"Emergency gall bladder surgery"

About: NHS 24 Royal Infirmary of Edinburgh at Little France / General Medicine Royal Infirmary of Edinburgh at Little France / General Surgery Scottish Ambulance Service / Emergency Ambulance St John's Hospital / Accident & Emergency St John's Hospital / General Medicine

(as the patient),

I had been having bouts of what I thought was gastritis for some months, latterly working while on sabbatical in Washington DC, but in early February started a particularly nasty attack, which lasted a couple of weeks. Once I had 'recovered', as I thought, I flew home to Europe, intending to stay for ten days, but after a week of travelling, was taken ill on arrival from an early morning flight from London to Edinburgh. The Edinburgh airport first aider (Mairi) was wonderful: she persuaded me to ring NHS 24 and told me I was underplaying the pain in what I was saying, so they sent an ambulance.

The Lothian ambulance team told me I could either go home under my own steam, or they could take me to Livingston St John's. At Livingston, I was met by a kind friend, whom Mairi had helped me contact. I suspect there were more life threatening cases because I was left in a cubicle for an hour, shuddering with cold and without a blanket (my kind friend put her coat over me). Couldn't a blanket be offered as a matter of course?

After assessment I was moved to the observation ward, but no tests were done until the following day. These began with my being sent with a very nice porter on a chair for a CT scan. The porter left me in the queue and quite rightly went off to do other jobs. After five minutes I could no longer stand the pain, so I took the blanket over my knees, put it on the floor and lay down, which was a vast improvement. After ten minutes a nurse appeared and sent for a trolley and a student nurse from the observation ward. As I had said before moving that being upright was extremely painful, it might have saved time and effort for the ward had I been sent on a trolley in the first place. It is obvious that many of the corridors (and corners) in St John's are not wide enough for passing trolleys, so some redesign seems desirable too.

After the CT scan, which was very impressive, the kind student nurse and I joined the queue for an ultrasound scan. After some time, I was wheeled in and a comedy scene ensued. The very cheerful and helpful radiologist could not find me on the system and then thought I was a patient with Crohn's disease. It seems the CT scan had already produced a diagnosis, so someone had removed me from the list for a second scan, but no one had thought to tell either me or the nurse with me and the system did not explain this either. Happily for me the doctor decided to do a quick check anyway, took one look, nipped away to check the CT scan and came back announcing that they had a diagnosis: acute calculous cholecystitis. They warned me that I would have to wait for confirmation from the consultants on the Obs ward. But it was wonderful to have a glimpse of a solution for the pain, especially since the consultants did not reappear for 5 hours. Thank you Dr Reid (if that is indeed your name )!

When the consultants did appear, the lead jokingly laughed at me, accusing me of changing the location of my pain. I replied that pain moves, something of which I am sure they were only too aware. It seemed to me he was irritated and that he was feeling, in front of students, outdone by a colleague: patient care should never involve that sort of silly rivalry. The team also told me I would have to be moved to Edinburgh Royal Infirmary and said that the original ambulance team could also have gone there. So 36 hours after first being taken into an ambulance, I was in another ambulance, being driven along the bypass to ERI. Again the staff were great, but what a waste of resources.

At ERI, things started well and the staff were kind, but no operating slot was available. Ironically, on the Wednesday, I lay in bed next to a young woman who had had a very similar critical bout on Monday morning, had had the good fortune to be taken straight to ERI, had had her gall bladder removed on Tuesday and was now being discharged. Meanwhile, I was getting more and more exhausted with the pain. The low point was late afternoon on Wednesday when I was moved ward. Once again, this was done on an upright wheelchair. It was fine for about five minutes but then the agony started - by the time we reached the new ward, I was weeping copiously unable to stop myself and the poor assistant pushing me was apologising profusely. It really did feel that I had been reduced to a machine to be slotted in as suited, rather than a human with severe pain (cruelty to animals shouldn't be what is crossing the mind of a patient). One of two things would have made all the difference: either checking whether I had had painkillers recently enough for them to be taking effect at the point of moving (which, unfortunately for me, I had not), or moving me on a trolley. Please do consider revising your protocols!

In the new ward, which specialised in livers, it took considerable time to get my painkillers since they are not on the ward. I gather this ward is often used as an overspill from the original ward, so surely this sort of problem could be resolved by clearer guidance, such as providing nurses with more than the saline delivered drugs to send with the patient? The staff on the liver ward were lovely but clearly massively overworked: I felt terrible needing to ring them to ask for painkillers when I could see they were dealing with more serious cases, and I often had to ring a second time after an hour to remind them because they had had to rush off to admit a new emergency. At one point, one nurse was in charge of 14 beds. That seems absurd. By this point I was also suffering withdrawal from my usual prescription drugs. It seems neither could be ordered by the hospital. So on top of the abdominal pain I started having mild jerking/electric shock sensations - unfortunately my own supplies were split between London, where I had expected to return almost immediately - and the USA, where I was supposed to be on sabbatical for a semester. I finally got the appropriate drugs - with many apologies - just before discharge, after five nights.

Happily for me, once I got to theatre, on the Thursday afternoon, the operating staff were superb - anaesthetists, theatre nurses and a student. I didn't meet the surgeon just then, for obvious reasons! The operation was apparently very smooth despite finding a 'very full sack of stones and substantial inflammation'. The after op. treatment was really wonderful and I was finally discharged on the Saturday, feeling a great deal more like my usual self.

So much about this experience was conducted by highly professional, warm human beings and I am enormously grateful to have been born in an era where there is a simple, key-hole solution to such pain, that it is free on delivery and that there are people prepared to dedicate their lives to caring for others in such difficult circumstances.

There were of course some surly staff (like patients, people working in hospitals are human, after all), but it struck me that when things did go wrong it was the systems in place rather than the people that made things difficult. This was the third time I have had to have major surgery through the NHS and I am sorry to say that such things seem to have got less efficient over the years.

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Response from Shona Lawrence, Patient Affairs Manager, NHS 24

picture of Shona Lawrence

Thank you for providing comprehensive feedback via Patient Opinion. I read your posting with much interest and note your comments in relation to the systems in place and how you feel this can make things difficult. You have also provided complimentary feedback in relation to some staff who assisted in managing your care, and it is always encouraging to hear of such experiences.

I note at the start of your story, that you have explained that contact was made with NHS 24 and that an ambulance was arranged. NHS 24 works closely in partnership with the local Health Boards, including the Scottish Ambulance Service, and I hope that you feel that this portion of your care was managed appropraitely. If you would like to discuss any aspect of the contact with NHS 24, I woud be happy to hear from you directly. I can be contacted on 0141 337 4582 or at patientaffairs@nhs24.scot.nhs.uk

I do hope that your health continues to improve and that you have a full speedy recovery.

With kind regards

Shona Lawrence

NHS 24 Patient Affairs Manager

0141 337 4582

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