"Mixed experience at Chelsea & Westminster"

(as the patient),

I have reported my medical history in other stories on this website. But my most recent experience was in mid-September 2009. Having refused to have a seventh procedure as a patient at Charing Cross hospital, I was transferred to Chelsea & Westminster foundation hospital for major reconstructive facial surgery, entailing the removal of muscle from my back which was transferred into my face. I have been told that it will take about three years and numerous further procedures before my face looks “normal” again. The muscle flap transfer procedure is commonly used to rebuild the faces of patients whose faces have been destroyed by cancer. Indeed, I am frequently mistaken for a cancer patient by medics who are not aware of my case history.

I spent ten days in Chelsea & Westminster hospital. For eight of these, I was one particular ward and generally the standard of nursing there was excellent, as were the ministrations of the physio team. There were only two nurses on that ward whose behaviour I thought gave me mild cause for concern - a night duty nurse who at changeover told me that administering eye drops every hour would be “inconvenient”. I replied that they had been prescribed hourly as there had been yet more damage to my eye during this latest surgery and the treatment was necessary to preserve my vision. The nurse responded that they’d meant it would be inconvenient to me. In fact, as I had suspected would happen, the nurse only came into my room twice during the shift to administer the drops rather than hourly as required.

There has been a brief article in a national newspaper recently about a minority of nurses who prey on previously attractive women who are in-patients suffering from serious facial injury and the second nurse appears to me to fall into this category. This nurse made, what I would describe as, inappropriate comments and complimented me in a personal way which made me feel uncomfortable. The nurse wrote their name and mobile number on my consultation notes, completely uninvited.

I thought I’d made it clear that I was uninterested, but persistence continued over the next few days. My comments were misinterpreted in a way which took them out of context and also suggested that I give the address of my elderly, partially sighted mother so that the nurse “could go to visit her and see if she required any help” whilst I was incapacitated. I was woken up on their last day on duty to be told their shift was finishing and hoped I would make contact. Friends have asked me why I didn’t complain, but I felt I had quite enough on my plate as it was, without getting embroiled in a complaint about this behaviour. However, I feel it is appropriate to mention it by way of a warning to other patients.

There was a problem with one elderly patient on the ward, who screamed and shouted foul-mouthed abuse twenty-four hours a day, literally for hours at a time. He had also attempted a number of times to assault nursing staff. I was told that the hospital was full so there was nowhere else to transfer him to. He was moved off the ward two nights before I was discharged and the difference made by being able to sleep was tremendous.

In addition to praising the nursing staff and physio team on my ward, I’d also praise the doctors in the ophthalmology team for the excellent care they took of me to sort out the post-operative complication resulting in very distressing temporary blindness in my left eye. (Charing Cross’ ophthalmology team has also been excellent).

There are some aspects of the hospital stay that I shall be making a formal complaint about, but with one exception they all involve events before I was transferred to the ward described above, and most worryingly to me largely took place on the High Dependency Unit. My surgery was twelve hours long, referred to by doctors as “very major surgery” and for several days afterwards I was on a high dose of morphine and very strong IV antibiotics, unable to move and still groggy from the long anaesthetic. I was initially put into the Intensive Care Unit, and then transferred to the High Dependency Unit. I felt that I was subjected to following:

After surgery I was wheeled in the bed from the ICU to the HDU. Before entering the HDU I had to have a list made of every item that I was bringing into the ward. I refused to undertake this procedure. The head of the HDU, that night told me that in that case I would not be admitted onto the unit. Fortunately I was sufficiently compos mentis to be able to point out there was no legal right to prevent my admittance. I felt the attitude was extremely rude, bullying and aggressive. To try to bully a seriously ill patient into listing every item, including toiletries, I feel is medically unacceptable behaviour.

I realised several days later, when well enough to go through my things, that my bags had been searched i.e. without my consent, and items, e.g. my Oyster travel card, and £10 in cash that I had deliberately not checked in so that it could be easily available to reimburse friends should I need them to buy anything for me, had been removed without anyone informing me. Initially I therefore assumed that these items had been stolen, and it was only when the things that I had checked in were returned to me that I found that these additional things had been removed and filed in an envelope.

I had earlier refused attempts to coerce me into signing a disclaimer for any loss, as it included that the hospital would have no responsibility even if at fault due to its negligence, and I found this unacceptable. I’m also getting tired of being asked nosey and intrusive questions that have no relation to medical issues as part of the admittance form filling process, for example how many rooms there are in my flat. When challenged by me as to what possible medical significance this could have, the hospital staff invariably have no reply.

Once on the HDU, in a screened off cubicle, I was unable to sleep because of the non-stop high volume yowling for hours on end of a doctor in the cubicle opposite. Most of the noise however consisted of this person yelling to a colleague further down the ward about matters entirely unconnected to patient care. After hours of this commentary, particularly repeated complaints that they hadn’t had any sleep for 24 hours, I said through the curtain during a brief silence that no-one else on the unit had been able to sleep either due to the non-stop yelling, and perhaps they could quieten down for a while and give patients a respite?

The effect of this request was astounding. The curtain was ripped open at the end of my cubicle, and the doctor yelled at me “I am a doctor! You are a patient! You shut up! You keep quiet!” and then yelled triumphantly to the other doctor: “huh! Thought that needed saying! That‘ll shut her up”. I was then yelled at, “Bet you don‘t know I can’t leave my station do you!” As this person had in fact just left their patient in order to rip back my curtain and yell at me, I remain unsure what this was meant to mean.

I think not only is this behaviour utterly unacceptable, it also appears to me to breach this doctor’s Hippocratic Oath of first doing no harm. I believe it is never acceptable for a doctor to behave in this manner and moreover, I feel it breaches the GMC’s code of conduct for doctors, e.g. re respecting patient dignity, treating all patients politely and considerately, protecting the health of patients etc.

Unfortunately for this person, even whilst strung out on post-anaesthetic drugs and morphine, I still had the mental resources to know that I needed to have them identified as quickly as possible in order to make a formal written complaint to the Chief Executive once I was sufficiently recovered, and to make an initial complaint through PALS whilst still in the hospital, who identified them for me.

After this I was repeatedly woken up by a succession of doctors wanting to move me from the bed (not just the HDU). I refused to consent to this as I believed I had already been subjected to painful mishandling earlier by two nurses. I felt they were not paying proper attention to what they were doing and had almost pulled one of the vacuum drains out of me, and also I simply felt too unwell to be moved. It seems to me that if I was in a fit state to be moved off the HDU, then my specific consent would not have been required. As for the magical properties of the bed I was in, which were never actually identified, it was not actually exchanged for a standard bed for forty-eight hours after my move to the ward - whether because it was not a necessary exercise or whether because the medical team responsible for me had refused acquiescence, I have yet to find out.

At one point, some of the staff asked me to consent to being moved. I was then told that there was a MRSA patient on the unit and this is why I should move, as I was particularly vulnerable to catching this infection. Again, I have yet to ascertain if this was true, but if it was, then questions must be raised as to why seriously vulnerable patients in the HDU were exposed to MRSA in this manner. Finally, I was awakened by a doctor who leaned over me and said, “I know you haven’t consented to be moved from this bed, but I am going to move you anyway”. I pointed out in no uncertain terms to this person that if they laid their hands on me without my consent, they would be committing assault and I would sue them personally.

When I was moved on from HDU, this same doctor repeatedly tried to put my overnight bag on the bed next to me, despite my protests. My bag had been left in unhygienic places, especially in circumstances where a patient is considered to be at high risk of further infection. I was then wheeled along a corridor that had rubbish bags lining both sides, which were in very close proximity to the bed. The hospital porter moving the bed I was in, who had been told to wear protective gloves and an apron, had to move some of these rubbish bags out of the way in order to manoeuvre the bed around a corner. When asked by me to now change his gloves, please, they did so but I felt unwillingly.

There were a couple of further unrelated examples of concerns with infection control later in my hospital stay - one junior doctor came into my room with a piece of paper in their mouth, removed it with their hands, and then without warning and without washing or putting gloves on, placed their hands on the transplant site on my face. Another junior doctor came in to take blood, wiped their gloved hands over the door handle and I thought was visibly annoyed to be asked by me to change the gloves, not touch the door handle with them before attempting to take blood from me and to put on a protective apron, please.

The surgery was carried out by the Plastics Team, some of whom including the lead clinician have been involved in my case and past surgery since January. However, I felt outraged when a member of the medical team suggested that I should not be angry about what had happened to me because sometimes bad things just happen, and now I was no longer an attractive woman, I should take the opportunity to develop another aspect of my personality.

I felt absolutely appalled by this inappropriate comment and that actually my personality is already fully developed. I feel this person didn’t relate well to patients whose lives and bodies have been devastated by medical incompetence and negligence. Doctors specialising in dealing with facial deformity I think are supposed to have a good understanding of the psychological devastation that can result for the patient. Surely I am entitled to get very angry about it if that is how I choose to react. I think medical incompetence and negligence did not amount simply to “bad things sometimes happen”. It amounted to negligent care which has devastated my life

From my experience it seems this is missing amongst some members of this team, a view reinforced by the lead clinician telling me on my second outpatient appointment that I’d change the way that I view my face, which I had referred to as a deformed, grotesque mess, and that some patients are happy to have a face on display in the state that mine currently is. I have forcibly emphasised that no, actually, I won’t feel better in due course about being transformed from an attractive woman into a grotesque gargoyle, and that this person should bear in mind that unlike most of their patients, I did not come to their team with a face deformed by cancer, accident or violence but with a perfectly normal face, which I feel has been accidentally damaged by the NHS.

The excellent care provided by the Dressings Clinic sister, Mariama Manu at the Charing Cross Hospital, one of the few positive aspects of my experience, unfortunately, does not so far appear to be reflected at the Plastic Dressings Clinic at Chelsea & Westminster hospital. On my first visit, I felt the dressings nurse unnecessarily interrupted me mid-sentence during my consultation with the lead clinician, causing me to lose track of what I was saying.

I was then warned that they were about to spray the back of my head with something, and without further warning moved around to my left and sprayed the substance straight into my injured eye. When I asked to not spray me in the face again with the substance, the nurse responded that they had warned me before spraying. I felt there was no explanation as to why I was not further warned that they were moving around and no explanation as to why no attempt was made to guard the injured eye from the spray by blocking it with their hand.

When the lead technician had left, the nurse tried to inform me that I’d have to buy surgical tape from my local pharmacy as it was in short supply. I didn’t feel this was appropriate. As I understand it, patients are legally entitled as outpatients to free supplies of dressings etc that they require as a result of surgery. Self-employed, I have been unable to earn any money since January and out of approx £80 welfare benefit for the week had already spent £18 on a mini-cab fare and bus fares to the hospital that week, and certainly was not going to spend between £4 and £6 buying an adequate supply of surgical tape for the week on top of that. The nurse then went and fetched a roll of tape for me.

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