This much I know about…witnessing all the vulnerabilities of our health service up close, first-hand

I have been a teacher for 30 years, a Headteacher for 15 years and, at the age of 54, this much I know about witnessing all the vulnerabilities of our health service up close, first-hand.

 

It began with a tick bite. I never gave it much thought; insect bites are, after all, an occupational hazard for any angler. But a few days later my wife said I should keep an eye on it. That was on the Tuesday. By Thursday morning the redness had begun to spread.

“Well, my wife drew around it with a pen this morning and now the infection is an inch beyond that.” It was late afternoon and I was speaking to the Priory Medical Centre’s switchboard.
“I’m really sorry, but we have no emergency appointments across the whole of York. Try 111. They might have some advice.”
“I rang them before I rang you. I was in a queue for ages.”
“Well, you could ring us tomorrow morning at 8 o’ clock and see if you can get an emergency GP appointment.”
I maintained my courteous tone. “OK. I’ll do that. Thanks very much. Bye.”

The next day I secured a 4.00 pm appointment at my GP’s. I had never met her before. She was clearly concerned. She donned some gloves. The infection had spread in a perfect 4 inch diameter circle across my ribcage. She packed me off with a prescription for Flucloxacillin, but warned me that should the infection continue to grow I should contact 111.

I rang 111 on Sunday morning. By now the infection was angry and the size of side plate. I was in A&E by noon with an appointment to see the out of hours GP. Just after 1.00 pm I was in Tesco’s with a prescription for Clarithromycin.

Late morning on Tuesday I asked our finance manager to join me in the toilet. When I pulled up my shirt he was shocked. The infection was the diameter of a large dinner plate. From its epicentre in the middle of the right hand side of my rib cage it had spread to the edge of my armpit, across my sternum and below my navel. He suggested I went to A&E, as did the woman on the 111 line. I had rung my GP earlier, but by 10.30 am the city’s emergency GP appointments had all been taken.

Initially A&E was quite civilised. After three hours of waiting, it was chaotic and undignified for so many patients. At one point I asked reception if I had been forgotten. I was my politest best, because there is no other way to be. No-one was choosing to make me wait. There was a sense of anxiety in the room that grew tangibly as every single seat was taken. By the time my name was called it was standing room only. On a Tuesday, at 3.00 pm.

The A&E doctor was concerned. He rang through to the Acute Medical Unit. He wanted them to admit me. He feared cellulitis. “There are no beds free at the moment, but they are sure there will be one soon.” He smiled. I smiled back. On the walk to the AMU, I googled cellulitis. I wished I hadn’t.

It was busy in the AMU. I walked past a consultant briefing five young trainees in the corridor. It took the receptionist a few minutes to find my details. There was nowhere to put me except for the “Quiet Room”. Except it wasn’t very quiet. Every few minutes came the agonising howls of a patient. It was the sound of pure fear, laced with intense pain. I just read my book intently.

One other patient was in the “Quiet Room” with me. He was worried. His legs felt odd. He had been a Physics teacher but had a stroke and lost his ability to compute numbers. He took early retirement on health grounds thirty years ago. He now had prostate cancer which had spread and the cancer was embedding itself in his spine. He had trouble with his bowel movements and excreting could be painful. He queried whether the pins and needles in his legs were due to some odd quirk or whether they were the harbinger of something much worse. His wife was at home.

You might wonder how I knew so much about my fellow teacher. Well, the admissions procedure was conducted in the “Quiet Room” because there was nowhere else for the nurse to hold the interview with him. At one point I went out into the corridor, only to find a woman weeping, and three ambulance personnel tending to a man wearing an oxygen mask on a trolley.

After two hours it was my turn to be admitted. The doctor was hassled and apologetic. She was embarrassed to have to check my vital signs, take my blood and fit my cannula in the “Quiet Room”. She tried to lock the door, but it was broken. I reassured her that I wasn’t bothered. That I understood.

When she had finished, I asked her whether it might be an idea to look at my infection. When she did she expressed surprise. She admitted that it didn’t look that serious and that I probably didn’t need to be in there at all. “I did wonder why you fitted the cannula before you had looked at my chest.”
“It’s just the pressure,” she replied sadly. “Look”, she went on, “I am pretty sure you don’t need to stay here tonight. I think we can send you home with some antibiotics, but I need a consultant to clear that. I’ll go and find one and be back soon”. That was 5.00 pm. I never saw her again.

At 6.00 pm I sidled down to reception and enquired as to whether the doctor had found a consultant. The woman I spoke to was nonplussed. “Your bed is nearly ready”, she said. My claim to be on the verge of going home fell on deaf ears. I was told that I would be seen by a consultant soon. Apparently a couple of them were on the wards.

Half-way through the evening my wife texted me: Dad says ask them whether it is Lyme disease. NHS 111 Online’s Lyme disease page described my symptoms precisely: the bullseye pattern; the delayed onset; headaches. I put that to the consultant when she arrived just before midnight. “I’m a head teacher. I get tired of people telling me how to do my job. I’m sure you do too, what with the internet and self-diagnoses. And I don’t want to be rude, but my father-in-law says it might be Lyme disease.”
She raised her eyebrows. “Maybe we’ll get you to see a dermatologist. In the meantime, we’ll put you on intravenous Fluloxacillin.”

I changed into the night clothes my wife had popped over to me earlier in the evening. The intravenous drugs were administered. Afterwards sleep was all but impossible. My bed was next to the ward toilet. The walls were wafer thin. Cecil in the bed opposite was having shouty nightmares about being killed. The poor man next to me had trouble breathing; the sound of him drawing breath was like someone blowing through a straw into a bucket of water. At 3.00 am a nurse helped him to cough up whatever it was deep in his lungs, with the aid of a tube. By 6.30 am I was having my second lot of intravenous antibiotics.

For the umpteenth time I explained my case to a new consultant. It was 9.00 am. The spread of the infection appeared to have been arrested. I was immediately transferred to the ambulatory wing of the AMU, called the Acute Medical Centre. I was going home. I was to have a new antibiotic – an intravenous double-dose of Teicoplanin – and then I would be discharged.

I arrived in the AMC and they took my blood again. At one point, around 11.00 am, the doctor had my discharge letter in her hand. But, she remembered, they had been in contact with Dermatology, and the dermatologist would be up to see me after they had finished their morning surgery. Better not go home right now, just in case. They had told them about my notion that it might be Lyme disease.

So I waited. And I waited. And I waited.

At 4.00 pm the dermatologist arrived. Probably my age, he wandered in unassumingly, nodded, read my notes and said, “Well, you’ve got Lyme disease”.
“That’s what I think it is, having read about it.”
“Pull your jumper up…yes, look at it. Almost certain. The antibiotics you’ve had won’t touch that. You need Doxycycline. The key thing is to stop it getting into your system.”
“How do you do that?” I asked. I had read about what can happen if Lyme disease takes hold. It’s not good.
“Catch it quickly and take the antibiotics. All of them. For three weeks.” He smiled. I reciprocated, feeling, for the first time since Friday, reassured that what had been prescribed would treat my condition successfully.

He left. The ward doctor explained it would be 30 minutes or so before the drugs would be ready. At 5.45 pm, I tentatively asked if there was any news. She looked embarrassed. It transpired that the ward pharmacy hadn’t enough doses for three weeks. She was sorry, it was her mistake. She should have chased it up an hour ago. She would ring down to the pharmacy in the main building. I finally left with sufficient drugs at 6.40 pm.

It took five days to diagnose me successfully. Now, as I write this, a further five days on, the infection has all but gone.

I am not critical. At every step of the way I was greeted with a smile. Even the AMU doctor who went missing whilst in search of a consultant, was kind and sincere. She was just under intense pressure. The beds in the corridors, the dying patients, the post-bank holiday A&E mayhem, the uncertain diagnoses and erroneous prescriptions – all manifestations of an NHS under impossible strain.

I saw all the vulnerabilities of our health service up close, first-hand. If I was so minded, I could complain about aspects of what I experienced. The truth is, I am in awe of the considerate, selfless dedication of everyone working in the NHS: our consultants, doctors, GPs, nurses, porters, receptionists, and 111 call-centre workers.

I was seen by two GPs, two doctors, three consultants and numerous nurses, and was prescribed a hatful of different, expensive medicines, all within five days, and, bar two prescription fees, all completely free of charge. Any errors or oversights along the way are both explicable and forgivable. I got an expert diagnosis and subsequently a successful treatment to stop the infection spreading across my chest.

The more serious symptoms of Lyme disease can take months to present themselves. There is a good chance, thanks to the NHS, that we have caught it early, that the disease has not entered my system. Here’s hoping.

 

POSTSCRIPT: All’s well that ends well. My blood test for Lyme disease returned negative.

About johntomsett

Headteacher in York. All views are my own.
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3 Responses to This much I know about…witnessing all the vulnerabilities of our health service up close, first-hand

  1. Kate Rowlands says:

    As usual a great post – and a sentiment echoed by all of us about this wonderful, underfunded service.

  2. Stephen Down says:

    Glad you’re OK after all that, but what an ordeal!
    It is really scary how underresourced our health service is right now – probably even worse than schools, although I know that might be a controversial thing to say…
    As you say, everyone there was doing their best in extremely stressed circumstances, but it should have been very straightforward.
    Nurse: “Do you know what caused the infection?”
    John: “It started after I had a tick bite.”
    Nurse: “Do you have any of these symptoms? (Lists symptoms of Lyme Disease)”
    John: “Yes, all of them.”
    Nurse: “Sounds like you could have Lyme Disease. Let’s get you tested…”
    It should be an immediate, automatic reaction. Tick bite? Check for Lyme Disease. The fact that none of the multiple medical staff who saw you even considered that until you suggested it to them shows how badly the system is broken if they are run so ragged that they aren’t even functioning at that level.

  3. Pingback: This much I know about…what I am doing to make my Alastair Campbell jam jar taller | johntomsett

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