000s and it was an utterly miserable experience. I was reluctantly admitted with suspected heart attack on Friday afternoon, saw enough medical attention at some point during a very troubled night that I was graded "death not imminent" and parked on a ward full of drooling oncology patients, mostly geriatric and all very sick people.

 

I couldn't stand it and as soon as my family appeared with my dressing gown, decamped to the patients day room and stayed there. There was no breakfast and lunch was foul, I gave up and went to the staff canteen (interestingly enough a number of other patients were doing the same). 

 

The specialist showed up on Monday and couldn't find anything so put it down to fatigue and stress. I was discharged but by then I had a acquired a diagnosis on admission of "suspected angina" which has caused certain problems since.

[Tony_S]

10 hours ago, jamie92208 said:

Yes and the Lake had a railway station named after it that I once travelled to with my mother.

It was being restored when we went in 2019. It was going to be used as a restaurant. There was some track outside and a couple of German (I think) carriages on a short piece of track. A replica loco (German big steam) was being delivered on the day we were due to attend a wedding and we were concerned our trip to the venue might be delayed. We were assured it wouldn’t and Aditi was given a nice piece of slate to bring home!

[polybear]

3 hours ago, jjb1970 said:

There was an old man on the ward for the first couple of days who really was a horrible individual. Many of the nurses were Ghanaian and Filipino and had to put up with him shouting stuff like 'you shouldn't be in this effing country', 'I'll cut your effing face' etc, the ward sister was an old school no-nonsense lady who would put him in his place and one of the doctors was quite good at handling him but nobody should have to put up with that.  

 

Bear has some VERY strong Ty-wraps (one would take a Bear's weight, no problem) and plenty of Gaffer Tape over the gob.  Not allowed?  Who cares.

[iL Dottore]

5 hours ago, jjb1970 said:

…However, they didn't clean my stomach properly and there was a couple of pieces of faeces left (a junior doctor told me 'there was puss everywhere), after four days post op recovery they sent me home as the infection markers were going down but after two days at home my stomach bloated like a beachball and I was re-admitted for emergency surgery to address a stomach abscess and do a full clean and then put on a cocktail of drugs to control an infection which had apparently exploded and run riot.

I am gobsmacked.
 

One of the first things you learn when doing abdominal surgery is that before you close up, the entire abdominal cavity has to be squeaky clean*. Which means the bowel is checked from top to bottom to see if there are any missed perforations, the entire abdominal cavity is sluiced out with normal saline (they used to add a wide spectrum antibiotic to the normal saline when I was a wee student, I’m not sure if they do that nowadays) and when the lavage came out clean, then you could start closing up. And given that the last thing you want is a few errant E. coli setting up a breeding colony in a patient’s  abdominal cavity, you monitor the patient VERY carefully for infection.

* admittedly not always possible - especially after major abdominal trauma

Not having really thought much about abdominal surgery for many, many years, I don’t know what is an acceptable level of “infection markers“ (which I presume are actually inflammation markers - such as CRP or Procalcitonin, which are also altered in other diseases or certain hæmatology tests - such as leukocytes or hæmatocrit - again also altered in other diseases, not just infections). I know that current surgical practice is to get patients ambulatory as quickly as possible post surgery and then discharge to home, also as quickly as possible – but I certainly wouldn’t sign off on a discharge note unless I was 100% convinced there is a very low probability of the patienr returning with an exploding belly…

 

You were, to be blunt, bloody lucky: Approximately 30% of patients admitted to an ICU with intra-abdominal infection succumb to their illness (range 5% - 50% depending upon a number of factors. [data from a 2022 review available via PubMed])

Edited September 24, 2022 by iL Dottore
Bloody autocorrect

[iL Dottore]

1 hour ago, rockershovel said:

I spent some time in hospital in tbe early 2000s and it was an utterly miserable experience. I was reluctantly admitted with suspected heart attack on Friday afternoon, saw enough medical attention at some point during a very troubled night that I was graded "death not imminent" and parked on a ward full of drooling oncology patients, mostly geriatric and all very sick people.

 

I couldn't stand it and as soon as my family appeared with my dressing gown, decamped to the patients day room and stayed there. There was no breakfast and lunch was foul, I gave up and went to the staff canteen (interestingly enough a number of other patients were doing the same). 

 

The specialist showed up on Monday and couldn't find anything so put it down to fatigue and stress. I was discharged but by then I had a acquired a diagnosis on admission of "suspected angina" which has caused certain problems since.

Why is the NHS still wedded to the idea of the multipatient ward? Definitely an obsolete concept, I would argue.

 

In Switzerland the standard is generally two patients to a room (although some university hospitals may have up to 4 patients to a room). The only multi bed units in common use across Switzerland are those high dependency units – such as an ICU, step-down ICU, CCU, etc - where monitoring is very, very intensive (e.g. vital signs q 15 minutes)

[Compound2632]

5 minutes ago, iL Dottore said:

Why is the NHS still wedded to the idea of the multipatient ward?

 

Money? 

[Happy Hippo]

12 minutes ago, iL Dottore said:

Why is the NHS still wedded to the idea of the multipatient ward? Definitely an obsolete concept, I would argue.

 

In Switzerland the standard is generally two patients to a room (although some university hospitals may have up to 4 patients to a room). The only multi bed units in common use across Switzerland are those high dependency units – such as an ICU, step-down ICU, CCU, etc - where monitoring is very, very intensive (e.g. vital signs q 15 minutes)

When I had my recent overnight stay in hospital, I was placed in the head/thoracic ward and not the orthopaedic ward.  Each bed was in  an individual bay off a spine.  It gave a lot more space around the bed than a wrap around curtain,and I was more than happy with the arrangement.  I believe the rest of the hospital is so arranged.

 

Forgive me for reverting to the ID card saga as I have been away all day, but most UK citizens now have a defacto ID card in the form of a driver's licence photocard.  The ignoratii  are just too stupid to realise that, until they are asked for ID, at say, a supermarket check out, and then inevitably produce their driver's licence with a flourish. Gormless f*8ktards.

Edited September 24, 2022 by Happy Hippo
snigelpl

[SM42]

19 hours ago, Winslow Boy said:

 

You paint the floor!

 

I think I may have just figured out where you may be going wrong.

 

Please don't tell me it's concrete just don't.

 

Only by accident and yes they are concrete 

 

Andy

[Happy Hippo]

Do not believe any rumours to the contrary, I met up with Dave this morning and had a most convivial time.  We were most cordial to each other without a bad word or an insult to be had... Apart from when I was directing him to our seats using helicopter marshalling signals.  This did confuse the non-rotary wing pilot somewhat, but he landed the coffee on the correct table despite my best intentions.

 

Sadly, he has been re-tasked next weekend, so is unable to attend the Telford RMG bash. So I am now required to visit him at Hunt Towers on the preceeding Thursday in order to pick up the previously promised pallet load of cake.

[polybear]

1 hour ago, Compound2632 said:

 

Money? 

 

As well as the ability to monitor a lot more patients simultaneously.

 

1 hour ago, Happy Hippo said:

When I had my recent overnight stay in hospital, I was placed in the head/thoracic ward and not the orthopaedic ward.  Each bed was in  an individual bay off a spine.  It gave a lot more space around the bed than a wrap around curtain,and I was more than happy with the arrangement.  I believe the rest of the hospital is so arranged.

 

 

Bear recalls SiL (who was a Ward Sister) saying that if you are in real trouble (unexpectedly) then it's much better to be on an open ward than in a side room - the latter get very cramped, very quickly when all the required staff and kit start piling in trying to save you.....

[Tony_S]

As mentioned earlier

Bassenthwaite Lake Station

 

And the loco that was moved later on to the track. 

Tony

[Winslow Boy]

2 hours ago, SM42 said:

 

Only by accident and yes they are concrete 

 

Andy

 

Aaaaarrrrggggh!!!!!!!!!

 

Runs screaming from the room.

[duncan]

4 hours ago, iL Dottore said:

Why is the NHS still wedded to the idea of the multipatient ward? Definitely an obsolete concept, I would argue.

 

In Switzerland the standard is generally two patients to a room (although some university hospitals may have up to 4 patients to a room). The only multi bed units in common use across Switzerland are those high dependency units – such as an ICU, step-down ICU, CCU, etc - where monitoring is very, very intensive (e.g. vital signs q 15 minutes)

 

I appreciate that single bed rooms are the best for infection control, but when I was taken in by ambulance from work, I was in a standard 6 bed room.  As I had nothing, no phone, book, clothes or anything, I was grateful for the company, chat & comradery.  This was a pre / post op ward so VERY different from a general ward (for those who have not been hospitalised) & the humour was wicked & the staff were just as likely to join in - kept everyone's spirits up.  It would have been very lonely & boring being myself.

[duncan]

One of the student nurses was regularly "persuaded" to entertain us, he should have had his own comedy show.  Sister actually ran a very strict ward, but that appreciated patient morale was important.

 

We voted a patient off the ward ( he had foolishly nipped into the toilet as the ward round was being done & we knew he was probably due for discharge ), the consultant looked at him as he jumped back in bed, told him we had voted him out & walked away - his face was a picture.

 

Another patient was brought back after having his appendicitis out about 11.30pm & the first thing he said to the ward was " don't any of you b******* make me laugh".  

[AndyID]

6 hours ago, Happy Hippo said:

Forgive me for reverting to the ID card saga as I have been away all day, but most UK citizens now have a defacto ID card in the form of a driver's licence photocard.  The ignoratii  are just too stupid to realise that, until they are asked for ID, at say, a supermarket check out, and then inevitably produce their driver's licence with a flourish. Gormless f*8ktards.

 

That's pretty much how it works in the Good Ol' US of A. You can't do much without a valid driving (drivers) license. The difference is licenses are issued by each state rather than the federal gubmint which is a bit of a burglar if you happen to move to another state. So far I've had five and I had to pass a written test each time.

 

Used to be that one's Social Security Number was plastered all over everything but there was so much fraud going on that its use is very much restricted now.

 

I think the NHS was a great idea and it does sometimes work very well. As we are retired in the US almost all of our medical care is now covered by Medicare with some supplemental insurance which is not expensive at all. In that respect it's not so different from the NHS for people of our age. The big difference is we actually see the bills that the providers submit to Medicare and our insurers.

 

Healthcare is not cheap and I sometimes wonder if recipients of NHS care have any idea just how incredibly expensive it really is.

[pH]

15 minutes ago, AndyID said:

Used to be that one's Social Security Number was plastered all over everything but there was so much fraud going on that its use is very much restricted now.

Canadian Social Insurance Number is supposed to be used only for communication with government departments. However, various other organizations ask for it. You can refuse to give it, but the response is likely to be “Well, I can’t help you, then.”