…. so what happened to the care and the caring?

St Vincent's Hospital (Vinnies), in Darlinghurst, Sydney, has a long-held, hard-earned and well-deserved reputation for the quality of its care and its caring. However, its Emergency Department on last Friday night was, in this humble writer's view, dear reader, a cesspit of cynical disregard, characterised by a desultory and incomplete triage investigation of me by one nurse, and the pompous refusal to review the history by another (“I might have a look at your papers in a minute”), which saw me walk out of the hospital in disgust at the cavalier disregard for my well-being some three and a half hours after I arrived (I add quickly at this point that a subsequent visit to another hospital some little time later resulted in my being given two infusions of intravenous antibiotics and a further oral dose to be going on with). I write this blog on what is now Sunday morning, Delhi time, with a flight to Delhi via Singapore, and a thirty hour period of shivering shakes and regular (constant) visits to the loo (punctuated by the grunting and groaning that accompanies a severe urinary tract infection), in between. A day and a half later, I am no less disgusted by the failure of basic standards of care that I experienced, and so I write about them here.

My story begins on Thursday morning last (6th December) when, as I had indicated in an earlier blog, it was my “visiting the doctors” day. First thing Thursday morning, it was off to a day surgery in Westmead so that my urologist could find his way into my wallet through my rectum, by performing a trans-rectal biopsy of my “monster” prostate gland (his description), and through my urethra, by performing a cystoscopy at the same time (two for one while he had me knocked out; that’s a joke, Andrew). “Sleepies” from 8.00am to after 9.00am (during which time the procedures were carried out), tea and couple of slices of raisin toast, then home for an hour before I headed to the endocrinologist for the annual check - losing more than 10kg, and having consistently lower blood sugar levels for a number of months, was rewarded with a significant reduction in my diabetes medication. Hip hooray for me and I was on my way to the city to continue my engagement with the ANZAM conference and meet up with Bev and Katy from Emerald.

Thursday morning was the third time in the last several years I have had the same biopsy procedure done. The first time, under local anaesthetic, resulted in my first dose of “iatrogenic septicaemia” (combined with the urinary tract infection (UTI) and the painful and exhausting attempts at urination for several days afterward), despite the dose of antibiotics that I had begun taking before the procedure and continued taking thereafter. The second time, in September this year, was done under general anaesthetic and a prophylactic intravenous dose of antibiotics administered at the time of the procedure was apparently sufficient to prevent the iatrogenic results that accompanied the first procedure (see the blog titled “Cute terms that doctors use” for an explanation of the term “iatrogenic”). The anaesthetist on this occasion was determined to make sure that there were no iatrogenic effects and mentioned before I went “under” that, as well as the intravenous dose, he would also give me a prescription for an oral antibiotic to make doubly sure. Unfortunately, I realised later in the day that, when I left the surgery, I did so without the prescription (if it had been prepared, because it wasn’t proffered). Still, based on the previous experience, and with lots to do during the rest of the day and evening for the ANZAM conference, I got on with the business of the business, confident all would be OK.

A good afternoon at the Conference, with Bev and Katy turning up from the ANZMAC conference in New Zealand ready for work and we were off to the Conference dinner (like most dinners, a not unpleasant experience, with rubber chicken, hot bread rolls and cold mineral water). We took our leave from the dinner early and went for a stroll down to the Rocks so that Bev and Katy could experience the Opera House from the other side of Circular Quay (where I think you get the best view) and then around under the Harbour Bridge to Pier One. A convivial time there, where Katy and Bev decided my Yorkshire accent was probably worth a 7/10 (well they are Yorkshire lasses after all) and we were off back to the conference hotel, walking all the way in the absence of a vacant taxi that could not be secured for love or money.

Friday was the closing day of the conference where, although the conference continued in full swing till late in the afternoon, it was time for us to pack up the goodies and take our leave as exhibitors. Bev and Katy were booked on a 5pm flight to Singapore and so they took their leave at 2.30pm to head out to the airport. I “manned the fort” until later in the afternoon – the courier came at the appointed time and took off with the Emerald regalia to be returned to their offices in Bingley, UK. It was about the middle of the afternoon when I got the first hint of the shivers to come and for the next couple of hours I was hoping against hope that my suspicions were incorrect (especially as I had to fly out to India the following morning).

By 7.30pm, it was clear to me that I was in the first throes of another dose of an iatrogenic illness, and I contacted the Concierge to see about getting access to the hotel doctor or a visit to one of the local medical centres. I was steered away from the hotel doctor on the basis of cost and a visit to the Darlinghurst Medical Centre was proposed. I hadn’t counted on trying to get a taxi on a Friday evening in Sydney on 7th December! After 10 minutes of fruitless effort on the part of the hotel staff, I hopped in a hire car (HC835, driver’s name Michael), who insisted that it was a minimum charge of $55. I figured I would have him there for a reasonable time and, in the circumstances, as they say, beggars can’t be choosers. A trip down to the Medical Centre, a script for Keflex in hand, off to the chemist, back to the hotel would see me having an expensive ride but not too far over the top. Then the cruncher – it’s $55 each “flag fall”, says this guy, so when I get back in the car after visiting the clinic, he’s going to charge another $55 for the return ride (this is a $12.00 cab fare in each direction, a total cost of less than half the price of the one way fare he was trying to gouge me for!). The mongrel act of this bloke didn’t stop there because he decided he didn’t know where the Darlinghurst Medical Centre was and eventually dropped me at the door of the St Vincent’s Emergency Department – I was already feeling weak and vulnerable, not thinking as clearly as I might and so, with a grudging completion of the taxi docket, gingerly approached the triage counter.

I had already heard the triage nurse telling the person in front of me, in response to the question of “How long will it be?”, that some people had been waiting already up to 6 to 7 hours, so I wasn’t filled with any sense of well-being and confidence as I approached the counter. On the other hand, I knew that I just needed a script for the antibiotics and that, really, a quick conversation with the doctor and a writing of the script and I’d be away. Well ……..

Name? David Lamond
What’s the problem David? I had a trans rectal prostate biopsy yesterday morning. I’m developing all the signs and symptoms of a dose of septicaemia, and I just need a script for antibiotics so I can “nip it in the bud”.
Well come in here so I can check a few things (temp and pulse OK but BP 146/100, quite high for me, as I tried to explain, since yesterday postoperatively it was still a very healthy 110/70). We’ll get you to pee in this bottle and see what’s there (bottle duly filled, although it took a little while longer, because I’d not long been. That being said, I guess the good thing about “frequency and urgency” when it comes to urination is that another one will be along soon).

Well, have a seat and we’ll get to you. And that, dear reader, was the extent of the interaction I had with the triage nurse.

Over the next three hours, I was witness to a variety of the Kings Cross dross wandering in and out of the department, making one and another demand on the staff, the hospital and the world in general, a young woman who thought she might be pregnant and was bleeding, a lad who had been celebrating not too wisely but too well and had damaged his foot, and a guy who came in, told the triage team he’d run out of a prescription for something or other, and walked out about 15 minutes later with his prescription in hand. All this while the triage staff were regularly responding to enquiries with “We can’t tell you how long it will be because we don’t know when the next serious emergency is going to be brought in through the ambulance doors”.

I might say at this point that in my efforts to engage the staff initially, and even when engaging the pompous CNS (Clinical Nurse Specialist) in his special blue scrubs, I did not play the “Do you know who I am?” card. None of the “I’m a nurse, my wife’s a nurse, blah, blah” – I was just trying to engage the staff on a human level, but perhaps, for these particular individuals at least, that was too much to ask. I tried getting a blanket to wrap round my shoulders because the chills were really setting in by this stage. “Yes sure, darls”, came the reply, but I was still without the blanket 20 minutes later when she left the hospital at the end of her shift. I even sarcastically “thanked” her for the blanket, as she walked out the door past me (sitting in clear view without a blanket) and her response was an air-headed “You’re welcome!”

I had hoped that, with the change to a new staffing group, things might improve and, for a moment, they did – “I asked your colleague for a blanket about half-an hour ago, but it hasn’t arrived yet, do you think I might be able to get one, please?” Sure! and the blanket was duly provided. I went back to the triage counter about 3 times during the time I was there to ask about how much longer it might be before I was seen. The last time was the worst. The CNS in his special dark blue scrubs had just been wasting everyone’s time for the previous 10 minutes, trying to score cheap schoolboy debating points with a thought-disordered junkie, when I approached the counter and said “Entertaining as this is, I really need to get seen and get going; can you tell me how long it might be?” “Well, there’s 9 people in front of you, so that’s at least 2 hours and then whatever emergencies come in, so probably 3 hours …” His matter of fact, almost dismissive response, was one offhand comment too many and I began to react. “So a case of iatrogenic septicaemia doesn’t count as an emergency any more? Or you probably haven’t got that far in the record keeping, given the desultory excuse for a triage examination I got when I arrived.” “I refuse to discuss the dynamics of your case.”. “Look, all I want is a script for Keflex and I’ll be on my way”. “We can’t do that, you have to wait your turn”. “Like the bloke who walked in earlier because he thought he had a supply of some medication but had run out, was able to leave 15 minutes later with his script?” “Well, I might review your case in a few minutes, if I have time” …. that was it for me, what was the point? In my physical state, I wasn’t up to trying to be civilised any longer with these uncivil people and walked out.

One can understand the reaction of nursing staff to drug disordered, personality disordered people like Melinda, who kicked a great glass crazing in the front door of the Emergency entrance (and insisted her Mum would ring all the TV current affairs programs to expose the lack caring experienced by her and her ilk), or Daniel, who came demanding a wheelchair to accommodate his bad back with all its steel rods and bolts, and then proceeded to try and throw the wheelchair through the triage nurse's station when he wasn't getting the attention he wanted as quickly as he required. I was glad as I observed their inappropriate, manipulative, thuggish behaviour, that I had given away the nursing role several decades ago and no longer had to be 'clinically correct' in my (covert) responses to them.

On the other hand, I was mightily unimpressed with my own treatment (which was, perhaps, a function, at least in part, of the daily exposure to the acts of (emotional and physical) bastardry committed by the Melindas and Daniels with whom they come in contact). A result of being overworked and underpaid? Well I can’t answer for the second part, but definitely not overworked on this shift by what was coming through the “walking wounded” door, as the boys and girls behind the glass had plenty of time to chat with each other gaily. I was sitting opposite the triage counter and able to observe (and hear) the exchanges.

I walked from Vinnie’s back towards Williams Street, hoping I could pick up a cab to take me back to the hotel, which I eventually did, at a cost of $10. I approached the hotel staff again and tried to get some sense about the hotel doctor, and the service was eventually contacted by the Duty Manager. I spoke to the doctor, explained the full story, and he wanted to charge me $300 for somebody to come and write me a prescription. I said, I can go to one of the suburban hospitals and back for a lot less than that, and his response, unsurprising by this stage, dear reader, was “That’s a good idea”. And so it was.

I found my way to the Ryde Hospital where, after a much better triage experience (by this stage my temp had risen to 38C, although I’m sure they would have found blood and protein in the urine sample I provided at Vinnie’s, but there, I think, they were just trying to dismiss me as a “big girl’s blouse”, unable to deal with the “expected” side effects of the procedure) and a full history taking by the registrar, I had inserted an IV catheter for the purposes of drawing blood for blood tests and giving me a couple of hits of IV antibiotics. The contrast with my Vinnie's experience could not have been more stark. I had joked with a friend earlier in the night that I would have to get sicker to be seen at Vinnies - I guess by the time I got to Ryde ... I was!

I waited for the results of the blood tests and the registrar showed them to me to confirm that the IV antibiotics were the correct response to what was a very high white cell count (the clear marker of infection). He also gave me the Keflex I needed for the urinary tract infection, taking my mobile number in case the liver function tests and kidney tests he also ran revealed anything untoward (fortunately not). I left him with my thanks, not just for his competence but also for his humanity. From Ryde, it was a dash back to the hotel, quick packing and checking out, so that I could get to the airport in time to check in for my flight to Delhi. It’s ironic that the only time I’ve been sick in the last couple of months is when I have returned to Sydney from India.