My Day In The Life of an A & E Department

On an all too regular basis we hear the news of yet another death in our hospitals' A&E Departments. Most recently a patient dying while waiting many hours to be assessed by staff. We cannot use the excuse of our country's recession for the deaths of these people. Our Government must invest the money needed to provide the staff and beds required to end this atrocity once and for all. I still think funds from the National Lottery could play a huge part in this. It just doesn't seem right that one person can win anything upwards of five million Euros while people are dying on hospital trolleys because of cutbacks in our healthcare - there's something terribly wrong somewhere!

Eight years ago, several days after having a positive Stress ECG, I was admitted through the A&E Department of my local hospital but lucky for me I only had a ten hour trolley wait. Because I'd been suffering from chest pain I was seen by the triage nurse almost immediately then brought in for assessment ten minutes later. The following sections are from a diary I wrote up on my discharge six days later.

Thursday:
"ECG then bloods taken. Sent for chest X-Ray. On my return discover a new occupant in my cubicle. Apologies offered and accepted I'm then shown to one of the vacant trolleys in the corridor. After a short while a nurse squirts a GTN (glyceryl trinitrate) spray under my tongue assuring me that this will help the pain in my chest. Some five minutes later, instead of feeling better, it seems like I am getting worse. Begin to feel dreadful again. A short while later (whether or not as a result of the spray) the pain leaves with just some discomfort remaining.

Sometime around 11.00am I seek permission to use my mobile phone to ask hubby, who is reading in the car, to come in. By this time most of the other trolleys in the corridor are now occupied by patients with varying degrees of illnesses and injuries, nothing too dramatic. No stabbings or gunshot wounds - yet. In fact for a brief while, it's only the sound of intermittent retching from a distant cubicle that disturbs the almost uncharacteristic silence of the unit...."

"It is after mid-day when I'm offered tea and sandwiches. As I don't drink "normal" tea I ask for hot water instead. Just then one of the cardiology team arrives to assess me. Says they will be admitting me and I will probably be having a test called an angiogram.

To facilitate a staff training exercise - coping with a major road traffic accident, all visitors have to temporarily leave the area and as my trolley is close to the entrance I'm moved into a cubicle alongside another lady. Quickly realise the need us human beings have for contact with fellow humans especially in times of distress. We introduce ourselves and I listen intently as this nice lady explains how she has successfully coped over the years with her heart complaint. Her words are very encouraging. It is now sometime after 3.00pm and hubby is allowed back in.

Shortly afterwards I'm taken down a short corridor from the main A&E thoroughfare to a large cubicle occupied by two elderly women and my trolley positioned between the two. Hubby remains with me for a while but as our son is soon due back from school, I tell poor hubby to go on home. He tells me he will return later in the evening. Exhausted, I resign myself to a lengthy wait, perhaps many hours, but am alarmed when the woman on my left explains she's been here waiting for a bed since 5.00pm yesterday evening! A couple of hours later her uncomfortable wait is over and she is moved upstairs to her ward.

It's never easy trying to catch a few winks in hospital but as I feel absolutely drained I close my eyes in the hopes of drifting off even for just a few moments. That's about all I manage as I wake to the sound of my name being called. A female doctor whose face I recognise as one of the haematology team calls by to discuss my situation.

She explains the problems posed by my bleeding disorder in the event of me having an angiogram. Basically I could haemorrhage from the site where the wire is inserted through my femoral artery. Also, the test itself is not without its risks - at best, an angina attack, at worst, a stroke! All that, coupled with the chance of bleeding afterwards, makes for very scary nightmares indeed. Soon after the doctor leaves, the woman on my right is told her bed is now ready.

For the first time today I'm alone and scared, separated from the world by a corridor while life in A&E continues unabated.

Thankfully, my isolation is short-lived when another woman is wheeled in beside me. She is very funny and makes me laugh from the word go with her hilarious goings-on about her broken arm which she is due to have set tomorrow but reckons she will be spending the night in A&E. Also admits to being on a high from her painkilling injections!"

"....At last, it's now my turn to be given the great news that there's a bed ready for me and immediately I phone hubby to give him the ward name.

It isn't until 7.15pm that I begin the long journey to the ward. I'm lucky to get the corner bed, in fact the room is identical to the one I was in five years ago when I had the D&C prior to my hysterectomy. My corner bed is on the same side and the same corner. It is almost eerie.

I share the ward with five other women...." (The two ladies who stand out from that night are Nora, an absolute comedian. She was in her sixties, twenty odd stone and seemed to have been inflicted with every disorder under the sun. Opposite me was Amanda, a young woman who'd had her appendix removed the previous day but had to return to A&E after her operation because there was no bed available. If this had happend in some far off war-torn country I would be aghast but this was an Irish hospital, that through lack of funding, could not provide this woman with a post-op bed thus putting her life in almost certain danger).

"....Hubby arrives bringing with him the old reliables (nightdress, dressing gown, slippers and most importantly, knickers) plus my beloved fennel and camomile teas. For some reason I always feel like a child on my first night in hospital so I'm feeling a bit lonely when he leaves at 9.00pm.

The remainder of my night is spent taking a couple of strolls up and down the corridor (even though I've been told to remain in bed), writing up my diary and generally getting to know my room mates. All the while Nora continues to entertain with her unique brand of fun. Her ability to describe all her tales of woe with such energy and humour prompts me to suggest a new career in stand-up comedy! Due to exhaustion I have to pull out of the conversations but still enjoy listening in on all the banter".

Friday:
"Wake up around 7.00am...."

"Sometime around 10.00am a lovely technician arrives to take my bloods. She reminds me of Shakira, the blonde, shaggy-haired Columbian singer/belly dancer. As always, my veins refuse to give up their blood without the usual struggle but in the end the blonde lady wins them over and they pump copiously!"

"....I arrive on the CCU at 12.15pm where I'm taken to Ward 1 and as I'm being wheeled into the room the first thing I notice is that I'm definitely the youngest patient here. In a strange way I find this very reassuring". "....as I begin putting away my things into the locker I realise everyone is having their dinner and I'm instantly reminded of how hungry I am. I've been fasting since last night because of the angiogram planned for this afternoon". "...Later, another nurse comes in to start up my platelet infusion, set to go in over an hour.

As the curtain is still around my bed, I don't see the patient being admitted to the bed next to mine but on listening to the voices, both male and female, I'm shocked to discover that it's the man who will be beside me. I've never been on a mixed ward before and my first though is how old is this guy! I pray he is in his nineties. It turns out he is a very quiet, gentle soul probably early seventies".

"....Not too long afterwards another gentleman is admitted, this time to the middle opposite bed. Even though both men appear to be very gentlemanly, I feel somewhat uneasy in their presence. For me, getting in and out of bed would now have to be executed with the greatest of dignity, no more bare thighs!

Shortly before my drip finishes, the cardiologist tells me that the angiogram has had to be cancelled. The word devastated doesn't come close to how I feel. Having been so nervous since yesterday I was now going to have to go through it all over again. Seemingly the person who was to carry it out was called off but the message never got through to the haematologists, hence my platelet infusion. Communication breakdown, big time! The platelets I'd just received would be no good as their effect lasts only around six hours. I'd have to start all over again on Monday morning".

Sunday:
"....After dinner, my chest is still hurting a lot and also the sharp pain in the left side of my chest returns.

As I'm due my angiogram tomorrow I feel the need of some spiritual comfort so on seeing the young priest attending an elderly lady a couple of beds down from me I decide to ask him if he could bless me also. After he leaves the ward I head down to where he's talking with the nurses at their station. He introduces himself and is so kind when I tell him how nervous I am about my procedure.

Little did I realise how anxious I was because as soon as he draws the curtain around my bed and sits down I burst into tears. He just holds me and tells me it's OK to cry. I've never met a priest with such feeling. I tell him about all my fears for tomorrow, how I'm scared that if I die I will leave behind two children. I'm not afraid of the pain, just of dying and leaving my husband and children. He holds my hands and reassures me that everything will be alright. He then anoints my hands with holy oil, saying the most beautiful prayers which give me a tremendous feeling of great inner peace.

It is nap time (1.00pm - 2.00pm everyday) and the nurse draws all the blinds, once again transforming the ward ambience to that of a warm, secure nursery. I slip into a peaceful sleep from which I awake much more rested".

Monday:
To make a long story fairly short, my angiogram was yet again cancelled and they started me on the anti-inflammatory drug, Aulin. I never like these drugs as I think they interfere with my clotting process.

Tuesday:
"....At 5.50am the nurse arrives to start my platelet infusion which would go in over two hours. Don't really sleep after that, just lightly doze as I have to have my BP checked regularly. At around 8.15am I head off into the bathroom for a quick wash but while I'm in there an attendant arrives with a wheelchair to take me down for my angiogram. I race back into the ward and get into my paper gown and knickers quicker than a fireman dons his work clothes. How I didn't have a heart attack there and then is beyond me! Finally, we're on our way.

I walk into the test room with my blanket wrapped around me and climb onto the table where one of the girls settles me into position. The pretty girl with curly hair places a little pill under my tongue then the doctor tells me he will explain everything as he goes along but I'm not sure I want to know!

Looking at all the monitors I notice the middle one only has my name in huge lettering on it. I joke with the staff telling them I've always wanted my name in lights but not exactly under these circumstances then the doctor laughs and says "now for the film". Even his comical remark does nothing to quell my anxiety.

Standing at my right side he presses the top of my leg in the groin area, looking for a pulse, I think, during which I repeat how terrified I am. After the incision, the tube containing the wire goes in and after that all I can hear is the doctor explaining to the other doctor exactly what's happening on the screen. At one stage I quickly glance at the monitor to see the wire moving up my artery which very quickly makes me look away again.

Every so often I'm asked to take a deep breath but I can't hold it for long. At one point I hear something about a narrowing on the left which I assume is in the artery. Towards the end the doctor tells me he is going to flood my heart with a warm eye which sounds very scary indeed! The sensation is really strange because I can feel the warm liquid whooshing up all through my chest. He then flushes it through and it's all over. I'm so cold.

Decide to ask him what he found and he explains that 40% of my left artery has narrowed and that most likely I will be put on medication which doesn't sound too life threatening. While moving over onto the trolley, with tube still in situ, I have to keep my right leg straight which I think is to prevent bleeding but I can't stop shivering and shaking. I'm then moved into recovery.

There, the other doctor removes the tube and presses very hard on the incision for 10-12 minutes which is absolute agony. Still shaking with the cold so a nurse puts extra blankets over me and also checks my BP. I remain there for about 20 minutes before going back to the ward.

While being transferred from the trolley to the bed I again have to keep my leg straight. Blood pressure sounds like it's a bit low so the bed is lowered. I continue to get colder by the minute so the nurse covers me up with another couple of blankets which probably now number five in total. I'm anxious to let hubby know how things are so my very kind nurse gives me my mobile phone so as I can phone him. He's thrilled I'm back safe and sound.

After about an hour I begin to warm up a little. I'm allowed dinner at around 12.30pm but I remain in bed with all my blankets wrapped around me. Since returning to the ward I've been having my BP and wound checked regularly but now there is a small amount of bruising.

At around 3.30pm I take my first tentative steps, praying I don't bleed and after having a pee I slowly walk up and down the corridor once to see how I'm doing. Wound is a bit sore but chest is still tight so I rest for a while. I always find the time between tea time and visiting to be an eternity and today is no exception so when hubby arrives in at 7.00pm I eagerly tell him all about the day's events. He is almost as happy as I am that it's all over and everything went well. I can't wait to see the boys tomorrow".

Wednesday:
"When I get up to pee at 7.30am I notice the bruising has spread down my leg a little. There is talk of some of us going home today so I ring hubby to tell him the good news.

One of the nurses tells me I'm starting on my new medication today which makes me feel a bit anxious as I have a bad history when it comes to drug reactions and the fact that this is heart medicine it makes going home on the first day of starting it somewhat scary. Nevertheless, I'm given my first beta-blocker, Atenolol, 25mg, this I'm told, is to slow down my heart rate so it doesn't need to pump as much blood as normal. Just as dinner arrives, the Prof. and all his doctors come in to see me. He tells me I'm going home. Says if medications (beta blocker) works he'll leave me on it for around six months, if not, he'd re-admit me and would have to consider surgery. I'm also prescribed a cholesterol-lowering drug, Lipostat, 20mg. (even though my level is way within normal level) plus a GTN spray. Anti-inflammatory drug, Aulin, has been stopped thank Heavens as I was never very happy on it...."

"After they leave I have my dinner. Unfortunately, I don't have time to finish my coffee as an attendant arrives with a wheelchair to take our luggage (two of the other ladies and mine) to the discharge room and we too have to go with her. Dreadful rush.

This is the first time I've ever been discharged this way and I can honestly say I feel it is not the best preparation for my re-entry into the outside world. From the comfort and security of the ward we're taken to a room that can only be described as resembling a bus or train station luggage area. Here we are formerly discharged. Our bags are labelled and put on a rack where I quickly discover another lady's name on mine and vice versa so I promptly get the nurse to reverse them. There are also several other people going home today.

Eventually, our doctor comes down to release us. The nurse tells me to contact hubby and tell him I'd be ready at about 2.15pm for collection at the main door. Out of our group, Teresa is the first to leave. With a big hug I wish her well and thank her for everything. She's a wonderful woman who lost her husband five years ago, has ten living children and twenty six grandchildren. She tragically lost seven children, three sets of twins and one triplet. I pray life will now be a little kinder to her, God knows, she deserves it.

The lady doctor then writes my GP's letter and hubby's letter which enables him to one month off work. Shortly afterwards the attendant arrives with my wheelchair. I kiss and hug Marie, wishing her all the best and telling her we might meet again one day in our local pub!

On my long journey through the hospital to the main entrance I meet the lovely male nurse from the first ward I was in and tell him I managed to survive it all and I'm now homeward bound.

I only have a few minutes to wait before hubby arrives. Can't believe I'm actually on my way home. Really looking forward to seeing the boys and our dog, Sandy.

Home just before 3.00pm".

UPDATE:
Within a week of returning home the bruising moved all around my leg right down to my knee. Rang the hospital to let them know, they asked me to come in immediately and proceeded to get a medical photographer to photograph the bruise as they'd never seen anything like it before!.

After three months I had to stop taking the beta-blocker, Atenolol (Prof's instructions) because I'd developed a dreadful cough from about a month on it. As I was never really able to master using the GTN spray, I gave that up too, so, by a couple of weeks later, I was feeling much better. Now at least I could walk again without developing a massive coughing fit! I did remain on, and still take, the Lipostat which I've discovered over the years is not without its side-effects.

Three years ago I developed severe pain in my right shoulder and upper arm to the point where I needed help taking a shower (I couldn't dry myself), combing my hair was a nightmare, what was left of it! Each washing and brushing resulted in losing handfulls, it was everywhere around the house. In order to maintain some degree of a normal life I had to resort to having physio on my shoulder for many weeks. Just before it completely improved the pain went over into my left shoulder and arm. I couldn't afford any more physio.

After many months of suffering I Googled cholesterol-lowering drugs and found to my astonishment that others also were severely disabled by arm pain. At this point I halved the amount to 10mg per night. It took another couple of months to notice a slight improvement so I then reduced it to 5mg per night. Only since the beginning of this year am I almost pain-free. There is still stiffness but I'm careful how I move. Last December my GP had my cholesterol checked and it's still well within normal levels, under 4.

In June of this year I had a heart CT scan which showed my heart still to be in great working order but most amazingly, the 40% blockage which showed up eight years ago on the angiogram is now totally disappeared! It has to be the Lipostat. The Consultant in the hospital suggested I should be taking 10mg but because of my normal cholesterol level and above all, the fear of getting the shoulder and arm pain back, I've decided to continue with the 5mg dose.

Not a day goes by that I don't realise how lucky I am and thank God that I'm still here, healthy and happy with my family around me.

Above image via: www.healthdirect.co.uk
Bottom angiogram image via: www.heart-valve-surgery.com

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