"The bigger picture from the patient’s point of view."

After having some serious acute back pain, just 9 months after a spinal decompression at the QEUH, I was referred to A&E by my G.P. who had seen me unable to walk on crutches into his clinic. My back had “popped” the day before (Sunday) while I was dressing after showering. I had to use my crutches to get about but it was a manageable pain that I was sure would rectify itself in time. However the next day (Monday) the pain had heightened to being unmanageable and I was now struggling to walk even with the help of crutches.

The process through triage at A&E Ayr Hospital was great, very helpful and helped by the fact my G.P. had phoned ahead of my arrival. My blood pressure was through the roof and I’m sure would have warranted being kept in for monitoring.

I was then assessed by a Registrar who did not let me finish a sentence. I have a complicated medical history involving my back and walking but they seemed unwilling to listen. I found their questioning patronising to say the least. One of their first questions were could I feed myself and did I have carers. I can only assume that this Registrar had made assumptions on my wide ranging genetic condition that affects my bones and certainly not my ability to feed or look after myself. I had to point out I that I worked full time and lived independently. I wonder if every patient would be questioned in the same patronising way?

I tried to explain to the Registrar that I had had a spinal decompression operation in May 2017 and that the operation had been successful but I was concerned that this might be connected although I was showing different symptoms. I tried to explain I had no pain sitting however as soon as I try to move the pain is so unbearable that I had no idea how I was even going to get off the A&E bed as they could not lower it any further for me. They did not ask to see me walk or move at all to gauge the pain I was in.

At this point I was told I was being sent home with co-codamol. I asked how I was going to get home as I could not walk at all, get in the car or even get off the bed I was sitting on without severe pain. I asked if they were insisting I was to go home, could they provide a wheelchair? I was told the hospital does not have wheelchairs only porters’ chairs. It was suggested that my Mum, who had driven me to the hospital, could go to the Red Cross to see if she could hire one for me to leave the hospital. It did not register with the Registrar that this meant I would be home alone for approx 9 hours a day, unable to walk or look after myself as my partner works. They only seemed interested in discharging me no matter what.

I was told I would have to wait for an MRI to confirm if this pain was relating to my spinal operation, which could take “3 weeks or so”. I explained that this wait was unacceptable considering the acute pain I was in and bearing in mind my medical history. I was told by the Registrar that I would be seen quicker if admitted but they could not admit me because I would “be taking a bed away from someone more needy”!! You have no idea how frustrating this was to hear when you are in acute pain with no idea how you are going to make it home in the pain you are suffering.

At this point I asked the Registrar to at least check with QEUH if the pain I was experiencing was related to the operation and for their advice. They were insistent at this point in doing a bowel exam even though I had confirmed my bowels were fine. I was unable to lie down flat or get into a position for this to be done. I was howling and screaming in pain that I had never felt before. I screamed at them that I was unable to do it. I was then asked to change sides and again I was howling and screaming with acute pain and the registrar was able to confirm what I had already told them, my bowels were fine. At least at this point they could see some of the pain I was experiencing. At this point I felt like giving up, I knew I could not go home but I had lost the fight to explain as I’m sure many people would, I was demoralised.

I had to ask the Registrar again if they had managed to contact the QEUH to which they replied yes and that QEUH had “agreed with experts here” (Ayr Hospital/this registrar), but they were going to admit me. I find that explanation confusing, if they had agreed why was I being admitted.

I then had to be wheeled up to the ward on the A&E bed as I could not get off it and pulled across to the ward bed which could rise to the height of the A&E bed and low enough for me to get off it. I had to use the hand rails on the bed to move at all. How would I have managed this had I gone home as the Registrar insisted?

I then stayed in hospital for almost 2 weeks, where I had an MRI and X-rays done. I had pain management team input and have gone from 3 tablets a day to 24 to control the pain. I have had physiotherapy and occupational therapy input. My pain is now nearly under control however I am still in a wheelchair and I’m still unable to take a step unaided, stand upright or lie flat. I can manage a few steps with the help of a Zimmer frame. In order to shower I have now to use a shower chair. How would I have managed that if I had gone home as the Registrar advised.

That was all required to get me in a position to get home yet a Registrar was going to send me home with co-codamol with no aids, no help, and no MRI or x-rays. with only a wait for an MRI. I have no doubt if I had gone home at the Registrar’s insistence I would have been back later in the day due to the acute pain and bringing unable to lie down flat in bed, something I still can’t do. With medication it makes it easier and I use a bed prop that Occupational Therapy have provided for me.

I am now awaiting my outpatient appointment with the QEUH, which I had already requested 2 months before the pop in my back. I am aware they were made aware of the fact I was an inpatient with A&A but they do not seem to be in any hurry to see me either.

My discharged letter says ‘felt a pop near site when bending in the shower and has decreased mobility and pain from the L4/5 region ever since’. I did try to explain to the Registrar several times that my back popped while bending to get dressed after my shower and although there was pain at the site for a second or 2 I no longer had pain there. It had now moved down my right leg. Again frustrating.

The registrar I saw was very pleasant and did nothing in malice. However they were unwilling to listen or look at the bigger picture from the patient’s point of view. A much better bedside manner is required, with an open mind, no preconceived judgements and a listening ear. My experience in A&E was horrific, I hope no one else has to experience this.