A less cosy view of the NHS at work

Other people’s medical problems are intrinsically tedious and only of interest to those immediately affected, so you may well wonder why I am revisiting my recent sojourn in hospital (blog 8 April, A Personal View of the Beleaguered NHS). This is because my experiences after progressing from A&E to Short Stay Ward were distressing and potentially life-threatening, and entirely contrary to the principles behind the founding the NHS.

For the second time in less than a month, I arrived in A&E in the middle of the night with congestive heart failure. Not surprisingly, doctors decided further investigations were needed and I was transferred to a ward.

“A cardiac consultant will see you, and will probably want you to have an echocardiogram and angiogram,” I was told. “You will stay here until that is done.”

Thereafter, as my recalcitrant heart continued to give me pain and breathlessness, I was told on a regular, certainly daily basis, “A cardiologist will come and see you today.”

No cardiologist ever came to see me. Not once in the five days I was on the ward.

I was regularly seen by student doctors, visited on a couple of occasions by the Registrar, and by the excellent Head of Clinical Medicine in charge of that area of the hospital. All appeared to believe that “a cardiac consultant” was due to see me almost immediately. I heard telephone calls made, and urgent appeals, but that elusive “cardiologist” never appeared.

At lunch time on the fifth day, I was told I could go home. The young doctor who came to “explain” told me that I should consult my GP. “He’ll probably be able to get you to see a cardiologist more easily than we can.” “But – I’m here, actually in the hospital…” “Yes. Sorry, nothing more we can do.”

My GP was appalled. He knew it would take 8 months at least to get a clinic appointment.

I suggested we go private – what am I hanging on to my savings for if my heart is liable to give up any time? The heart consultant saw me promptly, gave me that elusive echocardiogram immediately, and booked me in for an urgent angiogram the following day. (It’s a day procedure, where a wire is inserted into an artery and directed into the heart itself.) The result: a view of clear coronary arteries and a very damaged heart muscle due to a clot in the lower left ventricle dating from many years ago. Nothing to be done except change of medication and de-stressed life style.

How did the cardiologist know what these results would be? No one else did. Nor was I given further medication, simply was told to double the dose of everything I am on.

And how can it be that while I am actually in a ward in the hospital no specialist was willing to come up in a lift from one floor to another, just to speak to me?  Instead I am told to go through the tedious process of referral via GP and waiting list, which everyone knows will take months. And yet, a heart specialist who works at the same hospital was able to see me privately less than a week after referral, and immediately conducted the investigative procedures so that at last it is clear what can and cannot be done.

I wish it to be clear I have no criticism of the excellent heart specialist I was able to consult. He too appeared shocked to learn of my experience, and went out of his way to make things easier for me. I am grateful to him personally. And to my GP, who has been consistently supportive.

But the behaviour of those cardiologists responsible for my neglect is surely not what we expect of those at the top in the NHS. Specialists have always demanded – and received – special treatment, right from the inception of the NHS. We know that without special treatment, certain specialists would simply have refused to cooperate in a new-fangled  service designed to be for everyone regardless of means. Perhaps without our realizing it, some of these specialists are withdrawing their cooperation now. I hope this is not yet one more way in which private medicine is encroaching on our beleaguered NHS.

 

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A Personal View of the Beleaguered NHS

I have not written a blog for a long time now, and that is principally because I was anxious to complete my new novel The Porcupine’s Dilemma and gave myself an arbitrary deadline of Easter. The Book is done. Unfortunately, I forgot to take into account the physical realities of an aging woman with heart problems.

Few of us, I imagine, want to test the restricted resources of the NHS by being whisked off to hospital by ambulance in the middle of the night. A week ago, to my dismay, this did happen to me: and I was in the wonderful John Radcliffe Hospital, in Oxford, for long enough to develop some very firm opinions about the state of our beleaguered health service.

Without exception, the numerous doctors and nurses I encountered were courteous, kind, gentle and considerate, and, as far as one could tell, thoroughly competent. Their endurance and forbearance were particularly tested during the eight hours I spent in A&E (under surveillance, having tests, waiting for a bed), for some of the patients brought in were not patient at all.

By the time you are wheeled into a curtained cubicle in A&E, you have received any necessary first aid, your needs have been assessed and processes put in place to make sure what needs to be done will be done. It should be clear to anyone capable of thinking beyond their own immediate needs that instant treatment is simply not possible. Yes, there are a lot of nurses and nursing assistants around, and occasionally quite a number of doctors, but they are all busy. Occupied. Dealing with other, more urgent cases. Whenever I needed immediate attention, I got it. But those who scream for treatment when left alone and then  yell abuse when someone comes should not be surprised when they have to wait.

“I pay your salary,” shouted one angry elderly man with a painful leg, in the cubicle on my right. “I shouldn’t be left here like this.” His wife agreed: “It’s a disgrace. We employ you. You should be looking after us.” To my surprise, the doctor on the receiving end of this attack tried, quietly and gently, to explain what had been done for him and what he could expect. To little effect. This soft answer did not turn away this wrath.

Meanwhile, on my left, another unhappy woman whimpered for attention like a spoiled child for hours. Mental illness was clearly the main issue here. I got the impression that psychiatric help was not available in the small hours of the morning, despite the obvious probability that this might be exactly the time when such help would be most needed.

Conclusion? Surprise, surprise – A&E is functioning on a shoestring. Functioning well, as far as I could tell, but I was there on a Thursday night, not on a Friday or Saturday when drunkenness disrupts everything (yes, I’ve experienced that too!). Everyone I saw appeared to be working flat out, so there was little if any leeway for an emergency, like a motor-way pile-up, for instance. And provision for mental health emergencies appeared problematic.

Up in the Short Stay wards, the situation appears much the same. Doctors, nurses, nursing assistants all quiet, kind, helpful, all busy all the time. We patients wondered what would happen if the computer system in the hospital broke down. Nothing existed if it was not ‘on the record’. A doctor changes your prescription, tells you (the patient), but if the junior doctor taking notes fails to enter that change quickly enough in the official record, it didn’t happen. (Well, actually, it did happen to me – but was promptly sorted out by a very competent nurse who made a phone call.) I have no doubt that computerising records is sensible, but total reliance on a technological device can be dangerous. This change of drug was important for me – what if that doctor had NOT treated me like an intelligent human being, and not told me of the change?

There is a sense in which computerisation is being treated as yet another cost-cutting exercise. And we did experience a lot of that, most especially in the quality of the food and drink. As an experienced cook, I would say that all the ingredients, from teabags to carrots to bread, were the cheapest possible. Sometimes cheapest is a false economy: some of the food we were given was uneatable. I particularly remember a ‘quiche’ I tried – the ‘chopped onion’ appeared to be bits of chopped plastic, if there was any egg, it was overwhelmed by flour as thickener, and there was little sign of cheese. (I didn’t touch the pastry.) On the other hand, a plate of salad – chopped iceberg lettuce and a tomato – was unexciting but good. I was not alone in wishing Jamie Oliver could come and give a hand.

Just in case anyone out there has the ear of our Chancellor, he does need to register that the NHS appears to have cut costs to the bone. It functions, thank heaven, but there is clearly no more room to cut more. Any emergency will take resources needed elsewhere. And meantime, we all get older, there are more of us. It makes no sense to cut back any further. On the contrary, more funding is clearly needed just to keep it from collapse. And if we care about keeping our NHS as a National Health for all Service, then it needs a great deal more money immediately.

Of course, he knows this. But he undoubtedly has private health insurance himself, so ideologically speaking, why would he worry?

 

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Famous Well-Chosen Words

I simply wish to share this post, which I discovered on A Not So Jaded Life blog. Good stuff for aspiring writers, so read on if you are one of us. All has been said before, of course, but here we have the added spice of well-chosen words by famous authors

1. Cut the boring parts I try to leave out the parts that people skip. ~Elmore Leonard Unless you’re writing for personal reasons alone, you need to consider the attention of your readers. There’s …

Source: Some advice,perhaps. Be ruthless.

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China through fiction

I have long been intrigued by the China I have met through fiction, from Nobel Prize Winning Novelist Pearl Buck’s The Good Earth, to John Hersey’s A Single Pebble and Jung Chang’s Wild Swans, as distinguished examples. And now I have discovered a new book to add to my growing list of favourites: Sylvia Vetta’s Brushstrokes in Time, recently published by Claret Press.

This is the story of  Little Winter, a fictional member of what was the Star Arts Movement, a real and important part of the short-lived experiment in China between 1976 and 79 in freedom of expression in the arts. Vetta gives us an engaging heroine, who rises above oppression and loss of children and husband, to discover in the end both love and artistic success. We see her endure forced labour, imprisoned as a dissident, undergo ‘re-education’ and finally rescued by an American foundation. Her sufferings genuinely reflect those of many of the real members of the Stars, such as Wei Wei, listed in her book.

How realistic can Chinese experience be when reflected through the lens of a Westerner? That must depend on how familiar said Westerner is with Chinese culture. Hersey, for example, was born and brought up in China; and Vetta knows present-day China well, has many Chinese friends. This book is endorsed by specialists, with a foreword by Professor Maria Jaschok of Oxford University, testifying to its authenticity. So as a picture of life in China in mid to late twentieth century this may be trusted.

I really enjoyed reading this book, not least because the structure allows the reader to know that the miseries our heroine must suffer through will eventually come to an end. Harrowing, yes, but also uplifting. Definitely recommended.

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We are ACE !

Source: We are ACE !

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We are ACE !

Some time ago, I wrote rather sadly about the trials of being a Writer of a Certain Age, and suggested we older authors might gather together to provide mutual support and encouragement. Well, lo and behold – a new and vigorous, deliberately small group of novelists of a somewhat advanced age, all with new books just out or just about to be, and all delighted to encourage and support each other.

Meet the AUTHORS OF A CERTAIN ERA, aka ACE. We have all published extensively, but fiction is a relatively new venture, so I shall concentrate on that. After all, that is why we have gathered together…

Barbara Lorna Hudson calls herself ‘Academic reinvented as fiction writer‘, for she is Emeritus Fellow of Green Templeton College, Oxford, where she had a distinguished career as lecturer in psychiatric social work until retirement. She has published many short stories, and co-edited two collections. Her first novel TIMED OUT will be published by Driven Press in April (more about that later!).

Pam Nixon has published a delightful coming-of-age novel BUT I’LL REMEMBER THIS with 3-score publishing, Oxford, a book that entertained all of our new group as we, too, grew up in the fifties, and knew just how right she had got the era. She studied English at St Hilda’s in Oxford, and taught English in different parts of the world, so has material for lots more novels to come.

Heather Rosser headlines her website Novelist, Memoirist and Educational Author, and taught in Nigeria and Botswana for some years. Her moving first novel IN THE LINE OF DUTY, published by New Generation Publishing in 2014, is set during the First World War, and draws on family memoir, historical fact as well as her own imagination. She also has short stories in two collections with the Oxford Writers’Group. Writing from life and its attendant difficulties and need for delicacy are of special interest to her.

And then there is me, Elizabeth Mapstone, former academic psychologist and practising psychotherapist: I too, have published short stories in various small publications and on-line (see website), and my first novel THE AMAZON’S GIRDLE is being relaunched next month. Meanwhile, I have a second novel THE PORCUPINE’S DILEMMA which I hope will be published later this year.

So we are four published novelists, who have got together for moral support and encouragement. Why should we need it? you may be wondering.

The truth is that writing fiction is a lonely occupation. You can’t actually create anything worth reading unless you put your whole heart and soul into the making. But when you’re done, and it’s actually out there – a concrete reality that others can see and judge – then the nerves take charge and your courage may seep away. You want the world to love your work – and you are terrified they will not.

To have friends who write, who understand exactly where you are coming from and where you hope to go, friends who know that ‘kind words’ are not kind at all when it comes to creativity, friends you can trust to judge you as you would be judged: there can be little in the world better than that.

Moral support has allowed us to send out our manuscripts into the world, find a publisher, see them appear on that world-wide bookshelf known as amazon. And there we depend on our readers. Who all seem to think we are as good as we’d like to be! All of us have mainly five star reviews, on Amazon and on Goodreads. Barbara’s novel is still to appear, but we are all pretty certain it will garner starry reviews too. (Just read some of her witty stories on her webpage! link above)

But the agonising is never over, and we shall support each other as continuing to publish gets ever harder, and set-backs abound. For we are ACE – Authors of a Certain Era and Always Critically Encouraging to our friends! That’s a promise.

 

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HOW TO FALL INTO MURDER…

[I recently wrote the following as a guest blog on Marissa de Luna’s explorations of the travails of the would-be writer, the delightfully named The Coffee Stained Manuscript. My regular readers may be interested too.]

I never intended to write a murder mystery. The Amazon’s Girdle began as a love story, with former film-star Jacques, mouldering in a corner of the Michelin-starred Paris restaurant he runs with his wife Louise, remembering his all-too-brief time with the Amazon, the one woman he truly loved. But she died. I realized, rather belatedly, I had to decide how.

A natural death, by cancer say, was out – Eric Segal and “love is never having to say you’re sorry” (what rubbish!) had done that. Death in childbirth was possible, but my Amazon was a medical doctor, so improbable; and in any case, I didn’t want to deal with the concomitant inevitable guilt. A road accident seemed too facile. Suicide was out. Murder suddenly became essential to the story: it was the obvious way for someone as strong as my original heroine to disappear from the scene; she’d never have bowed out for anything less.

This was a bit of a blow. I had a small cast of characters, but now I had to decide which of them was a murderer. Each one might have had a motive, but how is it that all are carrying on with their lives 17 years later? What happened? Was it perhaps one of those murders that went undetected?

Who dunnit? And who decides to investigate this late in the day? And why? Inevitably, it had to be the young daughter of the doomed love affair between Jacques and the Amazon, inspired by her own heroine, the beautiful and malicious French film-star Madeleine Marvell, who deliberately sets out to disrupt the apparently peaceful and successful life of her former husband Jacques. Complicated? I’d say. But then murder mysteries usually are. And MM makes a delicious villain.

Given the way this story evolved in my head, it is clear that the book is not structured like a classic murder mystery. Working out whodunnit, I think, is not difficult for those who enjoy the challenge. But the motivations of all possible suspects are psychologically sound, and several reviewers have said they were surprised, even shocked at the outcome. Which is hugely gratifying!

Would I ever write another murder mystery? I’d have said NO, until I launched this one into the amazon.co.uk ether (where else?). It’s been fun. So when I have finished my quiet psychological novels (The Porcupine’s Dilemma is now with an agent), I might dip another toe in those dangerous waters.

 

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is the author of The Bittersweet Vine (Thames River Press) and most recently  Under the Coconut Tree, the first of a light hearted detective series set in rural Goa, The Chupplejeep Mysteries.
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